Stress: The Principal Cause of Insomnia

The Insomnia Solution : The Natural, Drug-Free Way to a Good Night's Sleep
by Michael Krugman, MA, GCFP

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What causes the transitory insomnia that plagues so many millions of us? And more important, why is it happening to you? The short answer is, stress. Stress is the principal cause of insomnia. But what is stress? Everyone talks about stress, and everyone suffers from it at one time or another, but when we come right down to it, we're not really sure what stress is. So let's try to clarify it a bit.

Any healthy animal, whether it's a jellyfish, your family dog, or you, exists for most of its life in a state of homeostatic balance. That means that certain essential measures of vitality-fluid balance, caloric intake, temperature, and so on-are kept close to the ideal "set point." This allows the organism to function at its peak potential.

A stressor is anything that throws that fundamental balance out of whack, and stress is the variety of physical responses the organism uses in attempting to restore it. In human beings, the stress response begins with the release of two hormones from the adrenal glands: epinephrine and cortisol. These two hormones channel extra energy to the muscles and boost blood supply to allow quick action in response to the stressor. At the same time, they withdraw energy from processes that aren't needed for short-term survival, like growth and digestion.

The stress response is often triggered by an acute physical threat or demand-fleeing from a predator is the most often cited example-but it can also result from less dramatic factors such as heat or cold, scarcity of food or water, exposure to pollutants or toxins, immobilization, crowding, noise, darkness, and, yes, lack of sleep. Then there are such intangibles as fear, anger, grief, uncertainty, even extreme joy. All of these things are stressors; all of them are capable of provoking a stress response.

When the average animal encounters a stressor, its body produces a stress response for only as long as necessary and then returns quickly and efficiently to its previous homeostatic state. But humans and other primates are not your average animal. For them, the stress response can be triggered not only by real threats but also by the mere anticipation of one. Sometimes, if stressful events persist for a long time or recur with great frequency, or even if we just anticipate that they will, the stress response becomes a more or less permanent state of affairs.

When the stress response becomes the norm rather than a transitory state, then we are in for some real trouble. In the homeostatic state, our bodies conserve energy, using only what is necessary to maintain the balance of life. But with the stress response, there is a generalized increase in our metabolic rate: Our pulse quickens, our blood pressure and oxygen consumption soar, our muscles tense, and our body temperature runs hotter than normal, as if to prepare us for immediate action. But this is far more energy than we can afford to spend on a regular basis. Whereas the purpose of the stress response is to restore the body to balance, prolonged or unremitting stress creates serious imbalances of its own. Keeping all our bodily systems in a constant state of alarm eventually wears us out. It's no wonder that stress plays a role in the development of so many diseases, from heart attacks and stroke to anxiety and depression, diabetes, ulcers, colitis, and cancer.

So where does insomnia fit into this picture? How does stress cause insomnia? To understand that, we must first know a little bit about the physical processes that occur when we fall asleep. Falling asleep is a natural process that involves a distinct sequence of events in the body. As we approach sleep, there is a gradual lowering of metabolism. Our heart rate slows and our blood pressure declines. Our breathing becomes more regular, and we consume less oxygen. Our postural muscles, which have worked all day to keep us upright and moving about, now relax. At the same time, there are changes in the processing activity of the brain. The activity of neurons in the cerebral cortex becomes first slower, and then more synchronized, indicating a shift away from the complex, activated patterns of waking consciousness and toward a homogenous, deactivated state. As a result, we cease to process the sensory messages coming in from the outside world, and we slip into quiet sleep.

If we compare this description of the sleep-onset process to the description of the stress response in the preceding paragraph, it becomes very obvious that these are two antagonistic processes. Falling asleep involves a decrease in metabolism, and a gradual cessation of readiness for action, whereas the stress response involves a rapid increase in metabolism, sending the organism into a state of preparedness for action. The sleep process decreases arousal, making us less alert, while the stress response increases arousal, making us more so.

You'll remember we mentioned that the adrenal hormone cortisol was a trigger of the stress response. That's not cortisol's only job, however. In addition to the sharp transitory peaks of cortisol secretion that characterize the stress response, there is also a daily, cyclical rise and fall of cortisol levels that govern our level of wakefulness throughout the day and night. Cortisol is excitatory; it arouses us and wakes us up. Blood levels of cortisol have been shown to increase between 50 and 160 percent within thirty minutes of waking; that produces the powerful jolt of arousal needed to wake us up and get us moving in the morning. Then, cortisol levels decline as the day wears on and reach their lowest point in the evening, allowing us to rest, relax, and sleep.

