What's the worst kind of stress for sleep?
Updated: Apr 16, 2020
I was quite surprised that I conked out (zzz) in typical form on Monday, despite a very real fear that I would blush uncontrollably, be rendered speechless with stage fright, or accidentally flick spittle at Phil & Holly on national TV on Tuesday morning.
Fortunately, the well-oiled machine that is the ITV This Morning crew took care of everything, and in the end all I had to do was answer a couple of quick questions about sleep.
The only problem is, solving the issue of getting a good night's sleep in a 5 minute soundbite is asking quite a lot..
'Stress' was topic number one, and the producer told me we had.. oh, about 60 seconds.
Crikey, where does one begin?
In biological terms, the problem sounds deceptively simple.. psychological stress leads to hyperarousal, otherwise known as over-activation of the sympathetic 'fight or flight' nervous system. The bad guy in this scenario is too much of the stress hormone, cortisol, which can have a bunch of negative effects on health. I saw in my PhD research that work stress during the day interferes with the natural decline in cortisol at the end of the day. This delays the onset of melatonin, the hormone which signals that the body is getting ready for sleep.
Even if you do get to sleep after a tough day, stress-fuelled sleep is more likely to be restless, and broken in the early hours of the morning, leading to that crushing realisation that it's 4am, and you're wide awake - tired, but wired.
'So, Dr Bostock, all we've got to do is chill out and relax then?'
Mmm well, that might be the 10 second answer, but when you're facing the sorts of life stresses that have affected one of my hosts on This Morning recently, a long hot bath or a spot of yoga are unlikely to solve the complex web of thoughts, worries and emotions swirling around the mind.
Ruminating about your worries can reinforce physical tension and arousal, which makes sleep worse. Lack of sleep then actually heightens your anxiety, and dials up the stress response. Truly switching off, both mentally and physically, becomes increasingly difficult.
Life stressors are by their nature, chronic. Relationship problems, work stress, financial issues.. these all have the potential to upset our sleep patterns if they invade our evenings on a regular basis.
But here’s some good news..
If we have good sleep habits, biology will soon take over. This is where a regular sleep-wake routine, low caffeine, low alcohol, winding down, practicing relaxation, dim lights, digital detoxing etc, etc, come in. With every night of short sleep, the brain and body builds up a sleep debt. Our biological need to sleep eventually becomes overwhelming, and we are rewarded with a deeper, juicier recovery night (or more) of sleep.
Sometimes it's helpful to just accept that you're just not sleeping well. You know that you’ve coped with worse before, and will do again. Make time for sleep, but if it won't come, don't panic. In the eye of the storm, the challenge is avoiding excess use of caffeine, alcohol, sugar or any other sleep-defeating fuel as a coping mechanism, because that can be the start of a vicious cycle...
Insomnia often persists long after the original source of stress has gone away, because unhelpful coping mechanisms become habits which disrupt natural sleep patterns. After weeks or months of sleepless nights, the fear about how you'll cope if you can't sleep yet again, can become a dominating force. Insomnia is a black cloud of fatigue and desperation that follows you not just during the night, but into the day.
So what’s the worst kind of stress for sleep?
It’s when sleep itself becomes a source of stress. Chronic insomnia warrants more than a 5 minute soundbite, it warrants medical treatment with a proven approach called Cognitive Behavioural Therapy for Insomnia. My former colleague at Big Health, Prof Colin Espie, has written an excellent explanation and rallying cry for CBT-I vs. mere ‘sleep tips’ in this Guardian article.
I think it’s fair to say that daytime TV is geared more towards entertainment than medicine. I did my best to shoe-horn a little science into yesterday's sleep chat with Phil & Holly, and if I’m ever offered another slot, I’ll try and include a little more.
I fully accept that a 5 minute discussion is not going to help solve sleep problems for the 1 in 10 adults currently experiencing chronic insomnia. But hopefully, sharing a bit of sleep science - even for 5 minutes at a time - could help the remaining 9 out 10 adults to prevent insomnia in the future.