Sleep on It: Rest, Replay, Rewire

I've often noticed that the passage of time seems to be a big contributor to changing how I relate to an obsession. I've had countless moments where I was triggered by contamination concerns; stuck staring at and inspecting some unknown substance or spot on a surface that I touched or got close to. I'd be trying to assess my level of risk and whether or not I need to do anything about my "predicament." Because I'd be engaging in all sorts of compulsive behavior I never really left the scene feeling reassured. Quite the opposite, the more I performed compulsions the stronger my doubt grew. At some point, possibly due to exhaustion, I'd be able to remove myself from the situation, but was left concerned. The day continued and night would come. I'd eventually fall asleep. I found that when I woke up the next day I usually wasn't as concerned about what happened the day prior. This seemed to happen more with the day-to-day obsessions but not always the long-standing ones.

I was recently listening to a podcast about sleep and started thinking about its possible role in how we relate to obsessions and the distress they cause. I too have noticed that after a good night's rest I was much better able to handle and cope with the day ahead. However, if I slept poorly everything stressful seemed to be that much worse. So I decided to do a little digging.

Before diving into OCD specifically, let’s take a moment to look at the broader mental health benefits of sleep. Consistent, quality sleep can support emotional balance, reduce anxiety, and improve cognitive functions that help manage OCD symptoms. On the other hand, chronic sleep disturbances (like insomnia or an irregular sleep schedule) often worsen obsessions and anxiety, creating a vicious cycle in which poor sleep fuels OCD symptoms, and those symptoms in turn make it harder to sleep. Here is a resource with some tips on getting better sleep.

So, if sleep helps regulate our emotions and strengthen our ability to cope with distress, it makes sense that it could also support another important strategy in managing OCD: delaying compulsions. Lengthening the time between an obsession and a compulsion is often a suggested strategy for managing OCD. One of the main reasons OCD sticks around is due to a process known as negative reinforcement. Because our compulsions aim to decrease our distress as a result of obsessions, the compulsions are reinforced (meaning we are more likely to do them the next time we get hit with an obsession). The negative part of negative reinforcement refers to the decrease or removal of distress. Usually the closer a compulsion is to an obsession and its distress, the more reinforcing it will be. Imagine this, you're trying to teach your dog to "Stay." When your dog stays after your command, when do you give your dog a treat? IMMEDIATELY because your furry friend will associate the treat with staying. Now, what would happen if you still gave your dog the treat but waited a week? Your pal isn't going to associate the treat with the staying. Or, imagine someone wanting to get high but it took two months after they took the drug to feel the effects; that drug would be less appealing. While these are more examples of positive reinforcement, they still serve as good examples for the benefit in delaying compulsions. When we delay compulsions, we're also learning to tolerate discomfort and uncertainty. While waiting until we get a night of sleep before even considering doing a compulsion can have this benefit, I believe it also has additional benefits.

So here is what I discovered in my digging:

Sleep doesn’t just reduce anxiety – it also helps the brain process emotions and tone down the emotional intensity of thoughts. During sleep, the brain sorts through emotional experiences from the day, helping them feel less charged the next morning. If a person is well-rested, an intrusive thought that appeared overwhelming yesterday might feel less intense or more manageable today. In other words, sleep helps keep the emotional “volume” of obsessions at a lower level. One way this happens is through overnight emotional processing: the brain replays and reorganizes memory traces of what we experienced. Sleep (especially REM and deep sleep combined) facilitates the consolidation of emotional memories. For someone with OCD, this might mean that after a day of confronting a fearful obsession (or resisting a compulsion), a night’s sleep helps the brain sift through that experience and store it in a less alarming way. In fact, research on fear learning finds that sleeping after encountering a threat supports better discrimination between danger and safety cues.

Therapeutically, exposure and response prevention (ERP) aims to create new memory traces that disconfirm those fears (for example, learning through experience that touching a doorknob and not washing leads to no actual harm). Sleep can be an ally in solidifying these new lessons. During sleep – both deep sleep and REM – the brain performs “offline” consolidation of what was learned during the day. Emotional and fear-related memories are actively processed: studies show that REM sleep in particular helps consolidate memories of fear extinction (learning that a previously feared cue is now safe). If an individual with OCD spends the day resisting a compulsion (learning that anxiety can subside on its own without doing the ritual), a good night’s sleep will help embed that learning into longer-term memory.

Moreover, sleep might aid memory reconsolidation – the process of re-storing memories after they’ve been retrieved and modified. Every time an obsessive fear is confronted without the old response (compulsion), the memory of that situation can be reconsolidated with a little less fear attached. Sleep, by virtue of its memory-strengthening functions, likely helps these reconsolidated memories stick.

Getting a good night's rest is essential for everyone, and especially for those with OCD and anxiety. If you believe you have significant issues with sleep, talking to your physician could be a good step. If you've found it hard to refrain from doing compulsions, consider delaying them. As your skill improves, consider delaying longer and longer, all the way to the point you get a good night's rest. Often we may say that the OCD itself is what keeps us from getting a good night's rest in the first place. If OCD or sleep struggles have been making life harder, know that help is available. Working with an OCD specialist can help you learn to rest more easily — both at night and within your own mind and body.