Friday, February 15, 2019

Stressed and Sleepless? 11 Unique Ways to Break the Vicious Cycle

An especially long to-do list, job pressures, a big event, family strife, financial burdens, tight deadlines — potential stressors like these fill modern life, and you’ve probably experienced their impact on sleep firsthand. It’s incredibly frustrating to be unable to calm or shut off your racing thoughts at the end of the day, or to wake up bleary-eyed and exhausted after a restless night.

Ideally, once the stressor is resolved, you’re usually back on track sleeping normally. But in today’s go-go-go world, that’s not always what happens. Instead, stress can easily turn chronic and cause likewise persistent sleep problems, both of which can have a disastrous and long-term effect on your health.

Beyond a racing mind keeping you awake, stress impacts your body on a physiological level, trapping you in a vicious cycle that usually starts with a disruption or changes in the normal cascade of hormones, neurotransmitters, and other functions needed for a good night of sleep. Poor sleep then compounds your stress.

“Stress and sleeplessness feed off each other,” says Singar Jagadeesan, M.D., a sleep expert, medical director of the Wake Sleep clinic in Raleigh, N.C., and a member of Vital Plan’s medical advisory board. “When you’re stressed, it deprives you of sleep, and when you’re sleep-deprived, you tend to get more stressed by simple situations.” Not sleeping well can also make it harder to address or remedy existing stressors that created the sleep problems in the first place.

How Chronic Stress Impairs Sleep

To fully understand the link between stress and sleeplessness, it helps to first understand how your body normally initiates sleep. Part of it has to do with the normal production and release of cortisol, a hormone that keeps you awake, alert, and otherwise ready for action.

Thanks to your body’s circadian rhythm or internal clock, cortisol naturally peaks in the morning, then declines later in the day, hitting its lowest point around 9 or 10 o’clock at night. As it wanes, calming and sleep-initiating hormones and neurotransmitters like melatonin and GABA begin to rise.

A process known as sleep pressure is another factor involved in initiating sleep. Sleep pressure centers around a chemical called adenosine, which naturally builds up in the brain throughout the day. The more adenosine builds up, the more tired you become, and the harder it is to avoid sleep. It’s why you eventually might drift off even when you’re watching television or not in bed yet.

There are a few different ways stress messes with these natural processes and the flow of chemicals and hormones that contribute to normal sleep. For one, stress activates your body’s fight-or-flight response, which triggers the release of adrenaline, a hormone that blocks the sleep-inducing effects of adenosine. As a result, you naturally feel more awake and your body is keyed up and ready for action. It’s a primitive response that helped our ancient ancestors survive physical threats.

These days, we’re not often faced with literal predators or true life-or-death situations, however our brains register mental stress or stressful situations — even just watching them in a movie, for example — as a physical threat. So your brain and body then respond in a physical way: Your heart rate and blood pressure rise, and adrenaline flows into your system.

Along with blocking adenosine, adrenaline also signals the body to keep cortisol levels high to keep your brain alert and awake instead of naturally waning in the evening. And elevated cortisol in the evening then sends the signal to block or interfere with the release or actions of natural sleep-related neurotransmitters and hormones. So, even though adrenaline tends to wane quickly — say you start to wind down in the evening after a stressful day or watching a suspenseful movie — cortisol stays in your system much longer, keeping you awake and restless.

What can compound the problem: The more and longer cortisol stays elevated rather than naturally dipping at night, the more sensitive you become to it (and stress) in general. In other words, the more chronically stressed you are, the more your body may pump out adrenaline at the drop of a hat, when a situation or stressor hardly warrants it.

The Role of the HPA Axis

The release of adrenaline and cortisol is regulated by what’s called the hypothalamic-pituitary-adrenal axis (HPA axis). It’s called the HPA axis because of the link and cross communication between a brain region called the hypothalamus and your pituitary and adrenal glands.

The brain’s hypothalamus acts as a regulator and monitor of lots of different functions in your body — temperature, metabolism, and sleep, among other things. Its primary role is to send and receive messages to and from different parts of your brain and body to regulate various key functions. “The hypothalamus monitors circadian rhythms and stress, giving the information to the adrenal cortex to produce cortisol or decrease its production,” Dr. Jagadeesan explains.

