Most of us cannot wait to get into bed and fall asleep after a long day, but for some, this is fear-inducing and causes anxieties to spiral. Although difficult to imagine for those who relate to the former, this is known as somniphobia, or the fear of sleep. Understanding the causes and how it manifest means could reduce the consequence of this condition on a person’s daily life. So if you’re reading this and feel that you relate to or know of somebody struggling, it might be worth seeking support.
What is somniphobia?
Somniphobia is the fear of sleep, meaning that someone who has this condition may feel distressed when thinking about going to bed or may dread going to sleep at night. Phobias are under the anxiety disorder umbrella, which is the most common psychiatric disorder worldwide1. In comparison to other phobias, like the fear of spiders (arachnophobia) or fear of snakes (ophidiophobia), sleep cannot be avoided in the same way and is needed for a healthy lifestyle, meaning more long-term health conditions can consequentially be caused by somniphobia. Hence, it is important to identify and treat it. Naturally, fearing sleep can lead to affected sleep patterns and sleep quality, which in turn can impact day-to-day life and may predispose to other, more serious health conditions.
Understanding the causes
Any anxiety conditions, including phobias, can be impacted by genetics and environmental factors. With phobias, the likelihood of having a phobia increases if a close family member also has this phobia, whether this is due to genetics or to a shared life experience.2
Somniphobia has a higher prevalence in elderly women, individuals who do shift work or have had a previous diagnosis of a depressive or anxiety disorder. However, it can affect anyone.2
People with PTSD are also reportedly more likely to suffer from somniphobia and other sleep disorders. This can be from a want to avoid nightmares and bad dreams, which are common symptoms in those with PTSD3. It also can be due to feelings of vulnerability that arise around sleep, as if something bad could happen while they are sleeping.
Sometimes, other sleep disorders can lead to somniphobia.4 People who sleepwalk may have somniphobia, as sleepwalkers can feel worried or concerned about where they can walk whilst asleep or may feel embarrassed if they wake up somewhere other than where they originally went to sleep. This can lead to anxiety. Some sufferers of recurrent isolated sleep paralysis may also be more likely to suffer from somniphobia. Recurrent isolated sleep paralysis is a disorder in which the individual cannot move voluntarily for a period of time before they fall asleep and after they wake up. This can be really distressing and upsetting, and so in not wanting to experience the paralysis, a person may try to avoid sleeping or feel anxiety about going to bed.
Other factors for having a somniphobia can be medical conditions like sleep apnea or narcolepsy or those who have trauma from something happening while they were asleep.4 The anxiety around something bad happening whilst they are asleep (such as a repeat of a traumatic event during sleep or knowing that they will not get a full night's sleep due to a medical condition) can develop into somniphobia.
Symptoms and manifestations
Here are the symptoms often experienced by individuals diagnosed with somniphobia:2
- Anxiety: Uncontrollable anxiety when preparing for bed or discussing sleep.
- Fear of Falling Asleep: Overwhelming anxiety when contemplating the act of falling asleep.
- Anxiety Management Difficulty: Challenges in managing and controlling anxiety related to sleep.
- Anxiety Attacks: Experiencing intense anxiety attacks in relation to sleep.
- Thanatophobia Symptoms: This includes avoiding sleep, increased heart rate, dry mouth, nervous excitement, muscle tension, and more.
- Delaying and avoiding nighttime routines: Purposefully putting off certain aspects of routine before going to bed, like putting pyjamas on, to avoid sleeping.
These symptoms can lead to various daily effects,2 such as:
- Daytime Fatigue: Feeling tired throughout the day due to disrupted sleep patterns.
- Irritability: Increased irritability and restlessness due to anxiety and lack of rest.
- Mood Swings: Rapid shifts in mood and emotions caused by sleep-related anxiety.
- Difficulty Concentrating: Struggling to focus and maintain concentration due to sleep disturbances.
- Reduced Productivity: Decreased efficiency and effectiveness in daily tasks and work due to inadequate sleep.
Effects on daily life
Across the board, 7 hours of sleep is recommended for adults, often with women requiring slightly more. Work, family life and stress are just a few things that can get between you and a good night’s rest, but for people with somniphobia, getting the recommended amount of sleep is more of a rarity.
Sleep is essential for the body for so many reasons. It plays a crucial role in impacting virtually every aspect of our body, from the brain, heart, and lungs to metabolism, immune system, mood, and disease resistance. Scientific studies highlight that enduring sleep deprivation or experiencing inadequate sleep quality raises the vulnerability to various health disorders, including high blood pressure, cardiovascular ailments, diabetes, depression, and obesity. Ensuring adequate and restful sleep is pivotal for maintaining overall well-being and reducing the risk of potential health complications.5
Not sleeping will also affect day-to-day responsibilities like working, taking care of family and maintaining relationships with the people around you. You may become more stressed, less resilient to things happening around you and have less awareness and response.5 Of course, all of these things have an impact on mental and emotional well-being too, which is why it’s so important to be able to recognise the signs and symptoms of somniphobia and move towards managing those symptoms as much as possible.
