Anxiety is a common and potentially devastating behavioral health problem. While the symptoms are similar in kind to ordinary nervousness, they are much more severe and significantly impede normal functioning. Insomnia is a symptom commonly associated with anxiety, and treating anxiety often improves insomnia. Similarly, treating chronic insomnia can often reduce the severity of anxiety symptoms. Fortunately, there are several pharmacological and non-pharmacological treatments available for anxiety and insomnia.
Benzodiazepines are a class of medications that includes such drugs as Valium, Ativan and Xanax. Benzodiazepines provide immediate relief from anxiety and in addition have a sedating effect that promotes sleep. They are not appropriate for long-term treatment of anxiety, however, due to the risks of overdose, dependence and abuse, as well as their negative effects on memory, concentration and motor performance. They also suppress the REM phase of sleep, so chronic use can result in symptoms of sleep deficiency even in patients who are sleeping several hours a night.
Selective serotonin uptake re-inhibitors (SSRIs) are a class of medications that includes such drugs as Lexapro, Paxil and Effexor. SSRIs are used to treat depression, and are also effective against anxiety, which often occurs along with depression. While there is a considerable body of clinical anecdote concerning the most effective SSRIs for anxiety, rigorous comparison studies are relatively rare and have produced conflicting results. So finding an appropriate SSRI for a patient's anxiety is ultimately a somewhat idiosyncratic process, requiring a certain amount of trial and error. In contrast to benzodiazepines, all SSRIs require several weeks of treatment before they begin to have an effect on anxiety.
Buspirone (Buspar) is a medication that is somewhat similar to an SSRI, but which is used only to treat anxiety and not depression. It is sufficiently different from SSRIs and can be used along with them to help control more severe anxiety. Like SSRIs, it usually takes several weeks for buspirone to begin reducing anxiety. The lack of an immediate effect, in contrast to benzodiazepines, leads some patients to conclude that buspirone is ineffective. But in direct comparison studies involving patients who have never used benzodiazepines, buspirone has proven to be about as effective as benzodiazepines for long-term anxiety control. Since buspirone does not cause dependence, does not affect memory, concentration or motor performance, and has no abuse potential, it is a much safer choice for long-term treatment.
Non-pharmacological approaches to treating anxiety include exercise, meditation and other relaxation techniques, avoiding caffeine, and psychotherapy focused on desensitizing a patient to anxiety provoking thoughts or situations. In addition, sleep-hygiene practices such as maintaining a consistent sleep schedule and adopting a bedtime ritual can have specific benefits for insomnia. These non-pharmacological methods are effective, both by themselves and especially in combination with medication, but, like some drugs, they usually require several weeks of application before their affects are fully realized.