Psychosocial stress and impaired sleep
Open accessAbstract
This review demonstrates that stress is closely related to impaired sleep in cross-sectional studies. In particular, the anticipation of high demands or effort the next day seems important. Sleep recordings show that stress is associated with shortened sleep, fragmentation, and possibly a reduction in sleep stages 3 and 4. Shortened or disturbed sleep causes increases in levels of traditional stress markers (eg, cortisol) and may thus exacerbate the effects of stress. Much knowledge is still lacking, however, particularly about the effects of real-life work stress. The latter requires longitudinal studies in real-life situations.
AI snapshot
Written from the paper’s full text.
TL;DR
This narrative review concludes that psychosocial stress is closely linked to impaired sleep, especially anticipation or preoccupation with next-day demands, with polysomnographic evidence of shortened sleep, fragmentation, and reduced slow-wave sleep. It argues that sleep loss itself activates stress markers, potentially creating a vicious circle, but longitudinal real-life work-stress studies are still lacking.
Key findings
- Cross-sectional epidemiologic evidence links work stress to disturbed sleep: in the Helsinki Heart Study, high work strain (high demands + low influence) was associated with a 30% prevalence of disturbed sleep versus 5% in the low-strain group; effort-reward imbalance/overcommitment showed a fourfold increase in risk of reporting disturbed sleep; and a prospective self-report found negative psychosocial work conditions predicted insomnia with an odds ratio of 2.15 over 5 years.
- Polysomnographic studies suggest stress and anticipation interfere with sleep: merchant marine officers had decreased slow-wave sleep (SWS) during on-call nights versus nights off; aircrew before an early morning flight had shortened sleep and reduced SWS, with stronger SWS reduction in those reporting high apprehension; burnout patients showed more microarousals, reduced sleep efficiency, reduced SWS, and increased sleep latency.
- Disturbed sleep and stress share physiological signatures: disturbed sleep is associated with increased cortisol, heart rate, body temperature, and oxygen consumption; sleep loss increases next-day cortisol, reduces glucose clearance, increases ghrelin, and decreases leptin; CRH infusion reduces SWS, and ACTH infusion increases sleep latency, lowers SWS, and increases fragmentation.
- Impaired sleep is linked to health and safety outcomes: disturbed sleep is related to depression, cardiovascular disease, diabetes, obesity, sickness absence, and higher risk of occupational and driving accidents; total sleep deprivation in rats leads to death after approximately 5 weeks, and fatal familial insomnia leads to death over 1–5 years.
Methods
- Narrative review of existing literature on psychosocial stress and sleep, including cross-sectional and prospective epidemiologic studies, polysomnographic field and laboratory studies, physiological studies, and animal stress studies.
- No primary data collection; the paper synthesizes findings from cited studies, including specific cohorts such as the Helsinki Heart Study and the French E.S.T.E.V. cohort of more than 21,000 persons.
- Main analysis is qualitative/narrative synthesis; no systematic search strategy, quality appraisal, or meta-analysis is described.
Limitations
- The paper states that most stress-sleep studies are cross-sectional and based on self-reports, so causation cannot be inferred; it also notes a lack of longitudinal studies, especially on real-life work stress, and that most polysomnographic studies assume a situation is stressful without systematic stress measurement.
- The paper notes there is no detailed consensus on what constitutes objectively poor sleep, conclusive evidence on the importance of SWS is lacking, and nothing is known about the effects of longer periods of increased load.
- Evident from the text: this is a narrative review without a systematic search or quantitative synthesis, and the cited evidence comes from heterogeneous designs and populations, limiting firm causal conclusions.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 23 cited sources checked · 0 supported · 0 flagged
- Interpretationreasoning
Stress is closely related to impaired sleep in cross-sectional studies.
“This review demonstrates that stress is closely related to impaired sleep in cross-sectional studies.”
- Also stated in: § Reports of stress and disturbed sleep · plain
“In summary, there is a close relation between reports of stress and disturbed sleep.”
- Also stated in: § Discussion · hedged
“Although the picture is not complete, the evidence indicates a close link between stress and sleep.”
Quote in the paperSubstantial claim - Also stated in: § Reports of stress and disturbed sleep · plain
- Interpretationreasoning
Anticipation of high demands or effort the next day is important in the relation between stress and sleep.
“In particular, the anticipation of high demands or effort the next day seems important.”
