How Stress Affects Sleep & What to do About it

Dr, Michael Breus - The Upside Blog

by | Updated: April 22nd, 2021 | Read time: 8 minutes

I don’t even have to ask whether you’ve ever lost sleep because of stress. We’ve all been there. Bedtime arrives, but your mind is racing. You can’t keep your eyes closed. You feel keyed up and restless, agitated and maybe overwhelmed. Whether you realize it or not, your heart is beating fast. It feels as though it takes forever to fall asleep, and even after you do drift off your sleep is restless. You wake up throughout the night and you might wake very early the next morning—exhausted.

Stress does a real number on sleep.

Woman Practicing Stress Reduction Technique in Bed to Fall Asleep |

The biological truth is this: our bodies are hard-wired to keep us awake when we’re stressed. Trying to get a restful night of sleep while you’re stressed out is like trying to make a half-court shot with a blindfold over your eyes. Once in blue moon, you might make it… but it’s really tough to sink that shot.

Every night, millions of Americans lose sleep because of stress. Research has shown that nearly half of adults in the US struggle with stress-related sleep loss in a given month—and that was before the coronavirus pandemic began. Over the past year, the many challenges associated with the pandemic have led to soaring rates of psychological stress and sleep problems, including insomnia. The American Psychological Association has reported that in 2020, Americans experienced record levels of stress, both more frequent and more severe.

For all the years I’ve been in clinical practice as a sleep specialist, there’s been no more common sleep issue among my patients than stress and worry, especially now.

Unpacking stress

Let’s talk for a minute about what stress is and how it works, and the different types of stress that can affect sleep.

Stress is our body’s response to a perceived threat. The stress response is an ancient, innate survival mechanism that our bodies activate to respond to trouble. The moment-to-moment threats to survival that our ancient human ancestors faced have long faded, but the survival mechanism that evolved to keep them alive remains with us. And it gets activated in us for all sorts of situations that aren’t actually life threatening: finances, social and relationship conflicts, family issues, worry about the future, worry about health—even stress about sleep itself.

The body’s network for activating the stress response is called the hypothalamic-pituitary-adrenal axis (HPA Axis for short). The brain’s hypothalamus and pituitary gland communicate to surge production in the adrenal glands of hormones—including adrenaline, norepinephrine, and cortisol—that stimulate our “fight or fight” stress response. That’s when something bad feels like it is going to happen and your HPA axis kicks into gear and gets you the hormones you need to either “put up your dukes” or “kick up your heels!”

The physical and mental effects of stress on sleep

Stress creates both physical and psychological challenges for sleep.

Elevated levels of stress hormones increase energy and alertness and raise heart rate and blood pressure. The upsurge in these hormones coincides with sugar, or glucose, entering the bloodstream, which also increases blood pressure. Soon, your muscles are tensing up, your heart is pumping, and your brain is in high-alert mode. These physiological effects of stress make it all but impossible for the body to shift into sleep mode, leaving you wired and hyper-aroused at bedtime.

Our thoughts and emotions also contribute to stress-related sleep loss. Stress and worry cause racing and intrusive thoughts, making it difficult to quiet the mind. After a few nights of not sleeping well, worry about sleep itself can also take hold and make it even more difficult to achieve the mental calm and relaxation that paves the way for slee

Both the physical and psychological effects of stress contribute to sleep problems, including:

  • Difficulty falling asleep
  • Trouble staying asleep throughout the night
  • Waking very early
  • Waking feeling un-rested and un-refreshed by sleep

How different types of stress impact your sleep

Stress takes different forms, and each can affect your sleep differently.

Acute stress

This short-term stress often arises from unexpected, often distressing, scary or upsetting events. Acute stress is the surge of panic you feel when you narrowly miss hitting another car on the road. The HPA axis roars into action, your body and mind become instantly hypervigilant and aroused. The immediate effects of acute stress are intense, but tend not to linger for a long time.

Acute stress often causes a short-term disruption to sleep. A bout of acute stress can lead to short-term insomnia—a night, or a few nights, of difficulty falling asleep and sleeping restlessly. Acute stress may also result in short-term feelings of exhaustion, regardless of how much sleep you’ve had. Research shows that some forms of acute stress may cause short-term changes to how much we sleep, and the amount of time we spend in the most mentally and physically refreshing stages of deep sleep and REM sleep. And acute stress that is traumatic may trigger longer-term sleep problems.

Episodic acute stress

This type of stress occurs when we experience repeated or regular episodes of short-term stress. Struggling to meet a series of deadlines for work, social and relationship conflicts that go on unresolved, are examples of circumstances that can create episodic acute stress.

Acute episodic stress can lead to repeated short-term sleep disruptions and may make you more vulnerable to chronic sleep issues, particularly if stress becomes chronic.

Chronic stress

Chronic stress occurs when stress persists regularly for several weeks or more. When stress is chronic, the body becomes accustomed to elevated hormones and a heightened state of arousal. We face many potential chronic stressors in our lives. Financial worries, job insecurity, divorce and other changes to family life, the loss of a loved one, are all examples of common causes of chronic stress.

