ERP skills for OCD about sleep✅ Key Takeaways

  • OCD can turn sleep into a persistent worry—fear of poor sleep can launch nighttime obsessions and compulsions.

  • Obsessions include thoughts like “What if I can’t sleep?” or “What if I don’t get enough sleep?” Compulsions range from rigid sleep hygiene behaviors to obsessive tracking.

  • Exposure and response prevention (ERP) therapy incorporating self-compassion and shifting focus from how tired you feel to what you’re doing can help weaken OCD’s grip on your sleep.

  • When sleep issues persist, CBT‑I (cognitive behavioral therapy for insomnia) can be an evidence-based next step.

⏱️ Estimated Reading Time: 4-5 minutes

The fear of not being able to sleep

Like many people with OCD, I’ve struggled with sleep my whole life. In fact, I searched for “sleep” in my memoir for quotes illustrating how monstrously hard sleeping can be when you have OCD. I was stunned to find there were 51 references 😱! I knew I’d struggled with sleep, but I’d forgotten how intense the problem was when I had untreated OCD.

The excerpt I chose for this post illustrates one of the issues many of us with OCD face after repeated nights of bad sleep: we become afraid that we’ll continue to sleep poorly and that we won’t be able to function as a result:

…I’d been trying to go to sleep in our apartment during our last semester of business school. On a weeknight like any other, some younger coeds had decided to take a rather noisy dip in the pool—which our apartment bordered—at one in the morning. I’d listened to them splash around, every whoop and holler fueling a fire inside my chest. Did they not know people were trying to sleep? That I was a student in a rigorous MBA program that seemed to require sixteen-hour days of work? That I had OCD I could barely control? That if I didn’t get sleep it would be virtually impossible to think the next day, much less deal with financial statements and case studies and interviews and my goddamn disorder that never gave me a moment’s peace?

“WILL YOU SHUT UP?” I’d yelled across the pool from our balcony, where I stood in a tattered green robe and baseball cap, Alex [my partner at the time] aghast behind me. The water undulated lazily around the stunned swimmers, who were spotlighted by the pool’s ghostly underwater lighting. “Do you have any idea what time it is? If you don’t get out now, I’m calling the cops!”

Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life (pp. 108-109).

Not one of my best moments. So let’s talk about how you can avoid situations like this when it comes to your sleep and OCD.

What if I can’t sleep?

We all know that sleep is important. OCD can only get your attention about things that are important to you, so if you care about sleep, sometimes it will become an OCD target. Especially if you aren’t sleeping well.

And sometimes those of us with OCD don’t sleep well. In Everyday Mindfulness for OCD, Jon Hershfield and I explain:

A recent review of research on sleep and OCD found that it’s pretty common for people with OCD to have some type of sleep disturbance, which may include shorter sleep duration, lower sleep efficiency (the ratio of total time asleep to the total time spent in bed during a night), perceived lower sleep quality, and having trouble going to sleep. While there are some theories as to why people with OCD experience disturbed sleep, at this point no one really understands why this occurs (Paterson et al. 2013). pp. 187–188.

So you might sleep badly, feel bad the next day, and then start worrying about your sleep, which can get you stuck in an OCD cycle that can include obsessions and compulsions like the following:

Sleep obsessions

Examples include:

  • What if I can’t sleep?

  • What if I can’t stay asleep or get woken up?

  • What if I wake up and can’t go back to sleep?

  • What if I don’t get good quality or enough sleep?

  • What if I’m tired the next day?

  • What if I can’t function because I’m so tired? (And then all the what‑ifs about what could happen if you’re not functioning well….)

  • What if my sleeping problems never go away?

Sleep compulsions

Examples include:

  • Becoming excessively rigid about sleep hygiene so that one little mistake doesn’t lead to any “bad” sleep outcomes.

  • Compulsively monitoring and analyzing your sleep with sleep‑tracking technology, and getting more stuck in the OCD cycle when the data isn’t what you want to see. (Check out a blog I wrote about how this happened to me not very long ago.)

  • Trying to achieve the perfect amount of sleep each night or on average over a period of nights.

  • Getting into bed and desperately trying to go to sleep.

  • Looking at the clock while trying to go to sleep.

  • Micro‑monitoring how you feel during the day to see how tired you are, and then micro‑monitoring how well you’re doing whatever tasks are in front of you (which is a recipe for not doing them well at all).

