When Your Brain Won't Shut Off

A Conversation with Dr. Aric Prather on Stress, Rumination & Sleep

Guest: Dr. Aric Prather — Clinical Psychologist, UCSF

Host: Natalie — BetterSleep

Topic: Why stress hijacks sleep, and what actually helps

Introduction

Natalie: Today, we're talking about those nights when your mind just won't shut off. You know the feeling — you're exhausted, you're ready for bed, and yet your brain insists on replaying conversations and every little thing that didn't go according to plan. Today, we're diving into the science of why stress hijacks our sleep and, most importantly, what you can do to finally reclaim your nights. To help us unpack all of this, we're joined by Dr. Aric Prather, a trusted advisor to BetterSleep. Eric, it is such a pleasure to have you here.

Dr. Prather: I'm so excited to be here.

Natalie: Before we dive into the science of sleep, I'd love for you to share a bit about your career. What inspired you to focus your research on sleep, and what drew you to study how stress affects it?

Dr. Prather: I really started as someone interested in stress and how it affects the body — specifically the immune system — when I was a graduate student at the University of Pittsburgh. I'm a clinical psychologist now, here at UCSF. As we were running research studies where we'd bring people in, stress them out, and see what happens to their bodies, their blood, all that kind of stuff, we began noticing in the literature how critical sleep was.

Dr. Prather: Of course, we all know in our lived experience that sleep is really important to how we experience stress and what stress can do to our sleep — but people just weren't really putting those two things together. So I took it upon myself to start tackling that research, initially focused on sleep and the immune system. From then on, I've really focused on how sleep is so critical to our health and well-being, and stress can get in the way. We're trying to figure out how those things are interrelated.

Natalie: This is why you're the perfect guest for this discussion, and why your involvement on our advisory board really strengthens our mission to support every sleeper. For our listeners, could you please explain your role on the advisory team and the perspective you bring?

Dr. Prather: I feel really grateful to be involved with BetterSleep. My role is to provide guidance around empirically based treatments for sleep — ensuring that people are getting the utmost scientifically supported treatments and strategies to help them sleep better, so everyone can get the rest they deserve.

How Stress Shows Up in Sleep

Natalie: Let's get into the meat of the topic. From your expert perspective, is there a recognizable pattern in how stress shows up in people's sleep, especially when it leads to rumination at night?

Dr. Prather: Absolutely. Insomnia symptoms — difficulty falling asleep, staying asleep — happen really commonly. At least 30% of the population reports difficulty sleeping on a regular basis, and stress plays a really important role in that.

Dr. Prather: Our lives are incredibly busy, and the truth is, when we turn off the lights and have that quiet moment for ourselves, a lot of that begins to come up. We can spend a lot of time thinking about the day we just had or what's coming up — the urgencies that feel particularly urgent when we get into bed. That can absolutely mess with our ability to shut off, to make the transition from daytime to nighttime, and cause a lot of restless nights.

Dr. Prather: Rumination — the process of replaying those things — is certainly incompatible with sleeping. Some people are more prone to ruminate than others, but all of us can have times in our lives where we're carrying too much and have an inability to get the sleep we really wish we did.

Do Different Types of Stress Affect Sleep Differently?

Natalie: Do different types of stress affect sleep in different ways? As a mom to a six-year-old, one of my common stresses is, "is it color day? Is it pajama day?" — remembering all of those, plus what I'm doing for my job. My cognitive load feels really heavy.

Dr. Prather: There's been quite a bit of stress research around different types of stressors and how they affect our biology. Probably the most powerful stressors people can experience are social in nature — ones that are interpersonal or have some kind of social-evaluative component. Those can really lead to increases in negative emotion that make stressors feel extra bad and can certainly impact sleep.

Dr. Prather: When it comes to sleep, we've found — and others have found — that when stressors are more severe, when really bad things happen, that sets off a cascade of other stressors. If someone gets into a traffic accident during the day, that's a really bad thing to have happened, but it sets lots of other things in motion: you miss work, you can't get your kid to school, you have to deal with the insurance. All of those things accumulate, and that can impact your sleep because there are just so many of them cascading.

