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.
