Sleep and Stress

Sleep hygiene, or the practice of enhancing conditions related to achieving restful sleep, is something I hear about infrequently. We think about and discuss sleeping habits rarely, even though it is a significant a contributing factor to our success or failure when we face challenges in our lives, the related stress, and other emotions. Our relative level of rest or fatigue, as it could be assessed daily, truly affects how effective we are at facing daily life in its complexity. If we are rested, we are effective, and if we are tired, we will not be at our best. This article is about sleep, so if you think you get enough of it, it might not be for you. With a gleam in my eye I challenge you to tell me that no one in your life struggles with finding restful sleep---ever. According to a study conducted in 1985, Sleep problems and stress affect as many as 35% of the general population at some point during the year (Mellinger, Balter, & Uhlenhuth, 1985). Since 1985, we have graduated into an era where on-demand television and radio, the internet, and mobile electronics are not only in our lives but in most of our bedrooms. Go ahead and try to tell me that you have fewer than two internet-capable devices in your bedroom at night. I recently talked to a guy who bragged about getting nearly all of his Christmas shopping done on his smartphone, while in bed. While this article is not about electronics, it is about our ability to get restful sleep. Data seems to support the idea that we are continually getting less and less of it. According to the a 2014 CDC report, between 24.3% and 48.5% of Americans report getting fewer than 7 hours of sleep each night. Possibly more disturbing is data about the incredibly high percentage of high school students who get less than 7 hours of sleep, when we know that adolescents require far more sleep, typically.

We could discuss causes of sleep deprivation across time and probably identify a hundred contributors. But to summarize, a map that can be found on the CDC website shows significant clusters of low sleep prevalence around population centers in the United States (https://www.cdc.gov/sleep/data_statistics.html). Take a look for yourself.

In my life and work, I cannot help but notice that people are busy and experience a ton of stress about all sorts of things. Stress varies in amount and intensity, but I don't know that I have ever met someone who does not know stress in one way or another. Stress is damaging physically, emotionally, behaviorally, and it seems to accumulate like snow. Interestingly, sleep can help with stress but is also experienced as "distressing" according to those who report significant sleep problems. While sleep can be a curative factor toward alleviating or relieving stress, lack of sleep can be a stressor, itself.

I think it's important to keep in mind that when we are under stress, our tendency is to focus on things that are probably important to recognize but often in a way that is counter-productive. So in a very simplistic manner I defend my emphasis on sleep today by noting that it is such a foundational issue in our lives and relationships that when it does not go well, we are nearly guaranteed to have problems. Fatigue is deeply and profoundly disruptive, so rest (the natural cure for fatigue) is the foundation upon which much of our lives rests.

Stress is a problem in a variety of ways, and this is only about stress in one way: We deal more effectively with a lot of things, including stress, when we are well-rested. Conversely, we are more disposed to stress when not rested, and the mistakes in judgement we make when not rested tend to result in higher levels of stress. Also stress, or our relative inability to shed it, can make achieving restful sleep more difficult or impossible. Similarly, lack of sleep with combined stress is known to contribute to mental health problems, and mental health problems are also known to contribute to sleep disturbance (Ohayon, Conlet, & Lemoine, 1998). Major Depression and anxiety disorders have been consistently shown to have a strong correspondence with insomnia and related problems (Ohayon, 2002).

For the remainder of this article I am going to focus on some practical applications of sleep hygiene that are universally suggested by medical and behavioral health providers around the World.

Restful Sleep

We vary in the actual amount of sleep that we each need, but there is some agreement on minimums and maximums. According to the National Sleep Foundation, the majority of adults need somewhere in the neighborhood of 7-9 hours of restful sleep each night. While there are differences based on distinct age categories, this gives you a point of reference for measuring your own sleep health. If you have problems in this area, it is certainly worth discussing with your doctor, because it is important to rule out any potential medical issues that might take the restful part out of sleep.

