Don’t Let Insomnia Spoil the Summer

Do you experience a sudden onset of insomnia at about this time every year? Not much is written on seasonal insomnia that occurs in warm weather. Yet I’m convinced it’s a real phenomenon since my posts on summer insomnia get lots of traffic starting in May.

Here’s updated information—and speculation—on what could be causing the problem and how to get a better night’s sleep.

Waking up too early caused by bright summer sunriseDo you experience a sudden onset of insomnia at about this time every year? Not much is written on seasonal insomnia that occurs in warm weather. Yet I’m convinced it’s a real phenomenon since my posts on summer insomnia get lots of traffic starting in May.

Here’s updated information—and speculation—on what could be causing the problem and how to get a better night’s sleep.

Excessive Heat and Light

Late spring and summer are the hottest, lightest times of the year, and excessive heat and light are not very conducive to sleep.

In humans, core body temperature fluctuates by about 1.5 degrees Fahrenheit every day. Sleep is most likely to occur when core body temperature is falling (at night) and at its low point (some two hours before you typically wake up). Some research suggests that impaired thermoregulation may be a factor in insomnia, that sometimes you may simply be too hot to fall asleep. If so, a bedroom that’s too hot may exacerbate that problem, interfering with your body’s ability to cool down.

Light, too, can interfere with sleep. It does so by blocking secretion of melatonin, a hormone typically secreted at night. Exposure to bright light late in the evening or early in the morning—a phenomenon more likely to occur in months around the summer solstice—may keep you from sleeping as long as you’d like.

Other Possible Challenges to Sleep in the Summer

Swedish researchers have found that people with environmental intolerances to things like noise and pungent chemicals are more prone to insomnia than people without these intolerances. Depending on where you live, sleeping with open windows in the warm weather—if it leads to more noise or bad odors in the bedroom—could interfere with sleep.

Finally, new research conducted at Poznan University of Medical Sciences found that medical students in Poland had higher levels of circulating cortisol—a stress hormone—in the summer than in the winter. This is a preliminary result, and whether it can be confirmed or will hold true for the general population is unknown. Yet if humans do have higher levels of cortisol in the summer than in the winter, this, too, could have a negative effect on sleep.

Sleep Better in the Hot Weather

Climate control is the answer to many environmental triggers of insomnia in the spring and summer. Yet not everyone has air conditioning. If at night you’re too hot to sleep, take care to cool your sleeping quarters down in advance:

  • In the daytime, keep window shades and curtains closed to block out heat from the sun.
  • Later in the evening, use a window fan (facing outward) to draw cool air through the house. Open and close windows strategically so the bedroom is cool by the time you’re ready to sleep.
  • If your bedroom is on an upper floor that simply won’t cool down, sleep on a makeshift bed downstairs.

If keeping windows open at night exposes you to too much outside noise, block it out with silicone ear plugs or high-tech ear plugs, or mask it with white or pink noise using a small fan, a white noise machine, or SleepPhones.

Manage Your Exposure to Sunlight

Daily exposure to bright light helps keep sleep regular—but not if the exposure comes early in the morning or at night. Sunlight that awakens you at 5 a.m. or keeps you up past your normal bedtime may shorten your summer nights, depriving you of the full amount of sleep you need. If you’re sensitive to light,

  • Install light-blocking shades, curtains, and skylight covers on bedroom windows.
  • Purchase a lightweight eye mask for use during sleep.
  • Wear sunglasses if you’re outside in the evening.
  • At home, lower shades and curtains by 8:30 or 9 p.m. even if it’s still light outside, and start your bedtime routine at the same time as you do in other seasons.
  • Avoid devices with a screens in the hour leading up to bedtime.

Reduce Stress

If circulating stress hormones are an issue during the summertime (or if for any reason you’re feeling stress), then kicking back and relaxing, typical in the summer, is not necessarily going to be a dependable path to sound sleep. To reduce stress and sleep better, find a way to make regular aerobic exercise part of your day despite the heat:

  • Do the outdoor sport of your choice—walking, jogging, bicycling—early in the morning or early in the evening. Mall-walking may not be very sexy, but it sure beats walking in 100-degree heat.
  • Buy a seasonal membership in a gym or recreation center, where you can work out in air conditioning.
  • Take up swimming.

