How stress affects sleep

written by Dr Monica Xu

Do you wake up between 3 and 5am? Do you feel tired, yet unable to sleep? Do you get anxious about not being able to fall asleep? Do you feel energetic at night and sleepy during the day? Do you get daytime fatigue, around 10am or 3pm?

If you answered yes to more than one of the questions listed above, you may have insomnia, or be experiencing sleep debt, and you are not alone. More than 40% of adults suffer from insomnia and sleep-related issues.

Conventional healthcare systems often misdiagnose sleep issues which stem from stress-induced cortisol response problems with melatonin deficiency.

So if you’ve ever taken melatonin and woken up in the morning feeling worse than before, it’s another clear indicator that you may have stress-induced cortisol problems.

How does stress affects sleep?

Cortisol is a steroid hormone secreted by the adrenal glands that governs the circadian rhythm, blood sugar, blood pressure, inflammation, and sleep-wake cycle.

Normally, the cortisol level is highest in the morning when we first wake up and peaks around 60 minutes after waking. It drops slowly throughout the day and is at its lowest in the evening around 9 pm or before bedtime, to help you get into the resting state.

When our body is under stress, our cortisol output increases beyond normal output to keep up with the demands. Short exposure to stress is often healthy for our endo-nervous system. However, chronic high-stress can lead to problems such as hyper-secretion of cortisol or irregular peaks at times when it is supposed to be low.

On the more technical side, when cortisol levels are in excess, combined with the inability to break down or metabolize the hormone efficiently, this often results in too much total cortisol circulating in our blood. When we are stressed later in the day, it provokes cortisol release as opposed to lowering it to prepare the body for rest.

When irregular cortisol response is not properly addressed, it keeps you awake at night, prevents you falling asleep, or gives you the feeling of being wired but tired.

Later, it can lead to secondary problems such as weight gain, memory loss, heart problems, and more.

How can you improve your sleep quality when you are stressed?

Sleep hygiene or having a sleep routine and a suitable environment is a good place to start.

4 things to try for your sleep routine

  1. Aim to reduce screen time 1 hour before bed.
  2. Avoid eating heavy meals 3 hours before bedtime.
  3. Try to exercise the first ½ of the day. Evening exercise delays melatonin release (the hormone which signals to our body that it’s time to rest).
  4. Take a warm shower or foot bath before bed.

4 things to check for sleep hygiene

  1. Keep your room temperature slightly cold, around 19-24 degrees Celsius. Our bodies tend to sleep better in cooler environments than in warmer ones.
  2. Minimize light exposure with a blackout curtain.
  3. Check the humidity level with an indoor digital thermometer. Too humid or too dry can impact breathing. 40% to 60% is the optimal range for most people.
  4. If you are a light sleeper, having a noise cancellation device (earplugs) or a white noise machine can be helpful.

I’ve tried all this, I still can’t sleep.

If you have done all the above but still have trouble sleeping, it could be something deeper that needs to be addressed, such as the irregular cortisol pattern mentioned earlier.

Unfortunately, this issue is still under-recognized and poorly addressed in the conventional healthcare system. Sleep medication is still the go-to option, but is often addictive and can cause undesirable side effects like drowsiness in the daytime.

IMI provides functional lab tests such as salivary cortisol pattern test to assess whether or not you have irregular cortisol patterns. Identifying this issue can help treat your insomnia at its root cause, rather than simply addressing the symptoms.

C Hirotsu, S Tufik, ML Andersen, Interactions between sleep, stress, and metabolism: From physiological to pathological conditions, 2015
J Dopheide, Insomnia overview: epidemiology, pathophysiology, diagnosis and monitoring and nonpharmacologic therapy, 2020.  
Risk factor, comorbidities, and consequences of insomnia in adults

About Dr Monica Xu

Dr Monica Xu is a US trained naturopathic doctor who chooses the best of conventional and natural therapies when treating age-related illnesses. She prefers and specializes in using nontoxic, natural compounds to promote the healing of age-related degenerative changes. These include formulated herbal extracts, compounded vitamins and minerals, natural hormones, diet and lifestyle modifications.

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