Stress and Insomnia
Lack of sleep has been a steadily escalating problem in America. Nearly one third of adult Americans say that they get insufficient sleep, and the CDC even went so far as to call the situation an epidemic.
There is no single cause behind this national sleep deficit, but insomnia is a driving factor. Insomnia is a sleep disorder that inhibits a person from being able to fall asleep when they want to (known as sleep onset insomnia) and/or stay asleep through the night (sleep maintenance insomnia).
At the same time, Americans report significant amounts of regular stress. The American Psychiatric Association’s annual Stress in America survey has continually found that people describe their stress to be well above what they perceive as a healthy level.
The fact that both stress and insomnia are significant problems appears to be more than coincidental. As anyone who has spent a night tossing and turning with grief, worry, or anger knows, difficult emotions can have a direct bearing on sleep. A growing body of research studies supports this anecdotal experience, finding that all types of stress can harm sleep quality and that sleep deprivation can fuel further stress and irritability.
While these are worrying trends, the good news is that there are ways to treat insomnia and better manage stress. Taking steps to address these problems can have positive impacts on mood and sleep. The following sections cover the key background so that you can be informed and empowered to make healthy changes to feel and sleep better.
Can Stress Cause Insomnia?
Stress has long been known to be linked with sleep problems. Most people have experienced this connection at some point in their life when difficult circumstances may have made it hard to get to sleep or fall back asleep after waking up in the night.
Researchers have verified this relationship in a bevy of studies across different cultures, age groups, and types of stressors. For example, a study in Sweden found that a stressful work environment significantly increased the risk of episodes of insomnia. In Japan, employees with high stress levels, especially when working hard for limited rewards, were more likely to develop insomnia, and a study in South Korea found a strong correlation between job stress and insomnia even when controlling for variables like work demands and limited rewards.
A study of college students in the United States found that stress from family life contributed to an increased risk of insomnia, and the risk was even higher when combined with stress from academic pressure. Stress can take a toll on children, raising their risk of insomnia as it does in adults. Worries about their social life and school can contribute to sleeping problems for adolescents and teens as well.
While there’s no shortage of experimental data confirming the connection between stress and sleep, recent developments in sleep science have offered a more robust understanding of the “why” behind this connection. Stress induces a range of bodily reactions in the brain and nervous system, endocrine (hormone) system, and immune system. Experts have increasingly come to identify the specific elements of the stress response that contribute to what is known as a state of hyperarousal in which the brain and body operate as if “on alert.”
Hyperarousal has come to be seen as a central underlying driver of insomnia. For people with insomnia, this state persists throughout the day, but at night, it manifests as the inability to fall asleep or to quickly get back to sleep after an unwanted awakening. Different scientific models explain hyperarousal as a function of cognitive factors (such as worrying) and neurophysiological elements (specific reactions in the nervous or endocrine systems), but all of these models recognize the potential for various types of stressors to contribute to hyperarousal.
To make matters worse, once stress comes to affect sleep, it can kick off a downward spiral as the lack of sleep makes a person more irritable and emotionally reactive. Sleeping problems themselves can become an added source of stress, and time spent lying awake in bed may induce further rumination and anxiety. Taken together, hyperarousal is a key cog in the development of insomnia, and once insomnia has begun, the lack of sleep may facilitate an even more acute sense of hyperarousal.
Does Stress Always Cause Insomnia?
While stress can promote insomnia, not everyone who experiences stress suffers from sleeping problems. There are two main explanations for why this is the case.
First, not all stressors are the same. The nature of stress as well as its severity and duration can all play a part in how much personal impact is actually felt. In most cases, the presence of multiple stressors is an aggravating factor.
Second, every individual responds to stress in different ways. Even when facing the same stressor, some people are more negatively affected than others. This is represented by the terms “emotional reactivity,” “stress reactivity,” or in more recent years, “resilience.” Resilience is a person’s ability to adapt and “bounce back” after stressful episodes. It doesn’t mean that a person with high resilience never feels pain or experiences sadness, but they are able to navigate those emotions and move forward in a healthy way.
More and more, sleep experts are connecting resilience to sleep. The concept of sleep reactivity represents how likely a person is to suffer from symptoms of insomnia after a stressful event. While this is still an emerging area of research, multiple studies have already found that people with low resilience are more prone to insomnia and that a focus on improving resilience may provide a viable avenue for helping to prevent serious sleeping problems.
It is not fully understood why some people have lower resilience and more sleep reactivity than others. Indications are that it may have a connection to genetics and a family history of insomnia. Gender and exposure to external stressors are also believed to influence sleep reactivity. While many of these factors are outside of a person’s control, experts also emphasize that virtually anyone can take straightforward steps to boost their resilience.
Can Insomnia Cause Stress?
Yes, insomnia can play a part in contributing to stress. Sleep deprivation affects mood, making someone more likely to be short-tempered, frustrated, and irritable. All of these things can create tension and heighten the risk of getting stressed out.
At the same time, insomnia can exacerbate stress because it creates a new stressor (sleeping problems) and because it provides a person with additional time -- such as when they are lying awake in bed -- to fret about the problems that they are facing, reinforcing their state of hyperarousal.
What is the Relationship Between PTSD and Insomnia?
