According to the Centers for Disease Control and Prevention (CDC), 70 million Americans suffer from chronic sleep problems. Unfortunately, the damage doesn’t stop at just feeling drowsy and cranky throughout the day: Poor sleep can lead to several other serious problems, from injuries and certain chronic diseases to lost productivity and poor quality of life. Unsurprisingly, one of the most common comorbidities of poor sleep is stress — and, in some cases, even more serious psychiatric disorders, such as anxiety. Furthermore, the relationship is circular: stress can make it difficult to sleep, and concern and worry about not sleeping well can stress you out even more. Fortunately, practicing good sleep hygiene and stress reduction techniques can help you sleep and feel better. However, if they don’t, have a discussion with your doctor.

The sleep-stress cycle

Because stress and sleep have a reciprocal relationship, you can easily find yourself in a frustrating loop where getting more sleep makes you more stressed and anxious about sleeping, which makes your sleep worse, increases stress, and so on. As with any challenge or problem, the first step to tackling it is fully understanding it. Here’s how the stress-sleep connection works.

How stress affects sleep:

• Chronic stress causes dysregulation of the sleep-wake cycle.
• Stress can reduce the amount of restorative, rapid eye movement (R.E.M.) and slow wave (deep) sleep we get each night.
• Stress can also impact dreams, including the emotions we feel related to our dreams.
• Cortisol, the stress hormone, is higher at night in people who have trouble sleeping. However, more research is needed to determine a cause-and-effect relationship between higher cortisol and poorer sleep.
• Stress can also kickstart our ingrained fight or flight response, which increases muscle tension, raises our heart rate and can cause indigestion — all things which make it harder to sleep. 
• Stress appears especially correlated with two common sleep disorders: insomnia and sleep apnea.

How sleep affects stress:

• Several studies suggest that poor sleep/sleep deprivation can alter normal function of the fight or flight response, causing it to be activated when it shouldn’t be.
• Disrupted sleep or going to sleep outside of the natural wake cycle (i.e., shift workers) can increase levels of the stress hormone cortisol.

What is sleep anxiety?

Prolonged and/or severe stress and sleep issues can lead to a more serious problem called sleep anxiety: a fear or worry about going to sleep. Sleep anxiety can affect anyone of any age, but there are some preexisting conditions that predispose a person to sleep anxiety:

• Insomnia
• Narcolepsy
• Restless leg syndrome
• Sleep apnea
• Sleepwalking
• Anxiety disorders
• Bipolar disorder
• Depression
• Drug/alcohol addiction
• Panic disorder
• Post-traumatic stress disorder (PTSD)
• Schizophrenia

You’ll notice that these conditions fall into one of two categories: sleep disorders or psychiatric disorders. 

If you suspect that you might suffer from sleep anxiety, you should visit your doctor. Symptoms of sleep anxiety include:

• Feeling overwhelmed
• Trouble concentrating
• Feeling irritable
• Feeling nervous and/or restless
• Experiencing feelings of impending doom
• Fast heart rate, rapid breathing, sweating, tense muscles, and trembling before going to bed

If your doctor confirms a diagnosis of sleep anxiety (usually done through a sleep study, an overnight visit to the clinic where various physiological measurements are recorded while you sleep), one or more treatment options may be recommended. While there are several different medications that can be prescribed to treat both sleep anxiety and sleep disorders generally, many if not most of these medications can lose their efficacy over time and/or have side effects and promote addiction. Therefore, as a first line of therapy, medical providers are increasingly looking to non-medication treatments; in particular, cognitive behavior therapy (CBT) heads the list of preferred treatments at many major medical organizations.

Sleep better with good sleep hygiene

You don’t have to wait until you receive a serious sleep/stress disorder diagnosis to benefit from practicing good sleep hygiene. In fact, implementing these approaches right now can help you sleep better even though you might feel stressed out, and might help prevent your problem from getting worse. Doctors generally recommend the following for anyone who has trouble falling or staying asleep:

• Get at least 7-9 hours of sleep each night. Going to bed and waking up at the same time each day will help you achieve this goal by establishing a routine for your body.

• Limit screen time. Blue light-emitting devices such as televisions, phones, and computers can suppress the body’s production of the sleep hormone melatonin. Either turn off screens at least two hours before bed, or consider wearing blue light-blocking glasses.

• Make your bedroom a sanctuary. Keep your bedroom cool (around 65 degrees) and dark (get blackout curtains, if necessary) to promote sleep. Also, reserve your bed only for sex and sleep. Engaging in other activities (such as reading) while in bed could make it difficult to teach your brain that your bed is only for sleep.

• Watch what you eat and drink. Avoid sugary foods and alcohol before bed, and keep caffeine intake reserved for earlier in the day. Good bedtime snacks are a small amount of complex carbohydrates and a protein, such as toast with peanut butter. 

Sleep better by reducing stress

Because sleep and stress are so intertwined, engaging in stress reduction techniques can also be a great way to get better sleep. A few great ways to reduce stress include:

• Exercise. Engaging in regular exercise and maintaining a healthy weight can help you sleep better. Just make sure you finish your last workout at least a few hours before going to bed.

• Meditate. Meditation/mindfulness exercises are a great way to relax and reduce stress. In a review paper, 16 of 17 mindfulness meditation studies demonstrated that meditation induced positive psychological and/or physiological outcomes related to anxiety and stress.

• Breathe. Several breathing techniques, such as box breathing, Pranayama, and others can be used to reduce stress and help you relax.

• Eat well. Did you know that following a healthy diet rich in fruits, veggies and whole grains can actually make you more resilient to stress? Conversely, a poor diet filled with processed, sugary foods can elevate your blood pressure and increase feelings of stress. In particular, watch your sodium intake and avoid alcohol and caffeine.

• Build strong social relationships. The science is clear — supportive, healthy social relationships are critical for our emotional and mental well-being.

Learn more:
Why Do I Keep Waking Up at 3am?
Gut Health And Anxiety: What’s the Link?
Can Stress Cause Illness?
What Is Oxidative Stress?

Key takeaways

Sleep and stress have a very intimate relationship with one another. Not only can being stressed out make it hard for you to sleep, but not sleeping well can also make you feel more stressed. If either problem isn’t held in check, more serious conditions — such as sleep anxiety, chronic diseases and more — can develop. Practicing good sleep hygiene and stress reduction techniques can help you sleep and feel better, but if you still can’t get a handle on your sleep and stress, the best thing to do is to talk to your doctor. With a sleep study, your doctor will be able to get a detailed view of how your body sleeps (or doesn’t) and then can tailor the best treatment options to relieve your particular condition(s).