A woman recently wrote me wondering if the allergies she normally experiences late in April could trigger seasonal insomnia. I couldn’t find any information on this. But insomnia that routinely occurs at certain times of year is probably triggered by environmental or situational factors. Figuring out what the triggers are is the first step to finding a remedy.

Tips for Stressed-Out Caregivers Seeking Better Sleep

Occasionally I get emails from people with take-charge, type A personalities wondering what to do about insomnia. Full of self-reliance, they’ve often scoured the internet for remedies—and tried every one—or amassed a mountain of books about sleep—and read them all—to little avail. Can I suggest anything that might help?

Here is Geri’s story (abbreviated to save space) and my response.

Insomnia can be relieved by focusing on stress reduction and self-careOccasionally I get emails from people with take-charge, type A personalities wondering what to do about insomnia. Full of self-reliance, they’ve often scoured the internet for remedies—and tried every one—or amassed a mountain of books about sleep—and read them all—to little avail. Can I suggest anything that might help?

Here is Geri’s story (abbreviated to save space) and my response.

A Caregiver’s Hectic Life

I have had insomnia since 2005. I have four children (13, 10, 9 and 7) and at time of onset only had one. Triggered by changing jobs and trying to get pregnant—so stressful! I am a community mental health nurse. I have a caseload of 22 adults with psychosis and am their primary support. . . . [At night] it can take 2 hours for me to fall asleep and then I usually wake between 12 and 2 a.m. I do not go back to sleep. . . . I am naturally an over thinker, I do stress easily and worry a lot. . . . I’ve never been a great sleeper but yes I used to sleep. We are struggling financially so not working is not an option. . . . I have a library of books on sleep, have spent hundreds of pounds on various remedies and treatments—but alas nothing really seems to help. Can you suggest anything?

Geri had a lot on her plate. She was on the go all the time, caring for patients during the workday and children at night. Her busy schedule didn’t leave much time for self-care.

She knew what she needed: fewer responsibilities. If she won the lottery, she said, she’d resign from nursing, fix up her house, and be the mother and relaxed partner she’d like to be. But that was not in the cards.

Adding Things In, Cutting Things Out

Despite her time constraints, Geri was resourceful in looking for insomnia remedies. She’d also established some habits conducive to sound sleep: eating healthy foods, getting plenty of exercise by cycling to and from work and her patients’ homes, and practicing mindfulness.

But she’d also tried a raft of insomnia remedies that didn’t seem to help, from herbs and homeopathic insomnia cures to acupuncture and CDs with “odd sleep-inducing sounds.” When Geri wrote to me, she was planning to ramp up her efforts to improve her sleep by:

  • Adding high-intensity interval training to the cycling she did everyday (though it was a struggle to find the energy for this activity)
  • Cutting out alcohol completely (which, in times of desperation, she used to get to sleep)
  • Cutting out processed sugar, including the “crap biscuits” (cookies) she was prone to eat when super tired

What did I think?

Regimentation, Stress and Sleep

My immediate reaction on reading Geri’s story was that I could never do half of what she does and expect to sleep consistently well. With so many responsibilities I’d be popping Valiums every day!

Seriously, though, Geri’s sleep problem may have been related to chronic stress and the double duty she was doing as caregiver for her patients and her children (i.e., caregiver stress). Even so, her inclination was not to find ways to make her responsibilities more manageable. It was to do still more, adding high-intensity interval training to an already busy schedule and restricting an already healthy diet still further.

I wondered if the restrictive regimen she was about to impose upon herself would sooner or later become yet another source of stress. It’s true that exercise is beneficial to sleep. But nowhere has it been suggested that a person should have to cycle to and from work and do high-intensity interval training to get better sleep.

Dietary Choices and Sleep

It’s also true that what we eat can affect our sleep. But having a cookie now and then is probably not going to make a difference. There’s a lot of information now suggesting that overindulgence in simple carbohydrates is harmful to health. We shouldn’t routinely have Hostess cupcakes washed down with Pepsi for lunch. But cut out sugar completely? I follow the literature on insomnia and sleep pretty closely, and not one study I’ve seen has shown that cutting sugar out altogether from our diets will improve sleep.

