Stress and poor sleep can lead to chronic insomnniaLet’s say you grow up in a family of champion sleepers, yourself included. At college, you sail through rowdy dormitory life sleeping like a log. Job interviews, stressful to some, don’t faze you. By 27, you’ve landed a good job and in a few years earned enough for a down payment on a house. Sleep is still dependable and stays that way for a decade.

Then, coinciding with a move and the birth of a second child, you find yourself wide awake at your normal bedtime, staring at walls. Soon this becomes the rule rather than the exception. Before you know it you’ve developed chronic insomnia. How can sleep go from good to bad so quickly?

How Insomnia Develops

For decades sleep scientists have been trying to work out how chronic insomnia develops. The main model they’ve proposed looks something like this:

  1. Predisposing factors are presumed to exist in everyone who develops chronic insomnia. They include such observable factors as (a) parental history of insomnia, (b) high sleep reactivity (a tendency to sleep poorly before and after stressful events such as giving a speech or having an argument; and to be highly reactive to caffeine, jet lag, and interpersonal stressors), and (c) poor health—all associated with biological challenges to sleep.
  2. Precipitating factors come next: major life stressors that often trigger an episode of insomnia such as a job loss, marriage, or relocation to a different town.
  3. Perpetuating factors are the habits some people then adopt for insomnia relief—taking naps, going to bed early, sleeping in on weekends—that actually make their sleep worse.
  4. Conditioned arousal of the cerebral cortex is the final step in in the process. Lying awake for long stretches of the night opens the door to worry and rumination. This brain activity can spill over into sleep and keep insomnia going indefinitely.

This may be how chronic insomnia develops in some people. There may also be alternative pathways to insomnia. A large community-based study (Evolution of Pathways to Insomnia Cohort) was recently conducted to figure out what those alternative pathways might be. Working with data from that study, Michigan researchers have concluded that even people who have no evident predisposition to insomnia may develop chronic insomnia through a process involving sleep system sensitization. Here’s more on what they found.

From Normal Sleep to Insomnia in Just One Year

In this prospective study, thousands of participants filled out a series of questionnaires at the start of the study and one and two years later. The Michigan researchers looked at the 262 participants who did not have insomnia at the start of the study but who, by year 1, had developed it.

These participants might be expected to have characteristics predisposing poor sleep from the start (a mother with insomnia, for example, or high sleep reactivity). But not all of them did. A total of 60 participants tested low for sleep reactivity at the start of the study (on the Ford Insomnia Response to Stress Test, or FIRST). But by year 1, these 60 people had jumped an average of 4 points on the FIRST, indicating a significant increase in sleep reactivity. Over two-thirds went from low sleep reactivity to very high sleep reactivity following major life stress and the onset of insomnia in the space of just one year. At year 2, the high sleep reactivity persisted regardless of whether their insomnia was chronic or not.

A Different Path to Chronic Insomnia

In a nutshell, here’s the take-away:

  • People with apparently low vulnerability to insomnia (like the person described at the beginning of this blog post) can develop high sleep reactivity in conjunction with major life stress and an episode of insomnia.
  • Stress exposure leading up to insomnia appears to sensitize the sleep system. This lends support to the idea that insomnia itself may be a perpetuating factor in chronic insomnia. Every episode may trigger neurobiological changes that increase the risk of subsequent bouts of insomnia, just as every experience of depression increases the risk of future depression.
  • High sleep reactivity, once it develops, is persistent.

No matter how or why your insomnia develops, don’t wait to look for help. Take action right away.

Posted by Lois Maharg, The Savvy Insomniac

Lois Maharg has worked with language for many years. She taught ESL, coauthored two textbooks, and then became a reporter, writing about health, education, government, Latino affairs, and food. Her lifelong struggle with insomnia and interest in investigative reporting motivated her to write a book, The Savvy Insomniac: A Personal Journey through Science to Better Sleep. She now freelances as an editor and copy writer at On the Mark Editing.

8 Comments

  1. I have tried sleep restriction and it actually works. It is a best tool to use to retrain your brain

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    1. Hi Kamal,

      I agree: sleep restriction therapy is at the top of my list when it comes to effective therapies for improving sleep. Thanks for writing in!

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  2. How persistent is sleep reactivity? Will sleep restriction therapy be able to eventually conquer it? Or will I have to restrict my sleep for the rest of my life? I’m typing this on my 5th month on the therapy and I miss my naps.

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    1. Hello,

      The answer to your first question—how persistent is sleep reactivity—isn’t yet known. If sleep reactivity really is a trait, then the degree of influence it has, and even its stability, may vary from person to person.

      The expectation would be that by going through sleep restriction and adopting habits developed during therapy—maintaining a fixed wake-up time, refraining from naps, and so forth—your sleep would be somewhat more protected from the types of stressful events that derailed it in the past. That is how it’s worked for me. It used to be that every little blip on my radar screen would trigger a bout of terrible insomnia. Had a test for sleep reactivity been available back then, I’m sure my score would have been off the charts.

