Generalized Anxiety Disorder (GAD) is a substantially personal topic for me as I was diagnosed with it at a moderate to severe level at twenty-one years old, during my second or third year of college. Managing it initially has been a struggle due to a variety of reasons. Since my anxiety revolves around being in new, quiet, or high pressure places like classrooms or courthouses, it was fairly easy to get “triggered”, which first meant feeling nervous/ gassy, then my heart rate would skyrocket and wouldn’t calm down, then the relentless stomach noises kicked in and that’s when it was time to leave. My parents wanted to sweep the problem under the proverbial rug and insisted that I needed to “toughen up”, and that I was being “too dramatic”. Maintaining the proper amount of medication meant running to the hospital for expensive appointments every six months, a difficult task to do while I needed to work to pay off bills.
My sisters were a good resource for support but they weren’t always present. Some of them even started becoming distant because they weren’t sure of how to handle their older sister who often came home crying. Meanwhile, my seemingly random episodes of crying and hyperventilating when I had to attend Jury Duty for instance, or even going to family functions became extremely uncomfortable. I’d start feeling the sense of dread every time I entered a quiet room, so I always made sure I’d sit either close to a window or an air conditioner which made a moderate amount of noise to soothe my anxiety. Though admittedly, I do not have it as bad as other family members such as my cousins or my grandmother, who had it the worst in the family as far I was told, but it has been a huge deciding factor in say, how I take my classes. As a result of my experience with GAD, I have a huge interest in connecting to others with it, and if possible, be a source of support.
GAD is an inhibiting disorder in which the sufferer is plagued by irresistible and constant worries, fears, or even stress over minor interactions that prevents productivity. Signs include irritability, restlessness, tense muscles, fatigue (which is most likely due to the constant muscle tension), and disturbed sleep as the sufferer’s thoughts often jumps from problem to problem. While going through the symptoms of GAD is unpleasant enough, it also has an affect on the sufferer’s quality of sleep, which further perpetuates the cycle of symptoms the individual already experiences, and becomes a hindrance in the healing process. In essence, the worrying that one with GAD feels promotes insomniatic behaviors (Mcgowan, 2014). Lastly, not only do those with GAD have problems falling asleep, but they also have trouble staying asleep (Duffy, 2012). At times, these individuals also experience panic attacks, which can cause a snowball effect of a severe lack of sleep. These related issues lead to finding effectiveness in treating those with GAD the same way we treat those with sleep disorders such as insomnia.
Those who suffer from Generalized Anxiety Disorder are also at risk for Panic Attacks, which are characterized by palpitations, racing heartbeat, lightheadedness, hyperventilation, nausea, dizziness, derealization and depersonalization. Association is drawn between panic attacks – a symptom of a panic disorder, and sleep disorder. It is stated that 65% of people from their study experience nocturnal panic attacks or sleep panic attacks, a symptom associated with nonrestorative sleep. These attacks disrupt normal sleep cycles, during late stage 2 and early stage 3 as the attacks themselves occur in NREM while the panic-related dreams occur in REM sleep. Furthermore, sleep deprivation increases the occurrence of daytime and nocturnal panic attacks which can be further complicated by fear of sleep as a result of the associated discomfort. Interestingly enough, studies have also shown that some of the increased daytime/ nocturnal panic attacks may be due to a respiratory issue that the patient is experiencing during sleep, creating the tight, closing feeling that one feels during a panic attack (Goldsmith, 2006).
Considering the symptoms that the sufferer experiences with GAD, it is evident to any observer that they do an exceptional job of keeping the individual from being a fully functional, contributing human being. According to the Anxiety and Depression Association of America, 18% or 40 million adults suffer from Generalized Anxiety Disorder and 66% do not seek treatment, a significant cache of the nation’s population. Which means 66% of the individuals in question are leading stressful, counter-productive lives, a form of social distress that is further compounded upon society to process.
