anxiety + sleep loss + self-love/esteem
November 28, 2016 10:12 AM   Subscribe

This will be a long one, so bear with me! I've had self-esteem issues for a while now, around 10+ years. I'm in therapy, I go to Al-Anon, call people in Al-Anon for support and have a decent social network. However, I'm in a healthy relationship that I value a lot and it's brought out a lot of my own personal insecurities as well as a decent amount of nights for the past 4 months of below average sleep. How can I address my anxiety better? Details in main post.

I met this girl in August, and she's been my first healthy relationship in my 11 years of dating. I'm 30 now, started dating a little after high school. Most of my relationships were sexual or just with people that I felt I was better than and could control.

She's a nurse, has a successful career and is a pretty positive and supportive person.

I've spent a lot of my life in either anxiety, depression or low self-esteem issues. I've come a long way, but the relationship is bringing out a lot of my own personal insecurities.


1) I don't make the money I want, and she makes more. Sometimes I get pretty insecure about this.

2) I find myself being too attached to her at times, to the point where I don't want to do my own thing and I lose sleep over it wishing she were in bed with me and by my side often. I don't know how to function fully as an independent adult, who is in school and working towards his first bachelor's degree. I find it hard to have my own life and feel happy when I'm away from her.

3) I'm insecure about my body compared to hers. She's a bit overweight and such, but can do a lot of workouts. I may need some neck surgery and feel sad and anxious that I can't do everything she can sometimes. When she tells me she's worked out, it can trigger my feelings of inadequacy even though I'm in fairly good shape.

The biggest thing is I lose A LOT of sleep about this because I think about these things at like 3, 4 , 4:30 am. By the time I get up, I have a hard time calming down with these racing /ocd thoughts and my work alarm goes off at 5:30 am.

What I do right now:

1) Therapy, talk therapist (once every 2 weeks)
2) Anti-depressant (Viibryd)
3) Al-Anon (1 mtg a week w/ my schedule for now)
4) Calling ppl in Al-Anon to talk things out and get perspectives
5) Exercising 4-5 times a week for at least 30 mins.
6) Physical therapy.
7) Borrowing my dog for the weekends from Mom's house occasionally (but then I miss my dog during the week because I'm at work and can't take care of him).
8) getting together with friends sometimes.
9) journaling about my thoughts, feelings. (not as often)

What should I do to help my anxiety with my issues? How can I better live my own life? Should I increase my therapy sessions and what can I do on my own, especially in the early AM hours to get back to sleep?
posted by isoman2kx to Health & Fitness (13 answers total) 1 user marked this as a favorite
And the relationship is going really well overall. IT's between the ears I'm having difficulty with.
posted by isoman2kx at 10:13 AM on November 28, 2016

I didn't want to use sleeping pills either, but I've been losing sleep for about 4 months now.
posted by isoman2kx at 10:13 AM on November 28, 2016

I feel like you are trying to address these issues by improving your situation (getting in better shape or making more money--all good pursuits) but the solution is to feel (some degree of) unconditional acceptance and support from your romantic partner. You haven't dated for very long so allowing yourself to be vulnerable might be some time off but that is what is required for a good relationships. At some point you are going to need to have the courage to talk to her about these things and I think this will be the long-term solution to your anxiety/sleeplessness.

Here's an interesting study on the subject
that might provide some more help. Good luck!
posted by sexymofo at 10:53 AM on November 28, 2016

Something I've been encouraging people to do more lately is learn to be a little uncomfortable. I also suffer from anxiety, and I have been working on this. I think we convince ourselves that Everyone Else is walking around feeling awesome 24/7, or they only have two sads a week or whatever, and so we are bad and wrong (just like we suspected all along!) and the most important thing is to make it stop.

But it's actually about tolerance levels. Everything in life comes with some kind of price, even things we love to do: if you love playing soccer, you're going to wake up sore sometimes, and there's a chance you're going to seriously blow out a knee or your back one day, but you live with that for as long as it's worth it, or at least until you need to change your priorities and save your knees for other things or spend your time on other things. You may love your teaching job, but not every parent/student/coworker/administrator is going to be your favorite, and the hours can be tough and it can be a lot of standing. Being in a relationship means being vulnerable, or it's a pretty shallow relationship.

