PURPOSE: Anecdotal experience suggests that stress is a major impediment to sleep, eroding overall sleep quality. Clinical programs universally endorse interventions for stress reduction to improve sleep, but there are few reports validating this therapeutic approach. To examine the relationship between stress reduction and sleep improvement, we measured changes in perceived stress and its correlation with sleep quality in a longitudinal outcomes study.
METHODS: The Integrative Cardiac Health Project (ICHP) is a heart health program with goals of improving diet, exercise, sleep and stress. At program entry and at graduation, participants were assessed with the Perceived Stress Scale (PSS14) and the Pittsburgh Sleep Quality Index (PSQI) which includes sleep duration along with sleep latency, sleep fragmentation, perceived restfulness, daytime functioning, nocturnal behaviors, and use of sleep aids. Subjects were divided into groups that improved PSS score and those that did not. Differences between groups were compared using unpaired t-test.
RESULTS: 66 consecutive graduates (mean age 59.6±11.6, 28 men) reduced their PSS 3.1±5.8 points and improved their PSQI 1.2±2.9 points. Fifty subjects were able to reduce their PSS by a mean of 5.5±4.5 points accompanied by improvements in PSQI (1.9±3.0 points), Lp-PLA2 (41.6±53.8 mg/dL), glucose (2.0±9.1 mg/dL), insulin (2.2±7.0 ug/dL) and HOMA (0.04±1.69). The other 16 subjects showed increases in PSS of 4.3±2.0, p<0.001 accompanied by worsening PSQI (0.27±2.49, p=0.02), Lp-PLA2 (21.7±65.5, p=0.02), glucose (2.8±11.0, p=0.08), insulin (1.4±6.1, p=0.07) and HOMA (0.49±1.51, p=0.04).
CONCLUSION: Reductions in perceived stress correlate significantly with improvements in sleep quality. Improvements in perceived stress and sleep quality are accompanied by improvements in cardiovascular risk markers including glucose metabolism and lipids.
CLINICAL IMPLICATIONS: Our findings underscore the value and importance of utilizing stress management techniques as a teachable sleep improvement intervention.
DISCLOSURE: Arn Eliasson, No Financial Disclosure Information; No Product/Research Disclosure Information