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Stress and Sleep Blog 

Tips, Tricks and Facts for a More Restful Night of Sleep: Better ways to manage your sleep and energy.

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When did getting a good night’s sleep become so hard?

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Insomnia and disrupted sleep are really common. (link to thread on stats on % with insomnia, etc)

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What causes interrupted sleep? (link to thread on medical conditions associated with poor sleep below)

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Why you should care about getting a good night’s sleep (link to thread on downstream health conditions below)

 

Our stress response is one factor that affects sleep that we can shift (link to thread on effects of stress on sleep below)

 

Tips and Tricks to improve your sleep that you can start today (link to SOLUTIONS section below)

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Insomnia and disrupted sleep are all too common for many of us. When did getting a good night’s sleep become so challenging?

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You put in 8 hours of work, come home exhausted, order take out and watch some Netflix with the hope that you’ll have a restorative night of sleep and awake rested the next morning. Instead, you find yourself tossing and turning, looking at the clock a few hours later, worrying about how you are going to make it through the next day without extraordinary amounts of coffee and snacks. After finally falling asleep, you wake up unrested to the sound of your alarm clock the next morning and start the whole process again.

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Sound familiar?

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What if there was a better way to plan your day to set yourself up for success so you DO get a restful night of sleep, waking up energized and ready to go instead of dragging through the day, and waking throughout the night?

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Insomnia and Sleep Disorders: Causes, Effects and the Impact of Stress

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Highlights/Thread:

  • Sleep Disorders and Insomnia are increasingly common, affecting at least 30% of the population

  • Physical and Mental health conditions, medications, lifestyle, and stress all affect our sleep

  • Poor sleep has been correlated with health conditions such as heart disease, hypertension, depression and anxiety, diabetes and obesity

  • Our stress response is one modifiable factor that has a significant impact on sleep: By managing stress, we can improve sleep quality and overall health outcomes

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Sleep Disorders and Insomnia: Just How Common Are They?

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Sleep problems have become increasingly common in modern society. Insomnia, a condition in which you have trouble falling or staying asleep, is the most common of the sleep disorders. Most studies evaluating the prevalence of insomnia indicate that 30% of adults report having this condition in a given year. These statistics have been reported in the US, with similar rates in several other countries. Clearly, insomnia and sleep disorders are a global problem.

Sleep problems tend to also increase with age and in those with mental health conditions. In a survey of nearly 9000 older adults above age 65, more than half reported at least one chronic sleep complaint. Several other studies examining the relationship between insomnia and mental health conditions like depression have found that insomnia and depression often co-exist and the majority of those with depression experience some form of sleep disturbance.

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What Contributes to Insomnia and Poor Sleep:

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There are many factors that can contribute to insomnia such as: mental health disorders, sleep apnea, medications, physical illnesses and pain, poor lifestyle/sleep habits and stress. The Sleep Foundation has a helpful summary of some of the main factors that can contribute to insomnia including lifestyle factors that may be modifiable. Below, we will focus on one of these important factors that is often overlooked: stress.

Why Does Sleep Matter? The Downstream Effects of Poor Sleep:

It is increasingly recognized that the quality and quantity of sleep have a profound impact on overall health. Most of us notice the effects of a poor night’s sleep on our general well-being and our performance the next day at work or while performing our routine activities. Research is also showing associations between sleep disorders and multiple health outcomes including heart disease, hypertension, mood disorders, diabetes and blood sugar regulation, and obesity.

Sleep and the Nervous System: The Effects of Stress on Sleep:

Stress is one important factor that can contribute to insomnia. Stress affects the autonomic nervous system, which plays a key role in sleep. The autonomic nervous system includes the sympathetic or “fight or flight” branch of our nervous system as well as the parasympathetic or “rest and digest” branch. While both the sympathetic and parasympathetic nervous system play a role in different stages of sleep, studies have shown that there may be an over activation of the sympathetic nervous system (and a loss of vagal tone) in patients with insomnia.

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Stress can contribute to this over activation of the sympathetic nervous system and contribute to insomnia. However, it’s interesting to note that while studies have shown that stressful events can increase the risk of insomnia, they have also shown that our response to stressful events plays an important role in this interaction. In other words: how we cope with and manage the inevitable stressors that we encounter is an important determinant in whether or not our sleep is affected. Since all of us will encounter both small and large stressors throughout our lives, it’s encouraging to understand that by working on managing stress, we can mitigate its effects on our sleep and our health.

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Conclusions:

Sleep disturbances like insomnia are extremely common and have a significant impact on quality of life and our overall health. By recognizing that stress affects our sleep, we can take steps to manage our stress as part of a comprehensive approach to addressing insomnia and improving sleep quality. (link to blog on Solutions to Chronic Stress)

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Tips and Tricks to improve your sleep:

While the exact number of hours can vary, most adults need between 7-9 hours of quality sleep. If you are falling short or struggling with the quality of your sleep, there is definitely hope for improvement with the strategies discussed below.

