WOMAN: Anxiety is a tremendous part of people's mind set in America.
ANNOUNCER: Stressed out. Feeling anxious. Welcome to life in the 21st century. And you're not alone. Studies show that almost 19 million Americans suffer from some form of anxiety.
MAN: When I am anxious I know I stay up late.
WOMAN: I will fall asleep, I will then wake up several hours later, think about all the things I should be doing.
DAVID P. WHITE, MD: Anxiety is probably the single major underlying component of most of what we call primary insomnia.
ANNOUNCER: While we have lots of daylight in which to worry, it seems bedtime is when anxiety really takes over.
DAVID P. WHITE, MD: People wake up, their mind starts racing, they start dealing with the anxieties, they can't fall back asleep, and this thing can build on itself.
ANNOUNCER: Often anxiety can result from stress.
DAVID P. WHITE, MD: There are a lot of people that can sleep just fine, no matter how much stress they're under, and other people's stress has a huge effect and it causes them to have inability to sleep.
ANNOUNCER: So while some people breeze through troubles, for others, stress actually broadcasts a no-sleep signal to the body.
RICHARD ROSS, MD: Certain neurochemicals are released in our brain, so that stress can in fact lead to heightened vigilance, heightened arousal and everything that counters the tendency to sleep.
ANNOUNCER: While the stress often results from the appearance of the usual suspects -- problems with work, loved ones, worries about health -- some forms of anxiety can appear with no apparent cause. And the feeling is constant.
RICHARD ROSS, MD: Anxiety disorders are perhaps the most prevalent mental disorder in the United States, including phobias and generalized anxiety disorder, obsessive-compulsive disorder, panic disorder.
DAVID P. WHITE, MD: General anxiety disorder is a condition with people that just have heightened anxiety at all times, and these people are, almost universally, going to have a certain amount of difficult sleeping.
RICHARD ROSS, MD: Panic disorder is characterized most specifically by unanticipated, spontaneous attacks of quite severe anxiety. A person feels heart rate going up, sweating.
ANNOUNCER: If the panic attack happens well before bedtime, sleep may not suffer. But troubled sleep does ensue when attacks happen near bedtime or even during sleep.
RICHARD ROSS, MD: A person typically awakens from what's called a nocturnal panic attack feeling quite anxious, may have some recall of the event the next morning, and it can actually be quite disturbing to the person.
ANNOUNCER: But you don't have to have an anxiety disorder to suffer from the kind of anxiety that makes for a fretful night.
DAVID P. WHITE, MD: The vast majority, of people that have insomnia due to anxiety would not be categorized as either one of those. The anxiety is closer to what you and I would consider normal, but it's enough to be able to impact their ability to sleep.
ANNOUNCER: And anxiety has a way of setting a vicious cycle in motion.
RICHARD ROSS, MD: What seems to happen is the person can become anxious about not being able to fall asleep. So anxiety can lead to a difficulty in falling asleep, and then that can be translated into another form of anxiety, where being unable to sleep is the focus.
ANNOUNCER: Dealing with any kind of anxiety disorder is the first order of business.
DAVID P. WHITE, MD: You can treat anxiety conditions behaviorally, by basically teaching people how to relax, teaching them how to approach life situations, getting introspective into themselves and understanding their anxieties, and that is probably the tried and true methodology.
RICHARD ROSS, MD: Cognitive behavioral therapy uses a combination of cognitive and behavioral techniques to help a person master his or her anxiety.
ANNOUNCER: Medications have also been developed to cope with anxiety problems.
The other side is pharmacologic approaches, and there are a lot of drugs that are out now that are effective in terms of dealing with anxiety.
ANNOUNCER: However sometimes these drugs can interfere with sleep.
RICHARD ROSS, MD: Oftentimes a psychiatrist will recommend that his patient take an antidepressant drug early in the day to avoid a possible activating effect of that drug interfering with sleep at night.
ANNOUNCER: Dealing with insomnia is next. It might mean rethinking how you behave, particularly around bedtime.
DAVID P. WHITE, MD: You can specifically teach people how to relax in a variety of ways. One of the primary things you tell them to do is to get out of bed and go do something else. Because if you're lying in bed, all you're going to do is think about your anxieties. They get up, read a book, watch television. Do something that's relaxing for you. And when you get sleepy again, to go back and jump in bed.
ANNOUNCER: Medications are another approach. There are several different types, serving different needs.
DAVID P. WHITE, MD: Benzodiazepines have been the classic drug that bind a particular receptor to the brain. They have a particular structure, and they have been the classic sleeping pill, and there are probably a dozen benzodiazepines with the main difference one to the other being their half-life.
RICHARD ROSS, MD: There are newer medications that act a little bit differently from the old-time benzodiazepines. You can take something and get help with sleep, but then not feel very tired, hung over or drugged the next day.
ANNOUNCER: While some people accept their insomnia as just part of the cost of living in a modern world, experts urge it doesn't have to be so.
RICHARD ROSS, MD: If insomnia goes on for longer than a week or two, then I think it is important to consult a physician and try to get some help in figuring out why you're having difficulty sleeping.
