The Relationship Between Stress And Insomnia

Last updated: May 10, 2019

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The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. Read our full medical disclaimer.

When a person is overly stressed they are likely to have poor sleep and even develop insomnia. It can be the other way round as well. An individual with no signs of stress could be sleep-depriving himself or herself which leads to an increase in stress hormones. This may or may not affect their mood right away, but sleep-deprived people are generally known to be emotionally unstable and they respond poorly to stressful situations. If this behavior continues over a long period they may find themselves suffering from insomnia.

Stress and insomnia are linked in many ways and the treatment may vary greatly from one person to another.

What is insomnia?

Insomnia is defined as an inability to fall asleep or stay asleep. It can be reflected through a long sleep latency (time it takes to fall asleep), frequent awakenings, or waking up too early.

Based on scientific findings some authors suggest that insomnia is not a state of sleep loss but rather a hyperarousal disorder which lasts during the day as well as during the night. Some of the reasons for developing insomnia may be stressful events like PTSD problems in veterans or other mental disorders, aging, a personality whose traits are inclined to anxiety, or menopause. Sometimes the problem lies in genetics.

Insomnia is one of the most common sleep disorders – about a third of the population claims to have difficulty falling and/or staying asleep, but a very small percent of chronic sufferers actually seek help from the sleep medicine experts. It can be chronic or transient – that is, it may last for a long time or just for a couple of days.

Those who suffer from insomnia can have problems focusing, suffer from excessive daytime sleepiness, fatigue, and other effects of sleep deprivation. There are many cases in which insomniacs seem to be highly alert during the day despite their inability to sleep. Either way insomnia can seriously impair the quality of their life, their work performance, and interpersonal relationships.

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Stress and personality issues with chronic insomnia

People who suffer from chronic insomnia tend to have not only more stress in life, but also to be more depressive and unhappy with the quality of their life from their childhood onwards. On average they do not form strong relationships with other people and are somewhat distanced. Having a poor self-image and stress coping mechanisms usually come hand-in-hand.

Insomnia is associated with a number of mental disorders like depression, bipolar disorder, and even substance abuse disorders.

Sometimes patients will claim their mental disorders come from insomnia, and sometimes insomnia will be a consequence of those disorders.

Transient insomnia

Perhaps the most common type of insomnia is transient insomnia. It is the inability to sleep on time or to sleep through the night without waking up, which lasts for a day or two. In most cases transient insomnia is not much of a problem – perhaps you were anxious about an important meeting, a trip, or maybe you just suffered a minor jet lag problem.

Once insomnia becomes a problem which lasts for days you should consider doing something about it – like removing sources of stress and relaxing more (if this works well for your sleep, there’s no need to consult a specialist, but if it doesn’t, think about that option).

Internalization and hyperarousal hypothesis

There are two interesting hypotheses which aim to tap into the insomnia problem. One represents the causes and effects as cyclical mutually triggering events. The other brings additional, external factors into the picture.

Internalization of emotions

The internalization hypothesis was proposed in the 1980s. The idea behind it is that patients with insomnia tend to deal with problems through the internalization of their emotions which leads to physiological arousals such as increased heart rate, body temperature, and limb movements before sleep. They are under a lot of tension due to emotional arousal and they keep remembering stressful and emotionally disturbing events.

Figure 1. Internalization Hypothesis. Source: Basta M, Chrousos G. P, et al. Chronic insomnia and stress system. Sleep Med Clin.

With time as they become aware of what’s keeping them up at night they develop a fear of not being able to fall asleep, which then results in more stress and anxiety and thus more insomnia problems.

Hyperarousal

There are many factors which support this hypothesis. Some insomniacs, due to their increased alertness, don’t show signs of sleepiness even though they are tired and worn out. The already mentioned physiologic factors such as heart rate, temperature, and body movement are also taken as a sign of increased arousal.

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When non-insomniacs get sleep deprived their bodies don’t show those changes, but rather keep their temperature at or below normal.

During Non-REM sleep insomniacs have increased brainwaves of high frequencies and low slow waves. This means they typically don’t have much deep sleep, also known as slow-wave sleep, which could have a restorative effect on the problems of insomnia.

The stress hormone cortisol levels remain high all the time. High cortisol is known to impair sleep and delay sleep time. In order to fall asleep we need to be relaxed. A neurotransmitter that helps our system relax is called GABA and it prevents the body and brain cells from being overexcited. A study has shown that people who suffer from insomnia have about 30% less GABA in their system compared to those who don’t have sleep problems.

Heuristic Model of Psychologic and Physiologic Factors associated with Insomnia

Figure 2. Heuristic Model of Psychologic and Physiologic Factors associated with Insomnia. Source: Basta M, Chrousos G. P, et al. Chronic insomnia and stress system. Sleep Med Clin.

Fight your insomnia – in a relaxed way

Whether your insomnia is caused by stress or your stress was triggered by insomnia one thing is for sure – in order to fall asleep, you need to relax. Make your bedroom a pleasant place for sleeping. It should be dark enough, cool enough, and quiet enough. If you can’t get rid of the noise or lights consider investing in some good earplugs, a white noise machine, blackout curtains or a sleep mask.

  • Create a relaxing routine before bed. This includes a warm shower (which relaxes and increases slow-wave sleep), reading a book or listening to a nice song. One hour (or even better – two) before bed avoid all technology and long conversations with people.
  • Don’t smoke, drink alcohol, or take psychoactive substances in the evening. You should stop caffeine intake at about 2pm.
  • Have warm chamomile or mint tea. You can pick any relaxing tea except for those which contain caffeine, like green and black tea. Chamomile soothes and calms you down.
  • You can do some light stretches to ease the tension from your muscles. During the morning or afternoon, you could surely do with some more vigorous exercise – it will increase your dopamine and make you feel better. More importantly, exercise eases falling asleep.
  • Practice progressive muscle relaxation. This is a technique in which you first tense and then relax all your body muscles group by group. You can start with your neck, chest, and back and work your way to your hands and toes. Become aware of all the muscles that are tense and issue them an order to relax. This way you are slowly relieving your entire body of stress and it might de-stress your mind as well.
  • After relaxing your body, don’t move. Make sure you’ve picked your sleeping position before relaxing your muscles. After that refrain from any movements or position changes.
  • Count. You can count sheep or just count numbers to prevent your mind from wandering into images which can associate you to something else and then the train of your thoughts will take you to arousal.

Once you are freshly bathed, relaxed and ‘locked’ into one position; make sure your mind stays focused on not thinking. Refrain from any thoughts that can cause you to become anxious – you can deal with them in the morning.

Additional resources

  1. Basta M, Chrousos G. P, et al. Chronic insomnia and stress system. Sleep Med Clin. 2007. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2128619/ Accessed April 4, 2019.
  2. Winkelman J. W, Buxton O. M. Reduced brain GABA in primary insomnia: preliminary data from 4T proton magnetic resonance spectroscopy (1H-MRS). Sleep. 2008. https://www.ncbi.nlm.nih.gov/pubmed/19014069 Accessed April 4, 2019.
  3. Vgontzas A. N, Bixler E. O, et al. Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis: clinical implications. J Clin Endocrinol Metab. 2001. https://www.ncbi.nlm.nih.gov/pubmed/11502812/ Accessed April 4, 2019.
  4. Stress and Insomnia. The National Sleep Foundation. https://www.sleepfoundation.org/articles/stress-and-insomnia Accessed April 4, 2019.

The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. Read our full medical disclaimer.

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