What are the physical signs of poor REM sleep?
Dr. Ramagopal: REM sleep is essential for emotional regulation, memory consolidation and enhancing recall and learning. Lack of REM sleep can present symptoms such as fatigue in spite of adequate sleep, irritability and mood swings. These patients also present with memory issues like forgetfulness and lack of recall and mood changes like anxiety and depression.
How does stress impact sleep?
Dr. Thomas: Stress activates highly conserved pathways that are intended to deal with and survive a range of biological threats. Conserved means that it can be demonstrated across the living kingdom. In animals, the two main drivers are the sympathetic nervous system (producing adrenaline and sympathetic activation, the flight or fight) and the hypothalamo-pituitary-adrenal axis (producing cortisol, biological protection when activated “just right”). It makes sense that sleep would be prevented or be light when facing acute danger. The problem comes with chronic/long-term stress, where these responses persist and are now maladaptive. Chronic insomnia is thus nearly certain when stress is persistent, inescapable and substantial. The stressor could be disease, drugs, social, thermal and so on. Sleep will be shorter, lighter, more mixed wakefulness and less refreshing. The longer stress and insomnia persists, the harder full reversal becomes. Disrupted sleep itself amplifies stress responses, and proper management of insomnia associated with stress makes good biological sense.
Dr. Ramagopal: Stress causes elevated levels of cortisol, which prevents the body from falling asleep. This leads to chronic insomnia, which can lead to anxiety and depression, setting up a vicious cycle.