Living with obsessive-compulsive disorder (OCD) means experiencing recurring intrusive thoughts, images or ideas and, as a result, developing compulsions in response to these obsessions. You can read all about the basics of OCD here.
OCD during the day and the night
Although the severity of these symptoms, and how they manifest, can vary widely from person to person, if you have OCD you’re likely to feel very overwhelmed or drained from your symptoms. OCD can take up hours of your days, even carrying over into the night, and causing issues with falling asleep, staying asleep or having bad nightmares related to your obsession.
Although research is still scarce on the subject and clinicians are constantly discovering more about what works and what doesn’t for different patients, sleep disturbance is absolutely a normal symptom of this disorder. It can be addressed as part of a holistic treatment to OCD.
The basics: How OCD affects your sleep
It has been scientifically proven that OCD patients have more trouble sleeping than people who do not have OCD, whether it’s falling asleep or staying asleep undisturbed. A Swedish study from 2020 measured that obsessive-compulsive patients were almost seven times more likely to be diagnosed with or treated for insomnia too, compared to people without the disorder.
If you have OCD you may have a hard time getting to bed because you may be constantly getting up to check something or perform a compulsion. Once in bed, you may have a hard time drifting off because your mind is fixated on obsessions that are making you anxious, worried and stressed. Once asleep, you may be disturbed by nightmares or very vivid intrusive thoughts during the night, and these may leave you feeling uneasy or wake you up. Several studies have also shown that the more severe the OCD symptoms are during the day, the more severe the sleep disturbance and insomnia can be.
One study speculated that there might be a slight difference between the subtypes of OCD one can manifest and how much they affect your sleep — but this, like most aspects of this condition, can be highly subjective, and there isn’t a one-size-fits-all conclusion.
A significant element that may be affecting your sleep, according to researchers, is the presence of “sibling conditions” associated with OCD (you may sometimes hear them described as “comorbid”), such as depression and anxiety. In some cases there can be an independent relationship between depression, anxiety and sleep, and in some studies OCD patients who do not have comorbid diagnoses don’t have as much trouble sleeping as OCD patients who do. In other cases the obsessions alone could be causing your sleep troubles. So it’s likely a combination of these conditions put together that are affecting your sleep cycle.
So will OCD make you have nightmares? Maybe.
Once again, clinical research on this area of OCD is still quite preliminary, and there isn’t much of a clean-cut answer. There just haven’t been enough studies with concrete results that can prove (or discredit!) relationships between OCD and nightmares, and clinicians are still mainly collecting clinical and anecdotal evidence about this topic.
In some studies, patients with OCD have much worse nightmares than patients without it, and getting consistent treatment decreases the negative content of dreams over time. In others there isn’t that big of a difference and all patients report very anxious nightmares, and in others there is no link at all between OCD and nightmares. There may be some anecdotal stories of people having OCD related nightmares or doing compulsions during dreams, but there is no straightforward answer because everybody experiences OCD in slightly different ways.
Top tips to improve your sleep if you have OCD
Extensive research suggests that getting little or bad sleep can have a negative effect on mental health in various ways, so there’s a possibility it could, as a result, have a negative effect on your OCD — especially during moments of heightened stress and anxiety. So, it’s important that you try to give yourself some solid snooze time every night by following a couple of best practices. You may also want to talk to your clinician about including sleep therapy into your holistic OCD therapy journey to enhance your treatment. Here are a couple of everyday tips you can try out yourself, or read our full guide of tips here.
- Create clear boundaries between an awake space and an asleep space: Try to limit time in bed to sleeping — not working, scrolling or doing anything else that might trigger unwanted thoughts. That way, when you get in bed there’s less stimulation that might take your mind into other directions, and the bed is just a place to sleep and relax.
- Develop a routine: Try to always go to bed at the same time every day, and wake up at the same time every day. It doesn’t need to be super early or super late; it’s most important that you try to create a pattern, routine and consistent cycle for you to find stability and comfort.
Telling your OCD therapist about your problems sleeping could also be really helpful in finding ways to include it into your ERP. But bear in mind that this will be a process. It will take a little time before you find something that works for you, and there might be a steep learning curve at the beginning.
If you are living with OCD and need help please consider letting NOCD help you. We offer affordable and effective ERP therapy to all users in the US and UK. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment.
