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.