Likewise, it’s smart to avoid using alcohol for sleep. But a glass of wine at happy hour is probably not going to have much impact on the night at all. It sounds punitive for Geri to try to regiment her life still more than it already is.

Reduce Stress With Better Self-Care

It could be that Geri would benefit from consulting a sleep doctor or a sleep therapist and that cognitive behavioral therapy for insomnia, administered by a trained professional, might help. A sleep study might uncover an underlying sleep disorder (or show she was getting more sleep than she thought).

But I think Geri’s sleep would improve if she were to reduce her stress by engaging in more nurturing self-care. She’s got a head start on some of the ways to do this but other readers may not:

  • Take half an hour a day for yourself and do something purely for pleasure (gardening, reading a novel, playing the piano)
  • Learn and use stress reduction techniques such as meditation, yoga, or Tai Chi.
  • Stay current with your own healthcare needs.
  • Eat regular, healthy meals.
  • Exercise daily.
  • Take time off when you can.
  • Maintain ties with friends and supportive family members, and when possible seek and accept their support.
  • Seek counseling when you need it or reach out to friends

If you’re a full-time caregiver, what’s the best way you’ve found to take care of yourself?

Tips for Relieving Stress and Improving Sleep

Do stressful situations throw your sleep off track? You’d probably score high in sleep reactivity, a stable trait associated with insomnia. If a rough day at work kept you tossing and turning last night, then similarly charged situations—arguing with your spouse, getting bad news, preparing to speak in public—may disrupt your sleep now and then.

But what if the stress is chronic? Then it’s time to deal with it head on. Here are four ways to reduce stress and improve sleep.

Stress-related Insomnia can be alleviated with social supportDo stressful situations throw your sleep off track? You’d probably score high in sleep reactivity, a stable trait associated with insomnia. If a rough day at work kept you tossing and turning last night, then similarly charged situations—arguing with your spouse, getting bad news, preparing to speak in public—may disrupt your sleep now and then.

But what if the stress is chronic? Then it’s time to deal with it head on. Here are four ways to reduce stress and improve sleep.

Have a Physical Outlet for Stress

Persistent activation of the stress-response system results in higher-than-normal levels of cortisol and other stress hormones, all harmful to long-term health. Not only does this increase your susceptibility to chronic insomnia, but it also suppresses your immune system and elevates your risk of hypertension, heart disease, and depression. It interferes with learning and memory as well.

Exercise—jogging, swimming, bicycling, playing tennis—protects against development of stress-related disease. Immediately following a workout there’s a decrease in muscle tension and a release of body heat, which can hasten sleep onset and enhance sleep quality. Exercise can also help to elevate mood. Long-term, regular exercise tends to lower the resting heart rate, making it easier to relax.

But to maximize stress relief, choose a form of exercise you enjoy (or at least find tolerable). Regularity in the timing of workouts, like regularity in the timing of meals, is also conducive to regular sleep. Continuing practice of yoga and meditation can yield similar results.

Reach Out to Friends

Feeling overextended and stressed out can be isolating. Your instinct may be to cut people and relationships out of your life as you move full speed ahead on whatever you need to accomplish.

But having an active social support system is another key way to reduce chronic stress. Research suggests that regardless of who’s doing the talking and who’s doing the listening, interactions with friends and supportive family members help cut down on chronic stress. Participating in group activities can also help with stress relief.

Increase Your Sense of Control When Possible

Some situations are beyond control—diseases that have no cure, job losses due to economic factors, deaths that cannot be prevented. Trying to take control of these situations will likely send your stress off the charts.

But there are situations where exerting more control affords stress relief. For instance, if you’ve got too much on your plate, separate tasks into “musts” and “shoulds” and prioritize them accordingly. To nonessential tasks just say no.

And say no when someone else tries to foist on you a responsibility you cannot fit in. You’ve watched the grandkids for the past three days—now it’s someone else’s turn.

Yes, browsing the internet for the latest political news can be invigorating. But if it tends to work you up too much, vow to tear yourself away from the iPad by 8 p.m.

