'Sometimes...I feel a sickening, physical dread'

A therapist's response to bed-time fear: "What would Jo say?"

May 30, 2025

Hello,
If we’ve not met before, here’s a brief catch-up on my Dilemmas page, ‘What would Jo say?’ - an oft-quoted question my clients have told me they’ve asked themselves when faced with challenges out there living their lives, in between sessions.

Taking a pause in my clinical work in order to manage a house move and caring for three elderlies, I’m keeping my hand - and head - in the therapeutic space by publishing weekly responses to questions readers send in on negotiating the knotty, messy struggles and conundrums of Real Life.

This week, how to avoid spinning into a vortex of anxiety in the deepest, sleepless hours of the night…

Dear Jo

I feel I have the life I have always dreamed of: a loving husband, good kids and a wide friendship group. I have creative outlets and even dabble in a little sport.

But when I wake in the night, or early in the morning, and try to fall asleep again, my brain seems to ping into action. I agonise over random problems, becoming more and more anxious. Sometimes I even feel a sickening, physical, dread. Mostly they are big abstract issues like: what is the purpose of my life? Am I being weak for worrying so much when there is terrible war and famine in the world? What will happen to me in the future? Sometimes they are more tangible: should I retire? What will I do with my life?

I also feel the stress of caring for elderly parents (my dad has dementia and my husband’s parents live 3 hours away but are becoming frailer). Sometimes I feel angry they are taking over my life and at other times I don’t feel like I’m doing enough, which means constant guilt.

What can I do about this? I am starting to dread going to bed at night – worrying about what is going to circle my mind. I feel I am being dragged down in a vicious self-perpetuating circle.

Answer
As a psychodynamic therapist, there are things I’d want to explore concerning the wider origins of these feelings. However, it sounds as if you’re after some coping tools in the here and now rather than a deeper analysis.

Firstly, to empathise, and normalise - I’m certain there isn’t a single one of us who hasn’t lain awake in the early hours ruminating over worries that may not feel quite so bad once we are up and about our day. I too have known these feelings, particularly in the perimenopause, when I was plagued with insomnia – which can go hand in hand with this kind of angsting (you’ve confirmed you are in the perimenopausal age-group – typically early to mid 40’s - advice and support on HRT from a supportive GP or menopause specialist such as The Newson Clinic can support sleep and be life-changing).

Are any of your family anxious worriers? Parents can model learnt ways of being to children through behaviour. Worry becomes like any bad habit we pick up, which I sometimes describe as: ‘over-catastrophising about the what-ifs’. Internal worry-voices are adept at becoming dominant, loving the night-time hours, because there’s nothing else demanding our attention – they can really let rip!

A CBT Tool…
You reference your body joining in. Again, I want to normalise this – and touch on a CBT (Cognitive Behavioural Therapy) way of thinking about the cyclical pattern of thoughts influencing feelings, which influence behaviour, which impacts on thoughts, and so on. It’s tough stepping off that wheel once it’s running, and CBT logic seeks to break this unhelpful cycle. Understanding that when we have worrying thoughts, our body will join in by making us feel worry or anxiety symptoms can help us gain a little objectivity over them; ‘Ah, here come the worry-feelings – yes, so predictable! The butterfly tummy, the shallow breathing’ – or however they manifest for you.

Try greeting your worries like a tiresome old friend; roll your eyes and think: ‘I’m familiar with your patterns by now!’, or visualise yourself wearing a white coat and clutching a clip-board, as if conducting an objective observation of yourself, attempting to isolate the worry-thought and send it away.

But as you say - it’s only when you’re lying in bed in those sleepless hours that you feel this worry and dread so, my other oft-shared piece of advice is: metaphorically or literally - go into another room! Get up, go downstairs, make a drink (not caffeine). Read a book, have some herbal sleep pills handy. If you’re starting the day with a dread-feeling, I think that being able to notice when you are entering this state will give you half a chance of stepping out of it before it takes hold, the physical feelings joining in and whipping it up into something bigger.

A helpful image is to imagine that you’re being carried along, at the mercy of thoughts and feelings as if riding on a huge, unstoppable wave. Being able to observe yourself and your ‘processes’ more objectively, like that scientist, can help you break out of that wave and take some control, choosing to immerse yourself in something distracting. First-thing yoga with Adrienne, on YouTube? Some word-puzzles on your phone followed by up and out for a quick walk or run? Whatever it is, it encourages diversion away from the place that your head has learnt to devote too much space to. So fill it with other things! Simply getting outside first thing can be powerfully mood-changing. It can also help to know that the stress hormone cortisol is at a higher level in the mornings, and getting up and moving flushes it through our system.

I’m not suggesting that we should all distract ourselves away from what our thoughts and feelings might be trying to tell us about our lives. (Though there’s more than enough to worry about in the wider world currently - try to limit any online news-scrolling habits). It’s easy to underestimate how life-events like children leaving home, caring for elderly relatives or contemplating ‘what’s next’ can impact - often feeling complex, leaving us conflicted or overwhelmed. You certainly have a lot going on with your elderly relatives’ needs.

Would your best friend or partner agree that your life is a contented one? Might a conversation with a therapist, or life-coach, allow you some supportive space to explore this further? Being able to approach our problems with curiosity, rather than investing mental energy trying to squash them down, is nearly always the more helpful – and hopeful path.

If you have learnt to allow the worry to dominate - like any bad habit, it takes effort to change – but you can begin by applying some tools and tricks to quieten the voice and starting to develop a kinder one, such as the voice you might use if you were talking to a good friend.

Thanks for reading. Subscribe to my Substack here; you don’t need an account. There’s no fee.

If you’d like to make a comment, please send it here:

'Sometimes...I feel a sickening, physical dread'

A therapist's response to bed-time fear: "What would Jo say?"

Discussion about this post