Too Stressed to Sleep: Is Stress Keeping You Up at Night?

By Nicola Cann - We’ve all been there. It’s 3am and you’re wide awake. You’ve been trying to sleep for hours but your brain keeps taking you back to that tricky conversation you need to have with a colleague tomorrow. Or to the disagreement you had with your partner over dinner. Before you know what’s happening your thoughts are spiralling out of control. No hope of sleep now.

These experiences are common, but for people experiencing acute or chronic stress the sleepless nights accumulate and lead to even more stress. You become stuck in a cycle of sleepless nights and daytime tiredness, which of course makes the stress even worse. 

We all experience stress differently but you’ve probably experienced some of these common symptoms of stress:

• Elevated heart rate

• Faster breathing

• Tense muscles

• Racing thoughts

• Getting stuck on negative thoughts and feelings (ruminating)

• Excessive worry (catastrophising)

When we’re stressed levels of cortisol, adenosine and adrenaline in our bodies are increasing. These are all associated with anxiety, alertness and sleep-wake timings. As these hormones are coursing through your body the regions of your brain involved in emotion regulation are starting to take over and the decision making regions are losing control. Your emotions are becoming heightened and your brain and body is going into ‘safety mode’. 

Stress in itself isn’t a problem. In fact it can be helpful. When we encounter a stressful situation our brains and bodies become more alert, making us ready for action. This process evolved to keep us safe. It’s a sign that something in our environment is potentially dangerous, and this stress response increases our readiness to respond. This was helpful when we were hunter gatherers and needed to be on the lookout for predators. However, if we experience extreme or chronic stress our bodies get used to being on high alert and this can become our default response. 

When Stress Takes Over

When we experience a stressful situation we have a stress response. For most of us most of the time we manage the situation and our stress response subsides. However, if the stressful situation is extreme, or we experience ongoing stress, our stress response can become maladaptive. We find ourselves experiencing those feelings of stress even in seemingly non-stressful situations. The more our bodies and brains experience a particular way of doing things, the more likely they are to default to those ways in the future. So if you felt stressed out last time you were buying coffee in your favourite cafe, you’re more likely to get stressed out next time you’re in that same environment doing that same activity. At this point we are no longer responding to something stressful in our environment but are reacting automatically. 

Unfortunately poor sleepers are more likely to struggle with anxiety, and anxious people are more likely to be poor sleepers. Here’s why.

Stress leads to poor sleep

If you’re stressed then you’re probably having trouble falling asleep. Our stress response can kick in at bedtime because we no longer have the distractions of the day to keep our mind busy. We go to bed ‘tired but wired’ after stressful experiences during the day and before we know it we’re lying in bed ruminating and catastrophising and telling ourselves we’ll never sleep again. 

Once that stress response kicks in, getting to sleep can be really tricky. Our brain and body are doing all they can to keep us alert. After all, you wouldn’t want to be falling asleep if there was a tiger prowling nearby! When we’re already tired and stressed we also have less resources for sticking to our planned bedtime, so we’re more likely to stay up late doom scrolling or watching Netflix.

Poor sleep leaves us with less capacity for stressful events the following day, leading to more stress when we’re trying to fall asleep the following night. Once we’re in this cycle it can be hard to get out. We start to associate bed and sleep with stress, so that our brains and bodies start to expect stress and sleeplessness whenever we get into bed.

Poor sleep leads to more stress

Even after a single night of poor sleep we are more likely to:

• Experience more negative feelings like anger and frustration (heightened negative reactivity)

• Focus more on the negatives (negative attentional bias)

• Respond in more extreme ways to stressful situations (emotional regulation)

• Over-react to stress (exaggerated stress response)

• Underestimate how much sleep we’ve had (subjective sleep is a good predictor of how tired we feel, regardless of how much actual sleep we’ve had)

• Be more sensitive to the negative effects of poor sleep

Why does this happen? Neuroimaging studies suggest that just like stress, sleep deprivation amplifies activity in the amygdala, and diminishes cognitive control, leaving us at the mercy of the emotional parts of our brain.

Research tells us that people with irregular sleep timings are more likely to struggle with anxiety, and that people who experience less Slow Wave Sleep are also more prone. So it’s not just about how much you get, but also when you sleep, and the quality of that sleep.

How to Disrupt the Cycle

The good news is that just as our brains get stuck in a negative cycle, we can create a positive cycle. Humans are wired to automatically look for the negatives, and our brains tend to take us down pathways that are familiar, so shifting from familiar negative to new positive pathways requires effort and practice, but with time these new pathways can become your default. 

Before You Start 

It’s important to consider whether there is an external stressor maintaining your poor sleep and anxiety. If this is the case, you can still benefit from the strategies below, but you should also try to improve your situation however you can.