In other words, the HPA axis is constantly keeping tabs on everything going on in your body and brain with the goal of directing resources (aka, hormones) where they need to go and maintaining balance. So, when the hypothalamus senses the upper brain perceives stress or a threat, it sends out the message to the pituitary and then adrenal glands to produce and maintain cortisol levels.

Your body is designed to cope with that extra influx of cortisol for a short time. But perpetually-high cortisol forces your hypothalamus to focus on ensuring the body has what it needs to address the chronic stress, so other functions (such as sleep and digestion) take a backseat. The result: Your body stays keyed up, and resources are rerouted to places they don’t necessarily need to be.

How Poor Sleep Increases Stress

You probably already know that not getting a good night of sleep can make you irritable and interfere with concentration, problem solving, and memory — all things that can make an already stressful situation even more so. Why it happens has to do with the vital role sleep plays in cognitive functioning.

Your brain is sort of like a computer, and just like a computer, when you’ve got lots of programs and files up and running, it can perform sluggishly unless you reboot. That’s essentially what sleep does; it reboots your brain in various ways during the four different stages of sleep — light, medium, and deep sleep, as well as rapid-eye movement sleep (REM).

Deep sleep and REM are arguably the most important when it comes to recouping from stress. “We know that deep sleep, or stage 3 sleep, is involved in hormonal restoration and cellular detoxification,” Dr. Jagadeesan says. “The brain is very active during the day, and when cells are active, they produce a lot of byproducts, so it’s in stage 3 sleep that all those byproducts get cleared away.”

This “cleansing” is needed for your brain to work optimally and to deal with your day-to-day tasks. But if it doesn’t happen, the cells becomes even more active, then eventually fatigue and send out a stress signal to your brain, Dr. Jagadeesan says.

REM sleep, meanwhile, which is when you dream, is key for helping you work out problems. It’s involved in intelligence and what’s called memory consolidation. “This is the stage where you purge unwanted memories, consolidate wanted ones, and make associations with memories,” Dr. Jagadeesan says. “Any time stress disturbs sleep, it will directly affect the amount of deep sleep and REM sleep you get.”

For example, stage 3 (deep) sleep typically happens more toward the beginning of the night; if you go to bed too late, you may miss out on this restorative rest. Cortisol (as well as alcohol, if you’ve had any) can block stage 3 sleep and prevent cellular debris from getting cleared away. So instead of deep sleep, you sleep more restlessly.

REM sleep, meanwhile, happens more toward the later part of your sleeping time, so if you have trouble winding down and falling asleep, then must rely on an alarm to wake you up after only 4 or 5 hours, you’re likely missing out on vital REM sleep, too. The result of too little REM: You start the day with your brain’s “files” disrupted, your processes sluggish, and your brain agitated, which makes it harder to solve problems and makes your day more stressful.

11 Unique Ways to Break the Stress-Sleepless Cycle

The best thing you can do, of course, is to take steps to address the underlying causes of chronic stress in your life, says Dr. Jagadeesan. Realistically, that’s not always possible. For example, most of us can’t just up and quit our overwhelming jobs, or pay off financial debt in one fell swoop.

The good news: “There are a lot of things you can do to mitigate or reduce the effect of stress on sleep,” Dr. Jagadeesan says. Likewise, you may be unwittingly doing things that exacerbate stress and/or that make it harder to sleep, and just becoming aware of those sleep disruptors can be an important first step toward making a big difference.

Often, it’s more important what you do during the day to set yourself up for a good night that matters the most. You’ve likely heard of the stress-reducing and sleep-promoting benefits of yoga, breathing exercises, meditation, and eating a healthy diet. Then there are the tenets of good sleep hygiene, such as maintaining regular bed- and wake times, ensuring your room is quiet, cool and dark, and avoiding using your phone in bed. And you could always quit caffeine, which blocks the effects of adenosine even hours after you’ve had your last cup of coffee.

All are well-known strategies proven to help reduce stress and help you sleep. And if you have trouble getting enough Zzs, you’ve likely tried some (or all) of them. But there are other, lesser-known ways to both address stress and help you sleep better. Here are 11 I highly recommend.