I am not a sleep specialist, but all of my clients do sleep. I have to remain constantly mindful that some of their experiences may be impacted by issues related to rest and fatigue. This holds especially true for young children and teens, who typically need a bit more sleep than adults. I keep problems related to sleeping in a few basic categories for that reason:

Issues related to getting to sleep (of getting to sleep too often)
Issues related to staying asleep
Issues related to the sleep cycle (or depth of sleep)
Issues related to unusual occurrences during the sleep cycle
Issues related to waking

No matter how well you sleep, you are not achieving restful sleep until you have reached deep sleep and stay there long enough to achieve rest. There are a ton of resources out there about where deep sleep occurs and how many hours of REM sleep actually constitutes sufficient sleep. For our purposes here, just know that restful sleep should probably conclude with the person sleeping feeling rested. If you believe you are getting enough sleep and still experience fatigue when you wake, then you may have a problem with sleep. Below, are some considerations related to sleep, that might be important to consider as a little self-assessment to determine if you are really doing your very best when it comes to giving yourself an opportunity to get restful sleep. Be honest with yourself and see how you do:

Things that can be Bad for Sleep

Napping during the day
Watching television in bed
Using a device with a bright screen in the hour before bedtime (e.g. a smartphone, a laptop)
Discussing serious issues or arguing before bedtime
Consuming drinks containing caffeine (includes tea, coffee, cola, energy drinks, hot chocolate) • How many each day? • What time of the day was your last caﬀeinated drink? (try to avoid caﬀeine after 6pm)
Drinking alcohol (alcohol typically leads to interrupted sleep)
Eating a 'heavy" food fewer than 3 hours before bedtime
Staying in bed even if you can’t fall asleep (you may have better luck getting out of bed and doing something relaxing until you are ready to go to sleep)

Things that can be Good For Sleep

Regular exercise- how many times per week?
Exercise at the proper times- most recommendations are to exercise 3-4 hours prior to bedtime.
Scheduled stress management- arrange your schedule to manage worries, discussions or thinking about serious issues well ahead of (at least 1 hour) prior to bedtime, more if possible.
Relaxation exercises- deep breathing, progressive muscle relation
Prayer- give your worries to God and pray that you will wake refreshed and prepared for a new day.
Consistent and relaxing bedtime routine- whether you take a shower or bath, read a book, sit quietly for a while, listen to calm music, the idea is calm and consistent. A good routine will help your body learn to wind down over time.
Proper conditions for sleep- dark bedroom, comfortable temperature, comfortable mattress and pillows, make sure the room is as relaxing as possible, and, if it isn't already as clear, turn the TV and other electronics off as early before bedtime as possible.

For anyone who has not spent much time considering the ideas I present above, I would suggest that you go over each line and make an honest assessment of where you might be able to improve. If you are not sleeping well or getting sufficient rest, it might be useful to start to make improvement in at least one area, with the eventual goal of making improvement in as many areas as possible. Remember that it is advisable to check with your doctor about sleeping issues or any major changes in lifestyle habits like exercise or eating.

As I mentioned earlier, problems with sleep and rest can have major impacts in other areas of life, such as mental health, work, physical health, and even relationships. For children, problems with sleeping can impact brain development, emotional health, academic ability, and social relationships. Developmental issues, such as delays in potty training, social milestones, or other abilities could arguably be impacted through a lack of sleep as well. Whether as adults or kids, it is most important to recognize that when sleep problems collide with our lives, we are not at our best for coping, learning, communicating, or problem solving. With that said, sleep is one of our foundations, and it should not be ignored due to it's simplicity. I wish you sweet dreams!

References

Centers for Disease Control online. https://www.cdc.gov/sleep/data_statistics.html

Ohayon, M.M., Conlet, M.,& Lemoine, P. (1998). Comorbidity of Mental and Insomnia Disorders in the General Population. Comprehensive Psychiatry.

Ohayon, M.M. (2002). Epidemiology of Insomnia: what we know and what we still need to learn. Sleep Medicine Review. Vol.6(2), pp. 97-111.

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About the author:

Brock Caffee, LCMFT is a Marriage and Family Therapist, licensed in California and Kansas. He has over a decade of practice experience. He has a private practice in Lawrence, KS. At home he has three children, three dogs, and a very patient wife.

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Parenting Disclaimer: As I mentioned earlier, parenting can be complicated and difficult. Please understand that not all families are prepared to change tactics, and not all children will demonstrate the same preparedness for behavior change. If you feel that additional guidance may be necessary, please contact a family therapist in your area. If you are in the Lawrence, Kansas City, or Topeka area, you may contact me (brockcaffee@familystrategiescounseling.com) for a free telephone consultation.

The views expressed in this blog are meant to help foster perspective, to entertain, and to be fun when possible. Any intent to regard the blog as counseling or therapy constitutes misuse. Advice offered in the blog should be considered only if consistent with your family values and with advice given by your own mental health professionals. Please seek consultation with a mental health professional in your area if you experience distress or feel you are in crisis. The National Suicide Prevention Lifeline is 1-800-273-8255.