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Using light exposure to your advantage:

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We all have a master circadian clock in our brain that helps regulate our sleep cycles. This clock responds to light even when our eyes are closed. What does this mean? It means that taking advantage of the light/dark cycle of the sun can help with improving both alertness during the day and getting quality sleep at night.

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In the evening, starting 2 hours before bedtime, keep light levels dim. Switch from bright overhead lights to dim ambient light if possible (like a desk lamp, etc.). Wraparound sunglasses are an option if you can’t control the light around you during this time. Specifically blue light (which comes from fluorescents, LEDs, and back-lit electronics on TVs, computers, tablets, cell phones) has a strong impact on our circadian rhythm and should be avoided for 2 hours before bed. If they can’t be avoided, “blue-blocker” glasses and some settings to minimize blue light on your electronics can help. Red, yellow, and orange lights have minimal effect on circadian rhythm so dim lights in these colors can be used for book lights, etc. in the evening.

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In addition to minimizing light exposure at night, it is important to include light exposure in the morning. Stanford neuroscientist Dr. Andrew Huberman, PhD has a toolkit and various podcast episodes on how to improve your sleep and always mentions the importance of morning light exposure.

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Dr. Huberman recommends getting outdoor light exposure within an hour of waking. If it’s still dark when you typically wake up, turn on bright artificial lights and go outside as soon as able once the sun is up. The more overcast it is, the more time you would want to spend in outdoor light. His general recommendations are: on bright cloudless days 10 minutes, on cloudy days 20 minutes, and on very overcast days 30-60 minutes. Some of you may already be doing this by walking your dog in the morning, or drinking your coffee on your front porch, or any combination.

 

Additional tips he mentions for light exposure:

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  • contacts and glasses are fine but avoid sunglasses if you can safely do so

  • you never want to look directly at the sun, we are talking about general outdoor time in the morning

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Caffeine intake:

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Most recommend avoiding caffeine 8-10 hours before bed, but some authorities like sleep guru Matthew Walker, PhD recommend avoiding it for much longer, closer to 12-14 hours before bed (yikes!). A practical approach would be try and stop caffeine intake by late morning if you are struggling with sleep in any way. Some people are much more sensitive to caffeine than others, and find their sleep improves with cutting out caffeine completely. On the flip side, for those that don’t feel they are sensitive to caffeine at all: Dr. Walker says caffeine in the evening still reduces deep sleep based on his studies.

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Take home points on caffeine intake:

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  • Avoiding caffeine 8-10 hours before bed is a good rule of thumb for all

  • If you are sensitive to caffeine, you may need to avoid it starting even earlier in the day, or remove it completely

 

Alcohol intake:

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While it may seem like alcohol can help us fall asleep, it can actually have detrimental effects on sleep quality and duration, and can even worsen sleep apnea. While even small amounts of alcohol can affect sleep (yes even 1 drink!), more alcohol definitely has an even more profound negative effect on sleep. Some of the ways alcohol affects our sleepinclude decreasing the amount of REM sleep and interfering with our ability to consolidate memories and learning that usually happens during sleep.

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Take home points on alcohol intake:

  • Even small amounts of alcohol on a regular basis can affect sleep

  • If you are struggling with sleep, it makes sense to consider gradually decreasing or eliminating your consumption (if you drink alcohol regularly, please consult with your physician before making any drastic changes)

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Stress:

We’ve all felt the effects of stress on multiple areas of our lives, including our sleep. When it comes to external factors contributing to our stress levels, some things are under our control and some are not. We want to both reduce those external factors when possible, and also learn strategies to improve our resilience and mitigate the impact of stress that is unavoidable.

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Controlling External Stressors: One habit worth breaking:

When it comes to avoiding external factors: using electronics before bed is a common habit that many of us have (and have the ability to change!). Scrolling through social media, reading the news on your iphone or sending one last email for work before bed can all activate our sympathetic nervous system. This can lead to increased feelings of stress and anxiety making it more difficult to go to sleep. Using electronics before bed can also suppress the release of melatonin, delaying the onset of sleep. Bottom line on using electronics before bed: try to stop looking at screens at least an hour or two before bedtime to help down regulate your nervous system before bed. Listen to a podcast, or read a book for better sleep.

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Improving our Resilience to Stress:

For all of the unavoidable stressors in life, it’s become essential that we build our toolkit for resilience for our overall health and specifically for sleep. If you feel like anxiety and stress are keeping you up at night, there are many choices when it comes to working with our stress response that can help immensely. Gentle yoga, meditation, breathing exercises, and guided imagery are just a few. This CDC website has some useful links to try out for some of these breathing and relaxation techniques.

