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Stress and Insomnia

Stress makes it hard to fall asleep and stay asleep throughout the night.  Like everything about sleep, different people respond differently, and some have little sleep disturbance from stress.  Some may actually appear to sleep more, though doctors would probably describe this more as a symptom of depression or avoidance anxiety than stress.  Generally speaking, stress is linked to shorter and lesser sleep than normal.

Hormonal Evidence of Stress and Insomnia

Stress puts the mind on alert, into a state of hypervigilance (hyperarousal).  The mechanisms for sleep are still there, but are overwhelmed by too-strong a waking impulse. Scientists can see this process play out through its effects on your hormone levels.

One marker of stress is elevated levels of the hormone cortisol in the blood.  Cortisol is a way the brain signals to the rest of the body that the period requites a stress response is required.

In healthy adults, cortisol and melatonin levels operate in inverse to each other. Sleep hormone melatonin rises in the evening, signaling to your brain that it’s time to sleep. It peaks around midnight. Your melatonin levels gradually drop to their lowest point in the early morning—right when stress hormone cortisol starts to rise, energizing your body to wake up. By the time you’re ready for bed, your cortisol levels have dropped off. They’re at their very lowest right around the middle of the night, when you’re asleep and melatonin reigns high.

For individuals living with stress and insomnia, cortisol levels remain elevated above normal levels, especially during their sleep. The chart below graphs cortisol levels in individuals with short sleep (the squares) vs. those with healthy sleep (the circles). The solid bar at the bottom indicates the period of sleep, which is where you can see the highest discrepancy between the two levels:

higher cortisol levels associated with stress and insomnia

With sustained levels of higher cortisol, these individuals remain in a state of hyperarousal, even when they’re asleep—thereby disrupting the overall quality and restfulness of their sleep.

How Stress Affects Sleep

People experience all kinds of stress, from workplace stress to serious stress disorders like PTSD. Here’s a look at how different types of stress affect sleep.

Post Traumatic Stress Disorder and Insomnia

PTSD is an anxiety disorder with many causes. It is frequently diagnosed in people who have experienced a traumatic event, whether physical, psychological, or, as in most cases, both.

After experiencing the traumatic event, the person may develop PTSD. This disorder is characterized by symptoms which may include re-experiencing the event through flashbacks or nightmares, being triggered, avoiding triggers associated with the event, and remaining in a state of hyperarousal or vigilance. Some of the most common PTSD symptoms include insomnia and nightmares. Between 70% to 91% of patients often have trouble getting to sleep or staying asleep.

People with PTSD are often living in a state of constant arousal and stress, even if it’s low at times, that they have difficulty resting sufficiently to fall asleep at night. They also often experience nightmares, which disrupt their sleep. Sometimes, the nightmares can be so lifelike and triggering that the person may even begin to fear sleep.

The frequency of nightmares is one main symptom that distinguishes PTSD-related insomnia from regular insomnia. A study of Vietnam War combat veterans with PTSD and insomnia found that they were significantly more prone to report repetitive nightmares. They also experienced higher levels of anxiety during their waking hours, body movement during sleep, and daytime fatigue than their peers with non-PTSD insomnia.

Problematically, the disturbed sleep individuals with PTSD experience often worsens their stress-related symptoms. A study of war veterans assessed their PTSD scores (PCL-M in the chart below) twice: once upon their initial return from deployment, as well as three months later. The Iraq and Afghanistan veterans were more likely to report PTSD and insomnia than other veterans. Those who reported initial symptoms of insomnia upon their return also had significantly higher PTSD severity scores at the three-month followup period.

insomnia as a predictor of ptsd in war veterans

Insomnia is not only the most commonly reported symptoms of PTSD among war veterans; it’s also one of the largest predictors of other PTSD symptoms, according to studies like these.

Work-Related Stress and Insomnia

People with burnout usually report sleep problems, including excessive daytime drowsiness and fragmented sleep.  Sleep duration is lower in those with burnout, and unlike regular stressed people without burnout, weekend naps do not solve the feelings of persistent sleepiness.