You should also make sure you’re getting the basics right when it comes to sleep. Good sleep hygiene includes things like sleeping at regular times, exercising regularly, getting out into the daylight in the morning. For more sleep hygiene strategies take a look at my free Sleep Sheet. 

Strategies

The goal here is to convince your brain and body that there’s nothing to fear. You do this by creating new patterns of thinking and behaving when you’re experiencing stress, and by managing the physiological and psychological stress response through relaxation. Every time you practise these skills these new pathways become stronger. 

Here are my favourite tried and tested strategies. You don’t need to do everything at once. Pick five strategies below that you haven’t tried before and give them a go.

1. Find a relaxation technique that works for you. It could be a breathing exercise, meditation, body scanning, reading, stretching… practise throughout the day as well as before bed and when you’re feeling stressed. This will help you regulate your emotions throughout the day and night.

2. Control your worry. For example constructive worry time i.e. setting aside a time for when you worry, or making a list of what’s worrying you and putting items into categories of ‘can control’ and ‘can’t control’. 

3. Take back cognitive control at bedtime by disrupting the thoughts that are leading you to spiral. You can do this by repeating a simple word or phrase every five seconds until you fall asleep. If this isn’t working for you try doing simple sums or word puzzles in your head instead.

4. Get meta - ‘This too shall pass’. Take a mental step back from the situation and remind yourself that this is just a moment in time, and you will sleep again.

5. Challenge automatic thoughts. Will you really never sleep again? Will you really be completely useless at work tomorrow?

6. Don’t worry in bed - The more time you spend worrying in bed the more you will expect to feel worried when you get into bed. Break this connection by getting out of bed when you start to feel worried and doing something enjoyable and relaxing instead. Don’t worry about lack of sleep. You’re not sleeping anyway. The goal is to reduce worry, which in turn will lead to sleep.

7. Don’t give airtime to your sleep anxiety. If you’re talking about it and thinking about it a lot you are reinforcing the old negative cycle. Try focusing instead on the times you weren’t anxious and the times you slept well. 

8. Stop trying to sleep. The more you try to sleep the less likely you are to sleep. Instead aim to relax. Sleep will come once you’ve mastered this so try and forget about your sleep deprivation for now!

Making these changes can be tough so be patient with yourself. If your sleep difficulties and stress are well established and difficult to shift you may need more support. Cognitive behavioural therapy for insomnia is one of the best approaches for dealing with insomnia, and has a high success rate for people struggling with sleep-related stress and anxiety. Typically you follow a programme of six to eight sessions, where you are helped to manage sleep-related stress and challenge any automatic negative thoughts you have about sleep, whilst learning more about your individual sleep needs. CBTi works for around 80% of people, so if you think this is for you please get in touch.

Assertiveness

Assertiveness is a communication skill that is learned, often from parents/carers, friends and partners. However, whether you tend to be more passive, assertive, aggressive or passive-aggressive, can also be down to your nature or personality, as well as the situation you find yourself in. Most people struggle with being assertive with particular people in their life (for example those in a senior position at work), or in situations that feel stressful or tense (such as during conflict or disagreements). When we have personality characteristics, such as people-pleasing, we often sacrifice our own needs to keep others happy, and tend to be more passive. We can lean towards more aggressive behaviour when we want to get our point across, or when we feel challenged or threatened. And we can be more passive-aggressive when we’re not confident enough to challenge someone directly.

Assertiveness involves both verbal skills, such as your words and tone of voice, and non-verbal skills, such as eye contact and posture. When speaking to people assertively, it is helpful to use ‘I’ statements, such “I would like”, “I feel”, “I think”. When we start a sentence with ‘You’, the other person will immediately feel defensive and it can come across as aggressive. Tone of voice is also important - we should use a firm and consistent tone but not shout or raise our voice at any stage, even if the other person does.

Non-verbals are perhaps more important than what we say. We should make eye-contact but not stare. Our posture should be open, no crossed arms or legs. We should match the other person’s position, so if they are seated, we should sit too and if they stand, we stand too. It is helpful to have a relaxed expression on our faces, not grinning, which can come across as either passive or aggressive. It is all a balancing act and it’s easy to slip into one of the other modes.

A great communication skill you can use is called DEAR MAN. It gives you an assertive structure to follow when asking people for something. So you can use to it to ask for your meal to be changed, for a favour, or for a pay-rise. It can also be used to ask someone to change their behaviour towards you. D is for Describe what you want to discuss; E is for Expressing how you feel about it; A is for Assertiveness; R is for Reinforcing to the other person why this is important or beneficial; M is for Mindfulness - keep in mind what your aim is; A is for Acting confident even if you don’t feel that way; N is for Negotiation - you may need to compromise on the outcome. Have a look at the DEAR MAN skill here: DEAR MAN skill

Here are some other links about Assertiveness: Psychology Today; Workbook Assert Yourself!

