How can I break my cycle of worried thoughts at night?

A woman often lies awake imagining various scenarios.

Mariella Frostrup advocates getting into the right headspace.

The dilemma 

I am a 34-year-old woman who (probably like many others) lies awake from 2 or 3 am most nights. There is a calm but doggedly persistent stream of thoughts, images and scenarios running on a loop in my mind. I think about moving to our new house, all the things we won't have and will strive to get but don't really need, how life is just an accumulation of stuff and then you die, how none of my things are packed and how I pretend to like change when really I don't. I think about the man at work who would have an affair with me if I said yes. I think about what we might do and how badly it would end, whether I am too weak and greedy for monogamy. I tell myself I should be a better mother, and then wonder if I have time to have another child. I don't know what to do break this cycle. I am very tired.

Mariella replies 

Aren't we all? Well maybe not the entire population, but certainly my female contemporaries. Now it seems nighttime anxiety is stalking us ever younger. At my age, lying awake fretting about everything from the weekly grocery list to the rise of Isis tends to be symptomatic of a much broader hormonal malaise. At yours, it's less dismissible to squander sleep on existential angst. 

On the plus side, the topics you're ruminating on are worthy of intellectual consideration and interesting enough to be open to broader discussion, unlike my Ocado sweats. There's clearly a lively, questioning mind at work, looking for answers and determined not to just blunder through a life ill-considered. That's all good news but an inquisitive psyche like yours often comes with a tendency towards depression, not wholly irrational when your thoughts are straying to the meaning of life and the big questions we encounter along the way.

I do feel you might be in the grip of that black dog, diagnosed in so many of us in the developed world. Dealing with your sleeplessness certainly requires the help of your GP, who can decide whether to medicate or not. I've found that a tiny dose of the sleep regulator melatonin, only available on prescription in this country but widely used in the US, taken for a couple of weeks regulates my sleep patterns and puts me back on the road to restful nights. Try to persuade your doctor that it's worth a try.

I can't take on the medical side, but I certainly have experience of the psychological end of it. Lack of sleep is a self-exacerbating condition. The less you sleep, the more you worry, so the less you sleep. Medication may well help you to get off that nightly treadmill, but your wakefulness can also be mitigated with a little effort from yourself. Airing your worries, however trivial, and irrelevant of how downright crazy they seem, is a positive first step. Voices trapped inside our heads resound deafeningly and trap turmoil between our ears. Exposing such inner angst to oxygen somehow mitigates the magnitude of such anxiety and puts big worries into perspective. Talk about what you're feeling with a friend or your partner, have a glass of wine and just let it all out. Their response matters much less than the act of exposing the demons dominating your dark hours.

Writing things down can be helpful, again as a form of offloading - you might even be feeling a bit clearer simply as a result of writing your letter to me. Take it a step further and list every topic as a tangible matter for consideration. You'll find that some of your concerns will naturally fade into insignificance the moment they are captured in ink and required to rise to the credibility of a tangible worry.

Then there's the issue of how you approach the night. This may seem obvious advice but getting yourself into the right headspace for sleep isn't something that all of us can take for granted. Some people simply need to wind down a little more systematically. A hot bath, a few drops of lavender oil, a relaxing nighttime tea, less alcohol - and plenty of exercise and fresh air during your waking hours - will all help you to unwind when you approach your bed.

Substituting technology with a book, either gripping or totally dreary, also makes a huge difference. Avoid the unhelpful influence of the tablet's blue light. Having succumbed to using my iPad as a bedtime reading tool - and failing to resist incoming emails and the occasional Amazon detour - where once sleep came easily, if lightly, I found myself still propped on my pillows at 3 am like an insomniac student. Eschewing bedroom technology for a 19th-century novel proved much more conducive to a good night's sleep.

So no instant cures, I'm afraid, but hopefully plenty to refocus your mind. Take comfort from knowing you are one amid a large community fretting through the small hours. Lack of sleep isn't an inconvenience but a debilitating health hazard, mental and physical, that requires addressing. Don't feel ashamed about taking it seriously and expecting others to do likewise.