OCD & Sleep: Understanding the Connection & How to Cope

What Is OCD?

Obsessive compulsive disorder (OCD) is a mental health disorder characterized by obsessive thoughts and compulsive behaviors like checking, cleaning, or counting. As with any mental health diagnosis, symptoms of OCD must be persistent and severe enough to impact functioning. OCD symptoms can be exhibited in a number of ways within a person’s life, with varying impacts and impairment levels, and vary depending on the type of OCD.¹

How Are OCD & Sleep Related?

OCD has been shown to negatively affect not only the amount of sleep someone gets, but also the quality of sleep. In particular, OCD has a negative impact on the phases of sleep and circadian rhythm. While there is no concrete evidence that one causes the other, people with OCD do have a greater chance of developing insomnia, which can make existing OCD symptoms worse and lead to a vicious cycle of sleep problems and increased OCD symptoms.

Forty-two percent of people with OCD have been shown to have a sleep disorder called delayed sleep-wake phase disorder (DSWPD). This is a circadian rhythm disorder that results in falling asleep up to two hours later than one would expect, and sleeping later in the morning. This is related to melatonin production and can be disruptive to one’s schedule and functioning.²

OCD and Insomnia

Research has shown that insomnia is related to the obsessive symptoms of OCD. People with OCD who experience obsessions, rumination, and intrusive thoughts are more likely to experience insomnia, as these thoughts keep them awake.¹

Some of the identified risk factors for OCD include adolescence/ young adulthood, being unmarried, substance misuse, family history, stress, illness, and the postpartum period.⁴ Identified risk factors for insomnia include being female, stress in adulthood, being a person of color, obesity, and use of caffeine and other stimuli.⁵ Overlapping risk factors for both OCD and insomnia are of particular concern for young adults under high levels of stress.

Common Sleep Problems Linked to OCD

The impact of sleep on mental health is one of the most important factors in maintaining physical wellness. Poor or limited sleep can not only be damaging to mental health, but mental health symptoms can also affect sleep, creating a vicious cycle. The obsessive thoughts, ruminations, and bedtime compulsions related to OCD in particular can delay sleep, contributing to chronically poor sleep.

The most common sleep problems linked with OCD include:

• Poor sleep: Sleep problems are extremely common and can include difficulty falling asleep, staying asleep, or the quality of sleep. There are many factors affecting sleep including emotional issues, anxiety, OCD, or physical problems like sleep apnea or airway problems.
• Insomnia: Insomnia is characterized by problems with the duration or quality of sleep. Insomnia affects a great number of people and is often connected with physical or mental disorders and causes long-term physical and emotional consequences.
• Sleep latency: Sleep latency is the amount of time it takes to fall asleep, which can be prolonged by the worries and obsessive thoughts that accompany OCD.
• Delayed sleep phase disorder: This refers to a specific sleep disorder in which one can take up to two hours longer than would be expected to fall asleep, and delayed waking up time as well. Studies have shown a specific link to this specific sleep problem and OCD.
• Somniphobia: Somniphobia is the fear of falling asleep. People with OCD may have specific fears about bad things happening in their sleep such as nightmares or sleep paralysis, and avoid going to sleep.⁷

Treatments for OCD & Sleep Issues

Medication as well as several different types of therapy are effective in addressing OCD and insomnia. Since there is some overlap in the symptoms of these two disorders, including anxious mood and impaired functioning, many treatments will treat these overlapping symptoms. People struggling with both at the same time will need an integrated approach that addresses all symptoms and the way they impact each other.

Therapy

Because OCD and sleep issues commonly occur together, it’s essential to address both for the best outcome. Several types of therapy for treating OCD are also effective at improving sleep quality, often by reducing OCD symptoms that often lead to disrupted sleep. It’s important to find a therapist who specializes in OCD, as specific care is crucial for easing symptoms of OCD. Consider using an online OCD resource like NOCD to get started with treatment.