But, as we know, cortisol levels can also be affected by the conditions of our daily existence. Dangerous, demanding, or threatening events-stressors-cause us to temporarily secrete higher levels of cortisol. That's a good thing, because we need to be aroused in order to answer the challenges that arise in the course of our lives. But when, as a result of prolonged or unremitting stress, whether real or perceived, our cortisol levels get stuck at a chronically higher level, that's bad news for our bodies and minds, and especially bad news for our ability to sleep and rest. Chronic oversecretion of cortisol leaves us chronically hyperaroused. Numerous studies indicate that insomnia is accompanied by excessive activation of the stress-response system not only during waking hours but during sleep as well. Furthermore, chronically elevated levels of cortisol and its precursor, adrenocorticotropic hormone (ACTH), can make sleep shallow, fragmented, and unrestful; delay the onset of sleep; and produce more frequent nocturnal awakenings.

To summarize: Stress is the principal cause of insomnia. Stress hormones are excitatory. When stress becomes chronic, we become chronically excited, or hyperaroused. When we're chronically hyperaroused, we can't sleep, and the sleep we do get is not as restful.

The Big Question: How Much Sleep Do You Need?

This is the question I'm asked most frequently, and it's a tricky one. Each person's needs are different, not only for sleep but also for all aspects of life. Consequently, there are probably as many ways to answer the question as there are people! To approximate any kind of an answer I would need to know: What is your age? What is the state of your health? What are your personal sleep rhythms? What is your profession? What is your work schedule? What is most important to you in life? What are your dreams, your aspirations? What is your life's purpose? When we know all of that and more, we can see how sleep fits into the total picture, and we can start to come up with an individual answer. In my private practice, I often spend quite a bit of time helping my clients discover how to balance their needs for sleep, rest, and repose with all the other aspects of their lives.

Of course, I cannot give an individual answer for each reader. I have to say something general that will be helpful to each of you! So here goes.

Before Thomas Edison's invention of the lightbulb and the advent of artificial lighting, it is believed that Americans slept an average of 10 hours per night. Medical science currently recognizes 8.4 hours of sleep per night as the average sleep requirement for general good health, though recognizing that some people can get along fine on an hour or two less whereas others need an hour or two more. I don't disagree with that general rule of thumb, but my perspective is a little different since I view sleep as not merely a medical matter but also a personal and spiritual one. My interest is not only in general health but in personal growth, pleasure, and self-healing as well.

It is my belief that we need something like eight hours of sleep per night, give or take an hour or two, but we can use a whole lot more. You see, I believe there are parts of each one of us in a state of profound un-rest, and these parts of ourselves require more than ordinary nightly sleep to be fully rested and fully healed.

To make an analogy with nutrition, we all know that there is a minimum daily requirement (MDR) set by the government for certain nutrients-vitamins A, C, and E, calcium, magnesium, and so forth. The MDR for a given nutrient is the amount you need to maintain general health. But, as you may be aware, these same nutrients can be taken in larger doses to enhance our overall vigor and vitality and, in the case of illness or injury, to support healing. The same goes for sleep.

That 8.4 hours, give or take two, is your MDR for "vitamin S," sleep. That's a medical necessity! Still, you can take higher doses of sleep to dig down into those deeper recesses of yourself that need resting, nurturing, and healing to help them to regain their full vitality, their full aliveness. These pleasurable, all-natural "sleep supplements" may include minutes or hours added to your usual bedtimes, as well as daytime naps, breaks, periods of deep relaxation, introspection, meditation, daydreaming, and anything else that helps you to maintain a more peaceful existence. All of the Mini-Moves(TM) presented in this book are designed to help you do just that.

The Other Big Question: How Many Hours Should You Spend in Bed?

People so often wonder how many hours of sleep they need, but they rarely think about how many hours it might take to get those hours. The question is one of efficiency: How many hours does it take to get eight hours' sleep? If you really think about it, you'll see that it takes considerably more than eight hours! Or, to put it another way, eight hours in bed is not the same thing as eight hours' sleep. Here's why: Let's say you go to bed at 11 p.m. and you plan to wake up at 7 a.m. In other words, you're planning to spend eight hours in bed. How much sleep will you get during those eight hours? Well, how long does it take you to fall asleep? Five minutes? Ten? Twenty? Or more? It is perfectly normal to experience some lag time between hitting the pillow and actually drifting off to sleep (scientists call this the sleep latency period). To be accurate, we really can't count that latency period as part of the sleep total. Subsequently, when you calculate how much sleep you've had, please do subtract that lag time from the eight hours you spend in bed.

