OCD and Insomnia: How to sleep better when you have OCD

Studies have shown that those with obsessive-compulsive disorder (OCD) struggle with increased rates of insomnia compared to those without OCD.

We all have sleepless nights from time to time.

The stressors of daily life can have our minds racing and us tossing and turning through the early hours of the morning. This is very common. 

However, for those with OCD, obsessive thoughts can keep them stuck in a miserable cycle of not being able to switch off their minds. Trapped in a restless cycle of racing thoughts and sleepless nights, insomnia adds a new layer of difficulty when managing OCD.

We’re going to talk about the ins and outs of insomnia, how it affects OCD life, and how you can help yourself get a better night’s sleep when living with obsessive-compulsive disorder.

Let’s begin!

The different types of insomnia

There are many ways to categorize insomnia. 

The Sleep Foundation breaks it down into two main categories:

1. Short Term Insomnia

This can also be known as acute insomnia or adjustment insomnia. Short-term insomnia is used to describe a person who struggles with brief episodes of sleeping that only last for a short period of time.

Often these episodes are caused by stressful life events.

For example; moving house, getting a divorce, losing a loved one, or receiving a distressing medical diagnosis could all be a source of concern and worry which of course, is likely to interrupt our sleeping patterns.

Acute insomnia like this can last between three and ten months.

As the individual is able to manage their stress levels of the circumstance over time, symptoms fade and they typically fall back into healthy sleeping habits.

2. Chronic Insomnia

Chronic insomnia is given to those with long-term difficulty sleeping. 

A helpful guideline to define this type of insomnia is a person who struggles to fall asleep or stay asleep for at least three nights of the week, and for three months or longer.

Whereas acute insomnia is typically associated with stressful life events, chronic insomnia has a range of causes.

Things that could cause chronic insomnia might include; poor sleep hygiene, mental health disorders, medications, underlying psychological or neurological problems, and irregular sleep schedules.

5 different insomnia types

We can then break these two main categories down into five smaller categories…

1. Sleep onset insomnia – Sleep onset insomnia describes those who struggle to fall asleep.

2. Sleep maintenance insomnia – Sleep maintenance insomnia describes those who are unable to stay asleep throughout the night.

3. Early morning awakening insomnia – Sleep maintenance insomnia describes those who awaken before intended, decreasing the desired amount of sleep time.

4. Mixed insomnia – Although this is not a formal term, mixed insomnia describes those who have a blend of the above three different insomnia types.

5. Comorbid insomnia – Comorbid insomnia describes those whose insomnia is in direct relation to – or exacerbated by – another condition (in this case, OCD).

How common is insomnia?

Insomnia is far more common than you might think with various studies worldwide showing prevalence in the range of 30% – 50% of the population.

And, up to 10% have insomnia that is so severe that it is considered a disorder in its own right. 

Insomnia and OCD (together and separate) are incredibly common disorders, far more common than most people realize. So it’s important to understand that there are many people who experience these conditions and you are not alone in your struggle if you present with symptoms of either.

OCD as a stand-alone mental health condition can be truly exhausting, coupled with a lack of sleep and you are fully justified in feeling endlessly tired and worn out.

The good news is, there are effective ways of managing both.

And when you help yourself with one, you automatically increase your chances of managing the other. 

How do I know if I have insomnia?

Typical symptoms associated with insomnia may include:

• Ongoing worries about sleep
• Repeatedly waking up too early
• Repeatedly struggling to fall asleep
• Repeatedly waking up during the night
• Repeatedly feeling tired in the daytime
• Lack of focus 
• Decreased sex drive
• Inability to pay attention
• Struggling with memory due to exhaustion
• Not feeling well-rested after a night’s sleep

The average adult needs between 7 and 9 hours of sleep each night to rest, recuperate, and function effectively during the daytime.

For those struggling with insomnia, it can make day-to-day tasks feel like a slog.

Everything requires extra effort that they just don’t feel they have to give because they are exhausted. And when we are in a sleep deficit, we can struggle with those executive functions that allow us to manage our lives.

The impact can be truly torturous.

If you suspect you may be struggling with insomnia, please speak with your medical professional who will be able to advise you on the best course of action.

Does OCD cause insomnia?

Despite studies showing that up to 48% of people with OCD also struggle with sleep disturbances, insomnia is not considered a core feature of OCD.

