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How to Get to Sleep With Intrusive OCD Thoughts (8 Ways)

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Intrusive OCD thoughts are unwanted and repetitive streams of thoughts, ideas, images, impulses, or urges that can stop you from getting to sleep because they prevent you from mentally and physically relaxing.

So how can you get to sleep if you suffer from intrusive OCD thoughts that won’t go away?

The most effective ways to get to sleep with intrusive OCD thoughts are Cognitive Behavioural Therapy (CBT), Exposure and Response Prevention (ERP), Acceptance and Commitment Therapy (ACT), mindfulness, medication, and good sleep hygiene – according to medical experts.

The rest of this article describes in more detail how to combat intrusive OCD thoughts that are resistant to natural thought and relaxation strategies.

I have personally suffered from insomnia related directly to anxiety and intrusive OCD thoughts for more than 25 years now (ever since I was a young child), so I have added my own insights where appropriate (see section 7 regarding medications).

The rest of this article has been written and researched by Ana Luiza who is a qualified biologist and has a Ph.D. in psycho-biology and sleep to ensure maximum factual accuracy.

However, you should always talk to your doctor to get the best and most personal medical advice for your individual needs.

Related: how to get to sleep after a hernia operation.

8 Ways to Sleep With Intrusive OCD Thoughts

Below are 8 methods that can be effective in stopping intrusive OCD thoughts that interfere with sleep:

1: Apply Good Sleep Hygiene

Sleep hygiene refers to a set of behaviors, environmental practices, and beneficial habits performed before bedtime to prepare your mind and body for sleep – with the intention of combating insomnia, intrusive thoughts, and helping you to get to sleep faster.

Below are 17 specific sleep hygiene habits that you can apply as soon as tonight to help combat your intrusive OCD thoughts and potentially help you to get to sleep quicker:

1.1: Go to Bed and Wake Up at the Same Time

Getting into bed at the same time each night and getting out of bed at the same time the next morning (regardless of how long you slept for) can help to set your internal body clock and thus get you ready for sleep each night.

Conversely, going to bed and getting up at different times can throw your body out of sync and make it intuitively harder for your mind and body to know when to go to sleep.

More specifically, you have a 24-hour internal clock that cycles between sleepiness and alertness at regular intervals, known as the circadian rhythm of your sleep/wake cycle.

Circadian rhythms respond to environmental cues, such as the light/dark cycle.

This is where the daylight is perceived in your eyes, sending a signal to your brain to stay awake.

And at night, your brain receives a signal to feel tired – making the body produce melatonin, a sleep inductor.

A regular eating, exercising, and sleeping schedule will help your circadian clock to synchronize with the external environment.

So naturally, you’ll feel sleepy at night and alert when the sun rises.

1.2: Only Use Your Bed For Sleep

You should only use your bed for sleeping because using your bed for more wakeful activities like eating, studying, or working can confuse your brain.

So if you only go to bed when it’s time for sleep, your brain will associate being in bed as a precursor to going to sleep and thus help to calm your mind so that intrusive thoughts are less likely to have the same hold on you.

1.3: Get Up If You Can’t Sleep

If several hours have passed and you cannot get to sleep, then you should get up and try to do something that’s relaxing and can stop your obsessive thoughts.

For example, reading a boring book can help to break the cycle of intrusive OCD thoughts and help to promote sleepiness.

But stay away from screens and mobile devices because the blue light and stimulation can further impede sleep.

Relaxing music and meditation can also help.

1.4: Avoid Heavy Foods Before Bed

Eating rich foods that are high in fat and calories can cause indigestion and spike energy levels – making it harder to get to sleep and potentially triggering your OCD thoughts due to the anxiety of not being able to sleep.

Foods and drinks to avoid before bed include fried meals, spicy dishes, citrus fruits, and soda – stick to light foods and give the food 2-3 hours to digest before lying down to go to sleep.

1.5: Try a Light Snack of Simple Carbs (Raw Honey)

Instead of eating fat-heavy foods before bed, a light snack that contains simple carbohydrates (like raw honey) can help you to get to sleep.

Dr Marinov explains how simple carbs before bed can help you sleep as follows:

“Some people tend to feel sleepier when they eat some amounts of simple carbs (without overeating) because it helps with serotonin and melatonin production. The elevated levels of insulin help tryptophan reach the brain easier than other aminoacids which equal more serotonin and melatonin (source). Of course, overeating should be avoided due to the risk of indigestion and heartburn.”

