It is becoming more and more obvious that stress plays a major role in insomnia. The development of insomnia is largely determined by how we react to stress — both psychologically and physically. In fact, many people experience transient insomnia, insomnia that lasts for a short period of time, after a stressful event. However, for some of us, stressors such as illness, work schedule changes, and interpersonal conflict can lead to chronic insomnia.
How Does Stress Affect Our Sleep?
We know that those most vulnerable to stress-induced insomnia seem to have the poorest coping skills. They are more likely to ruminate and suffer frequent mental intrusions, especially around bedtime. As a result, they present to sleep specialists, such as myself, with the classic complaint of “I can’t shut my mind down,” which makes it very difficult for them to fall or stay asleep.
Many people with chronic insomnia seem to be both psychologically and physiologically ill-prepared to deal with stress. Many people with chronic insomnia experience an overproduction of stress hormones, such as cortisol and adrenaline. Several studies have demonstrated that those predisposed to stress-induced insomnia have an overactive sympathetic (fight-or-flight) nervous system, as well as a hyperactive hypothalamic-pituitary-adrenal (HPA) axis, resulting in the overproduction of stress hormones. As a result, sleep is severely impaired and disrupted.
Even more bothersome is the fact that deep, slow-wave sleep is known to reduce the levels of these stress hormones and decrease the activity of the HPA axis. Wakefulness, on the other hand, increases its output. Thus, insufficient sleep tends to promote a vicious cycle of sleep problems, resulting in increasing levels of sleep-inhibiting stress hormones.
Lastly, high levels of cortisol can decrease levels of melatonin (a major sleep-promoting neurological hormone), which results in an even poorer sleep outcome.
Stress Less, Sleep Better
For the 15 percent of Americans who suffer from chronic insomnia, strong coping skills are crucial.
Lifestyle changes, such as regular daily exercise, plus eliminating nicotine and caffeine is often a good place to start. Cognitive behavioral therapy, meditation, progressive muscle relaxation, and hypnosis can also help relieve anxiety levels and intrusive thoughts.
Recognizing that your lack of sleep may be related to how you deal with stress can help you remedy your sleep problems. Many people with insomnia relapse when they stop taking sleeping pills because they fail to deal with the underlying problem — stress. Learn to manage your stress. If you need help, get it. If you do, you are more likely to reap the benefits of uninterrupted deep sleep.
Robert Rosenberg, DO
JUL