The night before something you are dreading

It is quarter past ten and the thing is tomorrow. The interview. The scan. The conversation you have been circling for a fortnight. Nothing is happening to you tonight, and tonight is still the worst part.

The dread is convincing because it is so physical. When you are anxious or afraid, the NHS says your body releases stress hormones such as adrenaline and cortisol, which can be helpful in some situations but can also cause a faster heart rate and more sweating. The same page lists shaking, breathlessness and stomach cramps among the physical symptoms of anxiety. All of that can fire on a quiet Tuesday night when the only things in the room are you and a phone charger. It is set off by what you are picturing, and in my experience how strong it feels tonight is a poor guide to how tomorrow actually goes.

You will not think your way out of it by bedtime. But the last few hours are the part of this you still have some say over, so spend them deliberately rather than letting them spend you.

The short version

• Dread before a known event is anticipation, not prediction. Your body getting ready is not your body knowing how it goes.
• Sleep goes first because you are wound up, physically and mentally. Winding the system down is the target, not winning the argument in your head.
• Write tomorrow down before you get into bed. If you are still awake after around 20 minutes, NHS advice is to get up rather than stay there.
• The target for the morning is not feeling calm. It is no longer reading a fast heartbeat as evidence against yourself.

Why sleep is the first thing to go

Researchers at the University of Cape Town gave 40 young adults either a laboratory stress task or a calm control task just before bed, then measured a full night with electrodes rather than self-report. The stressed group took almost twice as long to fall asleep and slept less deeply, and next morning were significantly slower at remembering to do something at the right moment.

Two caveats before you take too much from that. It is a small study of healthy 18 to 25 year olds on one laboratory night, with an artificial stressor rather than a real dreaded event. And the next-day difference showed up in reaction time but not in accuracy, where the gap was medium sized but did not reach statistical significance. A stirred-up evening costs you something. It does not ruin you.

The mechanism is the useful part. The authors put the delay down to raised pre-sleep arousal: falling asleep needs your physical and mental activity to wind down, and an aroused system has further to travel. What they conclude is worth managing before bed is the arousal. Which is why I think "stop thinking about it" is the wrong instruction: it goes after the content, when the problem is the state.

Get tomorrow onto paper

Every Mind Matters, the NHS online service, has a suggestion for exactly this: if you often worry in bed, try making a list of the things you need to do the next day before you go to sleep, because writing things down can help clear your mind.

My own addition is to do it at the kitchen table rather than under the duvet, and to make it dull. Then decide what time you stop preparing. Past a point, preparing becomes checking, and checking keeps you in the room with the thing all evening. A stopping time named in advance gives you something to obey at eleven.

If you end up lying awake anyway

The NHS says not to force it. If you are comfortable and resting you may fall asleep naturally, but if you are still awake after around 20 minutes, get up, sit somewhere comfortable and do something relaxing, then go back to bed when you feel sleepy.

It also advises against alcohol, tea or coffee for at least 6 hours before bed, and is clear on why the nightcap is a poor bargain: alcohol can make you feel sleepy at first, then lead to worse sleep later in the night. And do not sleep in afterwards; NHS advice is to keep your regular hours.

If you recognise all of that from most weeks rather than one night, breaking the 3am cycle is the better place to start.

In the morning, aim at the right thing

Most advice for the morning of tells you to calm down, which is a demand you cannot meet on request and then feel worse for failing. There is a better target.

In a study at Harvard, 50 adults were recruited to give a videotaped speech to two evaluators trained to look unimpressed, then do mental arithmetic under the same stare. One group had been told beforehand that the arousal they were about to feel is functional and aids performance. Against both control groups, they showed a more efficient cardiovascular pattern. They also showed less attentional pull towards negative words, though that difference was clear only against the group told to look away, and marginal against the group given no instructions.

The most useful finding sounds like a failure. That group did not report feeling any less stressed, because changing what the arousal meant was never meant to dampen it. This was a small laboratory study in young healthy volunteers and it did not measure how well anyone performed. But as something to do with your own hammering heart tomorrow morning, it beats calm for achievability.

The aim is not to stop your hands shaking. It is to stop your shaking hands being admitted as evidence against you.

When it is most nights, not one night

All of that is for an event with a date on it. If the dread attaches itself to whatever is next regardless of what it is, the last few hours are the wrong place to be working.

See a GP if you are struggling to cope with anxiety, if what you are trying yourself is not helping, or if the sleep has not shifted after you changed your habits and is making it hard to cope. Trouble sleeping that has run for three months or more has a name, and a GP may offer cognitive behavioural therapy for it rather than tablets. If you are 18 or over, in England you can also refer yourself straight to an NHS talking therapies service, and in some areas that starts at 16.

Again my view rather than guidance: the work on a recurring dread happens in the daylight in between, and it tends to start with one specific dreaded thing rather than a whole history. It is part of why our own sessions are built around 20 minutes on one thing at a time.

This article is general information and not a substitute for personal medical advice. If you are in crisis or cannot keep yourself safe tonight, call 999, or call Samaritans free on 116 123 at any time. brightloaf is not a crisis service.