2020 has taught us about murder hornets, PPE and now, COVID-somnia
The use of the word unprecedented has been, well, unprecedented. And yet, it is accurate. We are all living in a new reality where we must now think carefully about things we used to do without a thought. Going to the grocery store, sending the kids to school, catching a movie and then going to bed. For many of us, these innocuous activities are now complicated and associated with some angst – should I wipe down the cereal boxes? Will my kids be at home in the fall? Should I wait until that movie is available to watch at home? When will I ever be able to just close my eyes and go to sleep?
On top of all of these changes, or more likely, because of these changes, our sleep patterns have also changed. Data from FitBit shows that we are staying up later and most of us are getting more sleep. One other trend has emerged in sleep clinics– we are having a harder time falling asleep.
This is likely due to more than just one factor. Certainly, stress levels have been higher – we are worried about our health, our jobs, our finances, our family and friends. The other factor has to do with our circadian rhythms and habits. Since we are staying up later (usually watching a device) and sleeping in, we are changing our normal sleep-wake cycle. We may not be getting enough daylight in the morning. This resets when our brain is ready for sleep. For those of us who are working remotely, we no longer have a sharp delineation between work and home – no drive home to unwind, no clear transition from worktime to downtime.
Dr. Rachel Salas at the Johns Hopkins Hospital Sleep Department has some thoughts on COVID-somnia. She notes that “people without insomnia before now have insomnia secondary to COVID-19. Loss of jobs, fear of losing their jobs, fear of getting COVID-19, worries about their loved ones. People are not getting out, have even worse irregular sleep wake schedules, and are doing more in their sleep environment that is not conducive to sleep. For those with previous chronic insomnia, the pandemic has certainly worsened things for the same reasons. On top of all that with the social unrest and racism plaguing the nation, individuals of color are further experiencing disrupted sleep at a whole new level. “
We are reminded of the importance of our health, now more than ever. Eating well and exercise are vital to well-being. Sleep is the third pillar of health. Experts encourage us to spend this time making ourselves healthier and part of that includes our sleep.
It is easy to get side-tracked by the latest sleep gadget and to forget about the basic tenets of good sleep –avoid caffeine late in the day, exercise routinely, and have a wind-down period before sleep. This means that we need to be better about separating work from home and that we must be willing to putdown our devices. It is unrealistic to go from 90 miles an hour all day and then to turn that off and be able to sleep. Our brains need time to decompress and to transition from wake to sleep.
As part of our new promise to ourselves, let’s revisit what we need to do to sleep better:
1) Sleep environment: the room should be cool, dark, and conducive to sleep. This should be a serene place that feels safe and tranquil. It should be reserved for sleep and sex only.
2) Create a night time ritual: dim the lights, get ready for bed, and engage in something that you find relaxing – listening to music, yoga, meditation, an audiobook, or mindful relaxation. Melatonin is naturally released when the lights are dim as the mind prepares for sleep. Consider keeping a gratitude journal. When we can focus on our blessings, we spend less time thinking about our worries.
3) Close your eyes. Resist the temptation to look at your phone or tablet. The light (even on night shift mode) can suppress your release of melatonin. Checking your emails or social media feeds is inherently stimulating and causes your brain to awaken. It might take a few days to let go of that urge to grab your phone but data shows us that we sleep better if we can avoid screens for 30-60 min before bed. (Proceedings of the National Academy of Sciences, Dec. 22, 2014).
We know that sleep is important for our immune system. There was a study that looked into this relationship. Volunteers were asked to keep track of how much sleep they obtained over a two-week period. They were then given nasal drops that contained rhinovirus, the virus that causes the common cold. They were then quarantined and monitored to see if they got sick. Those who slept less than 7 hours or who were poorer sleepers were more likely to develop a cold than those who slept more than 8 hours or who were more efficient sleepers.
When we look at the data from New York City, we see that patients who had COVID-19 and also had diabetes, hypertension or obesity were more likely to have poor outcomes. These three conditions are very commonly associated with obstructive sleep apnea. We know that 80% of sleep apnea remains undiagnosed. There are sleep researchers who are currently exploring this link to see if untreated sleep apnea might be the reason why people with COVID-19 are not doing well.
It is a bit ironic that at the exact moment where we need our sleep, it has become harder to get. It is time for us to take a step back and reflect upon our sleep habits, our sleep environment, our wind-down routine and keep a critical eye on our daily schedules. We must take stock of our lives and determine what is stopping us from getting the sleep we need. We must use this time to improve our health. This means we need to be better about exercise, diet, and sleep. If you are still having trouble sleeping or feel as though your sleep is of poor quality, please talk to your doctor. You may have a sleep disorder.
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