One common predictor of burnout—and associated insomnia—is workaholism. Higher rates of workaholism are associated with longer sleep latency (the amount of time it takes you to fall asleep). Even if you’re not a workaholic, a stressful work environment can wreak havoc on your sleep.

One study surveyed 816 workers without any sleep problems. The workers completed a general questionnaire about their health, their work environment, and their working hours. A year later, the researchers followed up, only to find that over 14% of the participants now reported sleep problems. While the researchers did not find a connection between working hours and newfound sleep problems, they did find that a “poor psychosocial work environment” more than doubled the participants’ risk for developing sleep issues. Moreover, this led them to the conclusion that simply eliminating stress could have prevented over 50% of the cases of insomnia.

Larger studies have confirmed these findings. A study of nearly 9,000 Japanese male and female workers found a strong correlation between occupational stress and insomnia, resulting in short sleep (6 hours or less).

A similar study of 8,155 Korean workers found that those with “relatively high” job stress were significantly more likely to experience insomnia, and to experience it more frequently than their counterparts with lower job stress. The researchers of this study noted that the insomnia was also associated with a poor work climate, and a lack of adequate social support.

Job stress can refer to a lot of things: poor work climate, lack of social support, reduced employment opportunities, job dissatisfaction. Researchers in Japan sought out to determine which of these work-related stressors were most likely to cause insomnia. In a study of 1,161 male white-collar employees from the same company, they found nearly a quarter (23.6%) reported symptoms of insomnia (difficulty falling asleep, staying asleep, or waking up early). The strongest correlation with insomnia existed among those who had interpersonal conflicts with their colleagues, high job dissatisfaction, and a lack of social support.

Family Stress and Insomnia

It’s not a coincidence that lack of social support was consistently associated with stress-related insomnia in the worker studies above. For many people, their family represents a large part of their social support system. Studies isolating the family unit in stress-related insomnia have likewise found a concerning relationship between family stress and poor sleep.

A study of undergraduates found that family-related stress—completely independent of depression—was highly correlated with insomnia symptoms. At a three-week follow up, researchers noted negative family events were also more likely to predict increased insomnia than academic stressors.

On the other side of the age spectrum, many studies have observed sleep issues among menopausal women. Menopause may be a natural part of the aging process, but it can be physically taxing and emotionally distressing experience for many women. It’s also accompanied by a 2 to 3.5 times increased prevalence of sleep issues.

Midlife women with insomnia are significantly more likely to report psychological distress than those without insomnia—again reinforcing the cyclical link between insomnia and stress. While menopause itself contributes to sleep issues, studies have documented that partner unfaithfulness separately contributes to increased reports of stress and insomnia in middle-aged women.

Even a study of prison life found a correlation between sleep problems and family worries. In this study, researchers observed over 200 prisoners, some with insomnia and some without, to note whether any coping patterns alleviated their stress and insomnia. They documented strong differences between the groups. The individuals without insomnia engaged more in writing letters, art activities like painting or listening to music, sports, watching television and spending time with other prisoners. The insomniacs, on the other hand, were significantly less likely to engage in these activities.

In the next section, we’ll explore more healthy coping strategies for stress and insomnia.

10 Remedies to Reduce Stress and Insomnia

It is possible to sleep better, and to live with less stress. Below we share some of the most successful remedies people use to reduce their stress and insomnia.

1. Get more consistent sleep.

Just as stress worsens insomnia, we’ve seen (and you’ve likely experienced firsthand) how insomnia worsens stress. Begin working on your stress by making more room for sleep in your life. Create a sleep schedule that theoretically allows you to get between 7 to 8 hours of sleep each night. Go to bed and wake up at the same time every day (even on weekends). Don’t worry if you aren’t actually asleep the whole time; it’s more important that you start training your mind to follow a regular sleep schedule.

