Sleep Deprivation and Anxiety: New Findings

Researchers at UC Berkeley have shown that sleep deprivation amplifies anxiety in people prone to worry. In a study written up in Science Daily, the researchers found that a single sleepless night greatly ramped up neural activity in two brain regions associated with the processing of emotion.

Stress and negative emotion felt strongly after sleep deprivationIt’s a vicious circle, as many people with chronic insomnia will attest. Stress and worry lead to bad nights, and the resulting sleep loss seems to magnify the worries, which in turn leads to worse nights and soaring anxiety, and on and on. Once the cycle is set in motion, it can feel impossible to stop.

Researchers at UC Berkeley have shown that sleep deprivation amplifies anxiety in people prone to worry. In a study written up in Science Daily, the researchers found that a single sleepless night greatly ramped up neural activity in two brain regions associated with the processing of emotion: the amygdala and the insular cortex. Excess activity in these two regions is common in people that have generalized anxiety disorder, panic attacks, and PTSD.

Study Particulars

Eighteen healthy young adults were the subjects in this experiment. They spent two nights in UC Berkeley’s Sleep and Neuroimaging Laboratory. They got a good night’s sleep on the first night. The second night, they stayed awake.

After both nights, they watched a slide show containing neutral and highly disturbing images, during which time their brains were scanned using functional MRI. Before each image, a visual cue was presented to create anticipation for the image that would follow. A yellow circle indicated that a neutral image such as a bicycle was going to appear. A red minus sign portended a disturbing image such as the body of a burn victim. And a white question mark signaled that either a neutral or a shocking image would flash upon the screen.

An Emotional Roller Coaster

The red minus sign and the white question mark triggered enormous anticipatory anxiety in the subjects when they were sleep deprived, as shown by the excessive neural activity occurring in the emotion centers of their brains. And in sleep-deprived subjects who were naturally prone to anxiety, the activity in the amygdala and insular cortex was sky high.

The subjects in this experiment were not insomnia sufferers. But if sleep deprivation magnifies anxiety in healthy, normal sleepers, it’s bound to boost anxiety in us. I for one am as familiar with this pattern as with the back of my hand. Bad nights heighten whatever anxiety I may be feeling, in turn begetting more bad nights and even greater anxiety.

No wonder insomniacs sometimes feel like we’re on an emotional roller coaster and powerless to make it stop.

How does insomnia affect you emotionally?

Who Says Sleep Declines with Age?

Older adults tend to sleep less than younger adults, with total sleep time declining by about 10 minutes per decade.

But the assumption that sleep problems generally increase with age does not always hold true, according to two studies recently published in the journal Sleep.

sleep-agingI used to be the only insomniac among my champion sleeper peers. Now several of my friends report experiencing insomnia. I guess that’s not surprising: we’re the baby boom generation, and sleep problems tend to increase with age. Or do they?

Older adults do tend to sleep less than younger adults, with total sleep time declining by about 10 minutes per decade. But the assumption that sleep problems generally increase with age does not always hold true, according to two studies recently published in the journal Sleep.

Study Results

Investigators in the first study analyzed complaints of sleep disturbance and tiredness in over 150,000 Americans age 18 and above. What they found was surprising:

  • The youngest group (18- to 24-year-olds) had the highest rate of reported sleep disturbance, and the oldest group (70- to 74-year-old males, and females age 80 and above) had the lowest rate.
  • The 18- to 24-year-olds and adults age 70 and older reported the highest rates of tiredness, while adults age 65 to 69 reporting the lowest rate of tiredness.
  • Overall, the investigators concluded, “both sleep disturbance and tiredness complaints generally declined across the life span.”

In the second study, researchers took data from over 84,000 people in England and Finland and looked to see how sleep lost over worry changed with age. These findings, too, suggest that sleep quality doesn’t necessarily decline with age:

  • Sleep loss over worry was highest among 34- to 55-year-olds.
  • There was a decline in sleep loss over worry between the ages of 56 and 65 (in women, however, the decline began somewhat later than in men).
  • Sleep loss over worry was the lowest in old age.

Sleep Complaints, Health, and Stress

How can we explain why people in the oldest age groups reported better quality sleep than younger people? One factor that may be involved is overall health. People develop more health problems as they age, and many of these problems have a negative impact on sleep and on mortality. People who survive into the oldest age groups may be particularly resilient to age-related health problems and thus may not experience the associated problems with sleep.

Stress is clearly a factor in the sleep loss over worry reported by the younger groups: people in their 20s and 30s are completing college degrees, entering the job market, and bearing and rearing children. Baby boomers well along in middle age are contending with a few stressors too: we’re developing health problems; losing jobs to a younger, cheaper workforce; caring for sick parents; and even parenting grandchildren. Maybe it’s only the luckiest among us that will slide into old age with a clean bill of health and sound, restorative sleep.

Anyway, when I talk about insomnia these days, I’m not the Lonely Hearts Club Band member I used to be. Now I’ve got plenty of company.