1. Diffuse Stress with Activity

The expected endpoint for your body’s primitive fight-or-flight response is movement or action. So, when you feel yourself getting tense or anxious due to, say, a looming deadline or argument with your partner, avoid the urge to escape by chilling in front of the TV or reaching for a comforting snack. Instead, do some jumping jacks at your desk, go for a walk, do some gardening, or move around the kitchen cooking a healthy meal.

Notably, you don’t have to take a trip to the gym or go for a long hike to get the benefit of movement — any activity will be beneficial. Not only will it help diffuse stress, clear away adrenaline, and lower cortisol, the more activity you get during the day, the more effectively you build up adenosine and sleep pressure for later that night.

2. Exercise in the Morning

When you do engage in a more traditional workout or exercise program, schedule it for the morning and avoid strenuous or prolonged workouts in the afternoon. A recent study in the International Journal of Sports Physiology and Performance reports that 30 minutes of running at 4 p.m. lead to reduced levels of melatonin compared to the same exercise performed at 9 a.m. Researchers believe that the afternoon workout blunted the body’s natural secretion of the sleep-promoting hormone.

3. Balance Stress with Adaptogenic Herbs During the Day

Calming adaptogenic herbs like ashwagandha have been used for centuries to address stress. Adaptogens are thought to work directly on the HPA axis to help balance and regulate its response to stress (including cortisol and adrenaline production) without making you feel sedated, which is why they’re ideal to take in the morning.

For instance, in one study published in the Journal of Evidence-Based Complementary and Alternative Medicine, stressed, overweight adults who took ashwagandha supplements for eight weeks saw a 22% reduction in cortisol levels after 8 weeks, while the control group had no significant change. The ashwagandha group also reported less perceived stress and less emotional eating (a symptom of stress).

4. Front-Load Adrenaline — or Detox From It Altogether

Many people crave excitement and the adrenalin rush that comes with it. That can come from participating in extreme sports, or more commonly, enjoying a suspense-filled movie or action-packed book. And, because of our modern schedules, nighttime is when most tend to get their fix.

Unfortunately, research suggests these so-called thrills can trigger a very real stress response that can make it harder to fall asleep, interfere with normal sleep cycles, and increase middle-of-the-night awakenings. The reason: The adrenaline spike causes your body to pump out cortisol, which leaves your brain keyed up long after the movie’s over, and even after adrenaline has dissipated.

So ideally, try to avoid stress-inducing or exciting entertainment or activities completely until your sleep normalizes. If you don’t want to quit adrenaline cold turkey, try reading your book or catching your favorite TV show in the morning, and reserve your evening, pre-bed hours for more relaxing programs and novels or nonfiction. Even then, stick to only one or two shows at a time rather than binge-watching: A survey reported in the Journal of Clinical Sleep Medicine found a relationship between viewing multiple episodes of a show in one sitting and increased pre-sleep arousal, which correlated with poor sleep.

Along the same lines, if you know certain events or actions in your life will cause you stress or spike adrenaline — for example, a tough conversation with your boss or a family member, or filing your taxes — aim to schedule them in the morning. Save more neutral tasks or meetings for the afternoon or evening.

5. Keep Snacks on Hand

When your body is under stress, it mobilizes glycogen stores in your liver to be used as fuel for fighting or fleeing — whether you actually need it or not, Dr. Jagadeesan says. “As soon as your liver runs out of glycogen, it senses that it’s starving and can’t answer the body’s need, so it sends out a major stress signal,” he explains. “That activates additional cortisol that then breaks down your muscles to turn into glucose.” And that leaves you especially stressed and irritable.

You can blunt that secondary stress response and ensure your body knows it’s not starving by having a snack or snacking on healthy foods throughout the day, says Dr. Jagadeesan. Whatever you eat should provide a healthy source of non-processed carbohydrates, along with protein and healthy fats to keep insulin levels steady, such as a piece of fruit and some nuts or vegetables with guacamole. There are also several foods that can help with sleep specifically, including salmon and bananas.

6. Take a Midday Power Nap

Rest or meditate for about 20 minutes or until you barely doze off. I like to think of it as just “touching sleep.” This can help calm your brain, zero out adrenaline, and neutralize cortisol. Research also suggests a short nap can help with daytime fatigue and alertness. Just be sure to keep it brief so as to not clear out your adenosine bank entirely and interfere with sleep pressure and nighttime sleep. Also avoid napping in the evening. Rather, aim for middle of the day or early afternoon.