Post-Traumatic Stress Disorder (PTSD) is a specific stress-related condition that is closely connected to insomnia. PTSD can arise after someone is exposed to one or more traumatic events, many of which are violent, emotionally painful, and/or life-threatening. People with PTSD often experience symptoms including hyperarousal, negative emotions, avoidance, flashbacks, fatigue, and headaches. Sleeping problems are also common; research has found that between 70% and 91% of people with PTSD report having issues falling asleep or staying asleep.
How Do You Know if You Have Insomnia?
The only way to know for sure if you have insomnia is to talk with a doctor. During your appointment, the doctor will likely ask a number of questions to better understand your sleeping problems. You may be asked to keep a sleep diary that shows how much and at what times you sleep over a period of a week or more. Depending on your situation, the doctor may order other tests including blood work or an overnight sleep study (polysomnography).
These steps are necessary because insomnia is a sleep disorder that has specific diagnostic criteria laid out in sleep classification systems such as Third Edition of the International Classification of Sleep Disorders (ICSD-3) and the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Your doctor utilizes your sleep diary and other tests to determine whether your situation meets the formal criteria for insomnia or any other sleep disorder.
How Do You Know if Insomnia is Caused by Stress?
While stress can be a major driver of insomnia, it’s certainly not its only cause. In addition to stress, some of the other possible factors related to insomnia include:
- Poor habits around sleep such as inconsistent sleep times, excess caffeine, or behaviorally-induced insufficient sleep syndrome
- Mental health conditions including depression, bipolar disorder, and anxiety disorder
- Chronic pain, arthritis, and other health conditions
- Other sleep disorders such as obstructive or central sleep apnea or Restless Leg Syndrome
- Circadian rhythm sleep-wake disorders including those related to jet lag and shift work
Some people are affected by more than one of these causes of insomnia, so it is not always simple to determine exactly why a person has insomnia. However, if your sleeping problems started during an especially stressful period or seem to be heightened during periods of difficulty in your work or personal life, it may be a sign that they are tied to your stress levels.
What Steps Can Help Address Insomnia and Stress?
Unfortunately, many people accept sleeping problems like insomnia as normal or an unchangeable issue. The reality is that most people can meaningfully improve their sleep and shouldn’t accept sleep deprivation as a fact of life.
The best way to address insomnia depends on the person and their specific situation, but there are a number of methods that can go a long way to getting better sleep including if your sleeping problems are related to stress.
Consult With a Doctor and/or Psychiatrist
When sleeping problems are affecting your everyday life, it’s important to see a doctor who can do a thorough evaluation to help identify the possible causes. Following the established diagnostic process can determine if there are any more serious underlying health issues that need to be addressed and can guide the doctor in identifying the most appropriate therapy to meet your needs.
In many cases, it can be meaningful to work with a psychiatrist or counselor as well. These trained professionals can work with you to reduce stress levels, build resilience, and promote emotional well-being. Your doctor can usually make a referral to a qualified counselor for an appointment.
Practice Relaxation Techniques
Relaxation techniques are a useful tool for managing stress and hyperarousal that hinder sleep. These are techniques that you can use throughout the day, including at bedtime. Keep in mind that what helps one person relax may not work for other people. For that reason, the best bet is to try out different approaches to find the ones that offer you the greatest benefit.
- Meditation: research has found that meditation, including mindfulness meditation, can deliver meaningful health benefits with virtually no downside. Not only is it useful in managing stress, but studies have shown that it can help fight insomnia as well.
- Deep breathing: one of the simplest ways to relax is to control your breathing. Just ten deep breaths can have a positive effect, and more involved deep breathing exercises are available for enhanced relaxation.
- Progressive muscle relaxation: this is a technique that involves tensing and releasing muscles throughout the body in a specific sequence. It can help relieve both mental and physical stress and may be beneficial before bedtime.
Find Time to Exercise
Getting daily exercise can help reduce stress and make it easier to get quality sleep. This doesn’t mean you need to run a marathon; even just moderate exercise can be a boon to your mood and sleep, especially if it’s consistent. Exercise offers a bevy of other benefits for other aspects of your health as well.
Boost Your Resilience
Becoming more resilient doesn’t necessarily happen overnight, but with some practice, you can work to optimize your response to stress. Science-based strategies like reframing your thoughts, carefully facing your fears, employing self-compassion, meditating, and practicing forgiveness can all provide a noticeable boost to your resilience.
Focus on Sleep Hygiene
It can be easy to lose sight of how our daily habits influence our ability to sleep well. The concept of sleep hygiene focuses on how to use your habits and routines to your advantage when it comes to sleep. It also includes optimizing your sleep environment so that you can relax and rest easy when you turn in for the night.
There are myriad ways to upgrade your sleep hygiene, but some key examples include:
- Avoiding caffeine or other stimulants in the late afternoon and evening when they could make it hard to get to sleep.
- Setting a consistent sleep schedule so that your body and circadian rhythm work to your benefit.
- Following the same bedtime routine every night to help you mentally and physically wind down in preparation for sleep.
- Making your bed comfortable and supportive and your bedroom free of excess external light or sound that might be disruptive.
- Minimizing the use of electronic devices, including mobile phones, in the hour leading up to bedtime because they create mental stimulation and emit blue light that can suppress the body’s production of melatonin, a hormone that promotes sleep.
- Stopping the common practice of tossing and turning. If you can’t fall asleep within about 20 minutes of going to bed, get up and do a low-key activity (like reading) in dim light until you start to feel drowsy.