      I went through sleep restriction therapy almost 10 years ago. The process took a couple months (as I’ve documented in chapter 8 of The Savvy Insomniac). Ever since then, my sleep has been less susceptible to disruption by some of the stressors that used to interfere with it in the past. My sleep is more resilient, and that feels good.

      Even so, I’m still not like my husband, who can leave a stressful day at work behind him and easily fall asleep at the usual time. I’d still score moderately high in sleep reactivity—which is why these researchers’ findings make sense to me.

      If I could go back and live my life over again, though, I’d go through cognitive behavioral therapy (which includes sleep restriction) much, much earlier than I did. It’s made that big a difference in my life, both day and night.

      What I’m wondering about is why, at 5 months, you’re not seeing any therapeutic benefits. What I’d suggest is that you consult a sleep specialist or a sleep therapist or, if you’re a do-it-yourself person, revisit the sleep restriction protocol to make sure you’re doing it correctly. Here’s a blog post I hope will help:

      https://thesavvyinsomniac.com/2016/12/28/improve-your-sleep-with-cbt/

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      1. Hi Lois, sorry if my post was not clear. The five months I’ve been doing SRT have actually been terrific. I am averaging 6+ hours of sleep a day. My main concern these days is that since I need to adhere to the fixed sleep schedule, it is not sometimes flexible enough for me. I go to bed at 1am and get up at 7:30am. However, sometimes I need to get up earlier or stay later because of unavoidable work or social functions. The days following such events are always hard because whenever I don’t get my minimum 6.5 hours of sleep I start to feel terrible in the afternoon. Before doing SRT, I used to nap as needed during the day, but SRT has forbidden me to do that. So I was wondering if this will be the norm for the rest of my life or I can get to a point where I can take naps again to recover some sleep lost from the previous day?

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  3. OK, I’m glad to hear that. The fact that you’re benefiting from SRT throws a whole new light on your question.

    Some people can sleep wherever and whenever they want. Others, especially people prone to insomnia, have to be more careful. Your body’s going to like it if you stick to a regular sleep schedule. But that isn’t always possible. Work and social activities sometimes take precedence.

    Your sleep has stabilized, so now you can experiment by adding something in that you used to do that may have caused problems before. But do it gradually. If I were you I wouldn’t start by taking an hour-long nap in the middle of the afternoon. After a night when you have to stay up late, try taking a 20- or 30-minute nap. See how it affects your sleep that night. If there’s no negative effect, then maybe it’s OK to take a short nap from time to time. Maybe an even longer nap might work once in a while.

    But if you do experience trouble sleeping the following night, then you’ll want to rethink how to catch up on lost sleep. For myself, I’ve found that when I’m short on sleep, going to bed earlier that night (while still getting up at the same time the next morning) works better than taking a nap.

    Good luck in figuring out exactly what’s right for you!

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  4. Lois, thank you for the advice. I’ve had a few days I’ve been sleep deprived that I tried to nap in the afternoon to make up. But to my surprise I’m not able to even if I tried. Back before I developed chronic insomnia, I could easily roll with the punches, i.e. suffer a late night of social activity, but able to quickly take a nap in the afternoon the next day to recharge. I’m surprised that recently I could not even take a nap in the afternoon despite having slept only 4-5 hours the prior night. Is this part of the insomnia phenomenon?

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    1. No research has been done on naps as they figure in transitions from good sleep to poor sleep. But that would be an interesting study to conduct. Researchers know that people with insomnia generally have a harder time dropping off during the daytime than people who sleep well. That’s one piece of information that’s led to the conclusion that people with insomnia may be just a little bit more aroused than others 24/7.

      You haven’t mentioned your age. The sleep system undergoes some physiological changes as people age. It may become less robust. Your current inability to nap may have to do with aging, or situational factors (a job, a relationship), or psychological factors. It could be now that you’ve experienced insomnia, you’ve become more vigilant about everything to do with sleep. That vigilance could interfere with your ability to relax and take a nap. It could also have to do with drinking beverages containing caffeine.

      I haven’t ever been able to nap from as far back as I can remember (age 4). In fact I hated nap time in kindergarten! It was so boring. I’ve met other insomniacs who say they can’t nap. It’s common, too, for people with psychophysiologic insomnia, when they’re short on sleep, to find themselves suddenly drifting off in unexpected places, such as when they’re sitting down in a museum or in a dark concert hall.

      I sense you’re reluctant to give up on napping, and I can imagine, if you’ve taken naps in the past, that not being able to recharge with a nap could feel like a loss. Still, if you’re wanting to keep your sleep as dependable as possible, you should aim to get pretty much all of your sleep at night.

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