7. Avoid Reading Negative News

While research suggests that negative news itself may not raise cortisol, it can be arousing, similar to a suspenseful TV show or movie. So if you read the paper or watch the news, it’s best to do so in the morning.

However, women who are under a lot of stress should consider avoiding the news all together. A study in the journal PLoS One found that reading negative news increased womens’ stress response when confronted with a stressor (in the study’s case, a mock job interview). The women who read the negative news showed markedly higher cortisol levels in response to the stressor compared to women who read neutral news.

8. Cuddle Up with a Loved One (Pets Count!)

You might have heard of oxytocin, the so-called love hormone because it increases in response to social support and positive touch and relationships. Research suggests that oxytocin can help buffer or blunt a person’s stress response and help lower levels of cortisol. So get a hug from a loved one or furry friend when you feel the pressure rising — other studies have shown that pet owners’ oxytocin levels rise and cortisol falls when they physically interact with their dogs.

9. Try a Weighted Blanket

“Weighted blankets can definitely be helpful for sleep because they provide a soothing, calming sensation, like a gentle massage or hug,” Dr. Jagadeesan says. Indeed, research on the blankets, which typically have small weights sewn into or attached to them, has been promising. In one study, sleep time increased and study participants moved less in the night when sleeping under the blankets. Participants also reported it was easier to settle down, said that they had a better, calmer night’s sleep, and that they felt more refreshed in the morning.

10. Unwind with Calming Herbs and Natural Remedies

Several herbs are known for their abilities to help you relax and act as natural sleep aids without totally knocking you out or leaving you groggy the next morning. They help the body initiate the tide of sleep by working with sleep-promoting hormones or neurotransmitters like GABA, which reduces the firing of brain cells involved in alertness and wakefulness. Here are a few of my go-tos:

  • Bacopa: Along with helping promote relaxation and sleep, research suggests bacopa is able to enhance cognitive performance, which may help reduce stress during the day. It also works to reduce inflammation in the brain that may play a role in keeping you awake.
  • Passion flower: A gentle muscle relaxant, passion flower helps maintain a healthy nervous system to promote restful sleep.
  • Motherwort: Motherwort has been used traditionally to help relieve nervous tension, and its calming nature helps support sleep at night.
  • Magnesium: Research has shown that this mineral promotes restful sleep. It’s an effective muscle relaxant and acts on GABA receptors in the brain.
  • Tart cherry: This fruit is as impressive as it is tasty. One study found that older adults who drank 8 ounces of tart cherry juice twice a day slept more than an hour longer per night than on nights they drank a placebo juice. Other trials have found the juice boosts melatonin levels and improves the quality of sleep.
  • Full-spectrum CBD oil: Short for cannabidiol, CBD is a non-intoxicating compound in hemp plants that has been shown to help with sleep and anxiety.

11. Don’t Fight Sleeplessness

It sounds counterintuitive to just stay up if you can’t sleep, but consider what often happens when you’re having one of those nights: The longer you spend in bed tossing and turning, the more anxious and agitated you tend to become. Your temperature then rises (versus dropping, which is needed for the onset of sleep), and cortisol and adrenaline increase. And then as if on cue, your mind starts worrying about how little sleep you’re getting as your frustration bubbles over and wakes you up even more.

Instead of that domino effect, aim to make the time you spend in bed not sleeping more productive and conducive to sleep. For instance, engage in breathing exercises and other relaxation and mind-calming techniques. You might try guided meditation (there are apps for that, like The Mindfulness App and Calm), or listen to soft music. And be sure you’re not too bundled up; throw off some covers to help drop your core body temperature.

If you’re unable to calm your mind and body despite trying these tactics and are still not close to sleep, get up (but avoid turning on any bright lights) and do something calming, such as qigong or gentle stretching, then ease back in bed and try the relaxation techniques again.

Say Goodnight to Stress and Sleeplessness

Trying to get stress under control can seem like an insurmountable task, and even more so when you’re exhausted. So by taking small, effective steps to both mitigate the effects of stress on your body and encourage more restful sleep, you’ll feel better equipped to manage the harder aspects — and enjoy the healthy benefits.

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