You will never make all the feelings go away, but you can develop strategies for managing them, you can practice ways to take some of the sting out of them. I have an arsenal of visualization and distraction exercises for when middle-of-the-night worries pop up (and part of that is reminding myself that sleep is a key factor in my functioning and it has to be the number one priority between 10p/7a), I have things I do like brain-dump my work stresses out onto paper when I get overwhelmed and stuck during the workday (and sometimes I have to do it in the middle of the night or just before bed, with the understanding that I no longer need to hold this list in my head because it's on paper and can be dealt with later). I practice these things even when I'm not experiencing the discomfort, so that I develop the muscles for doing them when the pressure is on.

If you are not seeing a CBT-style (or DBT, maybe) therapist, you may not be getting trained in these techniques. You may need to diversify your therapy if you're doing talk-style processing with your current therapist, or maybe you can ask them to start incorporate some training/coaching. Talking/processing is great*, and medication is important for controlling neurochemical exacerbation, but that's rarely enough to just make it all go away. It's like learning a language or how to operate specialized machinery, you can only guess so much of it yourself. There are procedures you should learn and practice.

*There is, however, such a thing as just running on a hamster-wheel of pointless navel-gazing. There's such a thing as too much talking and not enough doing. Depression, especially, makes a lot of people really myopic and self-centered, and you develop this mindless habit of relentlessly centering yourself in the universe in a non-positive way. That's not productive, and I think you may want to be careful about over-leaning on calling people to talk about it instead of doing something like actively managing your feelings or actively doing constructive coping.

And, at some points, you just have to shrug and say "okay, there's that feeling, it's not helpful or productive so I'm just going to let it stew in the corner until it moves on" and get on with whatever else you wanted to do instead. That's harder to do at night, I find, probably for neurological reasons, so that's when you want to make sure you've got some combat strategies, but during the day sometimes you just have to practice walking it off and focusing on something else.
posted by Lyn Never at 11:58 AM on November 28, 2016 [8 favorites]

I sparingly use CBD medical marijuana for my rumination induced insomnia. Sleeping pills were not helpful because my paranoia of sleepwalking kept me in an agitated state. So while I would get a bit more sleep than no medication, it wasn't a restorative sleep.

I only use it for my insomnia, and I keep my therapist up to date on how often I'm using it. The goal is that eventually I can replicate the safe bubble of therapy on my own in bed. But just before sleep is when I'm my worst enemy because I'm too tired to engage in all the healthy coping mechanisms I'm learning, so I turn to the coping mechanism of rumination. And I find that rumination == attempt to control. Not an abusive level of control, but a passive level of control where you cut off your emotional reaction to their behavior so that you can tolerate the things they do that cause you discomfort. It's a better coping mechanism than being outright controlling, but it's still maladaptive because it doesn't create space for your significant others to be 50% of the relationship.

I found a lot of relief in finally increasing therapy from once a week to twice a week. I understand that's a very expensive route, because trained professionals aren't cheap. But I found that I needed to give control to someone else and learn how to fully trust them, even when they made mistakes. (I'm always surprised how meaningful it is when I feel like I've hit a dead end, and he apologizes that he hasn't figured out what I'm trying to tell him.)
posted by politikitty at 1:20 PM on November 28, 2016 [3 favorites]

Couple of thoughts to consider:

1. How long have you been on Viibryd? It looks like insomnia is a pretty common side effect - is it possible that your insomnia could be linked to starting Viibryd or increasing your dose?

2. You mentioned "racing/ocd thoughts" - do you have any other OCD tendencies or do you lean mostly towards depression except for this rumination? If you think you might have some OCD tendencies, you might:

a. Talk to your psychiatrist about switching from Viibryd to a straight-up SSRI. I have OCD and Prozac works well for me, but I tried a bunch of other meds before finding the right med at the right dose. None of those other meds I tried were Viibryd, so I wonder if Viibryd tends to work better for depression than for anxiety/OCD. (Of course, disregard this entirely if depression is your main concern and the Viibryd is helping with that.)

b. Try to find a CBT therapist who specializes in OCD (or anxiety, if that's more your flavor of discomfort). The difference for me between seeing a general talk therapist and then a CBT therapist who hadn't treated many people with OCD, versus the CBT OCD specialist I see now, is night and day. (Again, disregard if this doesn't apply to you.)