- Also stated in: § Reports of stress and disturbed sleep · hedged
“Anticipation or preoccupation with work seems to be a key component in this relation”
- Also stated in: § Stress and polysomnography · hedged
“The polysomnographical studies suggest that situations involving an anticipation of increased demands interfere with sleep.”
Quote in the paperSubstantial claim - Also stated in: § Reports of stress and disturbed sleep · hedged
- Premisecitation
High work strain (high demands + low influence) is associated with a 30% prevalence of disturbed sleep versus 5% in the low strain group (low demands + high influence at work).
“Kalimo et al (44) used the Helsinki heart study and found that high work strain (high demands + low influence) was associated with a 30% prevalence of disturbed sleep versus 5% in the low strain group (low demands + high influence at work).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [44]
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- Premisecitation
The effort-reward index was significantly related to disturbed sleep.
“Recently, Fahlén et al (46) showed that also the effort-reward index was significantly related to disturbed sleep.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [46]
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- Interpretationreasoning
It may not be work demands per se that are important, but rather the preoccupation with worries about them.
“These observations suggest that it may not be work demands per se that are important, but rather the preoccupation with worries about them.”
Quote in the paperSubstantial claim
- Premisecitation
Lack of social support at work is a risk indicator for disturbed sleep.
“Lack of social support at work is also a risk indicator for disturbed sleep (43).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [43]
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- Premisecitation
Self-reports of disturbed sleep are pronounced among people scoring high on burnout.
“Self-reports of disturbed sleep are pronounced among people scoring high on burnout (12,13).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [12]
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- cites [13]
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- Premisecitation
SWS was decreased in merchant marine officers during nights with on-call duty (but without calls) compared with nights off.
“However, in one field study on stress, it was shown that SWS was decreased in merchant marine officers during nights with on-call duty (but without calls) compared with nights off (66).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [66]
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- Premisecitation
In a retrospective study of reported life events, Cernovsky et al demonstrated a clear increase in negative life events before an outbreak of insomnia.
“In a retrospective study of reported life events, Cernovsky et al (55) demonstrated a clear increase in negative life events before an outbreak of insomnia.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [55]
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- Interpretationreasoning
Psychologically, the anticipation of stress may be a key factor.
“Psychologically, the anticipation of stress may be a key factor.”
Quote in the paperSubstantial claim - Interpretationreasoning
Disturbed sleep then becomes a stressor in itself.
“Disturbed sleep then becomes a stressor in itself.”
Quote in the paperNot a substantial claim - Interpretationreasoning
Chronic stress leads to disturbed sleep through increased levels of corticosterone.
“It appears, however, that chronic stress leads to disturbed sleep through increased levels of corticosterone.”
Quote in the paperNot a substantial claim - Interpretationreasoning
Sleep loss has almost the same effects on metabolic stress markers as stress does.
“The available data show that sleep loss has almost the same effects on metabolic stress markers as stress does.”
Quote in the paperSubstantial claim
- May combine two claims. 17
- Classified as probably not a substantial claim. 6
May combine two claims.
InterpretationreasoningShortened or disturbed sleep causes increases in levels of traditional stress markers (eg, cortisol) and may thus exacerbate the effects of stress.
“Shortened or disturbed sleep causes increases in levels of traditional stress markers (eg, cortisol) and may thus exacerbate the effects of stress.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationStress is considered the primary cause of persistent psychophysiological (or primary) insomnia.
“In fact, stress is considered the primary cause of persistent psychophysiological (or primary) insomnia (38).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [38]
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InterpretationreasoningMuch knowledge is still lacking about the effects of real-life work stress.
“Much knowledge is still lacking, however, particularly about the effects of real-life work stress.”
- Also stated in: § Discussion · plain
“The most obvious is the lack of longitudinal studies.”
Quote in the paperNot a substantial claim- Also stated in: § Discussion · plain
May combine two claims.
InterpretationreasoningSleep recordings show that stress is associated with shortened sleep, fragmentation, and possibly a reduction in sleep stages 3 and 4.
“Sleep recordings show that stress is associated with shortened sleep, fragmentation, and possibly a reduction in sleep stages 3 and 4.”
- Also stated in: § Stress and polysomnography · hedged
“A reduction of SWS seems to be common, but fragmentation and other disturbances also occur.”
