If you live with obsessive-compulsive disorder (OCD) and have noticed that you have trouble falling or staying asleep—you may be experiencing insomnia, a common sleep disorder that can be disruptive to your sleeping patterns. In fact, people with OCD are nearly 7 times more likely to receive an insomnia diagnosis or be prescribed medication specifically for insomnia, compared to those without OCD.
OCD is a chronic mental health condition that can cause a variety of symptoms—including sleep disturbances. OCD is characterized by obsessions, or recurrent and intrusive thoughts, urges, feelings, sensations, or images that cause distress. In response, people with OCD will perform compulsions, or repetitive behaviors or mental acts, in an attempt to ease anxiety or neutralize a thought.
As a result, the constant cycle of intrusive thoughts and compulsions can interfere with the ability to get restful sleep. Insomnia, or difficulty in initiating sleep, maintaining sleep, or general poor sleep quality is common in OCD. People with OCD have higher than normal rates of insomnia, and even other sleep issues like delayed sleep phase disorder, which can cause obsessive thoughts, keeping you up all night, trapped in your head or performing compulsions.
Here’s how OCD can cause insomnia, make OCD symptoms worse, and some tips on reducing intrusive thoughts at night.
Does OCD cause insomnia or trouble sleeping?
Generally, OCD can cause symptoms that completely engulf you in a cycle of doubt and uncertainty. You might experience intrusive thoughts right before you go to sleep, right as when you’re about to drift off. These thoughts, often irrational and unsettling, can trigger intense anxiety and make it difficult to fall asleep.
For example, you might suddenly become consumed by worries about harming yourself or others, or feel the need to double-check something you did earlier in the day, even though you know logically that it’s unnecessary.
“Some people keep getting up and checking things. An example of this is someone trying to make sure there’s no urine left inside of their bodies. So, they won’t fall asleep and keep going to the bathroom,” says Dr. Patrick McGrath, Chief Clinical Officer at NOCD. “Some do compulsions more than anything else. They find that once they lay down, they’re not being distracted and have time to ruminate.”
Can insomnia make OCD symptoms worse?
In return, insomnia can make OCD symptoms worse. Sleep is essential for brain function and overall physiological health, influencing metabolism, appetite regulation, and our immune, hormonal, and cardiovascular systems. As a result, any disruption to our sleep can be detrimental to both physical and mental health.
“Some people find that the more tired they get, the worse OCD is because it’s harder and harder to deal with it, or fight it, or to just be able to accept it and move on,” Dr. McGrath says. “Any mental health condition gets worse without sleep. A lack of sleep is one of the worst things you can experience for your health. It’s terrible for you.”
How to stop intrusive thoughts at night?
You may find that your intrusive thoughts get worse at night. The lack of distractions and more time to ruminate may be the reason.
“There’s fewer distractions at night,” Dr. McGrath says. “You probably can’t call anyone at midnight to talk to them. Or your spouse or children are asleep. You may not wanna turn the TV on and disturb the household or be able to listen to music. So, and if you keep getting up and down from bed, then your spouse will be woken up. Maybe you don’t even go to bed because you keep getting up and down.”
However, practicing good sleep hygiene may help to mainly integrate habits into your daily routine to ensure you have a pleasant space to sleep in and a consistent sleep schedule. Some tips for sleep hygiene include:
Having a consistent sleep schedule
Our bodies operate on a natural internal clock known as the circadian rhythm, which controls when we feel awake and when we feel sleepy. By going to bed and waking up at the same time each day, you help regulate this rhythm, making it easier to fall asleep and wake up without feeling groggy and tired.
Limiting caffeine, screens, and certain foods before bed
Caffeine is a stimulant, meaning it increases alertness and stimulates the central nervous system. As a result, you should avoid drinking coffee before bed or at least a couple of hours before bedtime, as it can interfere with your ability to fall asleep and disrupt your sleep quality.
The same goes for using your phone or laptop before bed. Blue light from screens can suppress the production of melatonin, the hormone responsible for regulating your sleep-wake cycle. This disruption can make it harder to fall asleep and negatively affect the quality of your sleep. To improve sleep hygiene, it’s recommended to avoid screens for at least 30-60 minutes before bedtime.
Good sleep hygiene practices also recommend avoiding eating or drinking before bed, especially large or spicy meals, as they can disrupt sleep and cause discomfort. Instead, plan meal times earlier throughout the day.
Exercising
Physical activity during the day can improve sleep in several ways. First, it boosts the production of melatonin, helping you fall asleep more quickly. Second, physical activity reduces stress, a common barrier to both falling asleep and staying asleep. Third, it enhances mood, which can increase motivation for regular exercise that further improves sleep quality.
Seeking professional help
If OCD is affecting your sleep, reaching out to a therapist might be helpful. A therapist who specializes in OCD can guide you in learning ways to manage intrusive thoughts and reduce the need for rituals that might be keeping you awake.
“I’d say to reach out pretty quickly,” McGrath says. “If you’re finding yourself not sleeping and you’re just getting really tired and overwhelmed, I think it’s a really good move to reach out to someone and say, I’m starting to have some trouble here. I need some help.”
Treatment for OCD and insomnia
Exposure and response prevention (ERP) therapy is the most effective treatment option for OCD. In EPR, you’ll work with a trained therapist to carefully confront your triggers and intrusive thoughts, and resist the urge to respond with compulsions.
For example, if you’re experiencing intense anxiety about whether you left your stove on or if you locked your door before bed, and you’re waking up repeatedly to check, a therapist would guide you through a process where they gradually expose you to situations that trigger that fear. Instead of checking to see if you left the stove on or if you locked your door, you would resist the urge to perform those behaviors and tolerate the anxiety that comes with not checking.
Over time, these exposures, or situations, thoughts, or scenarios that trigger anxiety or fear, increase in intensity, helping you build tolerance to the anxiety.
For ongoing sleep issues, your primary care provider may refer you to a specialist or suggest you participate in a sleep study. This comprehensive test records your brain wave activity, heart rate, muscle movements, and oxygen levels while you’re sleeping. Doing so can help to diagnose sleep disorders like sleep apnea, restless leg syndrome, narcolepsy, or any conditions that may be affecting your ability to get restful sleep.
As for treating insomnia specifically, cognitive behavioral therapy for insomnia (CBT-I) is often the first-line treatment. CBT-I focuses on addressing the thoughts, behaviors, and environmental factors that contribute to sleep problems. It helps people learn strategies to improve their sleep hygiene, manage stress, and break the cycle of negative thinking. In some cases, short-term use of sleep medications may be recommended.
“You can go to therapy for both OCD and sleep disturbances to learn what is contributing to a lack of sleep or just to check if there are other conditions that are going on,” Dr. McGrath says.
Bottom line
If you have OCD and you’re noticing it’s become harder to go to sleep or stay asleep, it’s important to reach out to a healthcare provider to address these concerns—whether they’re related to OCD or not. Addressing these sleep problems can improve your overall physical and mental health, ensuring that you can get better rest and manage your symptoms more effectively.