Increase Predictability

No one likes monotony. Yet a degree of predictability in life tends to lower stress. Says neuroendocrinologist Robert Sapolsky, “When it comes to what makes for psychological stress, a lack of predictability and control are at the top of the list of things you want to avoid.”

If your boss is liable to throw projects your way at any time, including 3 p.m. on Friday, muster up some negotiating skills and request advance notice. If late night phone calls tend to stress you out, ask friends and family to refrain from calling after 9 p.m. If you’re having trouble making ends meet, work up a monthly budget.

The more predictable life is, the better able you will be to plan coping strategies, which will make for better stress resilience and better sleep.

What activity or strategy do you find is most helpful in lowering stress?

A Sleep-Friendly Bedtime Routine

A cardinal rule of sleep hygiene involves establishing a bedtime routine and here, I’m a believer. Even if I’m out till midnight, leapfrogging from a meeting or a party straight into bed is a setup for insomnia. I’ve got to have at least 45 minutes—better yet, an hour or more—to shift myself out of overdrive and into idling mode.

Here are some things to do in the run-up to bedtime to ease the transition between wakefulness and sleep.

Bedtime routine helps condition body and mind to expect sleepA cardinal rule of sleep hygiene involves establishing a bedtime routine and in this, I’m a believer. Even if I’m out till midnight, leapfrogging from a meeting or a party straight into bed is a setup for insomnia. I’ve got to have at least 45 minutes—better yet, an hour or more—to shift myself out of overdrive and into idling mode.

Here are some things to do in the run-up to bedtime to ease the transition between wakefulness and sleep.

Create a Healthy Sleep Environment

  1. Turn off devices with screens. The light they emit (and your proximity to it) may delay secretion of melatonin, a sleep-friendly hormone whose levels normally start to rise a couple hours before bedtime.
  2. Set the bedroom up for comfort in advance. Adjust thermostats, windows, or fans so that by the time you go to bed, the room temperature will be a little cooler than is comfortable during the daytime. Turn down the covers and set the alarm clock. Your sleep environment should be set up so that at bedtime, the only thing you have to do is slip between the sheets.
  3. Turn clocks to the wall. If you’re a sleep onset insomniac like me, clock watching at night will make you anxious—and anxiety is incompatible with sleep. Stay away from rooms with wall clocks.

Dial Down Stress

  1. Take an evening walk. High levels of circulating stress hormones prepare your body for action—not to slow down. Work the stress out with physical activity, even if it’s only walking around the house.
  2. Relieve tension with the help of a shiatsu massage pillow for 15 or 20 minutes.
  3. Do 20 minutes of diaphragmatic breathing, progressive muscle relaxation, or yoga. All these activities help to reduce stress.
  4. Take a bath or a shower. Warmth relieves muscle tension. Warming the skin also increases your core body temperature, triggering an internal cooling mechanism conducive to sleep. In the summer months, lower your body temperature more quickly by taking a cool shower instead.

Immerse Yourself in a Relaxing Pastime

  1. Read an engaging book (but steer clear of books that are scary or upsetting), and keep a stash of them by your favorite chair. Or listen to a book on CD. If reading’s not your thing, stream movies on the TV (but not on the computer screen).
  2. Listen to mellow music or make music yourself (if you can do it without disturbing others).
  3. Page through photo albums, coffee table books, old National Geographics and Life magazines, or catalogs. Arresting images capture the attention quickly: they’re a good way to refocus your attention outside yourself.
  4. Do crafts: beading, needlework, scrapbooking, knitting, woodworking, leatherworking, macramé, or any other sedentary activity involving use of the hands.
  5. Keep a sketchpad and pencil next to your favorite chair and draw.
  6. Do crossword puzzles or play Sudoku or any other word game.
  7. Play Solitaire (with cards, not online).
  8. Work on jigsaw puzzles.

Once you’ve got a comfortable bedtime routine, stick with it. Going through the same routine night after night will condition your mind and body to expect sleep when it’s finally time to turn the lights out.

What type of activity helps you fall asleep at night?

Stress-Related Insomnia? Don’t Give Up

Why does stress cause insomnia in some people while other people can park their stress outside the bedroom door? No one has a comprehensive answer to this question.

