Stressed, Constantly Tired, Sleeping Badly
– How We Can Restore Balance to Body and Mind

The working day is over, but your thoughts keep circling. In bed, tomorrow's tasks run through your mind and unresolved problems won't let go. In the morning you feel exhausted despite having slept enough. And even at the weekend it is hard to truly switch off.

Many people know this situation: stress, tiredness and poor sleep often occur together. They can reinforce one another. Lack of sleep impairs concentration and emotional resilience. Persistent exhaustion makes it harder to cope with everyday demands. And anyone who is constantly under pressure often finds it hard to wind down in the evening.

Such a state is sometimes described as "sub-health". However, the term is not a clear medical diagnosis. Persistent tiredness or sleep problems should therefore not simply be regarded as unavoidable side effects of a hectic life.

What lies behind this interplay? How much exercise can help? And what options do modern medicine and Traditional Chinese Medicine (TCM) offer?

1. Why stress, tiredness and sleep problems often occur together

The body is tired, but the mind keeps working

In response to work pressure, family obligations or ongoing uncertainty, the body reacts with a stress response. In the short term this makes sense: we can concentrate better and respond more quickly to challenges.

If the strain persists for a longer period, however, recovery may fall short.

Perhaps the working day ended long ago, but in your head conversations are replayed, unfinished tasks are gone through and possible problems of the next day are anticipated. The body lies in bed while the thoughts continue to run at full speed.

This sustained mental activation can make it harder to fall asleep and promote waking during the night. Sleep may become less restorative.

At the same time, lack of sleep impairs attention, emotional regulation and the ability to cope with stress. In this way a vicious circle can develop:

To break this cycle, simply going to bed earlier is sometimes not enough. How we handle stress, movement and recovery during the day also plays a role.

Tiredness is not always a question of rest

Tiredness is a common but non-specific symptom. Lack of sleep, psychological strain, lack of exercise and an irregular lifestyle can all contribute. Other possible causes include, for example, anaemia, thyroid disorders, diabetes, infections or medication side effects.

Temporary tiredness after a strenuous day usually improves with rest. The situation is different if the exhaustion persists for a long time and hardly improves despite sufficient sleep.

If symptoms last for weeks, worsen, or are accompanied by concentration problems, palpitations, shortness of breath or marked changes in weight, a medical check-up is advisable. Whether further examinations or laboratory tests are needed depends on the individual situation.^[1]

Why do we often feel exhausted despite sleeping enough?

Adults generally need about seven to nine hours of sleep per night. Individual needs, however, vary.

What matters is not only the time spent in bed. The time it takes to fall asleep, waking during the night, waking very early in the morning and how well you function during the day are also important.

Anyone who regularly wakes up exhausted despite a sufficiently long sleep period should therefore look more closely.

Pronounced snoring, observed pauses in breathing, gasping for air at night or severe daytime sleepiness may point to sleep apnoea or another sleep disorder. In such cases a medical evaluation is advisable.^[1]

2. How long should you walk to sleep better?

It does not always have to be an intensive training programme. For people who sit a lot and move little, regular walking is a good start.

Start with 15 to 30 minutes

Anyone who has so far built little exercise into daily life can begin by walking 15 to 30 minutes a day. Duration and pace can then be adjusted step by step to personal capacity.

If your health allows, you can aim in the long term for at least 150 minutes of moderate physical activity per week. This includes, for example, brisk walking or cycling.

A systematic review with meta-analysis published in Sleep Medicine Reviews in 2024 examined 19 studies on exercise interventions in people with insomnia or related complaints. Overall, sleep parameters improved, particularly subjectively assessed sleep characteristics. However, the studies differed in the forms of exercise, duration and the people studied. The results for individual objective sleep parameters were also not consistent. An optimal training duration for everyone cannot be derived from this.^[2]

Regular exercise can nevertheless help to interrupt prolonged sitting, build a more stable daily rhythm and consciously create time for recovery.

Forest walks: movement and distance from everyday life

A walk in the forest differs from a hurried trip through the city. The natural environment often offers less traffic noise, fewer screen stimuli and fewer work-related interruptions. Attention can turn back to the surroundings, the sounds and your own breathing.

A study published in BioPsychoSocial Medicine in 2011 examined changes in sleep after forest walks in people with sleep complaints. A total of 71 people took part in the study; for 42 people, analysable data on objectively measured sleep duration were available.

In this group, the average actual sleep duration on the night after the forest walk rose from around 366 to 420 minutes. Subjectively perceived sleep depth and sleep quality also improved. Among the 16 people who walked in the afternoon, average sleep duration rose from around 343 to 475 minutes.^[3]

The results are interesting but must be interpreted with caution. It was a before-and-after comparison and not a randomised controlled trial. It is therefore not possible to say with certainty what proportion of the change was due to the exercise, the natural environment or other factors.

Nor do you have to go to a forest every time. A nearby park, a quiet path along the river or a green setting can also offer a pleasant framework for a conscious break.

How can a restorative walk be designed?

A few simple habits can help:

• Choose a suitable time of day: A walk in the afternoon or early evening can help build a regular exercise routine. Daylight also supports a stable day–night rhythm.
• Start with 20 to 30 minutes: If you feel comfortable, you can gradually increase the duration to 40 to 60 minutes. Two hours are not necessary to begin with.
• Deliberately slow your pace: The aim is not to collect as many steps as possible. Pay attention to your breathing, your surroundings and a pleasant rhythm of movement.
• Put your smartphone aside: If safety allows, it can help to switch off notifications and not deal with work messages during the walk.
• Observe your own response: Over a few weeks, note when you go for walks and how you feel by day and by night. Individual nights allow only limited conclusions.