However, as mentioned before, mental health conditions such as OCD, depression, and anxiety can contribute to inhibited sleep.

A person can be considered to have comorbid insomnia – previously known as secondary insomnia – if a person is believed to have this condition due to a mental disorder or known psychological condition.

In the context of OCD and insomnia, we can consider these three aspects as a reason why OCD could cause insomnia or make it worse…

1. Obsessive Thoughts

A person with OCD lives with recurring disturbing obsessions in the form of thoughts, images, feelings, urges, and sensations.

These obsessions trigger intense feelings of uncertainty and anxiety which the sufferer then feels the need to solve for in order to relieve their distress.

For someone with OCD, these thoughts are a great source of pain and discomfort. 

They are intrusive, unwanted, and often go against their values which is why they can feel so disconcerting. It is unsurprising then that people with OCD struggle with sleep.

These thoughts do not care what time of day it is, they can arise out of nowhere and plague the sufferer for extended periods of time. When they appear at nighttime, anxiety levels rise which makes drifting off to sleep feel like an impossible task.

2. Rumination

Obsessive thoughts can lead you into a cycle of rumination.

In trying to ‘solve’ or ‘fix’ those obsessions, people with OCD will try to think about what those obsessions must mean, why they had them in the first place, what might happen if they don’t respond, or even fall into the trap of self-punishment believing they deserve it somehow.

Their mind is in overdrive.

Finding themselves stuck in ON mode – with their thoughts racing and their mind whirling – sleep is hard to attain. After doing a significant amount of rumination it is very difficult to relax and fall asleep.

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3. Somniphobia/Sleep Anxiety

While this isn’t applicable to all strands of OCD, some sufferers will struggle with somniphobia (intense fear of sleep) or sleep anxiety.

This may show up in the following ways:

• Spending the daytime worrying about not being able to go to sleep
• Worrying about what might happen as they are falling asleep
• Worried about having nightmares while they are asleep
• Worried about something bad happening while they are asleep
• Trying to avoid sleep for fear of the above

All while desperately wanting to go to sleep because they know they need it to function!

In a common catch-22, many who struggle with sleep difficulties can find that their sleep becomes the source of their stress.

Despite desperately wanting to go to sleep, they are so aware that it might not happen that it becomes a fixation and source of rumination.

In an unpleasant irony, wanting to go to sleep becomes the reason it is so difficult to do so. When these fears are severe, this is when someone might fall into the category of having somniphobia.

Why might OCD be worse at night?

Nighttime can be a terrifying time for those living with OCD.

It’s the time of the day when you’re supposed to wind down, calm your mind, and switch off. But for people with OCD, it is a specific time of day when their minds can become loud in the silence of the night.

It is a very quiet alone time with just them and their obsessive thoughts.

To really understand, you must remember that for an OCD sufferer, those obsessions are unwanted, intrusive, and disturbing in nature. These obsessions can be tortuous and trigger intense feelings of fear.

Now, I don’t know about you, but I find it pretty hard to fall asleep when I’m afraid and anxious.

The uncertainty and anxiety that appears with OCD are all-consuming. And this is why it can feel impossible to switch off your mind or calm those thoughts, especially at night when your brain offers you thoughts that challenge your very self-concept.

Does lack of sleep worsen OCD?

A 2017 study has shown that a lack of sleep decreases the perceived control of obsessions and compulsions in OCD patients.

According to this study, when you interrupt the circadian rhythm either by sleeping at irregular times than you are used to, or reducing the number of hours you sleep each night, you impair your cognitive ability to manage your obsessions and compulsions.

We have all had sleepless nights.

Try and remember how you felt following a restless night.

Most people feel slow to respond, slow to function, and often have greater difficulty with emotional regulation. Things can feel foggy and everything you do is met with a type of exhausted resistance.

In OCD recovery, a takes a great deal of mental and physical effort to engage in the exposures and think clearly about how you intend to respond to those intrusive thoughts. 

When you’re running on limited hours of sleep, it’s more difficult to resist the symptoms of OCD.

The beautiful thing is that if you can manage OCD symptoms, your insomnia will improve and vice versa.

How to sleep better when you have OCD

First and foremost, the best way you can help yourself sleep better when you have OCD is to effectively manage the symptoms of OCD.