3. You mention exercise - have you ever tried yoga? Obviously, whatever you like best is great, and exercising in general is great, but I specifically mention yoga because:

a. It's about connecting the mind intelligence to the body intelligence through mindful movement and breath, and I find that it helps my little hamster brain take a break.

b. It's very much a "practice" - it's not competitive, it's about being where you are that day, and at some point, accepting your emotions and thoughts and letting them go so they don't keep you spinning in the early morning. It's been really helpful for my self-esteem and my feelings about my own body, especially as I've seen myself "improving" over time, but also seeing that some days you soar in crow and some days you can't get one toe off the ground, and *it's okay* either way.

c. You can actually use some of the tools (like Alternate Nostril Breathing) right there in bed when it's 4 am, even if your SO is sleeping right next to you.

I really, really, really like Yoga with Adriene - free on YouTube, affirming without being too woo, and generally a lot of fun. I'd suggest starting with her Bedtime Yoga sequence or her Yoga for Anxiety video.

Obviously, if you might need neck surgery, be very careful and aware of your neck position and opt out of any poses that don't feel good (maybe skip neck circles, but still stretch your legs and arms, or whatever works for you). There's no cheating in yoga and there's no "doing it wrong" in yoga - as long as it doesn't hurt!

Good luck!
posted by bananacabana at 2:00 PM on November 28, 2016 [6 favorites]

Lyn Never:

Thanks for the very helpful and well-thought out reply.

When you brain dump, is it a form of journaling for you at night? Or are you writing anything you can think of down on paper in terms of stress/problems? What do you do with it after?

I've tried journaling and/or dumping things in my brain to paper that I worry about before bed, it doesn't work all that well SO far.

I think I'm doing "talk style" therapy , as you say. In that I sit down, we do a bit of a Q&A to begin and then I launch into everything that's happened during the past week or my main problem areas. I don't believe we've done any CBT (or DBT) so far with me. I've read a little bit about each and know what they are. I could ask her to start incorporating this into my therapy or perhaps recommend someone who can.

In terms of you mentioning to perhaps call people less or secondary after I do the bulk of the work or calming down on my own, what would you suggest other than what I do now? I feel like at times some of my main coping mechanisms outside of therapy are indeed other people in my 12-step fellowship or just people in general. I don't find calming myself or writing about it as soothing or productive because I feel paralyzed with anxiety or fear sometimes :\.

I journal sometimes when I'm stressed, or I stretch or I take a shower. I don't always however have the most time when I get in from work to cope.
posted by isoman2kx at 5:48 PM on November 28, 2016


1) I've been on Viibryd for about 3, or 4 years now. I lose track lol. Don't a lot of antidepressants have insomnia side-effects? It's possible, sure. However, my additional sleep issues and anxiety have started since I've been in my newest relationship around early August. Originally, I was on it for depression and up until recently, was cool with it being for that.

2) That's a good question on my racing/ocd thoughts. By in large, I feel like I lean towards depression over the years, except in relationships where anxiety is higher. Usually I quit relationships because of the anxiety and also because I was settling in choices for my girlfriend. With this relationship, it's much more fulfilling and it can cause anxiety too because we are equals. I'm used to girls being more dependent on me, easier to manipulate or control and just more with me at the center of their world. I'm also used to girls I date being less successful than me or messed up in some way. Healthy has a strange anxiety for me that the girl I'm in a relationship with now doesn't seem to have a majority of those past shitty traits. I do tend to replay things over rand over however, not as much when I'm not in a relationship, but I still can do that.

a) I tried a lot of meds back in the day when I wasn't in talk therapy, Al-Anon, or had more friends like I do now so I got frustrated with them when they didn't work instantly. I wouldn't mind trying a different one perhaps too. I've been on Zoloft, Wellbutrin, Cymbalta, Lexapro, Abilify (not a true antidepressant I realize), Effexor XR. All of those again, I tried before Viibryd and before I realized that antidepressants are not a cure-all panacea. So maybe it would be better this time around to switch or ask about switching

b) Seems like this is mentioned again as well. How can I tell if general talk therapy isn't working for me? I THINK I have more of a general talk therapist and she's very nice, sweet, etc. I just don't know how much is her and how much is me in between sessions when I get anxious, frustrated, have crappy sleep nights. Am I making sense? lol. As in , would my in-between therapy anxiety be better if she were a good CBT therapist?

