As the coronavirus has swept the globe, many aspects of our lives have been dramatically altered. It should perhaps not be surprising that sleep also seems to have changed. There has been a significant increase in people experiencing insomnia. Why might it suddenly be more difficult to sleep well? Considering what contributes to normal sleep, it may be possible to understand how the coronavirus seems to have caused an insomnia pandemic. Fortunately, it might also be possible to restore healthful sleep through simple changes.
Even in the best of times, chronic insomnia affects approximately one in 10 people. Defined as difficulty getting to sleep, or getting back to sleep after waking, it contributes to complaints of fatigue and daytime impairment. Stress may precipitate this difficulty. In the context of the coronavirus pandemic, early research suggests that insomnia has increased: for example, there has been a 14.8% increase in sleeping pill prescriptions in the month ending March 15, according to Express Scripts.
Let’s consider some of the causes of insomnia that may be present now due to the public health requirements of quarantining, sheltering in place, and social distancing. By understanding these factors, it may be possible to take some corrective steps to optimize the ability to sleep.
Loss of schedule anchors
Many people are no longer working as they did before. Their jobs may be temporarily suspended through furlough or completely eliminated. Instead of going into their place of employment, they may be working remotely from home. Schools and universities have been closed. There is no morning commute. Without needing to wake at a consistent time, the alarm clock has been silenced.
The body needs an anchored wake time to reinforce the circadian rhythm, a pattern of wake promotion that also enhances sleep at night. Irregularity propagates disturbances. Getting up earlier also helps the sleep drive to build the desire for sleep, through the accumulation of adenosine during prolonged wakefulness. By sleeping in, taking naps, or going to bed too early, the strength of these signals are diminished.
In order to get back on track, think back to the sleep schedule you kept previously and return to it. Set an alarm to wake consistently throughout the week. Keep a regular sleep-wake schedule and go to bed roughly at the same time each night after spending one or two hours relaxing and unwinding before bedtime.
High levels of stress
There are many reasons why the coronavirus pandemic has increased our collective levels of stress and exacerbated mood disorders like anxiety and depression. With lost work, there is a financial and emotional toll. It has disturbed social connections, routines, and activities that reduce stress. The health risk presents an invisible and interminable threat to safety, revving up the sympathetic nervous system and increasing cortisol levels. The constant stream of distressing news, with no end in sight, may contribute to anxious uncertainty. None of these feelings are conducive to sleep.
It may be difficult to dial back the stress. Consider limiting the consumption of news and social media about the pandemic. Avoid the topic late in the day, especially in the hours preceding bedtime. Ban the smartphone from the bedroom. Stress management techniques like breathing, progressive muscle relaxation, and guided imagery may be helpful. If possible, try to reimagine activities or social connections previously used to reduce stress.
Increased sedentary time
Sheltering in place may involve an excessive amount of time spent resting, watching T.V., reading, or lounging about the house. There may be a general reduction in activities and lost exercise routines. Dozing and napping may be common. Excessive sedentary time, a lack of exercise, and napping may all reduce the quality of sleep at night.
As much as possible, try to be active during the day. Find ways to break a sweat and get the heart rate up. Jogging in place, jumping jacks, lunges, yoga, and home gyms may all be helpful. If possible, get out for a walk, steering clear of others. If you feel drowsy during the afternoon, do something more active to avoid the tendency to nap. If absolutely necessary, keep any nap short, such as to 20 to 30 minutes.
It is likely that habits surrounding the consumption of caffeine and alcohol have changed. The morning cup of coffee may have become bottomless, a prolonged or recurrent indulgence. Within the brain, caffeine blocks adenosine, a signal for sleepiness. It may take about four to six hours to be cleared from the body. Therefore, late consumption of caffeine may disturb the onset of sleep in sensitive individuals.
Alcohol, conversely, enhances the effects of adenosine and may contribute to sleepiness. Unfortunately, it is metabolized very quickly, and as the levels fall, sleep may be negatively affected. It can also contribute to relaxation of the upper airway muscles, potentially causing snoring and sleep apnea. It also suppresses deep and REM sleep. Therefore, last call for alcohol intake should be at least an hour — per serving — prior to bedtime.
Loss of natural time cues
Staying indoors leads to a disconnection from the natural patterns of light and darkness. In particular, morning sunlight is an important cue to the circadian rhythm. This is especially important among night owls, but most people genetically have a slight delay in their circadian phase. This means that without external time cues, like morning sunlight, the tendency will be to gradually stay up later and sleep in.
To get yourself back on track, get 15 to 30 minutes of sunlight exposure immediately upon awakening. It works best if it is directly hitting the face, even if the eyes are averted. Step outside, if able, or at least sit near the windows. As much as possible, preserve exposure to natural light during the daytime. At sunset, try to minimize exposure to artificial sources of light. It may be helpful to switch devices to nighttime mode to reduce blue light exposure. In the last several hours preceding bedtime, try to adhere to low-tech pastimes.
Sharing tight quarters
Unfortunately, staying at home may mean sharing tight quarters with family, roommates, or others. In order to preserve privacy (and sanity) amid this confinement, many people may be using their bedrooms and beds as a sanctuary and multipurpose space. Unfortunately, this affects the body’s conditioning in a negative way. It is best to associate the bed solely with sleep and intimacy. For this to occur, the space cannot be used for other purposes.
As much as possible, preserve the bed as a space for sleep. Ensure the conditions are right: comfortable bedding, low lighting, a cool temperature, and free of noise. Avoid spending prolonged periods of time awake in the bed, including during the day and night. Go to bed when feeling drowsy with the intent to sleep, and if awake in the night for more than 20 minutes, get up and do something quiet. Return to the bed if the desire for sleep recurs.
Exceeding sleep needs
After years of unabated sleep deprivation, with most adults not getting the seven to nine hours of sleep nightly that is recommended, many people may finally be sleeping more. This may be a mixed blessing. It is possible that some may actually be extending the time in bed beyond their current sleep needs. This may occur if someone naps, goes to bed too early, or stays in bed too late.
The amount of sleep needed by an adult varies across a population and changes throughout the lifespan. Older adults (beyond age 65) may only need seven to eight hours of sleep to feel rested. This may be a unique opportunity to reassess what your current need may be. Keep a consistent bedtime and allow yourself to sleep in until you feel rested. Early on, this may compensate for recent sleep deprivation, but it may gradually approach an average that reflects the current sleep need.
Once determined, try to match the total time spent in bed to your individual sleep need. (Extra time will be time spent awake.) Keep a consistent sleep-wake schedule with a fixed wake time and sunlight exposure upon awakening. Do not spend more time in bed than you would normally be able to sleep.
Reaching out for help
If you find that your difficulties sleeping persist, reach out for additional guidance and help. The first-line treatment for chronic insomnia is cognitive behavioral therapy for insomnia (CBTI). This may be accessed with the help of a therapist via telemedicine, through an online self-guided program, or with the review of a book.
Rest assured that chronic insomnia, even in these times of pandemic, can be effectively put to bed with these simple techniques.
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