Quote in the paperSubstantial claim- Also stated in: § Stress and polysomnography · hedged
May combine two claims.
PremisecitationSleep was shortened, and SWS was reduced before an early morning flight, and those who rated their apprehension of the early morning flight as high showed a stronger reduction in SWS.
“Sleep was shortened, and SWS was reduced before the early morning flight, but it was also found that those who rated their apprehension of the early morning flight as high showed a stronger reduction in SWS (67,68).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [67]
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- cites [68]
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PremisecitationThe first night in a sleep laboratory often, but not always, shows less sleep continuity, as well as an increased sleep latency.
“A stress situation of sorts is also the first night in a sleep laboratory.It often, but not always, shows less sleep continuity, as well as an increased sleep latency (74)(75)(76)(77)(78)(79)(80).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites (74)(75)(76)(77)(78)(79)(80)
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Study design and conductreasoningAll of the aforementioned studies are cross-sectional and based on self-reports of stress and sleep, therefore causation cannot be inferred.
“It should be emphasized that all of the aforementioned studies are cross-sectional and based on self-reports of stress and sleep.Therefore, causation cannot be inferred.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationPosttraumatic stress is a well-established cause of disturbed sleep, with the greatest effect connected with a disturbance in REM sleep.
“Posttraumatic stress is another well-established cause of disturbed sleep, even if many of the more common indicators of sleep quality (sleep latency, efficiency of sleep, total length of sleep, and the amount of stages 3 and 4) are relatively moderately affected (85)(86)(87)(88).Instead, it appears that the greatest part of the effect is connected with a disturbance in REM sleep, in particular in”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites (85)(86)(87)(88)
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PremisecitationPatients on long-term sick leave for burnout were shown to have a high level of sleep fragmentation and reduced sleep efficiency, as well as reduced SWS and increased sleep latency, as compared with age-and gender-matched normal persons.
“In another study, patients on long-term sick leave for burnout were shown to have a high level of sleep fragmentation and reduced sleep efficiency, as well as reduced SWS and increased sleep latency, as compared with age-and gender-matched normal persons (53).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [53]
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PremisecitationPeople with disturbed sleep exhibit much the same physiological changes as those under stress, including increased levels of cortisol, heart rate, body temperature, and oxygen consumption.
“People with disturbed sleep seem to exhibit much the same physiological changes as those under stress.Thus people with disturbed sleep exhibit increased levels of cortisol, heart rate, body temperature, and oxygen consumption (100-105).”
Quote in the paperNot a substantial claim0 of 6 sources checked- cites [100]
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- cites [101]
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- cites [102]
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- cites [103]
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- cites [104]
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- cites [105]
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PremisecitationDrake et al showed that those who reported habitual sensitivity to stress had a lower first-night sleep efficiency and longer sleep latency than those with low scores.
“Using an interindividual approach, Drake et al (81) developed an index for sleep vulnerability to stress and showed that those who reported habitual sensitivity to stress had a lower first-night sleep efficiency and longer sleep latency than those with low scores.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [81]
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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenMost studies assume that a certain situation is perceived as stressful, but no systematic measurement of stress was used.
“Another problem is that most studies assume that a certain situation is perceived as stressful, but no systematic measurement of stress was used.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationThose scoring high on burnout had more microarousals than their age-and gender-matched low-burnout colleagues, and the number of arousals was closely related to reported work stress.
“The results showed that those scoring high on burnout had more microarousals than their age-and gender-matched lowburnout colleagues.The number of arousals was, furthermore, closely related to reported work stress.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [52]
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InterpretationreasoningStress and sleep seem intimately connected, but there is much need for more systematic research.
“In summary, stress and sleep seem intimately connected, but there is much need for more systematic research.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
InterpretationreasoningThis review suggests a clear connection between stress and sleep, but the different pieces have never been put together in the same study.
“This review suggests a clear connection, but the different pieces have never been put together in the same study.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Interpretationnone givenThe most obvious lack is the lack of longitudinal studies.
“The most obvious is the lack of longitudinal studies.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationcitationDisturbed sleep in itself may raise worries about being able to sleep the next night, which will contribute to sleep problems the next night, a vicious circle thus being created.
“It should be emphasized that disturbed sleep in itself may raise worries about being able to sleep the next night, which will contribute to sleep problems the next night, a vicious circle thus being created (149).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [149]
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May combine two claims.