3) I have tried yoga, for about a year a few years ago. It wasn't bad, I just didn't stick with a schedule.

c) I like that alternate nostril breathing idea. I can give that a whirl too!

thank you again!
posted by isoman2kx at 6:00 PM on November 28, 2016

If CBT provides sufficient relief, don't change anything.

But I found that CBT and mindfulness merely redirected my rumination/controlling behavior into more socially acceptable avenues. Casual observers thought I made a lot of progress. But it was taking up so much head space that I didn't have the bandwidth for all the things people should juggle in a normal life. Initially, I identified a lot more with the depressive characteristics of my illness. But as I dig in, I find that the depression is basically just exhaustion from unchecked anxiety.

I did a stint in Al Anon. Philosophically, it speaks deeply to me. But I found it too hard to lean into the group. Letting my actions or feelings impact other people was ceding a certain amount of control that just felt alien to me. Therapy took a long time to get to that point as well, even though my relationship with my therapist only exists for my benefit. But I still felt that I was the adult, and I was responsible for directing the sessions and finding the relevant 'clues' and putting the learnings into action. And in a sense, that's accurate. But it's not sufficient. He has to see the patterns that I can't see. Because if I was able to fix me, I would have already fixed me. I need help, and I need to be open to that help.

Metafilter and insurance companies love the CBT. But I definitely think they are contraindicated in certain scenarios.
posted by politikitty at 6:35 PM on November 28, 2016 [3 favorites]

Thanks for the followup info. Here are some concrete things you could do on the meds/CBT front.

1. Make an appointment to whatever doctor (GP, psychiatrist, etc.) prescribes your Viibryd. Talk to them specifically about the physical things you're experiencing (insomnia, racing thoughts, etc.), rather than what the thoughts or emotions are about. (So "I often get a feeling of tightness in my chest when I can't sleep early in the morning because my thoughts are racing" rather than "I often spend a lot of time worrying about how much money my girlfriend makes compared to my income.") It's not that prescribing doctors don't care about your worries, but they can't really help you with specific worries. They *can* help you with specific symptoms. See what they recommend. Maybe it'll be a meds switch, or maybe it'll be bloodwork to see if you have low vitamin D and need a supplement - I don't really know, but get their thoughts and ideas.

2. At your next session with your current therapist, bring up the idea of CBT. See if that's something she can do with you. If not, see if she can recommend a colleague that could do CBT with you for, say, six weeks, and then your current therapist and you can reassess. You can also learn some of the basics in this book or this book, though I think it's more helpful to work with a therapist than just with a workbook on your own.

For me, the CBT work does help between sessions, not only at sessions - in fact, CBT often has a large "homework" component. That's partly because the aim of CBT is to change your patterns of thought so that instead of habitually thinking "Ahhhhh!" when you think about how much your gf makes, you habitually think "Wow, that's awesome for her to be a highly-valued, independent woman, and awesome for me that I don't have to support her because she's so awesome and rad" or whatever a better pattern of thought would be for you.

For me, CBT isn't the answer by itself. It's a combination of the right meds and CBT. It can be frustrating to be attacking your situation from both ends (meds and therapy), but at the same time, it also means you have a second avenue to pursue (like doing CBT homework) if/when the first one stalls or when you're trying to see if it will work (like giving a new med a 6-8 week trial).

Good luck!
posted by bananacabana at 6:51 PM on November 28, 2016 [3 favorites]

It's totally fine to talk to your therapist about a treatment plan, about more formal CBT, about the list you bring in with you of issues you're currently experiencing that you want help with. A lot of therapists can be a little too much "meet you wherever you are" and cautious not to try to push too much on you until you ask or indicate you're looking to step it up a little.
posted by Lyn Never at 7:31 PM on November 28, 2016

Consider asking about an antianxiety medication rather than an antidepressant. The very low dose anti anxiety med I'm on now had made a huge difference for sleep and stress. I didn't think I was anxious, because I thought it was just my personality or being overworked. I can do all my other stuff, therapy etc, better nose I'm not chasing my own tail with anxiety, quite so much.
posted by dorothyisunderwood at 12:12 AM on November 29, 2016 [1 favorite]

You guys are the best! :)
posted by isoman2kx at 10:26 AM on November 29, 2016 [2 favorites]

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