Managing Stress

Stress is something that affects us all at various times in our lives. It is often related to our work, studies, finances, health, families, friends and pets. Although some level of stress is somewhat normal, it can be harmful if not managed well, and chronic stress over time can lead to physical and mental health problems. There are, however, lots of ways to keep on top of stress levels.

Firstly, it’s important to make sure that you have a good work-life balance. In any given day, we should aim to look after our self-care (exercise, sleep, diet, hydration), achieve some goals (work, study, chores, hobbies), connect with others socially, and experience some fun/pleasure. When we feel stressed, most of these areas feel difficult to pay attention to but your mind and body will thank you. There are also effective ways to calm our minds and bodies, such as deep breathing, muscle relaxation, massages, tai chi, and mindfulness. And of course exercise is great for combating stress!

Managing our unhelpful thoughts is also necessary in order to limit stress. Are you asking too much of yourself? Imposing unrealistic standards or deadlines on yourself? Doing too much for others and not enough for yourself? Consider scaling back your goals for a while, putting yourself first and aiming for ‘good enough’ rather than perfect. Worry is another factor that contributes to stress and keeps it going. Try to work out if your worry is about things that can be problem-solved and take steps to address it. If your worry is hypothetical (it hasn’t happened yet and may never happen), then try to move your attention away from it and into something else. Hypothetical worry is circular and never goes anywhere - it just drains our time and energy.

And finally, stay away from unhelpful coping strategies such as alcohol and drugs, and avoidance.

https://www.mind.org.uk/information-support/types-of-mental-health-problems/stress/managing-stress-and-building-resilience/

Depression

Depression - this a big topic and is something that affects many people at some point in their lives. Typical symptoms include fatigue, loss of pleasure, withdrawal from social life, lack of self-care and sometimes, thoughts about ending life. There can be obvious triggers, such as changes in life circumstances (grief/loss, financial worries, relationship break up) or, in the case of chronic depression, people can be susceptible to ongoing mood issues which may not have any obvious triggers.

Antidepressants can be helpful for some people, particularly when combined with psychological therapy, because they often raise mood enough for people to feel motivated to use the skills we are working on. However, medication is always a personal choice and you should never feel pressured to take it. If you do decide to try antidepressants, it is important that you follow your doctor’s advice by increasing the dose slowly, taking it regularly, and never stopping it suddenly. Often, any side effects should wear off after a few weeks.

In therapy, we start by looking at four main areas of a typical week - self-care, achievement, connecting with others, and fun/pleasure/enjoyment https://www.getselfhelp.co.uk/ace-activity/ Often, most of these areas will be reduced or absent, so we work on slowly planning some small tasks in, and build from there as you have more energy. You will be encouraged to do some gentle exercise, connect with friends and family, eat and hydrate regularly and do one small task for a sense of achievement each day.

We then help you identify your negative thoughts and look at any unhelpful thinking traps https://www.getselfhelp.co.uk/unhelpful-thinking-habits/ that might be hindering you. These are really common for all of us and can include disqualifying the positives and black and white thinking. It does take time, but we can work together to bring your thoughts back into a middle ground, tackle any problems that can be dealt with, and help you see the positives in life again.

Mindfulness https://www.getselfhelp.co.uk/mindfulness/ is another useful skill that can help with mood issues. Often, in depression, we are stuck in the past, or imagining a hopeless future, so focusing on the present and noticing things as they happen keeps things real.

This is just a snapshot of how therapy can help with mood and depression. Each person is different and we use an individual approach depending on your goals and needs. Get in touch today if you would like to get support.

Anxiety

Anxiety - it affects most of us at some point in our lives and it's a normal human reaction to a perceived threat, like being evaluated by others, going into an unknown situation or being confronted with conflict. Our anxiety response goes way back to early humans when we had to be aware of threats such as animals and other humans that might hurt or kill us. It was also important to remain accepted as part of our social group because if we were cast out, we'd be vulnerable. So, our anxiety response persists today but the trigger situations look quite different.

Although anxiety is a normal emotion, it causes problems when it becomes triggered in situations that don't warrant it, and when it leads to panic attacks, which can be extremely debilitating. At Psychology Works NZ, we can help you to manage your anxiety more effectively, and re-train the anxious mind.

The first step is to calm your mind and body. You can do a few minutes of mindful breathing. You can tense and release the muscle groups affected by anxiety, which releases tension. Once your anxiety feels a bit more under control, you can then work on the thoughts which drive anxiety. Common thoughts include “I can’t cope”, “I will lose control”, “I’ll make a fool of myself”. Psychology Works NZ can help you re-train your brain and gently challenge these unhelpful (and often unrealistic) thoughts through Cognitive-Behavioural Therapy (CBT) and Acceptance & Commitment Therapy (ACT).

Get in touch today if we can help you with anxiety.