Are you having trouble getting to sleep or waking during the night? It may be because of hyperarousal, which is very common in people with insomnia.

What is hyperarousal?

We have two systems governing sleeping and waking: the arousal system or the ascending reticular activating system and the sleep system. When the arousal system is hyperactive, that is when an individual has hyperarousal.

People with insomnia also show very strong signs of hyperarousal may not be aware of their condition. They have these signs, and they experience it subjectively because they try to get to sleep and say, “I’m quite tired and I close my eyes and suddenly it’s like a switch turned on.” Sometimes, they also feel their heartbeat in the ear, feel nervous, and then over-thinking starts. It’s not the only factor in insomnia, but it’s a significant factor. 

On the other hand, many people with insomnia only show objective signs if you measure it by looking at signs of  autonomic nervous system over-activity. This can be seen in the EEG on a sleep study. It can also be measured using cortisol levels, but that is technically difficult and only really done in research studies as simple measures of cortisol are often not accurate. People may be subjectively experiencing it but not admitting it. Instead of saying “I’m anxious”, they’re saying “I’m nervous,” “I’m ruminating,” or “I can’t stop this. Something in my body is going wrong at a time where I should rest.”

How does hyperarousal develop?

Good sleepThe hyperarousal state associated with primary insomnia is usually present both throughout wakefulness and sleep. This may be due to an increase in ascending reticular activating system activity or a reduction in sleep debt.

If a person has insomnia or has difficulty sleeping, thoughts may kick in about what will happen tomorrow. That is when they get more aroused. There can also be a conditioned or learnt response developing an association between going to bed and feeling more alert. This can lead to a vicious cycle where the physical symptoms of hyper-arousal on going to bed also trigger an emotional response. 

When talking about hyperarousal, it is also important to note that we are thinking about the 24-hour cycle.  People might say, “I have trouble sleeping”, but actually, if they look at their day and night closely they may very active, always busy and totally under stress most of the time. 

How does hyper-arousal cause problems with sleep

People with hyperarousal often don’t feel sleepy at all in the evening, particularly when getting in to bed and feel like it takes a long time to switch off. Hyperarousal also causes problems waking during the night and being unable to get back to sleep. At the start of the night, we may have enough sleep debt to get to sleep. But once that sleep debt is reduced as the night goes on, there is insufficient sleep debt to suppress hyperarousal, and people can wake up and find it hard to return to sleep.

How can I reduce hyperarousal?

Reducing hyperarousal is possible. However, it is challenging, especially now that we live in modern society – keeping up with our responsibilities and tasks but balancing time for rest. We need to look at how we think and behave throughout the day. 

Cognitive behavioural therapy for insomnia has been linked to a reduction in sleep reactivity, meaning that this treatment option can help reduce the effect of stressful events on sleep. Studies have found that the thoughts and beliefs we have towards sleep can greatly influence sleep quality. Working to fix unhelpful sleep thoughts and beliefs can help to improve further sleep affected by stress and hyperarousal.

It can also be helpful to learn new skills such as:

  • Relaxation 
  • Mindfulness 
  • Yoga 

Sometimes, a person experiencing hyperarousal might behave in a self-destructive way. This can include driving recklessly, drinking excessively or stressing their life by being busy with many things. Ensuring their safety and the safety of the people around them means it is important for people affected by hyperarousal to get treatment.

What ​​should I do?

Experiencing the symptoms of hyperarousal can be distressing. If you notices these symptoms in yourself or someone else, it is good to speak to your doctor or health professional.

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