Disclaimer: The below sleep tips are meant for symptom free individuals. If you have contracted COVID-19 some of these sleep tips may not apply to your situation. If you have COVID-19 simultaneously with insomnia, speak to your medical doctor for help.
Have you lost sleep over COVID-19? You are not alone. Whether you are quarantined at home or a health worker in the front line, people’s routines are disrupted because of the COVID-19 outbreak.
Getting quality sleep has important implications for you right now and in the future. Restorative sleep can boost your immunity to viral infection and improve your mental health in the face of COVID-19 stressors. The way you are coping with sleep difficulties now can impact the likelihood that your sleep difficulties will worsen, persist, and develop into chronic insomnia long after the COVID-19 epidemic. To understand how you can boost your immunity and prevent chronic insomnia you must first understand what insomnia is.
Definition of Insomnia
Insomnia is characterized by these three symptoms:
(1) Taking a long time to fall asleep once you start trying
(2) Frequently waking up throughout the night
(3) Early-morning awakening with inability to return to sleep
You may be wondering- how long is taking “too long” to fall asleep, how many awakenings is “too many,” or how early is “too early” to wake up before returning to sleep?
Definition of “Normal” Sleep
Generally, you will hear that “normal” sleep includes the following:
(1) Obtaining an average of 7–8 hours of sleep per night
(2) No more than 2–3 awakenings per night, with these awakenings lasting no longer than 30 minutes in total
(3) Taking no longer than around 20 minutes to fall asleep
(4) Waking up no more than 15 minutes earlier than your desired wake-time
(5) A sleep efficiency of close to 89%. Sleep efficiency is the percentage of time spent in bed actually sleeping. For example, if you laid in bed for 7 hours but were only sleeping for 6, then your sleep efficiency would be 86% because 6 divided by 7 equals .86 or 86 percent.
However, what is considered “normal” sleep is subjective and varies based on an individual. For example, older adults may find they need less sleep whereas younger adults tend to report needing more sleep. Minority Asian groups report obtaining less sleep than majority groups. Older adults tend to experience more awakenings during the night. What is quality sleep to you, may not be quality sleep for someone else. In any case, there are unhealthy sleep habits that can increase and prolong sleep difficulties.
How Insomnia Develops into a Chronic Condition
Certainly, symptoms of insomnia are normal during stressful times. The way you cope with the sleep difficulties you are having now can make or break how your sleep will be when the COVID-19 related stress dissipates. People whose insomnia persists after stressful events, tend to be the kind of people who become overly concerned with their current sleep quantity and quality. These sleep concerns lead people to reasonably adopt a variety of strategies to attempt to improve sleep. Unfortunately, these strategies end up being harmful for your sleep in the long-term. The most common unhelpful strategies include:
(1) Trying to set an early bedtime
(2) Taking advantage of the days you are able to sleep to sleep in later
(3) Taking naps
(4) Spending time in bed while awake trying to “rest”
To understand why these strategies are ultimately not helpful, you first must understand the three main components in the sleep process, how the COVID-19 epidemic can impact each component, and the sleep strategies that target each component that are actually helpful.
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The First Component of the Sleep Process: Sleep Drive
The sleep drive refers to the increasing need for sleep the longer you stay awake. Think of the sleep drive as similar to our hunger drive. The longer we go without eating, the hungrier we become just like the longer we go without sleep, the sleepier we become.
How the COVID-19 Epidemic Can Impact Your Sleep Drive
1. Napping. During the COVID-19 social distancing, you may be more inclined to take a nap. Maybe you are less active or bored at home. Maybe you just want some privacy and time away from family. Taking naps during the day can decrease your sleep drive, making your sleep drive not as strong as it would otherwise be at night-time. If you snacked before dinner would you be hungry? Probably not. The same is true with napping. You are less likely to be sleepy at night if you nap during the day.
2. Trying to set an early bed-time. You may find that you have been staying up later than usual if you do not have much planned for the following morning. Maybe you are a healthcare worker and you finally have a night off and just want to get some extra shut eye to prepare you for the hard day you will have tomorrow. This may be fine for some people, but if you try to go to sleep early and cannot fall asleep, then all you are doing is reducing your sleep efficiency and increasing the chances that your sleep will not be as restorative.
Sleep Strategy: Make Your Sleep Drive Stronger at Night
1. Avoid naps. To ensure you are sleepy at night-time, avoid taking naps! This may be particularly hard if you are having trouble staying awake during the day. To combat day-time sleepiness, find activities to do that make you feel awake. Such activities could include going for a walk, calling a good friend, exercising outside, getting some sunshine, watching a captivating film, or taking a cold shower. Everyone is different, so you may need to experiment to figure out what activities make you feel more awake.
2. Stay up late and only go to sleep when you are sleepy, but do not sleep in late into the day. Wait to get into bed to sleep until you feel so sleepy that you think you would probably fall asleep within the next 20 minutes or so. Yes, as counter intuitive as it sounds, this means that there may be nights you stay up later than you expected, even when you need to get up early the next day. The sleepier you are when you go to sleep, the higher quality your sleep you will get and the greater your sleep efficiency will be. That is, you will fall asleep quickly, sleep deeply, and stay asleep throughout the night until your alarm goes off. Shoot for quality of sleep first, then you can work on increasing the quantity of your sleep.