Dr. Prather: The other thing we've found in our research is that when stressors happen close to bed, those are the ones that make the biggest difference. Not surprising — if it's social and close to bed, like you get into an argument with your partner right before bed, that has a little extra oomph to it. But the truth is, intensity matters. If you're worried about whether it's color day, and that's really meaningful to your child, and you're trying to hold onto that in your mind, that's a lot of cognitive load that can absolutely make it difficult to fall asleep.

Natalie: Well, thank you for recognizing the load of color day.

Pre-Sleep Anxiety and the Conditioned Arousal Loop

Natalie: How much does pre-sleep anticipation — that feeling of "I just know I'm not going to sleep tonight" — contribute to keeping insomnia going?

Dr. Prather: Oh my goodness — that's such a classic experience for people who have trouble sleeping, particularly with insomnia. I'll see patients in our clinic who say, "I was feeling sleepy, and then as it got closer to bedtime, I could feel myself getting more and more active. My brain would become active, or I'd feel more tense." That pre-sleep anxiety is really palpable for people with sleep problems, and it absolutely gets in the way.

Dr. Prather: It can perpetuate the problem, because people get in their head about their sleep. They're really worried. It becomes a foregone conclusion that they won't be able to sleep — and guess what? Most of the time, they're right. But a lot of that has to do with their cognitive activity, their active brain, their stress response.

Dr. Prather: We have this fight-or-flight system in our nervous system called the sympathetic nervous system, which really needs to be turned down before bed — while the rest-and-digest system, the parasympathetic nervous system, needs to be turned up. When people feel anxious anticipation about sleep, along with that often comes increased activation of the fight-or-flight system. They have a bad night, spend a lot of time lying awake tossing and turning, and over time that creates what we call conditioned arousal — when people get into bed, they start to feel anxious. That really begins to have a feed-forward impact on people's nights and their quality of sleep.

When Has Stress Crossed Into Insomnia?

Natalie: Here's my million-dollar question: when do you know your stress has crossed into the territory of insomnia?

Dr. Prather: Stress is part of life. It can be motivating — there's a positive spin to stress as well. It gets you to do things; it provides a challenge. But the truth is, it can absolutely impact your sleep. It can make it harder to fall asleep. You might wake up and your brain kicks on, and then you have difficulty getting back to sleep. When that starts happening regularly, it's important to take a look at what's going on.

Dr. Prather: It could be that you have bad sleep hygiene, or you're not protecting your sleep environment or your sleep parameters the right way. But there could also be things going on in your day that need addressing. I actually look at this as a really positive thing — that stress and sleep are related provides two opportunities for intervention. You can try to work on your sleep, and maybe that'll make it easier to deal with stressors during the day.

Dr. Prather: One of the challenges when people don't get the sleep they need is that it's really hard to regulate emotions. Little things feel like really big things when you don't have the right sleep — any parent can confirm that. In the same way, when people have too much stress in their life, it feeds forward into the night. Even if things don't seem that bad, as it gets closer to bedtime, it can pop back up.

Dr. Prather: If you're noticing difficulty falling asleep or difficulty when you wake up, it may be about stress management during the day. Try to build things into your day — meditation, breaks, other resources. Maybe it's creating a curfew around work. Those kinds of things are worth investing in. It's a 24-hour day, and we have lots of opportunities to build in supportive activities to make all of those things work better, whether it's dealing with stress or improving sleep.

The Neuroscience of Rumination

Natalie: It sounds like stress and rumination can create a self-perpetuating cycle of poor sleep. Can you help us understand in detail the "why" behind this vicious cycle?

Dr. Prather: We're learning more about the neuroscience of rumination. The current literature suggests that the default mode network — a connection between different aspects of the brain — becomes overactive when people are experiencing stress or insomnia. It seems to play out in rumination. These are circuits in the brain related to self-reflection, and you can get stuck — your thoughts can become circular, which obviously impairs your ability to fall asleep.

Dr. Prather: In your peripheral physiology, we also know that stress can increase your fight-or-flight response and the release of cortisol. Cortisol is a stress hormone, and it can impact your ability to fall asleep or stay asleep. The clearest example of this is when people get steroid injections — that can certainly cause insomnia in the short term. It's an example of a high dose of something your body can make naturally that can also impair sleep. Stress can drive that. Your brain gets really active, caught in thought loops, and ultimately it's really difficult to let go and fall asleep.

A Simple Starting Point: Fix Your Wake-Up Time

Natalie: You've spent your career translating sleep science into tools people can actually use — one of the reasons we're so grateful to have you as an advisor. What are some simple, actionable strategies listeners can start using tonight to improve their sleep?

