Posted by Dr Sophie Bostock - Sleep Expert on 5th Apr 2022
Stress and Anxiety: The Tools to Help You Sleep
Do you ever feel as though you’re always on, and have difficulty switching off?
Many of us fill our days to the brim with work, sport, family, friends, social media, DIY, shopping, hobbies. It’s all good stuff, but it can mean that we rarely make time to PAUSE and just be.
The problem with this ‘always on’ approach is that our brains learn to rely on our fight or flight stress response - powered by the energising hormones adrenaline, and cortisol - to keep our energy levels high all day. This is the same evolutionary response that our ancestors used to stay alert when they were under threat from predators. We become alert, or wired, all day long.
If your stress response gets stuck in the ‘on’ position all day, it can make it very difficult to get into a deep, restorative sleep at night. This is where the role of relaxation comes in.
The stress response is balanced by an opposing ‘rest or digest’ (or relaxation) response, which promotes digestion, repair, sexual arousal and sleep.
To flip the switch from stress and anxiety to relaxation, we have to convince the brain that we are safe, and in control. To do this, we can either focus on relaxing physically or mentally. Our minds and bodies are interconnected, so relaxing our muscles will still relax our minds, and vice versa.
Relaxation is a skill - the more often you practice, the more quickly and deeply you will be able to relax. It’s a good idea to practice for a few minutes during the day as well as part of your wind down before bed.
How can you sleep when you're feeling stressed or anxious?
Many of us struggle with sleep when we’re experiencing an acutely stressful situation. This might be work stress, a tricky relationship, a bereavement or significant life event.
Under stress, people often describe not being able to switch off their racing mind. You may find that you fall asleep OK, but then wake up in the early hours of the morning, wide awake.
The good news is that stress doesn’t have to keep you up at night. Some people seem to sleep soundly, no matter what is going on in their lives. Sleep reactivity is the name given to describe the extent to which stress disrupts sleep, a difficulty falling or staying asleep. Our genetics will influence our sleep reactivity, the nature of the stress and life experiences will all play a role.. but we can all learn strategies to decrease our vulnerability to stress at night.
What is stress?
In our bodies, the term ‘stress’ or ‘stressor’ can refer to anything which provokes our ‘fight or flight’ stress response. The stress response evolved to help our ancestors fight or flee from danger.
When the brain detects a threat, the body releases adrenaline, which speeds up the heart beat, increases blood pressure and triggers the release of the stress hormone, cortisol. Cortisol then stimulates the release of glucose into the bloodstream to fuel the body for action.
Stress and anxiety also influence the way we think and feel. We narrow our attention towards the threat; it takes on disproportionate importance, and it’s harder to step back and see the big picture.
The emotional centres of the brain become more sensitive to negative events when we’re already feeling stressed. We also tend to become more anxious, irritable and prone to low moods.
What are the most common causes of stress and anxiety?
The stress response was very helpful for our ancestors when they faced an acute physical threat (such as an attack from a predator) which they could run away from. Unfortunately, most of the stress we experience nowadays is not physical, but psychological.
Psychological stressors come in many forms. It’s not just about threats to our safety, or our loved ones’ safety; any situation which is new, unpredictable, makes us feel out of control, or overwhelmed, can trigger a stress response. Discrimination, or fear of exclusion, or a loss of status (such as financial pressures) can be another stressor.
The big problem with many psychological stressors is that there may be no clear ‘end’ to them. If a predator runs away, you can relax. But if you’re worried about money, or health problems, the stress can last for months at a time.
What are some of the signs of stress?
The way that we react to stress is individual, and will depend on whether it’s acute or chronic.
Most of us are familiar with the signs of acute stress, which are characterised by the ‘fight or flight’ stress response. This might be how you feel before public speaking, or if you narrowly avoid an accident on the roads. Signs of acute stress include:
- Sweating
- Racing heart beat
- Tense muscles
- Stomach upset, indigestion or heartburn
- Altered appetite
- Rapid breathing
- Narrowing of attention and focus towards the threat
When you are stressed for a long time, some of these physical signs are less obvious, and you might not consciously ‘feel’ stressed or anxious. It could be that the brain and body have simply learned a pattern of increased arousal (so-called ‘hyperarousal’) because you’ve been under stress for so long.
Chronic exposure to stress hormones takes its toll on the body. Signs and symptoms of chronic stress can include:
- Weight gain or weight loss
- High blood pressure
- Changes to the menstrual cycle
- Sexual dysfunction
- Constipation or diarrhoea
- Rashes or itchy skin
- Infections or illness
- Changes in mood - greater impatience, irritability, anxiety or depression
- Difficulty making decisions
- A feeling of being overwhelmed
- A worsening of physical or mental health conditions
- Difficulty sleeping, either falling asleep or waking up during the night
How is stress related to anxiety?
