Sunday, November 17, 2013

The Relationship between Sleep and Stress

The relationship between sleep and stress is complex and not clearly understood although, it is a bidirectional relationship in that each effects the other (Vandekerckhove & Cluydts, 2010). Stress alters an individual's basic sleep patterns as well as sleep's fundamental anatomy and these alterations have a profound influence on health and well-being. For example, in individuals who attempt suicide, increases in rapid eye movement (REM) sleep during the night prior to a suicide attempt have been identified. Further, altered sleep patterns have been identified in people with depression and in alcoholics prior to relapse (Vandekerckhove & Cluydts, 2010).

For general well-being, the impact of sleep is a salient determinant; it is restorative and may soften the blows of daily stressors. Considering Lazarus' (1991) explanation of the role of cognitive appraisal in determining the threatening nature of circumstances, a good night's sleep may help stave negative or threatening cognitive appraisals and may decrease an individual's predisposition to stress. Lack of sleep has neurophysiological implications as well, in its influence on neural activity in the extended limbic system and other brain regions. In short, sleep has a tremendous affect on the brain, which has subsequent far-reaching effects on cognitive processing, mood, and coping (Vandekerckhove & Cluydts, 2010). Further, it regulates emotions, the capacity to manage stress, and behaviors.

Sleep Deprivation and Illness

Sleep deprivation is implicated in several examples of ill health. It has been associated with substance use and abuse with over 45% of patients with sleep problems self-medicating. In older adults, self-medicating with sedative-type drugs is especially problematic since these drugs are harmful for this population (Wells & Vaughan, 2012). Sleep deprivation has been linked to decreased cognitive functioning, lethargy, and emotional instability (Alhola, & Polo-Kantola, 2007; Wells & Vaughan, 2012). In addition, lack of sleep has been associated with an increased risk of stroke, depression, diabetes, heart disease, and obesity and other chronic diseases (Balkin, Rupp, Picchioni, & Wesensten, 2008).

Sleep deprivation has been associated with increased blood pressure and stress hormones, which have the potential to interfere with cognitive functioning and memory (Joo, Yoon, Koo, & Hong, 2013). Stress events (such as sleep deprivation) cause an endocrinological response to stress via alterations in the balance of hormones, such as increased cortisol and thyroid hormone (Maggio et al., 2013) and biological markers for inflammation (Yoo et al., 2013). Sleep loss causes a stress response that provokes inflammatory proteins that play a central role in loss of immunity and disease progression (Frick et al., 2009).

Sleep Hygiene Education

One concept in the practice of good sleep hygiene includes developing a relaxing bedtime routine (Wells & Vaughan, 2012) that does not include watching television in the bedroom (National Sleep Foundation (NSF), 2012). Watching television in the bedroom decreases the quality of sleep. Especially violence, whether news related or fictional, can cause disturbing sleep (NSF, 2012). Caffeine should be avoided. For some, that means no caffeine in the afternoon if it has long-term stimulating effects.

Alhola, P., & Polo-Kantola, P. 2007. Sleep deprivation: Impact on cognitive performance. Journal of Neuropsychiatric Disease and Treatment, 3 (5), 553–67.

Balkin, T., Rupp, T., Picchioni, D., & Wesensten, N. (2008). Sleep loss and sleepiness: current issues. Chest, 134(3), 653-660.

Benham, G. (2010). Sleep: An important factor in stress-health models. Stress and Health: Journal of the International Society for the Investigation of Stress, 26(3), 204–214.

Bonnet, M. H., & Arand, D. L. (2011). How much sleep do adults need? Retrieved from

Frick, L. R., Rapanelli, M., Bussmann, U. A., Klecha, A. J., Barreiro Arcos, M. L., Genaro, A. M., & Cremaschi, G. A. (2009). Involvement of thyroid hormones in the alterations of T-cell immunity and tumor progression induced by chronic stress. Biological Psychiatry, 65(11), 935–942.

Joo, E., Yoon, C., Koo, D., Kim, D., & Hong, S. (n.d). Adverse Effects of 24 Hours of Sleep Deprivation on Cognition and Stress Hormones. Journal Of Clinical Neurology, 8(2), 146-150.

Kwon, J. A., Lee, M., Yoo, K., & Park, E. (2013). Does the Duration and Time of Sleep Increase the Risk of Allergic Rhinitis? Results of the 6-Year Nationwide Korea Youth Risk Behavior Web-Based Survey. Plos ONE, 8(8), 1-7. doi:10.1371/journal.pone.0072507

Maggio, M., Colizzi, E., Fisichella, A., Valenti, G., Ceresini, G., Dall'Aglio, E., & ... Ceda, G. (n.d). Stress hormones, sleep deprivation and cognition in older adults. Maturitas, 76(1), 22-44.

National Institute on Aging. (2011). A good night’s sleep. Retrieved from

National Sleep Foundation. (2012). Myths and Facts. Sleep Myths & Sleep Facts. Retrieved October 25, 2013, from

Vandekerckhove, M., & Cluydts, R. (2010). The emotional brain and sleep: An intimate relationship.(Report). Sleep Medicine Reviews, (4), 219. doi:10.1016/j.smrv.2010.01.002

Wells, M., & Vaughn, B. (2012). Poor sleep challenging the health of a Nation. The Neurodiagnostic Journal, 52(3), 233-249.

Wong, M., Lau, E., Wan, J., Cheung, S., Hui, C., & Mok, D. (2013). The interplay between sleep and mood in predicting academic functioning, physical health and psychological health: a longitudinal study. Journal Of Psychosomatic Research, 74(4), 271-277. doi:10.1016/j.jpsychores.2012.08.014

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