How do I manage sleep deprivation and anxiety due to stress?

Question

Hi doctor,

After a very stressful time last year, I started experiencing panic attacks and severe anxiety. I felt better for a couple of months.

Over the holidays, I started to feel anxious again. Last week, I went without sleep for over 24 hours. On that particular day, after being awake for more than 24 hours, I suddenly woke up after about 10 minutes of sleep and felt that I heard a very faint noise of people mumbling. I stood up and could not hear it again. This experience intensified my anxiety, and I began paying close attention to every sound.

I have struggled in the past with intrusive thoughts about schizophrenia, and I know auditory hallucinations are a symptom. A couple of days after this experience, I felt like I heard background noise, similar to news playing on a TV, around 2 a.m. This sound lasted about two to three seconds. Are all of these experiences still a result of anxiety?

Please suggest.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

First of all, I would like to reassure you that your current symptoms are a result of anxiety and sleep deprivation. People with schizophrenia usually do not have insight or awareness into their illness and tend to have many other troubling symptoms as well. Anxiety can cause a wide range of physical symptoms due to being hyper-alert all the time and constantly scanning for danger. This heightened state can also lead to sleep disturbances.

There are conditions known as hypnagogic hallucinations and hypnopompic hallucinations, which typically occur while falling asleep or upon waking. These are sleep-related phenomena and not psychotic symptoms of schizophrenia.

Your REM (rapid eye movement) and NREM (non-rapid eye movement) sleep stages are likely out of sync, which is why this is happening. Additionally, your past history of intrusive thoughts and an anxiety disorder makes it very likely that this is the same issue recurring.

You may consider taking Melatonin supplements, 10 mg at night, which are usually available over the counter, for one to two weeks to help reset your sleep cycle and internal clock. Another option is L-theanine, 100 to 200 mg at night, which may help reduce anxiety. Consult your specialist doctor, discuss with them, and take the medicines with their consent.

Keep in mind that anxiety disorders often have a waxing and waning course, as they may improve for a few months and then recur depending on external circumstances and support systems. With good sleep, you should start feeling better within a few days, which in itself will reassure you that this is anxiety-related.

I want to emphasize again that this is not schizophrenia or a psychotic symptom. It is part of an anxiety disorder, so there is no need to worry.

I hope this has helped you.

Please feel free to reach out to me again for further queries.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I understand your concern.

No, Zopiclone or Zolpidem, these “Z-class” drugs are mainly used for sleep initiation and do not correct sleep architecture. Therefore, they are not recommended for long-term use.

Safer options that you can discuss with your doctor for sleep include Melatonin, Lemborexant, Trazodone, Quetiapine, and others.

Additionally, treating the underlying anxiety will also help improve sleep quality.

I hope this has helped you.

Please feel free to reach out to me again for further queries.

Thank you.