A Different Pathway to Chronic Insomnia

Let’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?

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.

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?