Dr. Prather: I love what I do, because everybody wants to sleep more — they want to sleep better. Everybody is trying their best. Life is busy, and we're all just trying to live our best lives, which includes improving our sleep. There are some simple things people can start doing that I think of as a recipe for better, more reliable sleep, because we've worked out a lot of the science. Sleep is so embedded in our biology.

Dr. Prather: I always say people don't even wonder how sleep works until it stops or gets messed up, and then we get really focused on how to make it happen. But sleep isn't something you make happen — sleep is something that happens to you. Often it's the behaviors we have that get in the way of sleep working more naturally.

Dr. Prather: When people ask what's the first thing they should do, I always tell them: stabilize your wake-up time, seven days a week. People don't love that idea. They like to sleep in on weekends, they're carrying a sleep debt — I totally get it. Do your best.

Dr. Prather: The reason we have people stabilize their wake-up time is that the two primary ways our sleep is regulated are our internal clock and our homeostatic sleep drive. The sleep drive is simple: the longer you're awake, the sleepier you get. I think of it like a balloon. You wake up in the morning and the balloon is flat. As you go through the day, it fills up with sleepiness. It gets big, you get sleepy, you go to sleep, and you drain it out overnight, like draining air from a balloon.

Dr. Prather: When you stabilize your wake-up time, you also stabilize your internal clock — your circadian rhythm. Your body starts to know what time it's supposed to get up every day. Ideally, you get some sunlight in your eyes to shut off the melatonin your brain is releasing, which also starts filling that balloon — the sleep drive.

Dr. Prather: If your wake-up time swings by big differences, the balloon starts filling at a different point in the actual clock time. If you sleep in three hours later on the extreme end, it shouldn't be a surprise that you don't fall asleep at the same time that night. This is also why naps can be problematic if people are trying to improve their nighttime sleep — you're draining some of that sleepiness out of the balloon.

Dr. Prather: It's such a great anchor for people to start their sleep improvement journey. We don't get to choose when we fall asleep — it happens to us. But we can decide when we wake up. There's some autonomy there, and it removes the pressure of "what time do I need to go to sleep?" — because your body will tell you that.

Natalie: I think that is such a helpful tool. It's like: what can you actually control? You can control your wake-up time. That's excellent advice.

The Role of Digital Tools Like BetterSleep

Natalie: Building on your role as an advisor — how can digital tools like BetterSleep complement these strategies and make them more accessible or easier to implement in daily life?

Dr. Prather: There's a really important opportunity for digital tools like BetterSleep. People have a hard time winding down. People need tools on the go. People have different preferences about what works for them.

Dr. Prather: When I think about sleep and what helps people get to sleep or stay asleep — sleep is really universal. We all do it. It's been conserved across millennia; every species we've studied does something that looks like sleep or rest. But it's also really personal. There are things that work for some people that don't work for others. We have underlying biology that regulates our sleep, but when it comes to winding down — ways to distract, to meditate, tools in the palm of your hand that can push you over the threshold to sleep — there are preferences.

Dr. Prather: Digital tools are like a boundless library of high-quality content, and that's a really important area of innovation that has helped a lot of sleepers. It's been exciting for me to watch this unfold over the last decade, in parallel with people becoming more and more interested and invested in their sleep. I'm excited to see where this field goes as these tools continue to build on themselves — more and more people will get the quality rest they're really looking for.

Closing

Natalie: We are so lucky to have you guiding us and our sleepers through their journey. Eric, thank you so much for breaking down the science of stress and sleep in such a clear way. We're thankful to have you here today, and even more thankful to have you as a key part of the BetterSleep Advisory team. Your research and clinical insight help guide the direction of our work. Where is the best place for our audience to learn more?

Dr. Prather: I'm a professor at UCSF — we have lots of websites and all that kind of stuff. I'm pretty easy to find on the interweb. I also wrote a book called The Sleep Prescription, which breaks down some of these strategies to help people sleep well. You can check that out wherever you get your books.

Natalie: For everyone listening — if today's conversation resonated, please stay connected with BetterSleep. With expert advisers such as Dr. Prather informing our work, BetterSleep remains focused on delivering science-based strategies and practical tools that help you understand your sleep and regain a sense of ease at night.

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