If exercise late in the evening tends to activate you, move your walk to the daytime or early evening. What matters is a routine that suits you in the long term.

3. What can modern medicine do about sleep problems?

Lifestyle changes are important. In persistent insomnia, however, general sleep hygiene recommendations are often not enough.

Cognitive behavioural therapy for insomnia

Cognitive behavioural therapy for insomnia, CBT-I for short, is one of the most important recommended non-drug treatments for chronic insomnia.

It is not simply about thinking less. Rather, behaviour patterns and expectations around sleep are deliberately changed. The aim is to reduce excessive worry and to improve the conditions for a more stable sleep rhythm.

Possible components include:

• a wake-up time that is as constant as possible;
• stimulus control, so that the bed is again more strongly associated with sleep;
• a professionally guided adjustment of time in bed;
• cognitive strategies against excessive worry about sleep;
• relaxation techniques and realistic expectations of one's own sleep performance.

Someone who goes to bed earlier and earlier for fear of a bad night and then lies awake for a long time can, for example, benefit from a targeted adjustment of sleep behaviour.

The European guideline, updated in 2023, recommends CBT-I as first-line therapy for chronic insomnia. Treatment can take place as individual or group therapy and via suitable digital programmes.^[4]

When are medication or further examinations appropriate?

If sleep problems significantly affect everyday life, a doctor may, depending on the situation, consider drug treatment or arrange further examinations.

Sleeping pills are not suitable for everyone and should not be taken on your own over a longer period. Effects, risks and suitable duration of use depend on the specific preparation and the individual situation.

If there are also pronounced symptoms of anxiety or depression, chronic pain, heavy snoring or pauses in breathing, these possible causes should also be clarified.

The same applies to persistent exhaustion. If symptoms last for weeks, worsen or are accompanied by other physical symptoms, a medical assessment is advisable.^[1,4]

4. How does Traditional Chinese Medicine view stress, tiredness and sleep disorders?

An essential feature of TCM is viewing the person as a whole. A single symptom is not assessed in isolation but in connection with other physical and psychological complaints.

In traditional Chinese medicine, stress, emotional strain, sleep disorders and tiredness can be associated with different patterns of functional disturbance and changes in the flow of Qi and blood.

In the individual assessment, sleep habits, mood, energy, appetite, digestion, sensations of warmth and cold, as well as tongue and pulse findings are taken into account, among other things.

Some people under heavy strain suffer from brooding, inner tension and difficulty falling asleep. Others feel exhausted and lose their appetite after prolonged demands. Still others are tired by day but can hardly quieten their thoughts in the evening.

Such complaints cannot automatically be assigned to a single TCM pattern. Similar symptoms can have different backgrounds. An individual assessment is therefore more sensible than a uniform treatment scheme.

Can acupuncture help with sleep problems?

In TCM, acupuncture is used, among other things, for sleep complaints and accompanying symptoms. The treatment is based on the individual situation.

The available studies suggest that acupuncture might help some people with insomnia. The scientific evidence, however, is limited. A Cochrane review published in 2022 concluded that, owing to methodological weaknesses, considerable differences between the studies and possible publication bias, the studies do not allow a reliable statement on the benefit and safety of acupuncture in insomnia.^[5]

Acupuncture can therefore be considered as part of an individually tailored treatment concept. However, it should not be presented as a guaranteed cure and should not replace a necessary medical evaluation or evidence-based treatment.

Not just falling asleep faster, but feeling better during the day

In stress-related sleep complaints, the aim should not be solely to shorten the time it takes to fall asleep.

Equally important are daytime energy, the ability to concentrate, emotional resilience, physical tension and the return to a regular daily life.

Depending on the individual situation, TCM treatment can be combined with exercise, relaxation exercises, sleep-related behavioural changes and, where appropriate, medical treatment.

An integrative approach does not mean applying as many methods as possible at the same time. What matters is to choose suitable and safe measures according to actual needs.

5. Five practical recommendations for everyday life

If you often feel stressed, exhausted or poorly rested, the following steps can be a sensible start.

1. Keep to fixed wake-up times as far as possible. Even after a bad night, a regular daily rhythm is helpful. Try not to keep going to bed earlier or to stay in bed for a long time to make up for a single bad night.

2. Plan genuine recovery. Reading the news, answering e-mails and scrolling through social media are not necessarily restful activities. Deliberately create time in which you do not have to get anything done.

3. Exercise regularly. Start with 15 to 30 minutes of walking and gradually increase the activity. A realistic routine is often more helpful than occasional, very intensive training.

4. Give your mind a signal that the working day is over. Reduce work messages and other stimulating activities before going to bed. Reading, calm breathing exercises or other pleasant rituals can support the transition to night-time rest.

5. Take persistent complaints seriously. If sleep problems last for months or exhaustion clearly affects your daily life, you should seek medical advice rather than simply carrying on.

Conclusion: Sometimes what helps is not more effort, but a better balance

In urban everyday life we measure much by efficiency and performance. Even when we are exhausted, we often try to work faster, sleep better and recover as quickly as possible.

But health cannot always be achieved through additional effort.

Sometimes it is more important to create clear boundaries between work and recovery, to move the body regularly and to give the mind the opportunity to detach from constant demands.

A quiet walk, a stable daily rhythm or a suitable treatment can be first steps towards regaining balance.

If stress, tiredness and sleep problems reinforce one another, you do not have to face them alone. Appropriate medical evaluation, evidence-based treatment options and individually tailored support can help you find a suitable path to recovery.

Health does not mean never being under stress. It also means preserving or regaining the ability to recover, to adapt and to cope with strain.