COVID-19 has resulted in so many changes to our lives, habits, and routines. This includes our sleep patterns. At any given time, around 10% of the population suffers from chronic insomnia. The pandemic shutdowns have created many new challenges to restful sleep leading to even more sleep difficulties. Even people who were good sleepers now have problems.
A recent study reported a significant increase in internet searches for insomnia during the early months of the pandemic lockdowns in the spring of 2020. What’s even more interesting is that the searches peaked at around 3:00 a.m. on Sunday nights, which is typically the worst night for most insomniacs.
How the pandemic added to difficulty sleeping
“Coronasomnia,” a new term coined by sleep experts. It encapsulates the sleep problems related to the COVID-19 pandemic. Increased anxiety and stress are the most common contributors to poor sleep. The social distancing and quarantining made things worse and led to higher rates of feeling isolated and depressed. Surveys of sleep since the onset of the pandemic show more sleep dissatisfaction, poorer sleep quality, and even a signal for increased use of sleeping pills.
In addition to the increased stress and anxiety, the pandemic has created a higher level of precariousness for many people. Quarantines, school closures with virtual learning, working from home, and social distancing have altered our lives profoundly. Sunlight along with daily activities and routines helps keep our circadian rhythm on track. Being stuck inside the house disrupts the external cues our brains need to promote wakefulness.
Sleep loss adds up
Chronic insomnia contributes to serious health issues including diabetes, heart disease, high blood pressure, and weight gain. It also has a negative impact on our ability to regulate emotions and mood which can lead to interpersonal conflicts, lost productivity at work, and compromised relationships.
In addition, the coronavirus has serious implications for people with obstructive sleep apnea, which affects approximately 25% of the general population. Research published in 2020 found people with OSA to be 8 times more likely to contract the virus compared with age-matched controls.
Individuals with OSA who contracted COVID-19 had a higher risk of hospitalization and respiratory failure. While OSA shares risk factors and comorbidities with negative COVID-19 outcomes including obesity, high blood pressure, diabetes, and lung disease, current research suggests that it may be an independent risk factor for poor outcomes of COVID-19.
There is some good news, though. While many people experienced more insomnia due to the pandemic shutdowns and control measures, others started getting better, more restful sleep. Humans have a natural circadian rhythm that keeps our sleep/wake patterns on a 24-hour schedule.
But not everyone’s circadian rhythm matches with the demands of everyday life. Decreased commute time due to working from home and more flexible work and school schedules have allowed some to adjust their sleep period to better fit with their own natural rhythm.
Sleep strategies for insomnia
In spite of the challenges, you can take simple steps to promote better sleep during these trying times.
- Keep a consistent daily routine. It may be a different routine than usual, but consistency is the key. Set the alarm to wake up at the same time each day. If you work from home, incorporate regular routines to help provide cues throughout the day. These include showering and getting dressed after waking up, eating meals at the same time each day, and taking breaks just like you would at work.
- Do not use your bedroom as an office. Sleep experts agree that creating a strong association between sleep and the bed is important. This helps train your brain that the bed is the place for slumber and not the place to work, think, or worry.
- Stay active. Exercise is a great natural stress reliever and can help build sleep drive, thereby improving sleep quality. But avoid intense exercise and strenuous activity within a few hours of bedtime to give your body time to cool down.
- Avoid or limit naps. A short power nap (15-20 minutes) can be beneficial if it’s not too late in the day, but sleeping longer or later may disrupt your sleep that night.
- Show me the light. Getting natural sunlight in the morning can boost alertness and keep our sleep/wake rhythms on track.
- Be cautious with alcohol and caffeine. Caffeine is a stimulant and can cause sleep disruption when consumed later in the afternoon or evening. Alcohol may help people feel more relaxed, but it tends to disrupt sleep quality and should never be used as a sleep aid.
- Wind down. Set aside some time to wind down before bedtime. This can include reading for pleasure, stretching, meditating or taking a warm bath. Put away the electronics. The blue light from electronics can delay natural melatonin production which helps regulate the sleep/wake cycle. Turn them off about 1 hour before bedtime.
If lifestyle changes don’t help
If you continue to struggle with sleep disturbances despite lifestyle changes, you might consider cognitive behavioral therapy for insomnia. Cognitive behavioral therapy for insomnia, or CBT-I, is usually the next treatment of choice. It is preferred to sleep medications because it addresses the root of the problem rather than treat a symptom. CBT-I is a multi-component treatment strategy that helps identify and replace thoughts and behaviors that cause or worsen sleep problems. The therapy strives to replace those ineffective habits with those that promote better sleep CBT-I is delivered by behavioral sleep medicine experts or through web-based programs.
The stay-at-home orders and quarantining meant that many people delayed seeking health care for non-emergency circumstances. However, telehealth services expanded rapidly to meet demand, including for sleep disorders.
CBT-I and screening for sleep apnea have become increasingly accessible through telemedicine. A recent study showed patients who completed CBT-I virtually had similar benefits compared with those who received in-person therapy.
Healthy sleep is a crucial component of overall well-being. It’s even more necessary during stressful times. Adequate sleep is necessary for a functioning immune system and preventing infection. If you are struggling with insomnia, try the steps above. If you still have issues, talk to your health care provider.