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Health Team

How the pandemic is contributing to your insomnia

Posted October 27, 2020 6:28 a.m. EDT

— Sleeping during the Covid-19 pandemic has become a nightmare for Aparna Aswani.

Between cooling off from the stress of the workday and managing her anxiety from reading about the pandemic and politics, she's lucky to turn in before midnight. Once the 44-year-old marketing executive falls asleep, she usually wakes up two or three times before the alarm rings around 6 a.m.

On good nights, Aswani gets four or five hours of sleep before she must wake up and jump into her roles as mother and virtual learning facilitator for her 5-year-old son. On bad nights, Aswani barely gets any sleep at all.

"I've never been a good sleeper, but it's been 20 times worse since the pandemic started," she said. "It's gotten to the point where just thinking about sleep stresses me out."

Aswani, from San Clemente, California, is one of many people who have experienced some sort of disruption to their usual sleeping routines since the pandemic began this March. For some, the changes are subtle — more restlessness or a poorer quality of sleep. For others, the new reality is flat-out hell: either a chronic lack of sufficient sleep or full-on insomnia.

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Some experts have gone so far as to nickname the current trend "coronasomnia," said Christina Pierpaoli Parker, postdoctoral fellow of clinical psychology and behavioral sleep medicine at the University of Alabama at Birmingham.

Whatever we call it, Pierpaoli Parker said there are strong relationships between the pandemic and sleeplessness.

"Good sleep undergirds every aspect of mental and physical health, which we need to support now more than ever," she said. "When we create the optimal cognitive, behavioral and environmental conditions for sleep — including low ambient temperature — we also support optimal conditions for health overall."

Sleep woes by the numbers

We can't just blame the pandemic. Sleeplessness was a problem long before this latest crisis.

Roughly a third of US adults were getting the minimum of seven hours of sleep per night recommended by the American Academy of Sleep Medicine, according to 2016 data from the US Centers for Disease Control and Prevention.

Since the pandemic started, the numbers have gotten worse. While there has been an 11.3% overall decrease in the number of prescriptions filled for sleep disorders since 2015, the number of prescriptions filled for sleep disorders between February 16 and March 15 increased by 14.8%, a report from pharmacy benefits manager Express Scripts indicated.

More recently, 36% of Americans reported difficulty sleeping this summer due to stress about the pandemic, according to a study from the Kaiser Family Foundation.

Finally, while people are sleeping more during the pandemic, data from yet another recent study indicated that the quality of their sleep is declining precipitously.

There are many reasons to be concerned: Poor or insufficient sleep can increase risk for chronic health problems such as diabetes, obesity, high blood pressure, kidney disease, heart disease and depression. Sleep also is considered a critical part of the proper function of our immune systems, which is important during a pandemic.

Poor sleep habits also can lead to weight gain, according to the Society of Behavioral Sleep Medicine.

That's because lack of sleep is associated with dysregulation of the hormones that make us hungry and tell us we're full. What's more, fatigue hijacks our motivation to exercise, and when we're tired, we generally make more impulsive choices about everything — especially what we eat.

What's plaguing us

There are several different manifestations of sleeplessness plaguing us at this point in the pandemic.

The most common of these conditions is insomnia, a sleep disorder characterized by difficulty falling or staying asleep or early morning awakenings without returning to sleep at least three nights a week for a period of at least three months. Insomnia can include one or all of these symptoms, and can impact the patient's ability to function during wakefulness, Pierpaoli Parker noted.

Insomnia typically affects 10% to 14% of American adults, according to the CDC. This year, however, sleep experts say that based on the number of patients they're seeing for this condition, the number has spiked dramatically.

Not everybody with formal sleep problems is diagnosed with full-on insomnia; most sufferers instead are plagued by anxiety about the world, and, as a result, fail to get the minimum suggested amount, resulting in a chronic lack of sufficient quality sleep.

Jennifer Martin, professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles, said both disorders are understandable since humans are wired to stay awake in the face of danger and we're facing the first widespread global pandemic in 100 years.

