Category Archives: Stress

Too Stressed to Sleep?

It is becoming 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. We all may experience what we refer to as transient insomnia after a stressful event. However, for some of us, stressors such as illness, work schedule changes, and interpersonal conflict can lead to chronic insomnia. The question is…why?

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, about the stressful events of their lives. As a result, they present to sleep specialists such as myself with the classic complaint of “I can’t shut my mind down.” This makes it very difficult for them to fall or stay asleep.

Many of us with chronic insomnia seem to be not only psychologically ill prepared to deal with stress, but physiologically as well. We know that many 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 HPA (Hypothalamic-Pituitary-Adrenal) 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 resulting in ever-increasing levels of sleep-inhibiting stress hormones.

Finally, add to this the fact that high levels of cortisol can decrease levels of melatonin, a major sleep-promoting neuro hormone, which results in an even poorer environment for sleep onset.

Fifteen percent of Americans suffer from chronic insomnia with a majority experiencing it because of chronic stress. Therefore, stress coping skills are crucial. First, lifestyle changes needed. Regular daily exercise coupled with the elimination of nicotine and caffeine is a good start. Cognitive behavioral therapy, meditation, progressive muscle relaxation, hypnosis, and in some instances seeing a therapist can help diminish arousal levels and intrusive thoughts. There are also sites online that offer help in coping with stress and insomnia.

It is important to recognize that your lack of sleep may very likely be related to how you deal with stress. The reason so many insomniacs relapse when they stop taking sleeping pills is that they fail to deal with the underlying problem. That problem is their inability to manage 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.


Getting Divorced? Don’t Lose Sleep!

Divorce can be a very stressful time in our lives. Poor sleep is often a result of this stress. We refer to this form of insomnia as acute adjustment or transient insomnia. However, what happens if the problem persists?

In the July issue of Health Psychology, researchers set out to find the answer. In the study, 138 recently separated people completed a self-report of sleep complaints and resting blood pressure. The subjects were followed for 7 1/2 months. The study showed that sleep complaints predicted significant increases in blood pressure at subsequent follow-up visits. Most interesting was the finding that people who continued to show sleep complaints 10 weeks or more after their separation demonstrated the greatest increase in blood pressure.

As one of the researchers pointed out, sleep problems during the first 10 weeks after a separation did not appear to be associated with persistent increases in blood pressure. However, in those with persistent sleep problems after 10 weeks, chronic elevations in blood pressure were noted.

This is not the first study to point out the relationship between divorce, sleep, and blood pressure. A study published in the journal Psychosomatic Medicine in 2009 came to a similar conclusion. It was found that divorce-related emotional difficulty played a significant role in elevating blood pressure, particularly in men.

My conclusion is that these investigations demonstrate how important sleep is in dealing with stress. It is during sleep that our sympathetic (fight or flight) system shuts down. It is also during sleep when our cortisol production drops to its lowest point of the day. Add to that the fact that during sleep, especially REM (dream sleep), the processing of emotionally laden information takes place. Therefore, is it any wonder that poor sleep, during something as stressful as a divorce, would have significant negative health consequences?

What are we to learn from these studies? I think the first take home message is that poor and insufficient sleep due to life stressors can have serious physiological consequences such as high blood pressure. The second is not to ignore the effects on one’s sleep that are occurring. Had these individuals been helped with Cognitive Behavioral Therapy and educated about the importance of good sleep during a separation or divorce, it seems probable that the development of high blood pressure and all of its unfortunate consequences could be avoided.