InterpretationcitationStress involves increased psychological and physiological activation in response to demands, and an activated HPA system seems incompatible with normal sleep.
“Thus stress involves increased psychological and physiological activation in response to demands (140), and an activated HPA system seems incompatible with normal sleep.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [140]
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InterpretationreasoningThe resulting sleep impairment causes further increases in the HPA system and thus promotes a vicious circle of stress and insomnia.
“It seems likely that the resulting sleep impairment causes further increases in the HPA system and thus promotes a vicious circle of stress and insomnia.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningStress probably has secondary effects on metabolic stress indicators, exacerbating the direct effects on health and possibly interfering with subsequent sleep.
“This finding implies that stress probably has secondary effects on metabolic stress indicators, exacerbating the direct effects on health and possibly interfering with subsequent sleep.”
Quote in the paperSubstantial claim
The paper relies on this without support.
Stress disturbs sleep.
“It is common-sense knowledge that stress disturbs sleep.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Under chronic conditions, the relationship between HPA axis over-activity and disturbed sleep may be bidirectional.
“Under chronic conditions, the relationship between HPA axis over-activity and disturbed sleep may be bidirectional as elevated evening cortisol levels are likely to disturb sleep.26,27”
From Effects of Insufficient Sleep on Pituitary–Adrenocortical Response to CRH Stimulation in Healthy Men (2017) · cites this paper as [26]
Chronic sleep loss has been associated with increased psychological stress.
“While chronic sleep loss has been associated with increased psychological stress (Akerstedt, 2006)”
From Sleep restriction alters plasma endocannabinoids concentrations before but not after exercise in humans (2016) · cites this paper as Akerstedt, 2006
The citation lists haven’t been fetched yet
References 153 · Cited by 585
Part of this paper’s reference list could not be split into single entries.
Research works printed but not linked: 6
- Nilsson PM, Rööst M, Engström G, Hedblad B, Berglund G. Incidence of diabetes in middle-aged men is related to sleep disturbances. Diabetes Care. 2004;27:2464-9.
- Kalimo R, Tenkanen L, Härmä M, Poppius E, Heinsalmi P. Job stress and sleep disorders: findings from the Helsinki Heart Study. Stress Med. 2000;16:65-75.
- Coates TJ, George JM, Killen JD, Marchini E, Hamilton S, Thorensen CE. First night effect in good and sleep-mainte- nance insomniacs when recorded at home. Sleep. 1981;4:293- 8.
- Walsh JK, Sugerman J. Daytime sleepiness and the first-night effect: a model of transient insomnia. Sleep Res. 1986;15:181.
- Chrousos GP, Gold PW. The concepts of stress and stress system disorders. J Am Med Assoc. 1992;267:1244-52.
- Chrousos GP. Stressors, stress, and neuroendocrine integra- tion of the adaptive response. Ann N Y Acad Sci. 1998;851: 311-35.
- Authors
- Åkerstedt, T.
- Affiliations
- Karolinska Institutet (SE)
- Corresponding author
- Åkerstedt, Torbjörn
- ORCID
- Åkerstedt, Torbjörn
- Venue
- Scandinavian Journal of Work, Environment & Health
- Published
- 2006-12
- Volume
- 32
- Issue
- 6
- Pages
- 493-501
- ISSN
- 0355-3140 (ISSN-L)
- 1795-990X
- OpenAlex
- W2121547209
- Semantic Scholar
- 1024469f9c10116c59b49fdc1314455afb18c7e0
- Cited by
- 585
- References
- 153
- Citations by year
- 2026: 32 · 2025: 28 · 2024: 24 · 2023: 32 · 2022: 47 · 2021: 52 · 2020: 45 · 2019: 42 · 2018: 31 · 2017: 44 · 2016: 35 · 2015: 23 · 2014: 33 · 2013: 27 · 2012: 16
- FWCI
- 11.75
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Scandinavian Journal of Work Environment & Health (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
- Keywords
- psychosocial stress, sleep disorders, sleep fragmentation, sleep duration, sleep stages, cortisol, anticipatory stress, occupational stress
- MeSH terms
- Animals, Cross-Sectional Studies, Humans, Occupational Diseases, Safety, Sleep, Stress, Psychological, Workplace, Polysomnography, Dyssomnias
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