But researchers say that sleep reactivity, situational factors, and responses to stress determine who’s likely to develop insomnia and who isn’t. Here’s more about the research and how to keep stress from ruining the night.

Stress affects some people's sleep more than others, but everyone can become more resilientWhy does stress cause insomnia in some people while other people can park their stress outside the bedroom door? No one has a comprehensive answer to this question; too many things are involved.

But researchers at Henry Ford Hospital say that—in addition to sleep reactivity, a trait-level quality that predisposes some of us to insomnia—situational factors and responses to stress determine who’s likely to develop insomnia and who isn’t. Here’s more about their research on stress and sleep and thoughts about how to keep stress from ruining the night.

How Investigators Got Their Information

The study they conducted was aimed at identifying factors that cause sleep to go from good to bad. They used data collected from good sleepers participating in the Evolution of Pathways to Insomnia Cohort study.

First, the researchers determined that none of the 2,892 participants qualified for an insomnia diagnosis at the beginning of the study. Next, participants took several pencil-and-paper tests designed to assess relationships between stress and sleep. A year later, the group took the same battery of tests a second time to ascertain how their lives and their sleep had changed.

Impact of Stress on Sleep

By the end of the year, 262 study participants, or 9.1%, had developed insomnia disorder.* The number, severity, and duration of stressors had a significant impact on participants’ sleep. The odds of developing insomnia increased

  • by 19% for every additional stressor participants reported
  • by 4% for every one-point increase participants gave to stressors on a severity scale
  • by 2% for every 1-month increase in the duration of stress.

None of this is surprising, but it’s interesting to see quantitative data coming out of a prospective study.

Response to Stress

Many insomniacs say that what keeps them awake is a mind that keeps going and going at night. In this study, participants had to report how much they thought about the stress they were experiencing by assigning a numerical value to statements like this: “I thought about it when I didn’t mean to.”

The tendency to engage in intrusive thinking following stress exposure was a significant predictor of who would and wouldn’t develop insomnia, accounting for 69% of the total effect of stress exposure on insomnia. The inclination to ruminate has long been known to perpetuate insomnia. The results of this study suggest that rumination may also precipitate insomnia.

Coping Strategies Matter, Too

But vulnerability to insomnia isn’t just a matter of genes and traits and happenstance. How we cope with stress can also amplify or mitigate its effects on sleep. The authors note that thought suppression, a strategy insomniacs often use to hold intrusive thoughts at bay, usually backfires. It tends not to empty the mind but rather to heighten cognitive arousal.

They also report that under conditions of stress, the following coping strategies are predictors of insomnia:

  • substance use
  • giving up based on a belief that nothing can be done to ease the situation
  • self-distraction

But regarding self-distraction (which I believe actually helps me when I’m feeling too aroused for sleep), the authors acknowledge that the literature on this coping style is mixed. Some studies suggest it’s effective in times of stress and others suggest it’s of little or no benefit.

So What to Do?

What not to do is pretty clear from the above. Better strategies for managing stress (and its negative effects on your sleep) are these:

  1. Make sure you have a physical outlet for your stress: daily exercise, or a mind-body practice such as yoga, qi gong, and tai chi.
  2. Try mindful stress reduction. Early studies suggest that it helps reduce stress.
  3. Resist the urge to go it alone. Research has shown that spending time with friends and supportive family members reduces stress.
  4. Increase predictability where you can. If sporadic late night phone calls from your mother stress you out, ask her to refrain from calling after 7 p.m.
  5. Do what you can to increase your sense of control (except in extreme situations where you really have no control). Shorten your to-do list by getting rid of nonessential commitments; negotiate for someone else to cook the turkey this year; and when a stressor feels overwhelming, sit down with a paper and pencil and break the problem into smaller parts. This way, you can actively work to ease or resolve the situation in a step-by-step fashion, which will likely help your sleep.

When you’re stressed out, do you find that distraction helps or hurts your sleep?

* Insomnia disorder was defined in this study as (a) trouble falling or staying asleep, or nonrefreshing sleep, at least 3 times a week for at least 1 month, and (b) daytime distress or impairment.