If you’ve got a sleep problem, when did it begin? Was it related to stress or something else?

Age and Sleep Disturbances

Sleep Lost over Worry

Insomnia? The Doctor Is Out to Lunch

I’ve had some excellent medical care over the years, but when it comes providing help for insomnia, many doctors are out to lunch. They grab hold of a single idea about insomnia—it’s due to poor sleep hygiene, it’s due to stress, or it’s due to psychic damage that needs to be sorted out—and treat insomniacs as if we’re all alike.

Insomnia and DoctorsI’ve had some excellent medical care over the years, but when it comes providing help for insomnia, many doctors are out to lunch. They grab hold of a single idea about insomnia—it’s due to poor sleep hygiene, it’s due to stress, or it’s due to psychic damage that needs to be sorted out—and treat insomniacs as if we’re all alike.

I’ve spoken with several other insomniacs who feel the same way. Especially irritating are the doctors convinced that every person with insomnia has a mood disorder.

Jennifer’s Story

Jennifer, whom I interviewed a few years ago for my book, had tried several drugs to combat the sleeplessness she’d been plagued nearly all her life, and her doctor finally referred her to a psychiatrist. But the psychiatrist’s attempts to peg her as a depressive contradicted her belief that, apart from her sleep problem, she was basically a happy person.

“He was like, ‘Oh you look depressed today, I think you’re depressed.’ He kept trying to convince me I was depressed.”

“I’m like, ‘I’m not depressed.’ It was really annoying.”

“If I moved my fingers around at all, he was like, ‘Oh, you’re fidgety, you’re fidgety.’”

“I’m like, ‘OK.’ So I learned to keep my fingers still when I was around him.”

“And he’d say, ‘Oh, you’re calm today.’ He was just so eager to think he was doing something right. I stopped seeing him because it got to the point where he was trying to convince me that I was depressed when I was not.”

“I’m not depressed,” Jennifer continued. “Most people think I’m the cheerful one, open, outgoing. I don’t sit at home and cry. I’m not sad about things. I don’t have one single symptom except that I can’t sleep.”

Bill’s Story

Bill had a similarly negative experience with doctors who he believed had misdiagnosed his sleep complaint as depression:

“The doctors want to suggest that I’m depressed, and I deny it. I say I’m exhausted,” he said when I spoke with him on the phone. “The only time I really admit to something approaching depression is when you guys [the doctors] start trying to pin a DSM cultural label [a mental disorder] on me.”

Not All Insomniacs Are Alike

It’s true that many people with insomnia are also afflicted with mood disorders, but not all of us. The causes of insomnia are many and varied, and while sleep experts now acknowledge this, many other doctors are still in the dark.

Peter Hauri, a pioneer in sleep research who died two months ago, said in an interview in 2010 that one of the most important things he learned from his research was that every sleep problem was unique. “There is no one set of rules that can be mimeographed and given to every patient who comes into the office,” Hauri said.

Amen, I say. But how long will it be before medical schools start turning out doctors who are similarly savvy about insomnia and sleep?

What experiences have you had talking about insomnia with doctors? Have they explored the problem to your satisfaction, or not?

 

Too Aroused for Sleep? Try Yoga

Sat Bir Khalsa, a professor and researcher at Harvard Medical School, thinks that among alternative treatments for insomnia, yoga may also be a viable solution for people who feel too aroused to sleep.

I attended Khalsa’s presentation at a conference a while back. Here’s the gist of what he said.

Insomnia sufferers may want to try yoga to prepare for sleepAn acquaintance of mine said she’s often “just too wound up, too hyped up” to sleep.

I know the feeling. It‘s like my body’s stuck in overdrive, and I can’t find the brakes. The best solution for me is physical exercise.

But Sat Bir Khalsa, a professor and researcher at Harvard Medical School, thinks that among alternative treatments for insomnia, yoga may also be a viable solution for people who feel too aroused to sleep. I attended Khalsa’s presentation at a conference a while back, and later I contacted him for more information.

“Yoga works on inducing the relaxation response,” Khalsa said, producing “a reduction in stress system activation. Yoga and meditation practice also changes the perception of stress … creating a positive change in stress tolerance.”

Sounds good to me. But is there proof?

A small number of studies attest to the benefits of yoga as a strategy for managing insomnia, and some of them are randomized controlled trials (RCTs). In RCTs, the results of subjects who undergo a treatment are compared to the results of control subjects who do not, a protocol considered by scientists to meet the highest standard of proof.

  • An RCT conducted in an Indian home for the aged produced spectacular results: subjects who practiced an hour of yoga six days a week for six months increased their total sleep time by a whopping 60 minutes a night! They also reported greater ease in falling asleep and feeling more rested in the morning.*
  • In an RCT published last year, postmenopausal women in Brazil experienced a significant reduction of insomnia symptoms and increased stress resistance following four months of yoga practice.**
  • Khalsa’s RCT, which he discussed at the conference, showed that the sleep of subjects who practiced 45 minutes of yoga before bedtime every day for eight weeks improved substantially more than the sleep of control subjects, who received information about sleep hygiene. Yoga subjects reported increases in total sleep time that were two and three times as great as the increases made by controls. (Again, we’re talking in the neighborhood of 60 minutes’ more sleep a night.)