Chronic stress may pose the most significant long-term challenges to your healthy sleep. It’s a common underlying cause of long-term, chronic insomnia.  And chronic stress can lead to other serious health issues, including heart disease, hypertension, diabetes, and depression—all conditions that themselves contribute to sleep problems and the development of sleep disorders, including insomnia and obstructive sleep apnea.

How sleep affects stress

The relationship between stress and sleep is a two-way street. Stress has a negative impact on sleep. And poor sleep can also lead to increased stress and anxiety, making this a vicious cycle that can be difficult to break.

Poor sleep makes us more vulnerable to the symptoms of stress and anxiety, including:

  • Irritability and short-temperedness
  • Feelings of being overwhelmed
  • Struggles with motivation
  • Trouble with concentration and memory recall
  • Lack of energy
  • Increased emotional reactivity

Research has found that a single sleepless night can lead to a 30 percent surge in emotional stress levels. Sleep plays a critical role in regulating our mood and helping us work effectively; when we don’t get enough of it, it’s harder for our bodies to properly manage stress. One of the functions of sleep—particularly REM sleep—is to process emotional experiences, so that these experiences feel less painful, difficult, and emotionally charged. Scientific research has found that sleep “soothes” the brain of stress, reducing emotional reactivity and enhancing our ability to think rationally and calmly about difficult experiences.

It’s important to know that high stress and lack of sleep both contribute to greater risks for mental and physical illness. Stress and insufficient sleep are each independently linked to obesity and weight gain, anxiety and depression, type 2 diabetes and other metabolic disorders, cardiovascular disease and cognitive dysfunction.

How to de-stress and sleep better

When I see patients who are struggling with stress-related sleep loss—and I see a lot of them, one of the first things I tell them is this: the line between day and night is not so clear. How we behave throughout the day—particularly how we manage stress—has a significant effect on how well we sleep at night. I always encourage consistent daily attention to mind and body relaxation and stress management as a round-the-clock investment in your nightly sleep.

Here are several of the specific tools I recommend for alleviating stress and achieving deeper, more restful and restorative sleep. They’re non-invasive and safe for just about everybody, they’re easy to adopt, and incorporate relatively effortlessly into daily rituals. And they can deliver some pretty significant benefits for stress and sleep.

It’s important to discuss both your sleep issues and stress levels with your doctor. This is not medical advice, and none of these at-home techniques can take the place of consultation with your doctor to determine the right treatments for your individual needs. Sleeping poorly and feeling stressed take their toll on mental and physical health. Talk to your doctor about how you’re sleeping and feeling.

Relaxation exercises

Simple mind-body relaxation exercises are highly effective at reducing stress and improving sleep, and they’re easy to integrate into your daily routine. Guided imagery, breathing exercises and other relaxation practices can reduce both the physical and mental effects of stress. Here is a simple breathing exercise I share with all my patients:

In a comfortable position, with your eyes open or closed:

  • Inhale for 4 seconds
  • Hold breath for 7 seconds
  • Exhale slowly, for 8 seconds
  • Repeat several times


I’m a huge proponent of mindfulness meditation for alleviating stress and enhancing sleep. Meditation reduces blood pressure, lowers heart rate and can reduce symptoms of insomnia. Meditation also activates parts of the brain that help initiate sleep, and can elevate levels of sleep-facilitating hormones including melatonin and serotonin.


Reflexology is a form of touch therapy, where pressure is applied to points on the hands, ears and feet, to improve the function and health of different parts of the body.  Pressure points also connect to different physiological functions, including immunity and sleep. Reflexology can reduce the physical effects of stress, including lowering blood pressure and heart rate and slowing breathing. And reflexology has been shown to improve sleep, lessen fatigue and reduce the symptoms of insomnia.


Prebiotics are compounds within food, which cannot be digested by the body. Instead, they feed and spur the reproduction of the tiny, good-for-you organisms living in your gut. Gut health has a major impact on both stress and sleep. And research is showing that a diet plentiful in prebiotics can serve as a buffer against the negative impact of stress and elevate levels of deep sleep. Here’s where you can read more about the emerging science of prebiotics as a tool for stress relief and better sleep.

Prebiotics are present in foods that are high in fiber and resistant starches (starches that aren’t broken down by digestion). Some of the most prebiotic-rich foods include:

  • Whole grains, such as barley, rolled oats, whole wheat and wheat bran
  • Onions
  • Asparagus
  • Leeks
  • Garlic
  • Banana
  • Artichoke
  • Apples
  • Flaxseed
  • Yams
  • Chicory root (this you can get in granules, and add to your cooking, or to drinks—including your morning coffee)

The pandemic has turned our daily lives upside down, with major implications for stress and sleep. Sticking to sleep-promoting routines has become even more critical to protecting our nightly rest, and our mental and physical health. Here are 5 stress-relieving, sleep-boosting ways to adjust your daily schedule in these turbulent times, to feel more grounded, productive and calm, and to sleep better at night.