Worrying about falling asleep can actually keep one from doing just that, as illustrated in a study by Babson, Trainor, Bunaciu, and Feldner (2008), which included 41 adult participants, where anxiety sensitivity was tested as a moderator between sleep onset latency and sleep anticipatory anxiety. For example, the amount of time it takes for those with primary insomnia was largely overestimated, with reveals the correlation between anxiety over one’s ability to fall asleep and quickly falling asleep. Additionally, recent studies have shown that 75% of adults afflicted with GAD have reported disturbed or perforated sleep have experienced an increase in anxiety levels (Chrisman, 2018), revealing that focusing or fussing about whether or not the individual would be able to fall asleep becomes a self-fulfilling prophecy.
While maintaining quality of sleep is important for the healing process for those afflicted with GAD, it is important to note what kind of treatments are available and most effective in combating prevailing symptoms. Studies have shown that strict sleep hygiene is a highly effective tool in reducing overall rates of episodes. Sleep hygiene includes: maintaining a regular sleep schedule, avoiding caffeine (especially close to bedtime), and sometimes medication to treat panic disorder. Regular exercise has also been shown to be effective in making the patient tired, promoting a healthy desire for sleep. Antidepressants are useful for regulating sleep, however SSRI’s (Selective Serotonin Reuptake Inhibitors), or primarily antidepressants, come with a few caveats. They can cause Serotonin Syndrome, a condition in which too much serotonin accumulates in the body which in this case, could happen by taking the SSRIs too liberally and result in disrupted sleep (Goldsmith, 2006).
Additionally, antidepressants as a whole repress REM, experiencing REM too early in sleep is a symptom commonly found in those with depression. Abrupt withdrawal from antidepressants can actually cause the opposite wanted effect and produce rebound insomnia accompanied with frightening, disturbing dreams and perforated sleep. And lastly, medications such as benzodiazepines have addictive properties which put the patient at risk for substance addiction. With such risks on the line, and for the sake of the individual, medications should not be a first resort to treat those with sleep-related anxiety (Goldsmith, 2006). However, medication does have its uses when paired with Cognitive-Behavioral Therapy, which in time, has significantly proven to help eliminate symptoms of prevailing disorders. Other forms of sleep disorder treatments such as phototherapy, and shifting the sleep schedule forward along a clockwise route to properly set it back to normal.
While the fascinating world of Psychology is ever changing and improving its methods of diagnosing disorders and its treatment methods, one can take comfort that it is possible to have a sense of control or even fully recover from the sleep deprivation GAD can inflict, and in fact, have and maintain quality of life. Although one should take note of just how powerful the human brain is, with its ability to affect its owner so extensively as to deprive itself of the things it needs most in order to thrive: sleep, and mindful peace.
Works Cited
- ‘Anxiety Disorders; Research from Massachusetts General Hospital has Provided New Information about Anxiety Disorders.’ Psychology & Psychiatry Journal, June 18 2011, p. 26. ProQuest. Web. 27 Jan. 2019 .
- Chrisman, Jason A.A.T. “The Relationship Between Sleep Deprivation and Anxiety among Medical Students: A Quantitative Analysis”. Still University of Health Sciences, ProQuest Dissertations Publishing, 2018. 10827138.
- Duffy, Stacy. ‘The Relationship between Sleep Disturbances and PTSD, Major Depression, and Generalized Anxiety.’ Order No. 3544625 Alliant International University, 2012. Ann Arbor: ProQuest. Web. 27 Jan. 2019.
- Goldsmith, R. J., Paul Casola M.D., and Varenbut, Michael, MD,C.C.F.P., F.C.F.P. ‘Sleep Complications in Depression, Anxiety, and Psychotic Disorders and their Treatment.’ Psychiatric Annals 36.12 (2006): 853-9. ProQuest. Web. 27 Jan. 2019.
- McGowan, Sarah Kate. ‘Examining the Relationship between Worry and Sleep: A Daily Process Approach.’ Order No. 3639740 University of Illinois at Chicago, 2014. Ann Arbor: ProQuest. Web. 27 Jan. 2019.
