Effects of Stress on Sleep

Certain levels of stress can be beneficial in helping us to achieve something like sitting exams or presenting to an audience or a piece of work that needs to meet a deadline. Stress helps to keep us alert and focused on what we’re doing.

When high levels of stress are continuous over a prolonged length of time, it can result in insomnia. Stress causes insomnia by making it difficult to fall asleep and to stay asleep. It has the effect of hyperarousal on our bodies and minds, which negatively impacts on the balance between sleep and wakefulness. In most cases of stress induced insomnia, when the stressors are eliminated or the person’s stress response is managed, the quality of sleep begins to improve.

Why do we need sleep?

While we may not often think about why we sleep, most of us acknowledge at some level that sleep makes us feel better. The function of sleep is to enable our bodies and minds to rest and repair themselves. Having had a good night’s sleep, we tend to feel more alert, more energetic, happier, and better able to function the following day. The fact that sleep makes us feel better and that going without sleep makes us feel worse – begins to explain why sleep is necessary for optimum health and wellbeing.

One way to think about the function of sleep is to compare it to another of our life-sustaining activities: eating. Hunger is a protective mechanism to ensure that we consume the nutrients our bodies require to grow, repair tissues, and to function properly. And although it is relatively easy to grasp the role that eating serves— given that it involves physically consuming the substances our bodies need—eating and sleeping are not as different as they might seem.

Both eating and sleeping are regulated by powerful internal drives. Going without food produces the uncomfortable sensation of hunger, while going without sleep makes us feel extremely tired and sleepy. And just as eating relieves hunger and ensures that we obtain the nutrients we need; sleeping relieves our tiredness and ensures that we obtain the sleep we need.

The amount of sleep that we need varies from person to person. Most adults need 7-8 hours per night, but some need more and some need less. Small babies spend most of their time sleeping; children need more sleep than adults and small children often need to nap during the day.

Causes of sleep deprivation

So what factors actually cause sleep deprivation? Most people experience disrupted sleep from time to time, usually through a stressful time like starting a new job, sitting exams or moving house. Usually once the pressure is off, the person tends to return to his or her normal sleep pattern.  When sleep deprivation is prolonged with many wakeful nights, it can cause people to experience fatigue during the day. We need sleep to think clearly, react quickly, and to create memories. Lack of sleep can have an adverse affect on our moods, making us feel irritable, short tempered leading to poor relationships. People who are chronically deprived of sleep are more likely to become stressed and depressed.

Sleep is very important for good health too. Not getting enough sleep, or getting poor quality sleep on a regular basis can result in a poor immune response to infections, high blood pressure, heart disease and other medical conditions.

There are 4 main types of sleep disturbances:

• Insomnia: which is the inability to fall asleep or stay asleep
• Hypersomnia  – which is sleeping too much
• Sleep Apnea – this where the person gasps for air, snores or snorts whilst asleep
• Narcolepsy – this is the sudden urge to sleep particularly during the day.

Insomnia

In this video we will focus on the most common cause of poor sleep which is Insomnia. Insomnia is the inability to initiate or maintain sleep throughout the night or it is characterised by early morning awakening. This may manifest itself as excessive daytime sleepiness and low energy levels.

Long term Insomnia can cause you to feel depressed or irritable, have poor concentration levels, difficulty in learning and poor memory recall.

Causes of Insomnia

The most common causes of Insomnia are:

• Anxiety
• Stress
• Substance abuse
• Too much caffeine
• Side effects of medication
• Poor bed time routine and sleep environment
• Chronic illnesses like Asthma and an overactive thyroid

People who suffer with chronic Insomnia often report that they dread bedtime. They see bedtime as yet another stressful boring drawn out night of staring at the bedroom ceiling, watching the alarm clock and thinking “I have to get up and go to work in 2 hours time but I feel exhausted”. Insomnia is an extremely hard and frustrating experience for anyone, but thankfully there are some solutions that can be implemented to help get a good restful night’s sleep

Hints and tips for shift-workers ( HSE Website)

People vary in how they cope with shift work depending on their health, fitness, age, lifestyle, and domestic responsibilities– some adapt well, others do not. Whilst we cannot change our inbuilt characteristics, it is possible to alter our behaviour or make lifestyle changes that may make shift work more tolerable. The hints and tips below draw on commonly available advice and best practice from a range of sources and may improve sleep quality, increase alertness and reduce health risks for shift workers.

Driving to and from work

Driving to and from work can be risky, particularly after a long shift, a night shift or before an early start. The following strategies may make driving safer:

• consider using public transport or taxis rather than driving;
• exercise briefly before your journey;
• share driving if possible;
• drive carefully and defensively;
• try not to hurry;
• stop if you feel sleepy and take a short nap if it is safe to do so;
• make occasional use of caffeine or ‘energy’ drinks.
• Identify a suitable sleep schedule

Most adults need 7-8 hours sleep a day although this may decrease with age. If you cannot do this, try to rest, as this is still beneficial. Recording sleep patterns and problems using a diary may help to explain fatigue and tiredness. It can also be used to help find the most suitable strategies and conditions for a better quality of sleep.

If you work regular shifts, try going to bed at different times eg soon after you arrive back from work or stay up and sleep before the next shift;

• have a short sleep before your first night shift;
• if coming off night shifts, have a short sleep and go to bed earlier that night;
• once you have identified a suitable sleep schedule try to keep to it.