2. Practice good sleep hygiene.

Beyond following a regular sleep schedule, incorporate other good sleep hygiene practices into your life, too. Avoid doing anything in your bedroom besides sleep or sex. Avoid long naps during the day. Don’t engage in drinking, heavy eating, or intense exercise during the evening hours. If you wake up and can’t fall asleep after 30 minutes, leave your bedroom and do a calming activity in another room. Turn clock faces away from you at night, so you don’t get stressed about being unable to fall asleep.

3. Consider psychotherapy.

Researchers often stress (pun intended) that insomnia and stress be treated together, not in isolation. Multiple studies we’ve described in this article reiterate that your vulnerability to stress, and your insomnia, appear to impact and intensify each other.

One study specifically looked into this and confirmed it. Both poor and good sleepers in the study experienced minor stressful life events, but the insomniacs were unique in perceiving and rating those daily stressors as more severe. There was also evidence that insomniacs tended to rely on emotion-oriented coping strategies, leading researchers to conclude that therapy addressing stress coping skills may improve both the stress and any related insomnia.

4. Explore cognitive behavioral therapy (CBT).

CBT is the most effective therapy for treating insomnia. This form of therapy is usually short in nature, lasting a handful of sessions. The individual receives guidance from the therapist so they can identify the behaviors and thoughts (cognitions) that are disrupting their sleep. Once identified, they can enact healthier behaviors, thoughts, and habits to improve their sleep. CBT can be particularly powerful in reducing nightmares and other sleep disruptions common to PTSD.

5. Make your bedroom a stress-free place.

If you’re dealing with insomnia, going to bed can be a triggering experience on all its own. You may stress about not being able to fall asleep, or fear waking up in the middle of the night. To minimize that stress, change up your bedroom. Remove anything stress-inducing from your bedroom, including workplace reminders, general clutter, or pictures of family who stress you out. Then, transform your bedroom into a calming environment with peaceful-colored bedding, happy pictures or decor, and essential oils. Make sure you keep things dark and cool, too.

6. Follow a calming bedtime routine.

One way to calm down your mind before bed is to create a bedtime routine. Each night, around 30 to 60 minutes before bed, follow the same set of activities, in the same order. It doesn’t matter what the activities are. The only requirement is that they should be calming: like a warm bath, light stretching or yoga, deep breathing exercises, meditation, or reading. Beyond participating in activities that are naturally relaxing, a bedtime routine offers the bonus of helping your brain recognize this particular set of activities as the precursor to sleep.

7. Take up journaling or to-do lists.

Depending on the type of stress you have, it can be helpful to get your thoughts out of your mind and onto a piece of paper. The research proves it! Before starting your bedtime routine, mentally separate yourself from your stresses by jotting down your thoughts and worries. This can take the form of a stress journal, or it can be a to-do list. You no longer have to anxiously run through your to-do list every night while you lie in bed; you can trust that you wrote it all down earlier. Writing and organizing your thoughts will also give you a sense of control, making it easier to sleep.

8. Minimize stressors during the day.

This can be challenging, but do what you can to relieve your stress during the day. Identify what triggers your stress. Is it an obnoxious colleague? See if you can move desks or conveniently get up for a restroom break if you notice them walking down the hall. Turn off your phone notifications so you miss the relentless texts from that one frustrating family member. Then, later, you can open up your texts and respond when you’re ready, instead of letting them interrupt your day.

9. Exercise regularly.

Another way to reduce stress during the day is to physically stamp it out, through exercise. Exercise is also very good for your sleep, as long as you do it several hours before bed. Physically tiring out your body simply makes it easier to sleep at night. Those living with stress and anxiety often find yoga or running to be quite therapeutic.

10. Strengthen your social support system.

A lack of social support goes hand in hand with stress and insomnia. So does loneliness. How can you strengthen your social support system? Try forming closer bonds with those who love and care about you—and reducing the time you spend with those who don’t. You can also find new support systems through more formal group programs and online communities.

Additional Resources:

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