Types of therapy for OCD and related sleep issues include:

• Exposure and response prevention: ERP for OCD presents clients with increasing exposure to the feared situation in order to desensitize them to the fear and help them build confidence.
• Cognitive-behavioral therapy (CBT): CBT for OCD is a tried-and-true method that addresses the negative thoughts and behaviors that contribute to OCD symptoms.
• CBT for insomnia: A targeted type of CBT for Insomnia (CBT-I) is effective at addressing the negative thoughts and behavioral issues related to sleep issues.⁸
• Eye Movement Desensitization and Reprocessing (EMDR): EMDR has been found to be most effective in people with a history of trauma. People with insomnia or OCD obsessions related to past traumatic events may find relief with EMDR. There is even a specialized EMDR protocol for OCD.
• Transcranial Magnetic Stimulation (TMS): TMS uses magnets to reach deep areas of the brain associated with symptoms. People who have not found relief with traditional therapy techniques may be good candidates for TMS.
• Hypnotherapy: Hypnotherapy helps people into a calm and relaxed state, which can help quiet obsessive and anxious thoughts related to OCD and contributing to insomnia.

Medications

First-line medications for OCD are selective serotonin reuptake inhibitors (SSRIs). SSRIs like paroxetine and fluoxetine are common treatments because they work well and have lower side effects. SSRIs are shown to be effective early in treatment and to increase in efficacy with higher doses.

Medications can help by quieting the intrusive negative thoughts that are often shared by both depression and ODC. Some medications for OCD can interfere with daytime alertness and nighttime sleep, so patients need to work closely with their providers to address any unintended sleep effects.⁹

10 Tips for Coping With Sleep Problems & OCD Symptoms

While some may find that therapy is necessary to improve issues with sleep and OCD, sleep can also be improved with less intensive or structured methods. Many easily learned coping skills can alleviate some symptoms of OCD and sleep problems, and can help maintain symptom relief after therapy treatments.

Here are 10 ways to deal with OCD sleep issues:

1. Keep a consistent wake-sleep schedule: By keeping consistent routines, you can train your brain and body to be ready for sleep and awakening at roughly the same time each day. Aim for no more than one hour of difference in sleep and wake times.
2. Avoid naps or nap carefully: Naps during the day can make it more difficult to fall asleep at night, which just feeds the cycle of falling asleep and waking up later.
3. Relax before bed: Try meditation, listening to quiet music, gentle yoga or stretching, or reading. Getting into bed in a calm, relaxed state can help quiet the mind and prepare the body for sleep.
4. Reduce screen time: Reduce time spent on devices later in the day, especially before bed. Studies have shown that screen time can interrupt the brain waves that contribute to quality sleep.
5. Avoid stimulants during the day: Caffeine and other stimulants can not only increase alertness and make sleep more difficult, they can also increase anxiety.
6. Exercise regularly: Stay physically active each day, but avoid the last few hours before bedtime. Regular exercise during the day can help one become tired and ready for bed. However, rigorous exercise too close to bedtime can backfire because it can increase energy and alertness.
7. Try light therapy: Light therapy is thought to help with circadian rhythm disorders because it can mimic the effects of sunlight on the brain during dark winter months.
8. Do relaxing breathing exercises: A simple breath practice, such as breathing in on a count of 4, holding for 4, breathing out on 4, and holding for 4, can help quiet the nervous system and create a sense of calm.
9. Repeat a mantra: Repeating a positive mantra such as, “I am safe, I am calm,” can help by replacing the obsessive negative thoughts that get in the way of calm, restful sleep. It can even be helpful to repeat a simple phrase like “Breathing in, breathing out.”
10. Don’t worry about not sleeping: Laying in bed, watching the clock, and worrying about not being asleep can be one of the most counter-productive things to do. Try one of the above suggestions, or do a quiet activity like a crossword puzzle or reading something lighthearted. Even if you are not asleep, remember that you are resting.