- LIFE STRESS [Rev 1-26-2019]
This is one of the general issues considered in Step C
People don’t live in a vacuum. The conditions and events of daily life have an impact on our ability to sleep. Work, relationships, weather, outside events, all can create stress and stress can interfere with our ability to sleep. Good sleep is based on feelings of comfort and security – safety from outside forces as well as dangerous thoughts and emotions (Glovinsky and Spielman, 64).
As therapists, we might be tempted to focus on the person’s reactions to stress (fear, anger, obsessive thinking, etc.) which are, after all, the proximate sources of insomnia. However, external sources may be, in many cases, easier to identify and change.
33a. Effects of Stress
Stress can also interfere with our moods, leading to anxiety or depression. At the same time, stress has a direct effect on the ability to sleep, especially if a person takes the previous day’s events or the following day’s expected events to bed.
Often, a first approach to a mood issue – or insomnia that appears to be a result of a mood issue- can involve examining the person’s life for short- and long-term stresses (Morin, 53 ) .
Treatment involves finding ways to manage stress and the thoughts and emotions that go with it.
33b. Kinds of Stress
STRESSFUL EVENTS
We often think of stress in terms of immediately preceding or upcoming events that temporarily affect a person’s comfort level. However, some events (e.g.: death of a spouse) have a long-lasting impact, and some stresses (poverty or physical handicap) can be chronic.
CHAOTIC LIFE ORGANIZATION could occur if the organization of the person’s life leads to variable or inconsistent sleep patterns, or if the environment produces variable and inconsistent sleep-wake demands
- Responsibility for a newborn child
- Overcrowded sleeping auarters
DANGEROUS OR UNCERTAIN ENVIRONMENT
Dangers can be objective or subjective, but the person’s own subjective evaluation is what affects his or her ability to sleep. Objective dangers can include
- Combat
- Living in a war zone or dangerous neighborhood
Subjective dangers threaten the person regardless of how others might see them. But if the person is threatened, that stress can affect his or her ability to sleep.
STRESSFUL RESPONSIBILITIES
Here again, the person’s feeling of responsibility is what matters.
- Positions of leadership in uncertain situations
- First responders
- Caretaking someone who is especially needy, unpredictable, or at risk.
33c. A Measure of Stress
One index of life stress is the Holme s-Rahe Stress Inventory, which gives a point value to a person’s major life events in the previous year. The points are added to give a total. The total score may be indicative of the person’s pressures to illness, and possibly to insomnia as well.
The test’s originator (Rahe, 1974) points out that that both negative and positive events can increase a person’s overall stress level. Negative events could include trouble at work, divorce, sickness in the family, accidents or financial trouble. Positive events could include marriage, unexpected success, holidays, or graduation from college. Even neutral events such as change of address or change of habits can be stress-inducing.
33d. Stress as the Consequence of Poor Sleep
See Walker for this
References
Jacobs 134-135 and Chapter 9