Insomnia and stress at night

Stress and anxiety can activate mechanisms that make it difficult to fall asleep or that disturb sleep.

A yawn, eyes closing: it’s the signal that it’s time to go to sleep. But once in bed you don’t really talk about sleeping, or once you fall asleep you suddenly wake up.

Night sleep disorders are very frequent: 10% of the population suffers from chronic insomnia, especially women over 50, and 30% occasionally do not sleep.

A “quality” sleep

Sleeping is not enough to rest, what makes the difference is the quality of sleep. There are the “long dorms”, which need at least 10 hours of sleep; At the “short dorms” it takes about 6, and in between there are those who need 7-8 hours. All these categories, upon awakening, feel rested.

Those suffering from insomnia, on the contrary, may have slept 7 hours, but in a fragmented way, with frequent awakenings that compromise the quality of rest.

The insomniac is the person who sleeps insufficiently or has a poor quality sleep, not very restorative, so much so that he has to fight with fatigue during the day.

What is insomnia

Insomnia is characterized by difficulty falling asleep, insufficient hours and lack of continuous sleep due to intermediate awakenings and poor sleep quality.

It is often a symptom of specific physical or psychic conditions, the consequence of imbalances caused by particular situations or by the environment in which we live, but it is also a primary disorder, not necessarily associated with anything else.

When it occurs 3 times a week and lasts for more than a month it is called chronic.

«The “real” insomnia – explains Lino Nobili, specialist in neurophysiopathology and child neuropsychiatry, Head of the Sleep Medicine Center at the Niguarda Hospital in Milan – is the one whose consequences are paid during the day. The lack of rest has an important impact on the ability to concentrate, you become short-tempered and you have the feeling of being perpetually tired».

Insomnia is one of the causes of increased pressure and can lead to the development of cardiovascular diseases. Taking care of sleep therefore has positive effects on hypertension and overall health.

There are different forms of insomnia, for example stress and paradoxical insomnia. The following table summarizes the main symptoms.

Let’s find out together in more detail.

Stress insomnia

It is not always possible to put a stop to the day, and when the consequences reappear at night they are “pains”.

Emotionality and psyche are in fact closely linked to sleep: what we live during the day can have repercussions at night. Stress and anxiety activate hormonal mechanisms that keep us awake and compromise the natural lowering of cortisol in the evening hours, which keeps us in a condition of constant “excitement”.

“Very often – explains Nobili – the anxiety of not sleeping plays an equally important role. The fear of going to bed and having a blank night in front of you creates such stress that it is impossible to fall asleep».

“Sleep – continues the expert – is deep in the first 3-4 hours. You then enter the REM phase, the one in which you dream, after which sleep becomes lighter and slowly you go towards awakening. Those who have a fragmented sleep and enter the deep phase towards the morning, at the time of getting up will experience the sensation that is called “sleep drunkenness”: headache, lightheadedness and the beginning of the day is uphill ».

Those who experience this situation tend to develop behaviors that put sleep even more at risk, such as anticipating the time to go to bed thinking they can rest for more hours. It is also not recommended to overheat the body, as among the enemies of sleep there is also heat: therefore no hot baths or intense physical activity before bedtime. The best time to sleep is precisely when our body begins to imperceptibly lose heat, a phenomenon that occurs naturally in the evening hours.

Paradoxical insomnia

Another type of insomnia that has a correlation with stress is paradoxical insomnia. Its characteristic is explained by the term “paradox”, that is, the misperception between real sleep and perceived sleep. Those who suffer from it believe they spend the night without closing their eyes, but when they undergo instrumental examinations it turns out that they are actually sleeping, but his sleep is unstable with frequent awakenings, perhaps only for a few seconds.

Paradoxical insomnia is a severe form that overestimates the waking time, a significant number of people suffer from it, in most cases they are women over 50 years. “The brain of these people – clarifies Nobili – cannot sleep globally: a part always remains “connected” and this means that they do not perceive deep sleep because some regions of the brain remain awake. And in the morning having the feeling that you have never turned off your brain is very tiring.” The risk that these people run is to abuse pharmacological products.

Diagnosis

It is mostly clinical and takes place through an interview with the patient to collect information on how he spends the night, on nocturnal “habits”, as well as daytime activities and psycho-physical conditions.

“Often the patient is asked to fill out a sort of “sleep diary” with the times of falling asleep and awakenings, both during the day and during the night in order to have a more in-depth assessment of sleep-wake. In some cases – adds Nobili – it may be necessary to perform other laboratory tests. Or specific instrumental investigations can be carried out».

Instrumental examinations

The main ones are actigraphy and polysomnography. For the first, a device is used that the patient wears on his wrist for several days. It records all the data that is downloaded to a computer to make a graph showing the activity/rest alternation.

Polysomnography records electroencephalographic activity, that is, electrical phenomena of the brain, along with other parameters, such as eye movement, muscle tone, respiratory activity, heart rate. The aim is to evaluate both quantitative and qualitative characteristics of sleep.

These tests are performed in hospitals and specialized centers, are provided by the National Health Service and a medical prescription is required.

Drugs

A valid ally are sedative drugs that act on particular receptors of the central nervous system and produce a tranquilizing action.

Sleeping pills are also available that stimulate the mechanisms of falling asleep. They should be taken about 30 minutes before bedtime: their concentration in the blood is reduced within 4-5 hours.

Pay attention to treatment times: they should always be used at low doses, under medical supervision and for no more than 3-4 weeks.

“When you are over 50 years old – specifies Nobili – it is advisable to first try melatonin for its effects both “soporific” and synchronization of the sleep-wake and light-dark cycles. Currently we have an extended-release melatonin that is in effect a drug; It is generally used for a longer period, up to a couple of months.”

Cognitive behavioral therapy

It is an effective treatment for chronic insomnia, the aim is to address all aspects of sleep hygiene in a broad way and can be carried out both in groups and individually with the guidance of a psychotherapist or psychologist.

“The therapist examines what are the behaviors that the person implements in the wrong way and helps to reduce the levels of general attention, without going to investigate the experience and reasons for anxiety. The idea – clarifies the expert – is to make a therapy that is effective within two or three weeks. For the results to be good, the commitment of the person during the sessions is important, but even more so in putting the indications into practice at home».

During the meetings we explain the ways to regulate the sleep-wake rhythm, we teach relaxation methods and techniques of distraction and control of thoughts during the night. And also how to change harmful behaviors.

10 tips to sleep well

1. Go to sleep as much as possible at the same time
2. Avoid coffee, tea, alcohol and smoking in the evening, as they contain stimulants that worsen the quality of sleep. As well as a too abundant and heavy diet
3. Do regular physical activity, but avoiding the evening hours. In fact, physical exercise is a stimulant for the body and therefore can interfere with the ability to fall asleep
4. Make sure that the place where you sleep is comfortable. Preferably dark, quiet and with the right temperature. When there are factors such as light or noise, earplugs and masks are useful remedies.
5. Relax before bedtime, read a book, listen to music or engage in other relaxing activities
6. Use the bed mainly for sleeping, do not use it for working, studying or eating
7. If you can’t fall asleep and aren’t sleepy, better get up and do something that isn’t overly stimulating until you feel drowsy.
8. When you have particular concerns a good method is to make a list of things to remember for the next day so as not to focus on problems overnight.
9. Avoid using computers, tablets and smartphones before falling asleep
10. Don’t look at your watch all the time