Ask yourself whether you tend to have periods of wakefulness during the night. Do you observe a nightwatch, awakening to muse or meditate some time during the late night or early morning? That's normal, too, and it can be richly rewarding, but how much does it detract from your actual snooze time? Finally, what about the morning? Do you wake up ten, twenty, or thirty minutes before 7 a.m., just lying there, luxuriating in the waning moments of bedtime? That's an agreeable way to start the day! When you calculate your sleep time, however, that gets subtracted from the total.

So let's say you spent twenty minutes drifting off, twenty for the nightwatch, and twenty minutes lying in the gold of dawn. There goes sixty minutes of sleep right there! You got into bed at 11 and you got out eight hours later, but you slept for only seven hours! The bottom line is, depending on your sleep style, it may take considerably longer than eight hours to get eight hours' sleep.

Of course, this is only an example, and your own sleep needs and your sleep schedule may vary considerably. For that reason, I strongly suggest that you perform a similar calculation for your own bedtime habits, and determine exactly how much sleep you actually get. You may be surprised! As a result, you may wish to adjust your sleep schedule, allowing more time in bed so you can get the rest you need. Sleep on it!

Sleep Medication: Cold Comfort

Sleeping pills are currently a $2 billion industry, and for the pharmaceutical industry that's just an appetizer. An article in Business Week cites industry estimates that the market will more than double, to $5 billion by 2010. "This is unquestionably one of the largest potential pharmaceutical markets in the world," opines pharmaceutical executive Gary A. Lyons, quoted in the New York Times (January 14, 2004). This rosy forecast is based on the finding that only 40 percent of insomnia sufferers have been diagnosed, and of those, only about half are receiving treatment; and fueled by the expectation that new drugs entering the market will work more reliably than existing preparations and find greater acceptance among consumers. Industry-sponsored public-opinion campaigns begun years ago engender the belief that drug treatment for insomnia is on the one hand medically necessary, and on the other as natural, safe, and unremarkable as taking an aspirin for a headache.

But is it? It's telling to note that a recent study conducted at the Harvard Medical School found that half a dozen sessions of cognitive-behavioral therapy (CBT) can do more to help a troubled sleeper than the top-selling sleeping pill. CBT is a form of talk therapy previously proven to be highly effective for depression. The therapy addresses the root causes of insomnia-stress, worry, fear, anxiety-and teaches the patient to handle them more effectively. To me, that seems a much safer and more appealing solution than drugs. And by the way, the deeply relaxing movement and breathing techniques presented in this book are completely compatible with all psychotherapeutic approaches. The therapy addresses the emotional and behavioral roots of your problem, whereas the movement techniques restore your inborn ability for natural, restful sleep. Of course, swallowing a single pill at bedtime would be quicker and require less attention on your part. But I think you're worth a little extra time and attention, especially when the end result is likely to be safer, better, and longer lasting.

I personally have no qualms about sleeping pills as a last resort. I'm glad they're available to folks who are enduring pain, illness, side effects of chemotherapy, or overwhelmingly stressful life events, and who would otherwise go sleepless for long periods. In those cases I consider sleep medication to be a blessing. Why should people suffer when medications can help? However, sleep medication has become the first, rather than the last, resort even for short-term, transitory insomnia. "Missed a couple nights' sleep?" say our doctors with increasing frequency, "here's a sample. Take as needed."

It's easy to start on sleeping pills, but it's not always easy to stop. Much of my private practice consists of people who are terribly eager to wean themselves off sleeping pills, most of them in the grip of a single best-selling brand. They welcomed sleeping pills as an easy ride to sounder sleep, and now they find they can't get off the merry-go-round. Although they may not be technically "habituated," they may struggle with "rebound insomnia," sleeplessness that results when sleep drugs are withdrawn. After a period in which the sleep-wake rhythm was controlled by a drug rather than the body's natural timekeeping mechanisms, it can be hard for mind and body to resume their former duties. Even if you're suffering rebound insomnia, don't despair! If you're truly committed to your own self-healing, the insomnia solution presented in this book can help you.

If you're considering trying sleeping pills, here are four questions I suggest you ask your doctor-and yourself. First, how will sleeping pills affect sleep quality? Is the sleep you get with a pill equivalent to the natural, restful sleep we were born to enjoy? Or is it just an imitation of the real thing, like coffee creamer or a Dynel hairpiece? Bear in mind, sleep is more than just becoming unconscious for eight hours. Just as a balanced meal contains all the essential nutrients in precise proportion, natural sleep contains all the essential stages of sleep in precise proportion, too. Disturb that essential balance of sleep, as many medications are known to do, and you may get something quite different. What does modern science say on the subject? Is there any research to guide you? Sadly, not much. Research takes lots of money, and most studies on sleeping drugs are funded by the manufacturers themselves. They are interested in how long a drug takes to act, how long its effects last, and what the side effects are. That's about as far as it goes.

