Sleep and Stress

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hello I'm Dr. Mohan Dutt I am an assistant

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professor of neurology at the University

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of Michigan School of Medicine and today

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we're going to be discussing sleep and

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stress it's a generally large topic and

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we don't have too much time so what I

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really would like for you guys to learn

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uh by listening to today's lecture is

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firstly to describe the associations

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between sleep and stress they are very

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intertwined and we will discuss this

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through something called the stress

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sleep cycle i would like for you to

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understand the potential consequences of

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elevated stress levels and poor sleep

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and lastly we will discuss some

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techniques on how to break the stress

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sleep cycle and how to improve sleep at

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home so the first thing that we should

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discuss is what is stress well it's a

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normal physiologic response that helps

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us meet the challenges of the day you

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know if you have a work deadline and you

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need to meet it your body will respond

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by increasing stress levels and allowing

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you to meet that challenge it is usually

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associated with increases in heart rate

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and blood pressure and it is hormonally

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regulated the problem with stress is

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that if you have too much of it like it

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becomes constant and you're always

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stressed it can lead to emotional mental

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and physical problems so what you see

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here on this slide is a graphic

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representation of the sleep stress cycle

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as you can see there's no starting point

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and there's no end point and this is to

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indicate that this cycle can be entered

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at any point and that it continuously

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reinforces itself but for example if we

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were to enter the cycle at poor sleep

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one would then experience daytime

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fatigue and sleepiness this would lead

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to difficulty with daytime functioning

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and ultimately increased stress and

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anxiety this then feeds back on itself

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causing poor sleep again but again this

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cycle can be entered at any point so for

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instance let's say you had a really

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tough day at work or got into an

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argument with your spouse and then had

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to try to go to bed if you were stressed

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out you would then have difficulty

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sleeping which would then again lead to

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daytime fatigue and sleepiness

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difficulty with daytime functioning and

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then an increased level of stress and

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anxiety again then leading to poor sleep

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a lot of people actually experience poor

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sleep because they are already stressed

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out about having poor sleep so you can

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really see that this cycle is

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self-perpetuating and for some people it

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can be never ending so what are some

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causes of poor sleep generally from from

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a sleep medicine standpoint when we talk

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about poor sleep there are two main

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culprits insomnia which is pictured on

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the left and sleep apnea which is

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pictured on the right we will not be

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discussing sleep apnea in today's talk

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but briefly it is defined as a repeated

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collapse of the upper airway which leads

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to disrupted sleep and potential daytime

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sleepiness poor sleep isn't just limited

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to insomnia and sleep apnea however it

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can be caused by a myriad of issues such

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as

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medications chronic pain and something

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like frequent urination at night the

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American Academy of Sleep Medicine

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defines insomnia as a subjective

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perception of difficulty with sleep

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initiation duration consolidation or

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quality that occurs despite adequate

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opportunity for sleep and that results

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in some form of daytime impairment

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essentially individuals can have a

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difficulty falling asleep staying asleep

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or both and this leads to some sort of

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daytime dysfunction increased stress

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levels may lead to insomnia as it can

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cause a difficulty in shutting down at

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the beginning of the night or stress

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about not being able to fall asleep due

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to previous instances of poor sleep so

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when we talk about poor sleep we should

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set some boundaries as to you know how

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much should we be sleeping because

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that's a pretty common question that we

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get the recommended duration of nightly

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sleep is 7 to 9 hours per night though

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this does vary from person to person

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some people may need as little as six

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and may need as much as 10 if this is

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not obtained or if the quality of that

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sleep is poor such as with those who

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experience sleep apnea then one may

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experience daytime sleepiness and

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fatigue poor decision-m and difficulties

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with concentration work performance and

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emotional regulation

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these difficulties specifically with you

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know work performance and emotional

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regulation lead to increased stress

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because people have difficulty

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functioning during the day from a

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physiologic

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standpoint poor sleep is associated with

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an increase in cortisol

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levels and

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inflammation cortisol is one of our

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stress hormones

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poor sleep is also associated with an

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increase in risk of hypertension

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increases in risk for cardiovascular

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disease memory impairment and dementia

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and poor glucose control which leads to

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an increased risk for diabetes so far

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we've discussed the association between

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sleep and stress basically to sum it up

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sleep can lead to increased stress

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levels during the day which then feeds

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back to further poor sleep which then

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leads to worsening stress it's a

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potentially never-ending cycle that can

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have significant medical

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consequences oftentimes by the time I

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see someone in clinic it is very

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difficult to determine if poor sleep

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caused the stress or if the stress

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caused the poor sleep a real chicken or

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egg type question some things that you

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can do at home to break this cycle are

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to keep a consistent bedtime so again go

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to go to bed at the same time every

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night limit your screen time so avoid

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TVs phones laptops uh we recommend 2

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hours before bedtime definitely get off

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social media and doom scrolling as they

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now call it uh you want to avoid alcohol

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caffeine and nicotine especially before

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bedtime and to try to shut your mind off

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or reduce stress at night um there are

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relaxation techniques such as meditation

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or deep breathing that one can try

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and then lastly seek medical care if

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needed so when should someone seek

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medical care well if there's a concern

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for sleep apnea then you should see a

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physician and and get tested for that um

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when other medical disorders are causing

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difficulty with sleep then those need to

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be treated for instance if you have

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chronic back pain and that pain keeps

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you awake then the back pain needs to be

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treated so that you can get a better

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night of sleep

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we recommend that if insomnia has

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persisted for more than three months

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that it be

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evaluated and then just in general if

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there's any concern for daytime

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impairments in areas such as cognition

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memory or mood then it's probably time

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to see a physician that's our talk for

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today i hope you were able to learn

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something about the associations between

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sleep and stress how to potentially

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improve sleep at home and when to seek

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medical care