1.6: Avoid Caffeine Before Bed

Do not consume coffee, energy drinks, or any other food or drink that contains caffeine before bed – only have them in the morning or not at all – because caffeine can keep you awake for several hours and stimulate your intrusive OCD thoughts.

Click here to discover 6 ways to get to sleep after consuming too much caffeine before bed.

1.7: Avoid Alcohol Before Bed

Whilst alcohol may temporarily subdue your intrusive thoughts, alcohol consumption near bedtime can disrupt the restorative, REM sleep stage later in the night – causing you to wake up feeling terrible the next day.

Furthermore, alcohol before bed can aggravate breathing problems – such as snoring and apnea – whilst also acting as a diuretic; meaning you may have to wake up to go to the bathroom.

1.8: Exercise Earlier in the Day

Exercise can drastically improve your sleep quality by increasing the amount of slow-wave sleep (deep sleep), whilst also allowing for the release of muscular tension and energy that may otherwise contribute to restlessness, anxiety, and racing thoughts.

However, if you struggle to get to sleep then you should exercise earlier in the day (ideally in the morning – but certainly no sooner than 2-3 hours before bed) so that the spike in stress hormones is able to subdue before bedtime.

1.9: Reduce Physical and Mental Stress Before Bed

Avoid strenuous activities, arguments, and anything else that causes physical or mental stimulation before bed because this kind of stress can spike cortisol levels in your body.

Cortisol is the ‘fight or flight’ hormone that when released, prepares your body for action and inhibits the effects of chemicals like melatonin that help you relax and go to sleep.

Cortisol levels are usually highest before you wake up and lowest during sleep.

So when cortisol levels are higher than usual before bedtime, you won’t be able to sleep as well.

1.10: Keep a Sleep Journal

Keeping a sleep diary can help you find the reasons for your sleep problems, such as stressors, medicine intake, eating habits, etc.

In the case of insomnia due to intrusive OCD thoughts, writing down specific worries can help to unburden your mind and help you relax before bed.

1.11: Expose Yourself to Sunlight Early in the Morning

Light exposure during the day will help your circadian clock synchronize to the external light/dark cycle and help set your internal clock so that you stand a better chance of getting to sleep at bedtime and less time battling with intrusive thoughts.

1.12: Avoid Long Daytime Naps

A 30-minute nap can improve your mood, alertness, and performance.

However, longer naps may spoil your night of sleep – napping too close to bedtime will have the same effect.  

1.13: Avoid Screens Before Bed

Looking at a screen (such as your cellphone) before bed can make it harder to get to sleep because the blue light emitted from these devices has a short wavelength that’s very efficient at suppressing melatonin release in your body.

This can lead to a sleep delay, which means you’ll go to sleep and wake up later – causing sleep restriction and giving a window of opportunity for intrusive OCD thoughts to creep in and take hold.

Consider using a filter application like ‘f.lux’ for blue light if you cannot stay away from your phone or computer before bed.

1.14: Avoid Social Media

Avoiding social media before bed can help to slow down the excitement, stimulation, and fragmented attention span that social media platforms perpetuate and may otherwise provide fuel for an accelerated stream of thought.

1.15: Avoid Stimulating Movies and Shows

Watching movies or shows that are scary, thrilling, or thought-provoking just before bed can set off a train of thought that may make your intrusive OCD thoughts worse and interfere with the onset of sleep.

1.16: Don’t Look at the Clock

If you have a bedside clock, then you should turn it to face away from you so that you aren’t tempted to look at it – an action that can trigger sleep-hindering anxious thoughts about how much time you have left before you have to get up.

Similarly, you should turn off chiming clocks in your house and use earplugs to block out the sound of church bells and anything else that may remind you of the time whilst you’re trying to sleep.

1.17: Make Your Sleeping Space Comfortable

You should do everything you can to make your sleeping area as relaxing as possible – such as reducing the room temperature to 65 degrees Fahrenheit (18.3 degrees Celsius) and using cooling bed sheets if you sleep hot or live in a warm environment.

If you’re sleeping on a mattress that’s more than 5-7 years old, then you should consider replacing it with a new mattress that’s suited to your sleeping style for maximum comfort.

2: Improve Sleep Quality With Red Light Therapy

Red light therapy can help to improve sleep quality that may have the collateral effect of being able to help you get to sleep when battling intrusive OCD thoughts.

This is because longer wavelength lights such as red light have been shown to improve sleep quality without interfering with melatonin’s production.