Make the environment favourable for sleeping

Sleep loss and fatigue are some of the most significant problems for shift workers. It is important to try and maintain your normal level of sleep and rest. Daytime sleep is usually lighter, shorter and of poorer quality than night time sleep. It is more frequently disturbed because of warmer temperatures and daytime noise. To help make the environment favourable for sleeping:

• sleep in your bedroom and avoid using it for other activities such as watching television, eating and working;
• use heavy curtains, blackout blinds or eye shades to darken the bedroom;
• disconnect the phone or use an answer machine and turn the ringer down;
• ask your family not to disturb you and to keep the noise down when you are sleeping;
• discuss your work pattern with close neighbours and ask them to try and avoid noisy activities during your sleep time;
• if it is too noisy to sleep consider using earplugs, white noise or background music to mask external noises;
• adjust the bedroom temperature to a comfortable level, cool conditions improve sleep.

Techniques to promote sleep

To promote sleeping, try to follow a similar routine to the one you follow before a normal nights sleep. The following tips may help you relax after a shift and promote sleep:

• go for a short walk, relax with a book, listen to music and/or take a hot bath before going to bed;
• avoid vigorous exercise before sleep as it is stimulating and raises the body temperature;
• avoid caffeine, ‘energy’ drinks and other stimulants a few hours before bedtime as they can stop you going to sleep;
• don’t go to bed feeling hungry: have a light meal or snack before sleeping but avoid fatty, spicy and/or heavy meals, as these are more difficult to digest and can disturb sleep;
• avoid alcohol as it lowers the quality of sleep.

Diet

It is very important to consider the timing and quality of your meals. Digestive problems are common in shift workers due to disruption of the body clock and poor diet. Plan your meals to help you stay alert at work and to relax/sleep when you need to rest.

• regular light meals/snacks are less likely to affect alertness or cause drowsiness than a single heavy meal;
• choose foods that are easy to digest such as pasta, rice, bread, salad, fruit, vegetables and milk products;
• avoid fatty, spicy and/or heavy meals as these are more difficult to digest. They can make you feel drowsy when you need to be alert. They may also disturb sleep when you need to rest;
• avoid sugary foods, such as chocolate – they provide a short-term energy boost followed by a dip in energy levels;
• fruit and vegetables are good snacks as their sugar is converted into energy relatively slowly and they also provide vitamins, minerals and fibre;
• drink plenty of fluid as dehydration can reduce both mental and physical performance but avoid drinking too much fluid before sleeping as this may overload the bladder.

Stimulants and sedatives

Shift workers often turn to stimulants such as coffee or cigarettes to keep them awake and sedatives such as alcohol or sleeping pills to help them sleep. Avoid such aids as they only have short-term effects on alertness as tolerance to their effects develops. Persistent use may also increase the risk of dependence.

• caffeine is a mild stimulant present in coffee, tea and cola as well as in tablet form and in special ‘energy’ drinks. It can improve reaction time and feelings of alertness for short periods. Only use caffeine occasionally and don’t rely on it to keep you awake. If you do decide to take caffeine or other stimulants, you should consider what might happen when its effects wear off eg when you are operating machinery or driving.
• avoid the use of alcohol to help you fall asleep. Although alcohol can promote the onset of sleep it is also associated with earlier awakenings, disrupted sleep and poorer sleep quality. Regularly drinking too much increases the risk of long-term damage to your physical and mental health, your work, social and personal relationships.
• regular use of sleeping pills and other sedatives to aid sleep are not recommended because they can lead to dependency and addiction.
• new drugs have recently been developed that can alter our state of alertness. Although their use may be widespread abroad, the ways in which they work and their long-term effects are not yet fully understood and consequently their use is not advised unless under medical supervision.

Physical fitness and a healthier lifestyle

An unhealthy lifestyle combined with shift work may increase the likelihood of sleep disorders and sleep loss or exacerbate existing sleep problems. A good diet, regular meals and exercise can improve sleep quality, health and well-being.

you can improve your fitness by spending 30 minutes a day on a physical activity including housework and walking. Consider joining a gym or taking part in a regular exercise class;

• eat healthy meals on a regular basis;
• cut down or give up smoking;
• reduce your alcohol intake;
• seek advice from your doctor if you require regular medication such as insulin for diabetes or suffer from a chronic condition such as epilepsy.

Family and friends

Working shifts that differ from the routines of friends and family can leave you feeling isolated and it is important to make the effort not to lose contact with them:

• talk to friends and family about shiftwork. If they understand the problems you are facing it will be easier for them to be supportive and considerate;
• make your family and friends aware of your shift schedule so they can include you when planning social activities;
• make the most of your time off and plan mealtimes, weekends and evenings together;
• plan your domestic duties around your shift schedule and try to ensure that you do not complete them at the cost of rest/sleep. You may need to change the times/days when some jobs are done;
• invite others who work similar shifts to join you in social activities when others are at work and there are fewer crowds.

Ways to improve your alertness at work

On some shifts, such as nights and very early mornings you may find it difficult to remain alert and this can affect your performance. It may also increase the risk of errors, injury and accidents. You may find it helpful to:

• take moderate exercise before starting work which may increase your alertness during the shift.
• keep the light bright;
• take regular short breaks during the shift if possible;
• get up and walk around during breaks;
• plan to do more stimulating work at the times you feel most drowsy;
• keep in contact co-workers as this may help both you and them stay alert.