Second, what are the long-term effects of sleeping pill use? Sleeping pills can't actually cure insomnia. They are at best a stopgap solution designed to tide you over until the causes of the problem abate. Note that no sleeping pill has ever been tested or approved for more than short-term use-a month at best. Yet many troubled sleepers take them for months or even years. What are the health effects? What are the consequences? We can't be certain.

Third, how long will the drug retain its effectiveness? Many sleeping pills work one way when you start, and quite differently a month or two later. Your body and mind may become desensitized to the drug's effect. You might need to add another drug, and then another, just to get the same effect you began with. Not a few people end up taking several drugs, every night at bedtime, without a cure in sight. I have clients who take three different sleep medications every night; in The Promise of Sleep, Dement reports patients who take as many as eight.

Fourth, what's the exit strategy? How long should you plan to use this drug, and what will it take for you to stop? Will you experience rebound insomnia? Please discuss these and any other questions you may have with your doctor or other health care provider before embarking on a course of sleep medication. With your doctor's consultation, and a bit of your own research, you can make the decision that's right for you.

Even if you do decide to go the medication route, I hope you will choose to learn the gentle sleep-inducing exercises in this book as well. They will make your daily life more peaceful, thereby hastening the day when you won't need sleeping pills anymore. And when that day comes, the gentle, synchronized movements and breathing will put the healing power of natural, restful sleep quite literally at your fingertips.

The "Sleep Switch" and How to Flip It

More than seventy years ago, a gifted neurologist named Constantin van Economo speculated that there were physical structures in the brain that were responsible for sleep and waking. He postulated a wakefulness center in the posterior hypothalamus and a sleep-promoting center in the preoptic area. Twenty years later, a Dutch neurologist, Nauta, discovered that an incision in the front of a rat's hypothalamus interfered with its ability to sleep and one in the back of the hypothalamus sent it into a coma. But the exact location and character of the neurons responsible were unknown.

Recently, building on these earlier discoveries, a team at Harvard Medical School has located two centers in the rat brain, which they believe constitute the "sleep switch" in the human brain. As predicted, the ventrolateral preoptic nucleus (VLPO) in the front of the hypothalamus contains neurons that are active during sleep, while the posterior lateral hypothalamus contains neurons that are crucial for maintaining normal wakefulness. It seems that these two centers carry on an ongoing neurological tug-of-war in which each center attempts to inhibit, or suppress, the other's activity. Whether we're awake or asleep at any given moment depends on which of these centers is dominant at the time. Taken together, these interdependent structures are said to constitute a sleep switch that, when functioning properly, keeps us awake during the day and asleep through the night. By the same token, disruption of the communicating pathway between the two structures may be a cause of insomnia and other sleep disorders. Reports of these discoveries have caused a stir in the media, even making it to the cover of Newsweek. Much of the excitement centers on the search for new sleep drugs. Now that they think they know where the sleep switch is located, scientists plan to invent new drugs that will allow us to flip it "on" whenever we like. The hope is that the new drugs, rather than sedating the entire central nervous system, might act more specifically on the centers that actually control sleep, providing something closer to natural, restful slumber than existing sleep preparations, without the side effects, potential drug dependency, and unpredictable results.

My response to the discovery of the alleged sleep switch is a bit different. I welcome the discovery as a scientific elucidation of something I already know in my own experience. For I have known for some time how to flip the sleep switch without drugs, without any artificial aids whatsoever. And I can teach it to you, too. Using the simple, immediately available tools of physical movement and breathing, you can learn to throw the sleep switch whenever you need to. In doing so, you needn't introduce any foreign substances into your body. Rather, you can switch on your body's innate faculty for healthy, restful sleep simply by acting in perfect accord with nature's laws and your own deepest needs. And it won't cost a penny. That's what we're going to talk about in the next chapters.

Copyright © 2005 by Michael Krugman

About the Author

Michael Krugman, MA, GCFP, is the founder of the Sounder Sleep System. An expert teacher and lecturer on sleep, self-healing meditation, and corporate wellness, he has given seminars to major U.S. and European companies such as Saatchi & Saatchi, HBO, and Equitable Insurance.