Working with a highly trained professional you can make a full recovery from OCD. This means that not only will you be able to stop letting those intrusive thoughts control your life, but you will also stop them from controlling your sleep!

We have a team of qualified and friendly specialists in the areas of California who can support you in your OCD recovery. 

Guided by top OCD specialist, Kimberley Quinlan, you will receive a tailored and effective treatment plan designed to help you take back your life (and sleep) from those intrusive thoughts and resist the urge to do compulsions.

When you are able to change your relationship and response to those obsessive thoughts, you will be able to give them less weight and value.

This means you can find greater mental peace, and calm your mind at night.

Please submit an intake form here for an initial conversation about how we can help you.

Tips to immediately help you improve your sleep

While you are working through your OCD recovery, here are some concrete tips to help you improve your sleep:

1. Meditation and mindfulness

Meditation and mindfulness practices are highly effective in helping you slow down your thoughts, and calm your mind.

If you don’t feel comfortable doing this alone, you can find guided meditations on various apps, podcasts, and youtube channels. 

2. Sleep hygiene

Sleep hygiene is all about having a nighttime routine that gets you in the headspace for sleep.

For example:

• Set a regular time for you to go to bed
• Set a time for you to turn off all screens
• Read a relaxing fictional book for 1 hour before bed
• Turn off all overhead lighting 1 hour before bed
• Turn off your phone (if you can!) 1 hour before bed
• Have a caffeine-free herbal tea

This doesn’t have to be your entire nighttime routine. But it is important to identify one so you can teach your brain, ‘Hey! We’re going to bed soon… time to wind down’

3. Resist compulsions

Whether it’s daytime or nighttime if those obsessions arise you’re going to feel the urge to do compulsions. This is a great time to practice your exposure and resist the urge.

4. Remove distractions

You may want to surround yourself with distractions at this time of night to detract from the noise going on between your ears.

But in relation to sleep, this is highly detrimental. If you’re in the habit of scrolling through social media while you lie in bed, for example, your brain is not being given the cues it needs to identify that it’s time for sleep.

Help yourself by removing distractions and instead…

5. Wilfully tolerate uncertainty

Ultimately, this is where all the good stuff happens.

At nighttime, those intrusive thoughts may seem extra loud and the uncertainty is as alive and disconcerting as ever. This is a great time to show yourself that you are capable of managing that uncertainty and anxiety without the need to do compulsions.

Treatment for insomnia

Diagnosis of insomnia typically follows the process of a physical exam, a sleep habits review, and finally a sleep study.

You may be guided and asked to begin implementing lifestyle changes such as the ones mentioned above, however, if these fail to have any significant impact then your doctor may recommend cognitive behavioral therapy (CBT).

Cognitive behavioral therapy for insomnia (CBT-I) works by helping you change the beliefs that affect your ability to sleep and change your relationship to sleep.

Strategies might include:

• Stimulus control therapy
• Relaxation techniques
• Sleep restriction
• Remaining passively awake
• Light therapy

Treatment for OCD

The beauty of treatment for OCD and insomnia is that CBT is highly effective for both.

As we have mentioned throughout this article, if you help one you often greatly improve the other. 

CBT for OCD will look at altering how you think and respond to those negative intrusive thoughts. Then, through ERP (exposure and response prevention) you are asked to tolerate the uncertainty and resist the urge to do compulsions.

When you are able to do this in relation to insomnia, you can find a sleep routine that works for you.

It is entirely possible for you to get to a stage where each night you fall into a sleep that isn’t impacted by intrusive thoughts, anxiety, and the urge to do compulsions.

You can implement these effective treatments to find freedom from OCD and regain control over your sleep.

If you are unable to access or invest in 1:1 private therapy to help you manage your obsessions and compulsions, you can join ERP SCHOOL here. ERP SCHOOL is a self-paced online program that will give you every tool and technique you could possibly need to take your life back from OCD. If you feel tortured by intrusive thoughts and your life is being negatively impacted by compulsions, ERP SCHOOL will teach you exactly how to apply the lessons to your specific OCD symptoms so you can stop living a life driven by fear. These are the precise tools that Kimberley Quinlan – top OCD expert – uses with her private clients and THEY WORK. Success rates are high and full recovery is possible for you. To join the program, sign up here.