Psychological Stress and Sleep

Evidence begins to accumulate

You might think it obvious that psychological stress would affect your ability to get a good night’s sleep. But it wasn’t that long ago (2004) when researchers at the Henry Ford Hospital in Detroit first showed that individuals who had stronger perceptions that psychological stress impaired sleep took longer to fall asleep and spent less time sleeping while in bed.

How can stress harm your sleep?

It would seem that people who experience psychosocial stress would be prone to sleep problems. Stress leads to increased psychological and physiological activation via the hypothalamo-pituitary-adrenocortical hormone system, which impairs restful sleep. Yet, as of 2006, only cross-sectional and short-term studies linked psychosocial stress to sleep impairment. The lack of longitudinal studies limited researchers’ ability to distinguish the effects of acute and long-term psychosocial stress. Plus, cause-and-effect were impossible to disentangle. Does stress harm sleep or does poor sleep create stress?

The first longitudinal study of chronic stress and sleep

The first longitudinal study of the effects of chronic stress on sleep involved 330 older women (average age 51 years) at 7 clinical sites across the US. Chronic stress was classified as low, moderate, or high for each participant. A baseline, women in the high stress group were significantly more likely to be non-white, not married, have overweight or obesity, and report very upsetting acute life events or symptoms of depression. After 9 years of follow-up, participants in the high chronic stress group were significantly more likely to have lower sleep quality and sleep efficiency (that is, longer periods of wakefulness after initially falling asleep), and spend more time in bed compared to participants in the low chronic stress group. After adjusting for factors known to disrupt sleep (including baseline sleep complaints), participants in the low-stress group had significantly lower odds of developing insomnia compared to participants in the high-stress group. Over time, chronic stress diminishes aspects of sleep quality and duration.

What is sleep reactivity?

Sleep reactivity refers to a predisposition to sleep disturbance arising stressful life events, or environmental changes, or from medications. Researchers at the Sleep Disorders and Research Center in Detroit developed the 9-item Ford Insomnia Response to Stress Test (FIRST) to quantify sleep reactivity. A summary the recent literature by the same team of researchers showed how understanding sleep reactivity could help prevent insomnia and increase resilience to trauma. The 19 included studies showed that individuals with high sleep reactivity, measured using FIRST, are prone to developing insomnia after a stressful event. Additional downstream effects include psychopathology and traumatic stress. Preliminary evidence suggests that higher sleep reactivity prior to experiencing a traumatic event increases the risks of acute stress disorder, depression, and post-traumatic stress disorder.

Although early evidence suggested that sleep reactivity is a trait that could not easily be changed, more recent evidence suggests that sleep reactivity can be reduced via two-step approach: 1) FIRST can identify persons with high sleep reactivity who are more likely than persons with low sleep reactivity to develop insomnia. 2) Individuals who are more susceptible to insomnia can receive cognitive behavioral therapy oriented toward insomnia (CBT-I), which studies show can significantly reduce sleep reactivity, especially before insomnia has become entrenched. You can review FIRST to see how your score compares with the commonly used score that signifies high sleep reactivity. You can also check out a free CBT-I guide.


Psychological stress reduces your ability to get a restful night’s sleep.

What to do

If you experience chronic psychological stress, I encourage you to learn to relax before or just after going to bed. For years, I’ve repeated (silently) the script of a guided meditation by the Honest Guys from the UK. Rick Clarke’s soothing voice and the sounds of the waves calm my mind. In the past, I usually finished the first 8-minutes of guided meditation before falling asleep. When that happened, I’d continue listening until the end at 18 minutes. These days, I rarely get to the end of the first 8 minutes because I’ve learned to relax and to let my thoughts float away. This relaxing guided meditation might help you relax and sleep better. I’ve also found that regular, deep breathing while listening to or repeating the script helps me relax.

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