Anxiety is the name given to the way we feel when we are worried, tense or afraid. We feel anxious about things that are about to happen, or which we think could happen in the future. Anxiety can be a natural emotional response to a stressful situation.
While anxiety is a natural way to respond when we are genuinely under threat, it can also be a problem if anxiety is excessive and interferes with the way we live our lives. Anxiety disorders are a family of mental health disorders which are characterised by excessive and persistent worry. Examples include generalised anxiety disorder, social anxiety disorder (related to social situations), phobias and panic disorders. People suffering from anxiety disorders will typically perceive life to be more stressful, because their brains are in a constant state of high alert.
Chronic exposure to stress also makes people more prone to emotional disorders, including anxiety disorders, and depression. It’s as if we lose some of our emotional elasticity under stress, and it’s easier to become stuck in patterns of anxious thinking, or low mood.
Why do stress and anxiety impact on sleep?
Under stress, we tend to produce more of the hormone, cortisol. Cortisol is a very useful hormone for fuelling action. But before bed, it increases our levels of arousal, at a time when we need to relax. Stress therefore leads to a state of hyperarousal, where your brain and body are more alert than normal. It takes us longer to fall asleep, and because sleep is lighter, we’re more likely to be woken by noise, movement or changes in temperature.
Stress can also cause us to change behaviour in ways that are unhelpful for sleep, such as doing less exercise, relying on alcohol to relax, working late or taking long naps to recover.
Tools to help you sleep during times of stress and anxiety
Sometimes it’s possible to tackle stress by resolving the source of stress - for example, speaking to your manager about managing your workload, if work stress is overwhelming.
However, sometimes it’s not possible to avoid the source of stress, for example if you’ve been diagnosed with a chronic medical condition. What you can do though, is to learn tools to switch off the cortisol tap, and the associated hyperarousal, to promote a more restful night’s sleep.
Here are some of the tools you can use to help you switch from a state of stress and anxiety to one of relaxation.
Box breathing
When we’re in danger, our breathing tends to get faster, as we prepare to fight or flee from a threat. But occasionally, our breathing might pause completely: as we freeze, while we make up our minds. The same responses happen in moments of stress or anxiety.
Maintaining a slow, steady breathing rate, therefore helps to signal to the brain that we’re not under threat. This helps to drive the relaxation response. There are many different breathing techniques you can try, and it’s worth experimenting with a few different exercises until you find an approach which has a calming effect on you.
What is box breathing?
Box breathing involves breathing in for a count of 4, holding that breath for a count of 4, breathing all the way out for a count of 4, and holding for a count of 4. Set a timer for at least 5 minutes and aim to maintain this pattern.
If you’re lying down, it can be helpful to keep one hand on your belly and one hand on your chest. Focus on making your belly and fall, rather than your chest. This means you are more likely to be using your diaphragm to pull the air all the way, deep into your lungs, which provokes the relaxation response.
Positive imagery
If you need something which takes a little more of your mental focus when you’re feeling stressed or anxious, I’d recommend trying some positive imagery. Close your eyes and picture an event or place that makes you feel relaxed. This might be your favourite beach, mountain, lake, forest, or an imaginary place.
Imagine that you’re the movie director of your perfect scene.
Ask yourself:
What can you see?
What can you feel?
What can you smell?
What can you touch?
One of my clients pictured themselves walking through every room in their perfect home. I sometimes imagine myself on my favourite beach, catching waves at sunset.
You’re not trying to sleep - that’s important - you’re just going to enjoy visualising a happy place where you can feel calm and comfortable.
The more often you can return to this safe place in your mind, the more easily you’ll be able to relax and unwind, and eventually, it could help you to fall asleep.
Put the day to rest
If you’re plagued by a busy mind, one strategy is to get into the habit of writing down some of your inner dialogue in advance of bedtime. Put aside 10-20 minutes for this exercise, perhaps at the end of the workday, or after dinner. Ideally not right before bed since this exercise will get you thinking.
Sit down somewhere you won’t be disturbed and grab a notebook. Write a few bullet points about what has happened today.
What went well? How did that make you feel?
Has anything troubled you? Why was it difficult?
What could you do differently next time?
When you’ve finished reflecting on the day, think about what’s coming up tomorrow.
What are you looking forward to, and why?
What’s your number one priority?
The aim is to stop unnecessary thoughts whirring around your head. If the same thoughts pop into your head when you’ve switched out the light, you can tell yourself that they are on the page, and you don’t need to think about them anymore. If any urgent thoughts do come up in bed, keep your notebook and a pencil by your bed so that you can write them down, and then let them go. This will help to calm your stress and anxiety levels which should, in turn, help with sleep.