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Second Component of Sleep Process: The Circadian Clock
The circadian clock refers to one of your body’s internal 24-hour biological clocks. The circadian clock sends your body signals to help you stay awake. If your circadian clock did not send you signals to keep you awake you would probably give into your growing sleep drive and sleep most of the time! As your sleep drive grows stronger during the day, so does the circadian clock’s wake signals to help keep you awake. However, like clockwork, your circadian clock should naturally begin to weaken at the same time every 24 hours to allow your sleep drive to take over. The ideal time for your circadian clock to weaken would be when you want to fall asleep at night and when your sleep drive is at its peak. The earlier you wake up, the earlier your circadian clock will begin to weaken at night. The later you sleep in, the later your circadian clock will weaken at night.
How the COVID Lockdown Can Impact Your Circadian Clock
1. Irregular sleep schedule. Most people’s schedules are being disrupted during the COVID-19 epidemic. You may find that you are sleeping late into the day on some or most days. If you are healthcare worker, you may be alternating between morning shifts and night shifts throughout the week. Variability in wake time can interfere with your ability to sleep well because it weakens the signals from the circadian clock. Having an irregular sleep schedule is like having frequent “jet leg” — your sleep is out of sync with your biology.
Sleep Strategy: Get Your Circadian Clock Set Correctly
Wake up at the same time every day, even on the weekends. Even if you had a late night, it is crucial that you do not sleep late into the morning! Waking up at the same time helps you set your circadian clock. If you wake up at the same time consistently, your circadian clock will weaken around the same time every night. Pick a time that makes the most sense for you to wake up at every day. This could be the time you expect to be getting up for work or for school once the lockdown ends. For the time being, you may need to schedule tasks in the morning to help you keep your wake time. Tasks that would motivate you to get up and help you stay awake and not return to bed would be the most helpful.
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Third Component of Sleep Process: Hyperarousal
If you wake up at the same time every morning and you feel exhausted at night but, you are still not able to fall asleep, the problem may be with your physiological arousal system. In other words, you are feeling too anxious and distracted with your thoughts and emotions so you cannot fall asleep. This arousal system has an important evolutionary purpose: to keep you awake for long periods of time in the face of danger. However, this arousal system can go off at night when we are not in real danger due to our anxiety or overwhelming thoughts.
How the COVID Lockdown Can Impact Your Hyperarousal
Indeed, many people feel anxious about COVID-19. You may be anxious about contracting the virus, spreading the virus, having a loved one die due to the virus, maintaining employment, completing everything you need to do tomorrow, feeling frustrated that you cannot get good sleep, or wondering when life will return to normal. It would not be a surprise if these thoughts and the related anxiety were keeping you up at night.
Sleep Strategy: Relax Your Mind and Body at Night
1. Use your bed for sleep only (sex is the exception). If you are lying in bed awake, frustrated, or anxious then your bed becomes a cue for wakefulness, frustration, and anxiety. To make sure your bed cues sleep and relaxation, only use it for sleep! This means no Netflix or reading in bed either.
2. Create a “buffer zone” before bed. Give yourself some time to wind down by doing pleasant and relaxing activities. Choose activities that you can finish or easily leave unfinished. Some ideas include taking a bath, stretching, reading a book, listening to a podcast, or listening to music. Experiment with some activities to figure out which activities work for you.
3. Use relaxation techniques. During your “buffer zone,” use relaxation techniques to calm your body. Many different relaxation techniques exist, so spend time trying out different ones and seeing which work best for you. Common relaxation techniques used before bed include progressive muscle relaxation, diaphragmatic breathing, guided imagery, and meditation. You can download a smart phone application called CBT-I Coach that has several relaxation techniques you can listen to while you follow along.
4. Create a “to do” list for tomorrow. If whenever your head hits the pillow you cannot stop thinking of the things you need to get done tomorrow, it can be helpful to create a to do list for the next day. This way your mind will be less likely to worry about these things at night when you are trying to sleep.
5. Schedule “worry time” into your day. Schedule a dedicated time during each day to worry. Make sure that you use “worry time” productively. That is, identify your worries and figure out how to cope with them or how to problem-solve through the situations that are creating anxiety. This way, if you have intrusive worries at night while you are trying to sleep, you can put your mind at ease by postponing these worries for “worry time.” Do not schedule worry time right before bed or during your buffer zone.
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1. Maximize your social capital. Recent research has shown that individuals in China with more social support were less likely to develop symptoms of insomnia during the COVID-19 lockdown. Find ways to connect with others while under lockdown. Connect with family and friends more through texting, calling, or video chatting.
2. Get professional help from a qualified therapist. Therapists can help identify the specific problems contributing to your sleep difficulties and tailor treatment to fit your unique needs. The most effective treatment for insomnia is called Cognitive Behavior Therapy for Insomnia (CBT-i). CBT-i is considered the first line of treatment for insomnia. Research shows that CBT-i has better long-term outcomes than using sleep medications.
Your sleep may be disrupted during COVID-19 for various reasons and causing symptoms of insomnia. Insomnia is defined by difficulty falling asleep and staying asleep. While sleep difficulties are normal during stressful times, the way you cope with these difficulties can impact whether or not these sleep difficulties persist when the COVID-19 situation is under control. To improve your sleep now and prevent the likelihood that your sleep difficulties will become chronic, use sleep strategies that directly target the three processes of sleep (i.e., sleep drive, circadian clock, and hyperarousal). Such coping strategies include avoiding naps, going to sleep when you are sleepy not at a specific bedtime, waking up at the same time every day, using your bed for sleep only, creating a buffer zone before bed, using relaxation techniques, creating a “to do” list for the next day, and scheduling “worry time” into your day.