Yoga may achieve its calming effects in a paradoxical way, Khalsa told me, by increasing levels of the stress hormone cortisol while at the same time improving stress tolerance. The overall effect is to decrease feelings of arousal.

This is why insomniacs – particularly those who tend to feel wound up at night – may want to try it out.

*   Influence of Yoga & Ayurveda on self-rated sleep

** Yoga decreases insomnia in postmenopausal women

Insomnia and Hyperarousal

Lots of factors can push you in the direction of persistent insomnia: chronic stress, rumination and worry, and too much time in bed, to name a few.

Another factor that increases your susceptibility to insomnia is physiologic “hyperarousal,” sleep experts say.

Insomniacs may experience hyperarousal night and dayLots of factors can push you in the direction of persistent insomnia: chronic stress, rumination and worry, and too much time in bed, to name a few.

Another factor that increases your susceptibility to insomnia is physiologic “hyperarousal,” or so some experts say. Measures of heart rate, metabolism, stress hormones, and body temperature have shown that insomniacs are cranked up a notch higher than normal sleepers.

At first blush the idea may seem like a stretch. When you think of what hyperarousal might look like, you think of multi-taskers who can scarf down an order of General Tso’s while answering email and jabbering on the phone. Or maybe you think of the person who crowds you at the checkout counter or who tailgates your car.

If you have trouble sleeping, chances are these profiles don’t fit yours. You’re more likely to slog through the day, hard-pressed to muster enough energy and sharpness to do your job. It’s tough to imagine this kind of exhaustion could square with being hyperaroused.

Looking for Hyperarousal

The notion of hyperarousal hit home for me when I came across a metric designed to assess people’s vulnerability to stress-related sleep disturbance – the Ford Insomnia Response to Stress Test (FIRST).* Take an abbreviated version yourself:

How likely is it that you’ll having trouble sleeping

  • after a bad day at work?
  • after an argument in the evening?
  • before an important meeting the next day?
  • before a trip?

If your answer is “likely,” if your sleep is prone to disruption by stressors that good sleepers can often park at the bedroom door, this could be a sign of physiologic hyperarousal – at least in the eyes of the researchers who created the FIRST. Christopher Drake and colleagues claim this sleep-related vulnerability to stress, combined with other measures of arousal in our bodies and brains, make people vulnerable to persistent insomnia.

Thursday’s blog will examine a way to lower your arousal levels and increase your tolerance to stress.

* Stress-related sleep disturbance and hyperarousal

Better Than Marijuana Brownies

Let’s be honest: the holidays aren’t always easy. The whole thing can stress you out to the point where all you want to do is eat, eat, eat. But you can’t exactly indulge yourself — it would look unseemly for you to scarf down all the Christmas cookies you yourself have baked.

Who knew that the solution to these inopportune food cravings lay in Ambien, America’s favorite sleeping pill?

Let’s be honest: the holidays aren’t always easy. Yuletide spirit, family togetherness, gathering ‘round the festal board night after night … Well, it can get to be a bit much. Especially if you’re the one doing most of the cooking, the whole thing can stress you out to the point where all you want to do is eat, eat, eat. But you can’t exactly indulge yourself — it would look unseemly for you to scarf down all the Christmas cookies you yourself have baked.

Who knew that the solution to these inopportune food cravings lay in Ambien, America’s favorite sleeping pill?

Writer Paul Simms knew it, and he told all. If you missed these recipes from the Ambien Cookbook when they first appeared in the New Yorker in July of 2006, maybe you’ll find them helpful now.

Sorpresa con Queso

Ingredients:

7 bags Cheetos-brand cheese snacks

17 to 19 glasses tap water

5 mg. Ambien

Place Cheetos bags in cupboard.

Take Ambien, fall asleep.

Wait 2-3 hours, then sleepwalk to kitchen, tear cupboard doors off hinges in search of Cheetos.

Find Cheetos, eat contents of all 7 bags.

Fall back asleep on kitchen floor.

When awakened by early-morning sunlight, get up and say, “What the—?”

Wipe orange Cheetos dust from fingers, face, and hair.

Drink 17 to 19 glasses of water from kitchen tap.

Return to bed.

Icebox Mélange

Ingredients:

Entire contents of refrigerator

1 Diet Snapple

5 mg. Ambien

Take Ambien, fall asleep.

Wait 2-3 hours, then sleepwalk to kitchen.

Devour everything in refrigerator (including all fancy mustards and jellies, iffy takeout leftovers, and plastic dial from thermostat).

Belch loud enough to wake wife or girlfriend. When she enters kitchen, bellow, “Can’t you see I’m working here?”

Fall asleep on kitchen floor.

After 4-5 more hours, wake up on subway, fully dressed from the waist up, drinking a Diet Snapple.