Hypnophobia

In order to function properly, the human body needs to regularly restore the functionality of all organs and systems. This happens during night sleep. It turns out that while we sleep, our brain works, restoring the connections that ensure the coordinated work of internal organs. On average, to compensate for the energy spent during the day, you need to sleep 7-8 hours a day, and saving time on sleep results in disruptions in the functioning of the heart and metabolic processes. In light of this, hypnophobia (panic fear of falling asleep) seems to be a serious problem. A person subject to such an obsessive fear experiences daily stress as night approaches, and regular lack of sleep quickly leads to complete exhaustion, mental and physical.

Hypnophobia, also called somniphobia or clinophobia, is a phobic anxiety disorder. In this case, the predominant symptom is the fear of falling asleep, and the need for sleep occurs daily. This is a natural need of the body, and it is impossible to avoid it, like heights, water, spiders or encounters with dogs, so this phobia is not only painful, but also fraught with serious complications.

Epidemiology

Various studies and surveys, the topic of which was irrational fears at the everyday level, indicate that the majority of the world's population at some point in their lives encounters psychotraumatic situations, and about a quarter of such cases end in the development of a phobic disorder. This is the most common anxiety disorder, which occurs in 22% of primary care patients. [ 1 ]

Causes hypnophobia

Basically, irrational panic fear before falling asleep is associated with the fear of dying in a dream. It develops on the basis of some negative event directly related to the period of falling asleep or that occurred in a dream, causing a sharp awakening and fright. The evolutionary nature of the pathology is assumed, because in a dream a person is least protected. However, not everyone who has experienced some stressful event at night develops hypnophobia.

Risk factors

The personality type of the individual is of great importance. People with a stable psychotype are not susceptible to developing this disorder. Most specialists in the field of psychiatry consider personality characteristics to be the main factor in the development of hypnophobia, and the impact of stress factors to be secondary. After all, the same event does not cause a phobic disorder in everyone. The physical and mental state of the individual at the time of the psychotraumatic situation also plays an important role.

Sociodemographic, psychosocial and mental health risk factors are predictive of the development of panic disorder and generalized anxiety disorder in the general adult population. [ 2 ]

Risk factors for the development of this mental disorder include the presence of cardiac and respiratory disorders – chronic diseases manifested by acute obstructive sleep apnea, extrasystole, acute respiratory diseases with nasal congestion, polyposis and similar conditions.

Psychotraumatic situations, such as the sudden death in a dream of a loved one, usually living with the victim; an injury sustained in a dream (often when falling out of bed); a movie watched at night or a book read with a frightening mystical content can cause a vivid, memorable nightmare and lead to the development of hypnophobia. Even close communication with a person suffering from this pathology can be “contagious” for an impressionable individual.

The risk of developing hypnophobia, as well as other pathologies, increases during periods of endocrine system restructuring (in adolescents and people during periods of diminishing sexual function), during overwork and decreased immunity, and latent cerebral ischemia.

Children who suffer from bedwetting and are punished for wet bed linen often become afraid to sleep, which in turn only makes the situation worse.

Childhood fears and impressions can push towards the development of an uncontrollable fear of falling asleep already in childhood, or they can remain deeply hidden in the subconscious and trigger the pathogenesis of hypnophobia in adulthood under the influence of additional stress.

Obsessive phobic disorder is usually considered as a dysfunction of the limbic-reticular complex, primarily affecting the hypothalamus, provoked by acute or chronic emotional shock. This part of the diencephalon is responsible for the integrity of the life processes of the human body, which is ensured by adequate interaction of components covering the emotional, vegetative-visceral, endocrine and motor spheres.

In addition, not everyone will experience a nervous breakdown from the same stress factor. It must be superimposed on fertile ground in the form of a tendency to worry, excessive anxiety, sensitivity and emotional lability.

Genetic epidemiological studies have confirmed that these disorders are familial and moderately heritable.[ 3 ]

Symptoms hypnophobia

Clinical manifestations of obsessive fear caused by the upcoming need to fall asleep depend on the characteristics of the patient's personality, and since each individual is unique, the symptoms are multivariant. They have one common feature: they intensify in the evening or when the patient is physically tired and understands that he will need to sleep. At such moments, anxiety and worry about the inevitable increases. People try to avoid the frightening situation in different ways: some do not sleep for several days, others try to load themselves with things so that they fall and immediately fall asleep. Patients complain that even during the daytime, at the mere mention of sleep, they begin to feel anxious, and sometimes even have a panic attack.

The first signs of the disorder are noticed by the patient himself, when he is overcome by fear of sleep. If he does not share his experiences with loved ones, then for a long time this phobia may not manifest itself in any way. You can simply notice that the person has become lethargic, constantly tired, angry and irritable. Constant lack of sleep leads to headaches, cardiac and respiratory disorders, depressed mood, development of anxiety neurosis, depression. The patient's hands begin to tremble, increased sweating appears, he may be tormented by thirst, in advanced cases, various somatic pathologies can develop from constant lack of sleep. [ 4 ]

What do seizures look like during hypnophobia? They cannot be called seizures in the full sense of the word. Hypnophobia is not epilepsy. A person is afraid to go to bed, and everyone shows their fear in their own way. Some people just sit at the computer for a long time, read, or do something else. Some resort to sleeping pills or alcohol.