  • Compulsively doing particular things during the day to “make sure” you get good sleep. Sometimes these can be magical and sometimes actually related to sleep. For example, here’s one of the oldies but goodies from my past: “I must do 30 minutes of cardio a day or I won’t sleep.”

  • Trying to go to bed early to “make up” for lost sleep, and then lying there worrying about the fact that you’re not sleeping.

Reclaiming your sleep from OCD

In my own journey to reclaim my sleeping life from OCD, I used exposure and response prevention therapy, ERP, the good standard therapy for OCD, with a focus in the following areas:

Be flexible with the things that help

ERP skills for OCD about sleepFollowing sleep hygiene guidelines can be very helpful. However, trying to rigidly adhere to every single bit of sleep hygiene advice is not.

For example, I go to bed and get up around the same time (i.e., within a 30ish‑minute window) on most days. But there are exceptions, like on Sunday when I was exhausted and slept in two hours. In the past, I might have compulsively ruminated during the day about whether that extra sleep was going to cause me to have trouble falling asleep that night, but instead I…

Don’t be attached to the outcome of a good night’s sleep

…embraced the uncertainty! I use “may or may not” (MOMN) statements as needed, such as “I MOMN have a hard time getting to sleep tonight because I slept in,” or I simply put my Shoulders Back and ignore OCD’s invitations to discuss this topic in my head.

OCD wants certainty about sleep. It gets extremely attached to whatever metrics it uses to determine whether we had a “good night’s sleep.” While it’s always nice to sleep well, and we can do what we can reasonably do to help the situation, whether we sleep well or not is often out of our control.

And you’ve probably noticed that trying to sleep well, especially when OCD is involved, often just highlights how poorly things are going and makes the whole situation worse. Learning to do what you reasonably can to help set yourself up for good sleep and then letting go of how well you actually sleep can loosen OCD’s grip.

Talk to yourself kindly

Use self‑compassion liberally when you’re struggling with sleep. A long‑form self‑compassion statement for sleep highlighting ERP tools you could use might go like this:

I’m feeling tired and worried because of my sleep issues, and it’s okay to have these emotions. Many people with OCD struggle with sleeping. I’m going to give myself a break.

I’m noticing what I’m doing right—identifying how OCD is involved in my sleep and trying not to do compulsions.

I’m giving myself permission to sleep however much I sleep without judging the experience or how I feel.

I’m going to make a reasonable effort to set myself up for sleeping success but accept that my sleep will be what my sleep will be. I will reward myself with my favorite coffee in the morning for doing such a good job reducing my OCD rituals around sleep.

Shift your attention from how you’re feeling to what you’re doing

All of us with OCD can be really hard on ourselves, especially when we’re tired. We tell ourselves we’re not going to do a good job, we’re going to miss things, and others will negatively judge our performance. This self-criticism can make us over-focus on how tired we feel, as if doing so will somehow help us to feel and perform better.

But one of the most important things I’ve learned in my own journey to manage OCD around sleep is this: if I can accept feeling tired and shift my focus from how I’m feeling to what I’m doing, I tend to do just fine—not perfectly, but well enough. The more I’ve practiced this skill of turning my attention away from the sensations of tiredness and toward what I care about, the easier it’s gotten to carry on with my day. The more I’ve been able to do this, the weaker OCD’s obsessions about sleep have become, because I’ve learned that I can function on less sleep than OCD wants me to have.

Still struggling? Try CBT for insomnia

If you’re really having a hard time with sleeping, try cognitive behavior therapy for insomnia, or CBT‑I—an evidence‑based treatment for insomnia. You can find a provider here: CBT‑I provider directory. You can also search for apps that offer CBT‑I digitally.

References
Paterson, J., A. C. Reynolds, S. A. Ferguson, and D. Dawson. 2013. “Sleep and Obsessive‑Compulsive Disorder (OCD).” Sleep Medicine Reviews 17, no. 6: 465–474.

Photos taken at Zion National Park (c) Shala Nicely

Learn more about taming OCD

To learn more about those 51 😱 references to my sleep struggles and my journey to reclaim my life from OCD with exposure and response prevention therapy, see Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life.  Click here to purchase your copy.

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My blogs are not a replacement for therapy, and I encourage all readers who have obsessive compulsive disorder to find a competent ERP therapist. See the IOCDF treatment provider database for a provider near you. And never give up hope, because you can tame OCD and reclaim your life!