Original Article Published Circadiance on Jun 16, 2020 5:00:19 PM https://blog.circadiance.com/blog/sleep-during-covid-19
On March 11, 2020, the World Health Organization (WHO) declared the novel coronavirus (COVID-19) outbreak a global pandemic and as a result the way we live changed dramatically. As of June, 2020, there have been over two million confirmed cases and over one hundred thousand confirmed deaths in the United States, and rising…
Sleep is Important, Especially During a Pandemic
At first glance, sleep is unrelated to a raging virus. But there is an inter-relatedness that is hard to ignore: quality sleep boosts the immune system, reducing the risk of infection, and can improve outcomes for people fighting a virus; on the other hand, poor sleep can weaken this line of defense and make someone susceptible to acquiring a virus.
Sleep serves to keep the brain and body in a state of balance. For most people, having a world out of balance has had a similarly unsettling effect on sleep.
Sleep Troubles of Pandemic Proportions
Psychologists studying the phenomenon say that society is living through a collective trauma from the aftermath of the novel coronavirus (COVID-19) outbreak. Whether one is directly (i.e., through illness, job loss, etc.) or indirectly (i.e., witnessing one’s community in chaos) affected by the pandemic crisis, psychological trauma is prevalent in society. When trauma extends to entire groups of people and societies it reaches a “collective” level of suffering.
This inability to grasp or cope with what is happening leads to a host of experiences including anxiety.
Anxiety is the kryptonite of sound sleep.
Sleep specialists who typically focus on OSA (Obstructive Sleep Apnea) have expressed concerns that living through a pandemic is a clear and present danger to sleep apnea care, with many sleep labs, clinics and DME service centers having been labelled “non-essential” and thus reducing operations.
With the focus on ICU treatments for COVID-19 and other medical emergencies, there is a real concern among sleep professionals that sleep care is flying under the radar for other sleep disorders like Insomnia and sleep disruption leading to nightmares, which are more directly tied to the experience of trauma.
A “Perfect Storm” of Sleep-disrupting Factors
We are far from coming to grips with the full consequences of COVID-19 on sleep, but we do know some indirect effects based on the challenges it has created on our daily lives, including:
- Disruption of our usual routine
- The transition to inconsistent work and school schedules removes many of the body’s usual wake / sleep cues known as “zeitgebers” which can confuse the normal circadian rhythm process (i.e., the “body clock”).
- Increasing levels of stress, anxiety and worry
- The closure of our normal recreation and diversion outlets has meant less available coping mechanisms for stress
- The anxiety and worry associated with exposure to traumatic events in the media have led to an increase in ruminating thoughts; this negative thinking habit is inversely related to the time it takes to fall asleep.
- Social isolation
- Shelter-in-place has dramatically cut us off from our social supports. Positive social interactions have been shown to boost immune function and lower stress, a sleep-promoting function.
- More screen time
- We have resorted to TV, smartphone and other devices for diversion and connection. Blue light from screens tells our body to not produce the sleep hormone melatonin.
It is no coincidence that each of these challenges are also triggers for Insomnia symptoms.
“A ruffled mind makes a restless pillow.” — Charlotte Bronte
Insomnia occurs with either a 30 minute or greater difficulty in getting to sleep, difficulty staying asleep, or waking early combined with daytime sleepiness effects.
Donn Posner, PhD, a Diplomate of Behavioral Sleep Medicine (DBSM), said in a recent Harvard online forum (Simon, 2020) that even in normal times, approximately 30 to 35 percent of the population experiences acute, or short-term, insomnia.
Out of these brief insomnia episodes, most brief insomnia episodes resolve and don’t precipitate into long-term, chronic insomnia. But in times like this, all bets are off.
This anxiety is thought to be interwoven into our sleep quality because it represents a heightened arousal state of the central nervous system.
“All that we see or seem is but a dream within a dream.”― Edgar Allan Poe
There has been another, if less expected phenomenon during the pandemic: reports of odd and anxious dreams and nightmares. Some have called them “Covid Dreams.”
Dream content has been shown to reflect your waking reality, and during a pandemic not only will this lead to negative dream content but having disrupted sleep—including during REM sleep, the period when most of our dreams take place—means we are waking more often when we are more likely to remember our dreams.
For those of us sleeping longer than normal, REM is more concentrated in the latter portion of the sleep period, and at the end of each sleep “cycle,” and more people are waking up during this dreaming stage as a result of sleeping in. Either way, we are getting more time to dream, for better or worse.
The experience may not be pleasant, and a negative dream can stay with you longer if you are not running off to work or school, but dreams serve an adaptive function. They help you to process what happened during the day and make sense of it. Dreams are a kind of “overnight therapy” to cope with the anxiety brought about during the day (Godshalk, 2020).
Coping with the Sleep Consequence of COVID-19
How do we cope when so much of our world is out of our control?
Counter-intuitively, the steps we are taking to protect ourselves from the virus are what is leading us to disrupted sleep. Having a set plan for protecting our sleep needs is crucial at a time like this, just like one would have for protecting one’s medical health.
Besides sleep, there are other ways to compensate for the loss of routine and usual coping mechanisms that you can incorporate right now (National Sleep Foundation, 2020):
- Find alternative hobbies like painting, exercise videos, writing, photography
- Stay connected with people using technology, if necessary
- Prioritize the health triad (i.e., sleep; nutrition; exercise)
- Put together a coping toolkit (i.e., a list of activities and objects that increase your quality of life)
- Minimize exposure to traumatic news stories in the media
- Utilize telemedicine to keep up with your preventative medicine visits
- When all else fails, normalize your struggles and be kind to others
And there are some simple behavioral changes you can make to set you up for quality sleep this evening:
- Even though it may appear to be a solution to a lost night of sleep, avoid napping, or at least cut it short. Think of a nap as a snack, not a meal: napping for longer than 20 minutes or late in the day ruins our “appetite” for sleep.
- Avoid sleeping in late to try and compensate for a poor night’s sleep. It will only further take you off of your wake / sleep rhythm. It’s okay to have a bedtime and wake-up routine that is different than it used to be—a typical example of this is found in adolescents who may need a later bedtime and later wake time due to changes in their sleep needs.
- Once awake, however, try to get some sunlight, whether by taking a walk or sitting by a window.
- It’s not just sleep that follows a rhythm. Eating and exercise should be kept to as regular a schedule because they too are cues to the body that regulate alertness.
Finally, if sleep isn’t happening for you, get out of bed and do something relaxing that will tire you out, like reading or doing a puzzle. Only return to bed when you feel sleepy again. As Dr. Posner (2020) reminds us, “If you can’t sleep do not try to force it. Good sleepers put no effort into sleep whatsoever.”
Simon, C. (2020, April 24). Sleep problems becoming risk factor as pandemic continues. Retrieved from https://news.harvard.edu/gazette/story/2020/04/sleep-problems-becoming-risk-factor-as-pandemic-continues/
Godshalk, D. (2020, May 14). Sleep in the age of COVID-19. Retrieved from https://news.temple.edu/news/2020-05-14/sleep-age-covid-19
National Sleep Foundation (2020, May 11). Sleep Guidelines and Help During the COVID-19 Pandemic. Retrieved from https://www.sleepfoundation.org/sleep-guidelines-covid-19-isolation