"It would have been an unfortunate mistake of evolution if we were sleepy when there was a tiger outside of our cave and we went to sleep," Martin said. "When we perceive a threat, we are awake. That's adaptive. That's good for us. Yet when there is a large threat in our environment like a global pandemic, one of our initial biological stress reactions is to not sleep so we can be prepared to deal with the threat."

Why we're up all night

Experts agree there are several factors contributing to our general lack of sleep.

First on the list: disruption to routine. Human beings operate in accordance with natural, internal processes that regulate our sleep-wake cycle and repeats roughly every 24 hours. Known as circadian rhythms, these are connected to certain external factors that happen every day: sunrise, sunset and more. Because most of us are spending more time at home, we're all thrown off our natural respective routines, adding to an overall sense of confusion and unrest.

Without typical social time cues such as getting dressed for work or dropping off the kids at school at a certain standard time, our brains are less aware of when to prepare for sleep, said Chandra L. Jackson, Earl Stadtman investigator at the National Institute of Environmental Health Sciences.

Staying in the house, which lowers our exposure to natural light, also throws off these circadian rhythms and sleep schedules, she said.

Another explanation: Between Zoom meetings for work and people being glued to their phones, screen time is at an all-time high.

Blue spectrum light generated from screens tells the brain to stop producing melatonin, a hormone that regulates the body's sleep-wake cycle, said Dr. David Neubauer, associate professor of psychiatry and behavioral sciences at Johns Hopkins Medicine in Baltimore.

Of course, other factors contributing to poor sleep habits include money worries, anxiety over employment and the all-too-understandable fear about actually catching Covid-19 and transmitting it to loved ones.

Seeking solutions

For those formally diagnosed with insomnia, there are medicinal aids such as zolpidem (Ambien) or benzodiazepines (Xanax and Valium), but these require prescriptions and generally are only limited to no more than a couple of weeks.

Cognitive behavioral therapy for insomnia, or CBTi, helps people identify the underlying causes of their insomnia and adopt behaviors to change it. It usually takes six to eight sessions to work — which means sufferers experience relief about two months after they start treatment.

Jennifer Kanady, a clinical psychologist and the clinical innovation lead for sleep at Big Health, a medical technology company in San Francisco, said the "treatment is about breaking bad habits and retraining the individual to sleep the healthy way." Stimulus control is one component of treatment, she added, and it "strengthens the bed-sleep connection by limiting wakefulness in bed."

For those suffering from a chronic lack of sufficient sleep, experts say it's critical to get yourself back on a regular schedule — even if it means first depriving yourself of sleep to do it.

People should get out of bed if they can't fall asleep (or return to sleep) within 15-30 minutes, or as soon as trying to fall asleep feels frustrating, Pierpaoli Parker suggested. She added it's important to minimize exposure to anything with blue light or a backlit screen for about an hour or two before bed. This means no television or scrolling on your phone within an hour of bedtime. Yes, really.

Other options

Tactical changes to your everyday lifestyle can improve sleep habits, as well.

Regular exercise is a great practice, as it helps tire your body. Another good idea: making your bedroom sacred. With so many people working from home, it's important to ensure that the bed remains a place for sleep, not a place for activity, said Bill Fish, president of OneCare Media, which publishes SleepFoundation.org.

"Set up your bedroom as a sanctuary for sleep and sex," Fish, a certified sleep science coach, said. "The more you do in there during the day, the harder it will be to recognize it's a place for sleep at night."

Another good strategy, Kanady said, is setting aside 20 minutes each day for letting out worries and anxieties by writing them down on a piece of paper. She said that by worrying at the same time and in the same place every day, your brain will start to learn that there is a dedicated place and time for worries, and the worries will start to interfere with sleep less.

Many sleep sufferers are open to trying anything. Meg Alcazar, on the other hand, a single mother who lives in Durham, North Carolina, has had enough.

"My main issue seems to be that all the advice is about self-discipline: Cut out alcohol, don't eat after 6 p.m., no carbs," she said. "Our normal has already been upended, are we really to deny ourselves the few remaining pleasures for something as basic and unexciting as sleeping through the night?"

Alcazar noted that she'd rather suffer through current challenges than give up things she loves.

"The idea of living like a monk on a mountain with the world burning down around me makes me feel I'd rather just sleep when I'm dead," she said.

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