Acute hypnophobia manifests itself as panic attacks (a flash of intense fear with rapid heartbeat, hyperhidrosis, shortness of breath, trembling, ripples and flashes in the eyes, bouts of nausea) at the mere thought of having to go to bed. A person may feel hot and then shivery, he may feel a lack of air, tingling in the fingers and toes, dizziness up to fainting. Even the perception of the surrounding world may be distorted for a time.

Many patients come up with certain rituals for themselves that allow them to reduce anxiety and fall asleep. However, hypnophobes have shallow sleep, its duration is insufficient for a full rest, and a prolonged sleep deficit negatively affects not only mood and performance, but also the health of all internal organs.

Complications and consequences

Agree, it is not easy to experience strong and uncontrollable fear every night before going to bed. You can quickly become a complete neurasthenic. And hypnophobes tend to hide their condition from others, disguising it under different activities, and explaining their condition by overload and stress. It is absolutely not recommended to do so. If you cannot cope with your condition for several nights in a row, it is recommended to immediately contact a psychotherapist. It is much easier to cope with a recent phobia than when it has already become overgrown with rituals and somatic manifestations.

Regular lack of sleep is a serious health hazard, affects work capacity and communication with others. At first, a person constantly feels tired and exhausted, becomes inattentive, forgetful. He suffers from dizziness and migraines. Weakness manifests itself in sweating and tremors, the need to perform even everyday duties begins to irritate him, some additional tasks - attacks of anger. Constant fatigue, inability to cope with everyday tasks causes a depressive mood, severe neurosis can develop, the likelihood of accidents increases. The quality of life tends to zero.

Without treatment, health deteriorates - first of all, the cardiovascular system, vision, and endocrine organs suffer.

Diagnostics hypnophobia

Hypnophobia is diagnosed based on the patient's complaints. There are no other methods. In the initial stages, patients are only concerned about the fear of having to fall asleep. In more advanced conditions, when the patient has somatic complaints, the doctor may prescribe laboratory and hardware tests to assess the patient's health. [ 5 ]

Differential diagnostics are carried out when there is a suspicion that the symptoms of hypnophobia are caused by some pathological factors, such as: brain injury, drug or alcohol intoxication, etc. In this case, certain diagnostic procedures may also be prescribed. [ 6 ], [ 7 ]

Treatment hypnophobia

Sometimes a person can cope with hypnophobia on their own, however, in most cases, the help of a psychotherapist is needed, who can “pull” to the surface and dispel fears that prevent sleep. This is the main way to treat the disease. Individual sessions are usually necessary. The help and support of loved ones, the patient’s attitude to the need to eliminate the problem are of great importance. [ 8 ]

In addition to sessions with a psychotherapist, it is recommended that the patient's attention be switched to some new, exciting activity, and that his or her lifestyle be changed to a more measured and correct one.

In more complex cases, hypnosis sessions can help get rid of the pathology. This method allows for a fairly quick impact on the cause of fear and a change in attitude towards it, leveling the level of danger. The patient's condition often improves significantly after the first hypnosis session.

Rarely, drug therapy with anxiolytics with hypnotic effect is used. However, it can have an unpredictable effect, and it should be used only under the supervision of a doctor. Although benzodiazepines are widely used in the treatment of generalized anxiety disorder (GAD), their short-term benefits are overshadowed by their reduced long-term effectiveness, minimal treatment of psychiatric symptoms, and worsening of the patient's general condition. The selective serotonin reuptake inhibitor (SSRI) Paroxetine is indicated for the short-term treatment of GAD, although adequate data supporting the use of most SSRIs for GAD are not yet available. The serotonin and norepinephrine reuptake inhibitor Denlafaxine provides a treatment option that results in both short-term and long-term improvement of symptoms, achieving not only a clinical response, but also remission and prevention of relapse. [ 9 ]

Combination therapy is also used to treat severe patients – hypnosis in such cases helps to reduce the duration of the course of medication.

Yoga, meditation, and autogenic training are used as independent methods, as well as for the purpose of preventing the return of phobia.

Prevention

The main risk factor for the development of a phobic disorder, according to experts, is the personality traits of a particular individual, such as anxiety and suspiciousness, and increased suggestibility. Neurosis-like disorders occur in people who do not have sufficient information to cope with a life situation that knocks them out of their usual routine. Therefore, the best prevention of the emergence of an uncontrollable fear of sleep is upbringing and education from childhood, aimed at overcoming various difficulties, that is, the formation of a rationally thinking, stress-resistant personality.

In addition, before going to bed it is recommended not to read or watch thrillers or horror films, but to focus your attention on something fun and pleasant.

A healthy lifestyle, strong immunity, walks in the fresh air before bed, for example, with a favorite dog, and sports activities help to increase stress resistance. People who, even in our difficult times, find the strength for all this, as a rule, do not suffer from hypnophobia.

Forecast

Pathological fear of falling asleep is quite amenable to correction. The main recommendation of specialists is not to waste time. If you notice symptoms of hypnophobia, do not resort to sleeping pills or alcohol, which, according to many, helps to relax and fall asleep. Start with a visit to a psychotherapist. Perhaps you will not need many sessions.