After a long day, many of us look forward to unwinding in bed, lights off, rolling over and shutting off from the world. However, it’s not always easy for those with Obsessive Compulsive Disorder (OCD), with nighttime often being something they dread or even avoid. Whilst many of us find peace in the quiet, OCD often takes advantage of the stillness, using it as an opportunity to plant the worst thoughts imaginable to a human: ‘am I a paedophile, am I contaminated, will I kill someone’. The darkness, quiet and vulnerability leaves OCD with a blank canvas to play with.
Stephanie Fox, who has been diagnosed with OCD, used to face this daily. Her thoughts took on many forms with the worst surrounding death, a deep rooted anxiety triggered by past experiences, including attending nine funerals in a single year and, a few years later, losing her father, grandmother, and father’s best friend within just one week. Thoughts of death, harm, or her harming others often kept her up at night she recalls “if my mum were doing a night shift I’d think, what if she has a car accident and I don’t pick up the phone, or what if my partner slips and falls down the stairs, so I need to stay awake. And if I did get some sleep and I woke up in the middle of the night, I would convince myself I’d woken up for a reason, something bad’s happened, someone’s going to die so I need to be on alert and prepared for whatever’s coming. So I struggled to sleep.”
OCD is often portrayed by the media as a person excessively cleaning or repeatedly flicking a light switch, but this represents only one part of OCD, the compulsive side. A significant and often overlooked part due to their dark nature involves obsessions and intrusive thoughts. Another part of OCD is compulsions, either physical behaviours such as checking locks or repeating going up and down the stairs or mental compulsions like counting in your head or mental reassurance like ‘no I am not dirty’. These thoughts and compulsions typically go hand in hand, with compulsions acting as a response to the obsessive thoughts. This is something Stephanie experienced “I would scratch the back of my head and behind my ears sometimes, until it bled, I physically couldn’t stop myself from doing it, but I chose to do it there because then no one could see it or know what I’m doing.”
Dr Stuart Brownings, a clinical psychologist at The Specialist OCD Clinic, offers further insight into intrusive thoughts. “The intrusive thoughts OCD puts into a person’s head are almost like a backhanded compliment. OCD is saying you’re a really nice person, you love your family, you love your kids, so what I’m going to do is put the opposite of that into your head. It has to be the opposite because if someone was killing people, hurting people, was really homophobic and racist and had those thoughts they wouldn’t make them feel anxious at all. They’d be like, well, that’s who I am. What you have to remember is that thoughts are not facts.”
Intrusive thoughts affect a person’s daily life in many ways but unlike many other mental health issues like anxiety or depression where sleep offers a temporary escape, sleep is often a trigger for intrusive thoughts. Molly Lambert who has now been through therapy for intrusive thoughts explains her struggles with sleep “Sleep is not something I took comfort in, it was quite a scary point of the day. It’s sad because you think sleep is when you escape your day and your thoughts but with OCD you just can’t. I would lay in bed and have these horrible thoughts like am I a paedophile, or images of rape and just think, how am I ever gonna be a normal person in society if this is how bad of a person I am, which looking back now, is so irrational.”
Molly started experiencing these thoughts during her final years of school but did not reach out for help until a few years later. While not receiving treatment she tried to cope by distracting herself and managing her thoughts on her own. This included staying busy during the day, constantly being around others or watching television. She says “I felt like I was putting on a mask trying to be normal, constantly busy and surrounding myself with friends and my family. But there was still this insane, almost like pantomime, background noise being like, do you remember this, do you remember all these awful things you think about, go back to thinking about that. And I would just torture myself, it was just exhausting.”
Distraction is not a long term fix for OCD, it often leads to burnout or worse thoughts during the night. Stephanie experienced this firstand, “I was running on adrenaline. You just literally force yourself, there’s no other way around it, and then when you do have free time, you’re so burnt out that you generally just crash and burn and even sleep during the day. But at night I was like everyone’s asleep now so that means that they’re safe. But what do I need to do to make sure that when tomorrow comes so they continue to be safe. Have I put the plates in the right order in the cupboard? Have I locked the doors? Are all the switches turned off in case the house burns down, the worrying never stops?”
OCD is not always a lifelong illness, it can be significantly improved with professional help and therapy. There are many different areas to work on, including discussing and challenging intrusive thoughts. However, one main area to improve is sleep, Dr Brownings explains why, “sleep is such an important facet of anyone’s life it’s such a big determinant of health, mental and physical. When you are tired any emotion is hard to challenge, so if OCD is keeping you awake at night or you’re avoiding sleep because of OCD then it’s another opportunity to grab you and go, brilliant you’re tired I will try even more. Invariably, when I work with people they often have sleep issues as part of OCD. We start thinking about getting rid of parts of OCD that affect their sleep first because then that has a double benefit of improving sleep and OCD by making the next day better. This means they can challenge OCD and break the vicious cycle.”
Outside of therapy, many turn to alternative methods to improve their sleep and avoid the distressing ruminating that can happen before bed. This may be watching a TV show for background noise to escape their thoughts or even using substances like drugs or alcohol as a form of self medication. Molly experienced this struggle when younger, “I would panic before bed. It was an impending feeling of doom, I’ve gotta go to bed and be by myself now. Having a comfort show helped, I steered clear of anything that had, dark topics, murder or rape because it would trigger me. I stuck to reality TV as your brain can’t attach to anything. Although I never drank with the intent of not thinking about stuff, I wasn’t as phased or had as many thoughts when I was drunk, which subconsciously did cause an issue as my thoughts were finally at rest.”
Another way OCD can cause disturbances to someone’s sleep is through their dreams, with many people having dreams and images related to their intrusive thoughts. This is something that particularly worried Molly. “I would dream these thoughts and images, almost like movie clips about harming people and that would really mess me up for days and weeks, I would just think oh god it must be true because I’m dreaming about it and it’s my subconscious desires. Obviously, now I know it’s not that, but I used to wake up in tears.”
When people spend their entire day worrying about these thoughts it’s no surprise that they creep into our dreams. Dr Brownings explains this: “Before bed our brain processes and downloads all the experiences and anxieties of the day, for everybody not just those with OCD. And so it’s understandable that if you spend your day worrying about these particular intrusive thoughts and then acting on them in terms of compulsions. It’d be almost odd to not have nightmares or dreams about it, because your brain has to download the information from the day to be able to file it away.”
Another worry for Molly, particularly at night time, was groinal responses. These are unwanted and often anxiety provoking physical sensations in the genital area, such as tingling, warmth, or swelling, that can occur in situations of anxiety or fear. Molly says, “I detached from sex and anything related to it for years because I was so scared to face it. I was worried if I think about sex in any way, what if I have these thoughts or responses?” After becoming educated about how anxiety can manifest itself Molly says, “I now know I’m not actually aroused, just anxious. I shouldn’t deny myself of sex just because I had awful sex thoughts about other things.”
Through therapy and understanding, both Stephanie and Molly now manage their OCD and intrusive thoughts, finding healthier ways to navigate their lives. While OCD can deeply affect sleep and daily functioning, recovery is possible with the right support, and learning to challenge these thoughts is key to healing.