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Here’s a summary of some resources to consider to modulate the stress response:

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Exercise:

Exercise has so many benefits and improved sleep is definitely one of them. Any amount of physical activity is better than none. Sleep expert Dr. Matthew Walker, PhD writes about a study in his book showing older adults who increased their physical activity were able to sleep about an hour more on average after just four months!

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One caveat is that high intensity exercise too close to bedtime may negatively affect sleep in some, so if you are someone who exercises in the evening and you are having sleep challenges, experiment with moving your workouts to at least 2 hours before bedtime. Other forms of exercise like gentle yoga and stretching can actually help promote sleep.

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Sleep Hygiene: Light and Temperature in the Bedroom and a Schedule for Sleeping and Eating:

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We’ve already talked about the effects of light exposure on our circadian rhythm, but let’s talk more specifically about how you want to set yourself up for success by making your bedroom as dark as possible. Melatonin is a hormone that our pineal gland makes; melatonin makes us start to feel sleepy. Exposure to light blocks melatonin production and can disrupt our sleep cycles.

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Here’s some tips to make your room as dark as possible at night:

  • Blinds or curtains (black out curtains if needed)

  • Turn off hallway lights and/or put a rolled up towel against the gap between the door and the floor

  • if you can’t control the light entering the room, consider wearing an eye mask

  • If you have digital clocks, or other electronics with flashing lights, either remove them from the bedroom, or use electrical tape to cover any light exposures

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In addition to sleeping in a dark room, you also want to make sure your bedroom is cool enough. A good starting point is aiming for around [65 degrees fahrenheit](https://www.sleepfoundation.org/bedroom-environment/best-temperature-for-sleep#:~:text=The best bedroom temperature for,for the most comfortable sleep.) for the bedroom at night and adjusting as needed. During summer months, keeping the curtains in the bedroom closed during the day and only opening at night, and of course using air conditioning or opening the windows and using box fans can all help.

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Finally, keeping a consistent schedule of when you go to sleep and wake up, and avoiding eating within 2-3 hours of bedtime have been shown to help improve sleep quality.

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Summary: Tips and Tricks for Better Sleep at Night and Better Energy during the day:

  • Get outdoor light exposure early in the day

  • Watch your caffeine and alcohol intake

  • Reduce stress at bedtime by avoiding electronics 1-2 hours before bed

  • Consider building your stress resilience (meditation, breathing, yoga, etc.)

  • Exercise most days

  • Keep the bedroom dark and cool

  • Keep a regular sleep/wake schedule and avoid late-night eating

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Helpful Resources on Optimizing Sleep:

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Improving our Sleep by Managing Stress and Balancing the Autonomic Nervous System:

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A common method used in these studies to look at the balance between the sympathetic and parasympathetic nervous system is the measurement of heart rate variability, or HRV for short. HRV is a measure of  the variation in time between each heartbeat. A lower HRV would correspond to an overactivation of the sympathetic nervous system (fight or flight), while a higher HRV would correspond to a more parasympathetic (rest and digest) predominance. If we can move towards a higher HRV, this may help sleep disorders such as insomnia.

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Improving our HRV to Improve our Sleep: Harnessing the power of breathing:

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We do have control over our autonomic nervous system and the balance between the fight or flight and rest and digest branches. One method to improve the autonomic balance involves HRVB, or heart rate variability biofeedback. This is an easy way to use specific breathing exercises to improve heart rate variability and our overall sense of wellbeing. These specific breathing exercises can help us modulate  the impact of stress on our nervous system, and improve our sleep.

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Really, Breathing can Help me Sleep Better? Here’s the Research:

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A 2019 study looked at the effects of a slow-paced breathing intervention on sleep quality and heart rate variability. The intervention involved slow-paced breathing for 15 minutes once a day for 30 days with the use of a smartphone app. The results showed that this simple intervention improved sleep quality (measured by the Pittsburgh Sleep Quality Index questionnaire) and heart rate variability.

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Another study published in 2009 looked at the effects of heart rate variability biofeedback on insomnia in a military service member who was serving overseas in a combat zone. This study pointed out the need for interventions to improve sleep in military members, particularly when pharmacologic interventions may not be possible due to sedating side effects. The service member was given a portable heart rate variability biofeedback device that used a finger sensor. The device used slow abdominal breathing to improve HRV and activate the parasympathetic response.  After using the device for a week, sleep was significantly improved.

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Finally, another 2009 study using a portable heart rate variability device looked at the effects of the device on sleep quality in patients  that presented to a sleep lab for an overnight sleep study. They found that the use of the heart rate variability biofeedback device significantly improved sleep quality.

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Conclusions:

There is great potential for slow paced breathing exercises to have a positive impact on sleep quality in those experiencing insomnia and other sleep disorders in a variety of settings.

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