One study tested the exposure to red light for 30 minutes at night for 14 days in Chinese athletes.

Whole-body irradiation with red-light treatment improved sleep, serum melatonin levels, and the performance of elite female basketball players (1).

Red light therapy can also reduce sleep inertia (reduced performance and alertness upon waking).

One study compared individuals exposed to a dim light condition (control) to red light delivered to closed eyelids during sleep (red light mask) and to eyes open upon waking (red light goggles).

The results showed improved auditory task performance and decreased sleepiness with red light exposure without melatonin suppression (2).

3: Try Cognitive Behavioral Therapy (CBT)

CBT is one of the gold-standard treatments for OCD – it’s effective in improving the symptoms of people with the disease (3) and could have a significant positive effect if you’re struggling to get to sleep at night due to intrusive OCD thoughts.

CBT is a kind of psychotherapy that combines cognitive therapy and behavioral therapy.

According to CBT’s principles, what we think, how we feel, and how we behave influence our well-being.

Commonly, it is not the situation that causes problems, but the importance we give to it.

CBT aims to reveal and change false and distressing beliefs; it helps people learn how to replace exaggerated or catastrophic thoughts with more realistic ones (4).

Unlike other psychotherapies, CBT does not deal exclusively with the past.

The approach is problem-oriented; it focuses on identifying current problems and finding a solution for them.

The therapy involves recording your thoughts in a journal for a while, relaxation exercises, and problem-solving strategies.

4: Apply Exposure and Response Prevention (ERP)

Exposure and Response Prevention (ERP) is a form of CBT that’s considered the first-line therapy for OCD and may help you to get to sleep faster if you have intrusive OCD thoughts that are centered around a certain trigger – such as specific thoughts or an underlying fear.

ERP treatment is effective in improving the symptoms of patients with OCD in the long-term.

The method was born after a researcher noticed that OCD symptoms improved after exposing them to feared stimuli (5).

In other words, ERP exposes you to the things that trigger your anxiety.

The treatment is gradual; it begins with stimuli that cause less stress and moves to more distressing stimuli.

When faced with a stressful situation, you are encouraged to avoid neutralizing thoughts or behaviors (6).

The video below explains more about how ERP works and how you can start applying it right now to lower your OCD:

ERP Therapy for OCD | A Complete Guide

5: Use Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment Therapy (ACT) is a type of psychotherapy focused on ‘acceptance’ that can help you to get to sleep when you have intrusive OCD thoughts that are triggered by past events or future worries that you cannot physically change – such as the fear of death or regret for something that you have done.

ACT stimulates psychological flexibility by increasing acceptance of certain situations or thoughts.

Acceptance would protect against avoidance of these thoughts (7).

Unlike traditional CBT, ACT does not aim to reduce the symptoms’ frequency or severity, but the struggle to control them.

ACT is often referred to as a third wave treatment, particularly helpful for those who had failed pre-existing treatments.

6: Try Mindfulness-Based Cognitive Therapy

Mindfulness is a meditation that focuses on paying attention to the present moment and acting non-judgmentally towards stressful events – which can offer relief from intrusive OCD thoughts when you’re trying to sleep.

Mindfulness practices include respiratory exercises, focusing on the body’s sensations, and developing a sense of gratitude and acceptance.

When thoughts and distractions arise, you learn how to cultivate a state of awareness without immediate reaction.

One study compared the efficacy of mindfulness-based cognitive therapy (MBCT) versus stress management training (SMT) in treating patients with OCD.

Sixty participants were divided into two groups: MBCT (N=30) and SMT (N=30) for 12 weeks.

The majority of the participants responded better to MBCT than to SMT (80% vs. 27%).

The authors concluded that MBCT was effective in the treatment of OCD (8).

7: Medications Can Suppress Anxiety and OCD Thoughts

Medications can provide acute relief from the anxiety that fuels intrusive OCD thoughts at night – to help you to get to sleep faster and prevent waking up too soon – with some medications also inducing a feeling of drowsiness.

Those who live with OCD may benefit from using medications such as tricyclic antidepressants (clomipramine) and selective serotonin receptor inhibitors (SSRIs).

Examples of SSRIs are fluoxetine, fluvoxamine, paroxetine, and sertraline.

OCD patients may require higher doses than that used in patients with anxiety and depression.

Most experts believe the best approach is to combine drug therapy with cognitive behavioral therapy to reach the highest treatment efficacy.

Talk to your doctor to find the best option for you.

