The double whammy of insomnia and anxiety is one of the most common complaints physicians hear from their older patients. According to our research this combination of anxiety and insomnia may actually be more prevalent than depression-insomnia or dementia-insomnia.

Anxiety is generally defined as a degree of worry that is far out of proportion to the actual situation or threat. When combined with insomnia, anxiety can produce an emotional and physical cycle that becomes extremely difficult to break. The anxious person finds it difficult to sleep, which in turn increases the amount of anxiety the person experiences in relation to sleep. This further exacerbates the inability to sleep. And so on.

The issue for the insomniac and his or her caregiver if there is one, is that exhaustion, depression, and an increase in physical symptoms can increase for both. If a caregiver cannot get a good night's rest because sleep is interrupted by the insomniac, both will suffer. Some caregivers have found themselves so exhausted and desperate for rest that they have been forced to turn to facility care for their loved one.

Feeling anxious is not always simply "mental." There are quite a few things that could cause an anxiety-insomnia cycle. With the help of a good health care provider these are usually identifiable and treatable. So a targeted visit to the doctor is certainly in order.

As we age we become more susceptible to medical conditions that can both interfere with sleep and cause anxiety. Some of the most common are arthritis, neuropathy, leg cramps, obstructive sleep apnea, restless leg syndrome, and difficulty breathing due to heart or lung disease.

Certain drugs can lead to symptoms of anxiety due to either side effects or withdrawal from the drug. Such drugs include caffeine, alcohol, nicotine, bronchodilators for asthma, tricyclic antidepressants, amphetamines, diet pills, ADHD medications, and thyroid medications. Many over the counter cold medications and herbal products contain caffeine and/or other stimulants such as pseudoephedrine.

Low levels of vitamin B-12 can lead to feelings of stress and anxiety. An imbalance of thyroid hormones can also cause overwhelming feelings of anxiety.
If you have been through a complete medical workup, and all the possible causes of insomnia and anxiety have been either treated or eliminated as culprits, don't be surprised if your doctor is still reluctant to prescribe a sleeping medication. Before turning to additional chemical intervention his or her advice will probably be to try a few weeks with the following routine:

1. Avoid using alcohol, caffeine and nicotine.

2. Establish a regular bedtime, but don't go to bed if you feel wide awake. Use the bedroom for bedroom activities only.

3. Once in bed, use creative imagery and relaxation techniques to keep your mind off stressful thoughts. Avoid staying in bed for long periods of time while awake, or going to bed because of boredom.

4. Take your TV or computer out of your bedroom. Otherwise, your brain becomes used to the stimulation and starts to expect it when you are there. This makes it harder for you to fall asleep.

5. Relax by reading, taking a bath, or listening to soothing music before getting to bed.

6. A snack before bedtime helps many people. Foods such as warm milk or turkey have a natural sleep inducer called L-tryptophan.

7. Exercise regularly, but not in the last two hours before going to bed. Exercise, especially aerobic exercise, has been show to make people fall asleep faster and benefit from deeper and more restful sleep. Sex can be a natural sleep inducer and helps some people.

8. Avoid emotional upset or stressful situations prior to bedtime.