Overcoming Sleep-Related Obsessive-Compulsive Disorder: A Personal Journey

Time Anxiety Disorder

Dear Dr.
Ding,
At the age of 18, after undergoing laser skin treatment, I began my journey with insomnia, which subsequently led to anxiety and obsessive-compulsive disorder (OCD).
I told myself that I needed to sleep early and get enough rest for my skin to recover more quickly.
I developed a fixed routine before bed, which included drying myself after using the restroom, washing with water, and drying again.
If the order was incorrect, I would start over.
I must have at least 9 hours dedicated to sleep each night; if I had to wake up early the next day and couldn’t allocate 9 hours to prepare for sleep, I would start to feel anxious.
During sleepless nights, I would want to check the clock to see what time it was, but I would tell myself not to look, knowing that checking would prevent me from falling asleep, yet not looking would also keep me awake.
It was agonizing to feel so out of control.
If I saw that I hadn’t slept for at least 7 hours, I would feel very depressed.
If I checked the clock and saw that there were less than 2 hours until my wake-up time, I would also be unable to sleep.
I would experience insomnia whenever I needed to wake up early or had special plans, as I would tell myself that I needed to sleep early to feel energized.
I know that the more I think this way, the worse my sleep becomes, but I cannot control it.
Sometimes, I even have thoughts of wanting to die.
Doctor, I feel like I’m going crazy.
How can I resolve my OCD issues? Please help me.

Annie, 40~49 year old female. Ask Date: 2016/07/14

Dr. Ding Shuyan reply Psychiatry

Hello, your inquiry can be discussed on two levels.
First, let's examine your beliefs about sleep.
For instance, you mentioned that you must sleep for 9 hours, which is problematic.
I'm curious where this concept originated.
Different individuals have varying physiological needs for sleep based on their body type and age.
Additionally, humans are organisms, not machines that function uniformly; our physiological responses can change daily, even hourly, and with the seasons.
Sometimes we sleep more, sometimes less, and that is natural.
As long as we do not deliberately stay up late playing video games, watching TV, or browsing the internet, our body's natural rhythms will indicate when we need to sleep and for how long.
Secondly, how much sleep is sufficient? Aside from falling asleep quickly and having uninterrupted night sleep, a duration of approximately 6-8 hours is generally adequate for feeling refreshed the next day.
Even if you sleep for 9 hours or even 12 hours, if you still feel fatigued the next day, that is not effective sleep.
If you sleep for 8 hours but feel unhappy because you did not reach 9 hours, it would be better to sleep for 7 hours and feel happy every day.
What we should focus on is whether sleep restores our energy and alleviates fatigue, rather than fixating on a specific number of hours, to avoid losing sight of what truly matters.
If you understand these principles but find it difficult to let go of the 9-hour sleep obsession, it may indeed be a manifestation of obsessive-compulsive behavior, in which case consulting a doctor and possibly taking medication might be beneficial.
Wishing you all the best.

Sincerely,
Dr.
Ding Shuo-Yan

Reply Date: 2016/07/14

More Info

Dear Patient,
Thank you for sharing your experience with sleep-related obsessive-compulsive disorder (OCD) and the challenges you face with insomnia. Your situation is complex, and it’s important to address both the psychological and physiological aspects of your sleep issues.

From what you've described, it appears that your insomnia and compulsive behaviors began after a significant event in your life, specifically following a skin laser treatment. This is not uncommon; many individuals experience heightened anxiety or stress following medical procedures, which can lead to changes in sleep patterns. The pressure you place on yourself to achieve a specific amount of sleep—nine hours, in your case—can create a vicious cycle of anxiety and insomnia. This is often referred to as performance anxiety related to sleep.

Your compulsive rituals, such as the specific way you prepare for sleep, are classic symptoms of OCD. These behaviors may provide temporary relief from anxiety but ultimately contribute to a cycle of distress. The need to follow a strict routine before bed can make it increasingly difficult to relax and fall asleep, as you’ve noted. The anxiety surrounding the clock and the fear of not getting enough sleep can exacerbate your insomnia, leading to a situation where the very act of trying to sleep becomes a source of stress.

It’s crucial to recognize that while your desire for a good night’s sleep is valid, the pressure you place on yourself can be counterproductive. Cognitive-behavioral therapy (CBT) is often effective for treating both OCD and insomnia. CBT for insomnia (CBT-I) focuses on changing the thoughts and behaviors that contribute to sleep difficulties. It can help you develop healthier sleep habits and reduce the anxiety associated with sleep. Additionally, exposure and response prevention (ERP), a specific type of CBT, can be beneficial for OCD. This involves gradually exposing yourself to the thoughts or situations that trigger your compulsions while learning to resist the urge to perform those compulsive behaviors.

In your case, it may be beneficial to consult with a mental health professional who specializes in sleep disorders and OCD. They can provide you with tailored strategies to manage your anxiety and improve your sleep. Medication may also be an option to consider, particularly if your symptoms are severe. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for OCD and can help alleviate some of the anxiety that contributes to your sleep issues.

In the meantime, here are some strategies you might find helpful:
1. Sleep Hygiene: Establish a calming bedtime routine that doesn’t involve rituals. This could include reading, listening to soothing music, or practicing relaxation techniques such as deep breathing or meditation.

2. Limit Clock-Watching: Try to avoid looking at the clock when you wake up during the night. Consider turning your clock away from view to reduce anxiety about time.

3. Gradual Exposure: If possible, gradually reduce the time you allocate for sleep. For instance, if you currently aim for nine hours, try reducing it to eight and a half hours, then eight, and so on, until you find a balance that feels comfortable.

4. Mindfulness and Relaxation Techniques: Incorporate mindfulness practices into your daily routine. Techniques such as progressive muscle relaxation or guided imagery can help reduce anxiety and promote better sleep.

5. Professional Support: Don’t hesitate to seek help from a therapist or counselor who can provide support and guidance tailored to your specific needs.

Remember, you are not alone in this struggle, and there are effective treatments available. It’s commendable that you are seeking help and looking for solutions. With the right support and strategies, you can work towards overcoming these challenges and achieving a healthier relationship with sleep.

Best wishes on your journey to better sleep and mental health.

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