Sleep Smart: Stressed and Tired

Recently, Philips introduced a new series of articles that explore how sleep affects different aspects of health, in an effort to help the world open their eyes to the importance of a good night’s sleep. In these uncertain times, stress and anxiety are not only debilitating to everyday tasks, but directly impact sleep health. Increased levels of stress can cause sleep loss, and more severely can lead to long-term insomnia. In fact, according to Philips annual global sleep survey, 33 percent of respondents cite stress as the most limiting factor to a good night’s sleep. Understanding how sleep and stress are related is key to maintaining balance and possibly even preventing sleep-related comorbidities down the road.

The science between stress and sleep

Stress has long been linked with sleep problems. Around the world, researchers have verified the connection of sleep and stress in a multitude of studies. For example, a Swedish study found that a stressful work environment significantly increased the risk of episodes of insomnia [1]. Another study focused on American college students found that stress from family life contributed to an increased risk of insomnia, and the risk was even higher when combined with stress from academic pressure [2]. 

The scientific connection between stress and sleep starts in the brain. Research has confirmed that stress induces reactions in the nervous system, endocrine system, and immune system [3]. These reactions create a state of hyperarousal where the brain operates on “high alert”. It’s because of this arousal that people under stress may experience symptoms of insomnia. Traditionally, this manifests in difficulty falling asleep initially or being unable to fall back asleep after waking up in the night. 

These days, people around the world are experiencing increased levels of stress and anxiety as the economic and societal impacts of the coronavirus pandemic foster sentiments of uncertainty. And with stress, comes insomnia. In fact, according to a recent report, the use of antidepressant, anti-anxiety, and anti-insomnia medications spiked 21 percent between February and March of 2020. 

Insomnia is a disorder characterized by repeated difficulty with either falling or staying asleep, despite adequate opportunity, condition and time to do so. Chronic insomnia leads to higher risks of developing obesity, diabetes, cardiovascular disease, hypertension, anxiety and depression [4]. Further, people who frequently have trouble sleeping typically complain of impaired daytime functioning. 

Insomnia can be difficult to diagnose. For people who have trouble falling and staying asleep, a programmatic approach to changing behaviors may be the ticket. Mark Aloia, PhD, Global Lead for Behavior Change at Philips, recommends a series of challenges to help retrain sleep habits without the need for medication or supplements:

• Wake up at the same time every day to reset the body’s clock and build its drive to sleep.
• Reduce time in bed to ONLY time spent sleeping. This may can seem counterintuitive, but it can help the body associate the bed with sleeping alone. 
• Conversely, increase time in bed if a healthy amount of sleep is being achieved.
• Test out different sleep and wake times to adjust the body’s natural clock. 
• Once a stable schedule has been reached – which may take time – maintain it. Journaling about the experience can be a useful tool.

Take a deep breath

The way we lead our daily lives truly impacts our sleep and overall health. In general, people looking to maintain good, regular sleep hygiene should engage in bedtime activities and behaviors that enhance sleep, like following a regular sleep schedule, relaxing before bedtime and participating in aerobic exercise during the day. 

According to Dr. Teofilo Lee-Chiong, Chief Medical Liaison at Philips Sleep and Respiratory Care, “we are increasingly more aware of how sleep affects our health. A philosophy of self-care, including a greater sense of responsibility over our lifestyle, will likely highlight sleep habits as an essential component of healthy living. Breathing exercises, meditation, mindfulness and other practices that focus on self-management of sleep offer opportunities for further enriching our lives."

Having trouble relaxing to sleep after a particularly stressful day? Patterned breathing may be worth a try:

1. Find a place and body position in which you can truly relax, and potentially drift off to sleep
2. With eyes closed, breathe in for about four seconds – whatever feels comfortable 
3. Hold that breath for about seven seconds – slightly longer than the breath in
4. Exhale continuously for about eight seconds – ever so slightly longer than you held it
5. Repeat for at least four full breaths, until reaching a state of deep relaxation or fall asleep

The natural act of breathing has been used as a means of relaxation intuitively, and has been traditionally part of different yoga traditions and is now incorporated in many relaxation programs. Many studies have shown the effectiveness of breathing techniques [5-9] in both managing stress and preparing the body for sleep. In some cases, slow-paced breathing techniques have even been shown to help improve sleep quality overnight [10].

It’s important that people around the world recognize if their sleep is being negatively impacted by increasing levels of stress and anxiety. By recognizing troubles with falling and staying asleep, people can address the issue head-on and move forward towards adopting a healthy lifestyle – starting with practices to improve sleep quality. To better understand these issues, Philips SmartSleep Analyzer online assessment tool offers a clinically validated way to identify and suggest solutions for some of the most common sleep challenges. 

[1] https://www.ncbi.nlm.nih.gov/pubmed/15125800 

[2] https://www.ncbi.nlm.nih.gov/pubmed/17371110

[3] Institute of Medicine (US) Committee on Military Nutrition Research; Marriott BM, editor. Food Components to Enhance Performance: An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations. Washington (DC): National Academies Press (US); 1994. 10, Endocrine and Immune System Responses to Stress. Available from: https://www.ncbi.nlm.nih.gov/books/NBK209065/ 

[4] Institute of Medicine (US) Committee on Sleep Medicine and Research; Colten HR, Altevogt BM, editors. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington (DC): National Academies Press (US); 2006. 3, Extent and Health Consequences of Chronic Sleep Loss and Sleep Disorders. Available from: https://www.ncbi.nlm.nih.gov/books/NBK19961/ 

[5] Jamie Alan Bell, Josette Bettany Saltikov. Mitchell’s relaxation technique: is it effective? Physiotherapy. 2000, 86, 473-478. http://www.sciencedirect.com/science/article/pii/S0031940605608097

[6] Liza Varvogli, Christina Darvin. Stress management techniques: evidence-based procedures that reduce stress and promote health. Health Science Journal. 2011, 5, 74-89. http://www.hsj.gr/medicine/stress-management-techniques-evidencebased-procedures-that-reduce-stress-and-promote-health.php?aid=3429 

[7] Brook, R.D. et al. Beyond Medications and Diet: Alternative Approaches to lowering blood pressure. Hypertension, 2013; 61:00-00.

[8] T.J.W. Tijs, J. Du, M. Krans, O. Ouweltjes, J. Vogt, J.J.G. de Vries. User tests on paced breathing procedures. (2010) Technical note: PR-TN 2010/00256

[9] J. Du; R.M. Aarts; J.M. Krans; R.J.E.M. Raymann; T.J.W. Tijs; J. Vogt; J.J.G.de Vries; P.H. Pelgrim. User test on paced breathing for sleep: comparing competitor algorithms. (2010). Technical note: PR-TN 2010/00263

[10] Laborde S, Hosang T, Mosley E, Dosseville F. Influence of a 30-Day Slow-Paced Breathing Intervention Compared to Social Media Use on Subjective Sleep Quality and Cardiac Vagal Activity. J Clin Med. 2019;8(2):193. Published 2019 Feb 6. doi:10.3390/jcm8020193