Personal Note and Warning

At the time of writing, I have been taking between 12.5 mg and 100 mg of sertraline each night for just over 18 months and it has proven to be the only reliable way to help reduce my intrusive OCD thoughts at night (unless I’m very stressed – then I can even remain awake through the drowsiness that this medication causes).

HOWEVER, the major downside to using sertraline as a ‘sleep aid’ is that I’m now dependent upon it – if I miss a dose I literally cannot sleep at all.

Stopping the use of sertraline can cause ‘rebound insomnia’ due to the withdrawal effects that are most pronounced when you stop taking the drug abruptly.

However, I also experienced rebound insomnia – where I would only sleep from 6 am – 8 am after lying awake all night – when I tried to gradually taper off sertraline over a number of weeks (this happened for both of my attempts to stop taking sertraline).

So always do as much research as possible and consider talking to multiple doctors before taking any kind of drug to combat your OCD thoughts.

8: Seek Professional Assistance

If you have been experiencing intrusive OCD thoughts at night that these natural thought and relaxation techniques have not solved, then you should certainly consider seeking professional help from your doctor, a psychiatrist, a psychologist, or a sleep coach.

Dealing with OCD can be an extremely frustrating experience – especially when it disrupts your sleep due to the knock-on effect it has on your life.

But you don’t have to deal with it alone with the help of a qualified professional.

A Guide to OCD Thoughts and Sleep

Obsessive Compulsive Disorder (OCD) is characterized by recurrent, persistent, unwanted, and intrusive thoughts.

‘Did I wash my hands? Did I really turn off the bathroom light? Did I leave the oven on?’

These are some of the thoughts a person with OCD experiences all the time.

People with OCD may try to prevent this obsession through repetitive and compulsive behaviors (13).

Worldwide, 1.5% of women and 1% of men will develop OCD during their lifetime (9).

In the U.S, the disease affects 2.5% of the population (10,11).

The condition is disabling, and it can appear at any age (12).

Obsessive Thoughts May Be an Anxiety Response

The exact causes of OCD are not fully understood and may pertain to genetics, brain abnormalities, distorted beliefs, and/or learned behaviors.

But the obsessive thoughts associated with OCD are believed to be an anxiety response related to a fear of causing harm to others or oneself, fear of being contaminated, a need for symmetry, or a fear of having inappropriate behaviors.

To neutralize these obsessions, patients may engage in rituals like washing their hands or showering several times a day to avoid germs, arrange their things in a specific way, do repetitive counts, and continuously check things (13).

Other conditions often coexist with OCD, such as depression, eating disorders, Tourette’s Syndrome, and substance abuse (12).

Waiting to Go to Sleep Can Trigger OCD Thoughts

For those with OCD, being alone with their obsessions can be frightening.

The quiet, lonely time that precedes sleep can cause residual anxious thoughts to creep into the forefront of your attention and increase anxiety levels to the point where it can interfere with sleep.

This is why many people with OCD experience sleep problems such as insomnia, sleep restriction, and sleep loss.  

While some studies found a link between OCD and sleep disorders, other studies couldn’t demonstrate a difference in sleep variables between people with OCD and people without OCD.

It seems that sleep changes occur in those patients with more severe diseases and with more comorbidities, such as depression.

One analysis summarized the evidence of six studies to determine the differences in sleep between people with and without OCD and differences in comorbid depressive symptoms (12).

People with OCD sleep less and spend more time awake when compared to people without the condition.

They also show a poorer sleep efficiency (percentage of time spent asleep whilst in bed) and a higher amount of time spent in light sleep (12).

When the participants with depression were excluded from the analysis, the differences disappeared.

People with OCD and without depression only had a higher sleep latency (the amount of time it takes to fall asleep) than people without OCD (12).

More studies would help to establish a causal relationship between OCD and sleep changes.

Lack of Sleep Can Trigger OCD Thoughts

Intrusive OCD thoughts at night can prevent sleep, whilst a lack of sleep can trigger OCD thoughts – creating a vicious cycle.

One study has shown that people with sleep disturbances reported increased OCD severity than people with no sleep disturbances.

The results were observed in the presence or absence of depression and anxiety (14).

Also, sleep loss is associated with a decreased ability to stop unwanted and unpleasant thoughts.

Sleep-deprived people have 50% more unwanted thoughts than people who sleep 8 hours a night (15).

Conclusion: Take the Appropriate Action

Intrusive OCD thoughts at night can be chronic (present over a long time) or acute (happening only for a short time before passing).