Diagnosis and professional help
Diagnosis revolves mainly around the symptoms that are being presented. The Diagnostic and Statistical Manual (DSM), a resource utilised by mental health professionals for diagnosing mental or behavioural health conditions, outlines seven primary criteria for specific phobias:
- Experiencing significant fear or anxiety linked to a particular object or situation.
- Consistent fear or anxiety when confronted with the specified situation or object.
- Actively avoiding the situation or object and feeling anxious or fearful when unable to avoid it.
- The phobia causes distress or hinders functioning in other areas of life, such as work or school.
- Sustained fear and anxiety concerning the specific phobia, usually lasting for over 6 months.
- The level of fear or anxiety is considered excessive when compared to the actual threat posed by the situation.(Sleep Foundation)
Symptoms cannot be more effectively explained by the presence of another mental disorder, such as obsessive-compulsive disorder (OCD) or social anxiety disorder.4
Specific phobias are usually targeted for treatment in a similar way, using one or a combination of methods. This can include methods like exposure therapy, cognitive behaviour therapy (CBT), and less commonly, medication. There are also relaxation techniques that you can practice yourself to help alleviate the stress and make you more resilient to anxiety.
Exposure therapy exposes you gradually to different levels of your fear, but in a safe space with a professional to help you manage and work through coping mechanisms6. This is easy to imagine with the fear of spiders, as you would work up from a plastic toy spider to a picture of a spider to a spider in a cage, for example, but this may be more difficult to picture with somniphobia. It’s likely to revolve around the bedtime routine, so it may address the emotions and physical sensations felt when putting pyjamas on to start with, for example. A professional would work through this with you, taking note of the physical and emotional sensations and talking through the best practices of coping to release stress and anxiety.
CBT is used more commonly as a general approach to anxiety but can work to help with specific phobias like somniphobia.4 This entails interrupting harmful and negative thought processes around sleep and works to alter those thoughts and behaviours to get you a better night's sleep.
It’s also important to have a good nighttime routine set up, which should aim to calm you and prepare you for sleep. Sticking to the same schedule before you sleep and going to bed at the same time each night can lessen stress and anxiety. Practising breathing techniques or taking up yoga and meditation can also help.
At times, insomnia-treating sleep medications are prescribed to offer temporary relief to patients.7 D-cycloserine is an example of such a medication. It acts as an N-methyl D-aspartate receptor agonist, potentially diminishing the fear response during exposure therapy. Benzodiazepines form another drug category, mainly used for managing panic and anxiety disorders. These can aid in alleviating Somniphobia symptoms, though their use needs careful regulation to prevent habit formation. Additionally, beta-blockers can prove beneficial. They typically assist in reducing blood pressure levels. In cases where exposure therapy doesn't yield results for individuals with Somniphobia, taking beta-blockers a few hours before bedtime can notably decrease anxiety levels. These should only be taken if prescribed by a medical professional and often will have side effects, so it is important to discuss this with your healthcare provider.
In conclusion, somniphobia is a real and challenging condition that affects many individuals. The fear of sleep can cast a long shadow over daily life, impacting mental, emotional, and physical well-being. However, by recognizing the signs, seeking professional help, and exploring coping strategies, those grappling with somniphobia can find relief and regain control over their sleep and their lives. Whether it's through exposure therapy, cognitive behavioural techniques, or appropriate medications, there are pathways to managing this fear. Remember, you're not alone in this journey. Speaking to professionals, psychiatrists, your loved ones, and even other people who suffer from somniphobia can help. By taking steps to address somniphobia, you can pave the way for restful nights, improved mental health, and a brighter outlook on life.
- Somniphobia: Understanding the Fear of Sleep. Sleep Doctor. 2023. [accessed 25 Nov 2023] Available from: https://sleepdoctor.com/mental-health/somniphobia/
- Somniphobia: Symptoms, causes, treatment, and more. 2023. [accessed 25 Nov 2023] Available from: https://www.medicalnewstoday.com/articles/somniphobia
- Somniphobia: Causes, Symptoms, and Treatments - Amerisleep. 2023. [accessed 25 Nov 2023] Available from: https://amerisleep.com/blog/somniphobia/
- Fear of Sleep: Definition, Symptoms, Causes, Treatment. Verywell Health. [accessed 25 Nov 2023] Available from: https://www.verywellhealth.com/fear-of-sleep-5209894