To stop chronically intrusive OCD thoughts at night that prevent you from getting to sleep, you need to tackle the underlying cause using proven techniques under the guidance of a qualified professional.

They may advise that you follow one of the courses of treatment mentioned in this article, such as CBT, ERP, ACT, or even medication.

For intrusive thoughts that are not as severe and that may be related to episodic events (like moving house or worrying about a presentation the next day at work), you may find relief using the short-term thought and relaxation strategies outlined in the article that you can read by clicking the button below.


Sources and References

[1] Zhao J, Tian Y, Nie J, Xu J, Liu D. Red light and the sleep quality and endurance performance of Chinese female basketball players. J Athl Train [Internet]. 2012;47(6):673–8. Available from: https://pubmed.ncbi.nlm.nih.gov/23182016

[2] Figueiro MG, Sahin L, Roohan C, Kalsher M, Plitnick B, Rea MS. Effects of red light on sleep inertia. Nat Sci Sleep. 2019;11:45–57.

[3] Wheaton MG. Introduction to the Special Issue: Challenges in Treating Obsessive-Compulsive Disorder With Cognitive-Behavioral Therapy. J Cogn Psychother. 2019 Aug;33(3):171–3.

[4] Cologne GI for Q and E in HC (IQWiG); InformedHealth.org [Internet]. 2006-. Cognitive behavioral therapy. [Internet]. 2016. [cited 2021 Jan 27]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279297/

[5] Hezel DM, Simpson HB. Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian J Psychiatry [Internet]. 2019 Jan;61(Suppl 1):S85–92. Available from: https://pubmed.ncbi.nlm.nih.gov/30745681

[6] Stines LR, Feeny NC, Foa EB. Emotional Disorders: Treatment. In: Squire LRBT-E of N, editor. Oxford: Academic Press; 2009. p. 929–32. Available from: http://www.sciencedirect.com/science/article/pii/B9780080450469008470

[7] Vakili Y, Gharraee B. The effectiveness of acceptance and commitment therapy in treating a case of obsessive-compulsive disorder. Iran J Psychiatry [Internet]. 2014 Apr;9(2):115–7. Available from: https://pubmed.ncbi.nlm.nih.gov/25632289

[8] Mathur S, Sharma MP, Balachander S, Kandavel T, Reddy YJ. A randomized controlled trial of mindfulness-based cognitive therapy vs stress management training for obsessive-compulsive disorder. J Affect Disord. 2020 Dec;282:58–68.

[9] Fawcett EJ, Power H, Fawcett JM. Women Are at Greater Risk of OCD Than Men: A Meta-Analytic Review of OCD Prevalence Worldwide. J Clin Psychiatry. 2020 Jun;81(4).

[10] Ruscio AM, Stein DJ, Chiu WT, Kessler RC. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry. 2010 Jan;15(1):53–63.

[11] Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):617–27.

[12] Díaz-Román A, Perestelo-Pérez L, Buela-Casal G. Sleep in obsessive-compulsive disorder: a systematic review and meta-analysis. Sleep Med [Internet]. 2015;16(9):1049–55. Available from: http://www.sciencedirect.com/science/article/pii/S1389945715007352

[13] Katharine A. Phillips M. Obsessive-Compulsive Disorder (OCD) [Internet]. 2021 [cited 2021 Jan 26]. Available from: https://www.msdmanuals.com/professional/psychiatric-disorders/obsessive-compulsive-and-related-disorders/obsessive-compulsive-disorder-ocd

[14] Cox RC, Olatunji BO. Sleep disturbance and obsessive-compulsive symptoms: Results from the national comorbidity survey replication. J Psychiatr Res [Internet]. 2016;75:41–5. Available from: http://www.sciencedirect.com/science/article/pii/S0022395616300061

[15] University of York. Study reveals role of sleep deprivation in unwanted thoughts [Internet]. 2020 [cited 2021 Jan 26]. Available from: https://www.york.ac.uk/news-and-events/news/2020/research/sleep-unwanted-thoughts/

Medical Disclaimer

Although this article was written by a qualified Ph.D. in psychobiology and biotechnology, no part of this article or website is intended to provide medical advice – always speak to a qualified medical professional for such guidance.

Image Attribution and Licencing

Main image: ‘Sleeping’ by Steve Cole Images (Getty Images Signature) – used with permission under the terms of Canva’s One Design Use License Agreement.

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