The coronavirus may be causing a second pandemic of insomnia
COVID-19 has given us plenty of reasons to lose sleep. Here is another one: Because of the pandemic and the stress, more people than ever are fighting a serious loss of sleep.
It’s being called “coronasomnia.” It’s very real and very widespread.
“It’s a problem everywhere, across all age groups,” said Angela Drake, a UC Davis Health clinical professor in the Department of Psychiatry and Behavioral Sciences. She has treated sleep disorders and is trained in managing insomnia without medications.
“Insomnia was a problem before COVID-19,” she said. “Now, from what we know anecdotally, the increase is enormous.”
Most of the information sleep experts have on coronasomnia is anecdotal, but there is plenty of it. And a report from the National Institutes of Health highlighted a study early in the pandemic that “revealed very high rates of clinically significant insomnia” along with more acute stress, anxiety and depression.
This is a surprise to no one. Who hasn’t suffered some sleepless nights during the pandemic? Or many sleepless nights? And who hasn’t felt the stress from scrambled lives and health restrictions with seemingly no end in sight?
Even before COVID-19 and the highly contagious Delta variant, medical experts were concerned about increasing rates of insomnia and its impact on physical and emotional health. Now, with COVID-19 stress, the huge changes in routines and the decreased activity for many people, sleep experts say the coronavirus has caused a second pandemic of insomnia.
“COVID-19 is causing a huge amount of anxiety for so many people,” said Kimberly Hardin, a UC Davis Health professor in the Internal Medicine Department, co-director of the sleep center and the director of the Sleep Medicine Fellowship Program. “People worry about jobs, about their kids being home, about getting sick. There’s a lot more anxiety, fear and depression – and those can cause insomnia.”
— Kimberly Hardin
Broken routines fuel coronasomnia
As if all the COVID fatigue and anxiety were not enough, there’s another reason for coronasomnia: Our normal routines have changed. Even though restaurants, schools and movie theaters have reopened, many events are still being held virtually, and there are mask and vaccine regulations that vary by location.
“As human beings, we need some stimulation. We need some variety in our activities,” Drake said. “When our lives become so repetitive, the lack of stimulation and activities contributes to poor sleep.”
On the other hand, many people still working at home have gotten out of their normal daily routines, which also affects sleep.
“We’re supposed to be up in the daytime and sleeping at night, but a lot of people are working and sleeping all these weird hours,” Hardin said. “Their circadian rhythms get out of whack. Those regulate every cell in your body. They affect your eating, digestion, immune response and sleep. Once the master clock gets disrupted, everything else breaks down.”
Coronasomnia is a series of vicious circles
“Insomnia perpetuates itself,” Hardin said. “The more you can’t sleep, the more you worry about it and the more you don’t sleep.”
In fact, COVID-19-related insomnia is a Venn diagram of connected vicious circles. Along with the insomnia-causes-stress-causes-more-insomnia cycle, they include:
- Many of the things we do to fight insomnia, like taking a daytime nap or having that extra glass of wine, actually increase our sleep problems and disrupted routines.
- We’re all fatigued by COVID-19. When you pile on exhaustion from lost sleep, every new annoyance, large or small, creates frustration and anxiety – and more disruption to sleep.
- Poor sleep can lead to weight gain, which causes problems like reflux that keep you awake.
- A lack of sleep can have a range of health impacts – ranging from depression to high blood pressure to higher risks for heart attack or stroke. Those can make us more vulnerable to COVID-19, and knowing that creates more worries and more insomnia.
Tips to help you sleep
“If you’re not sleeping once in a while, don’t worry about it,” Drake said. “I want to emphasize that one bad night now and then is nothing to worry about.”
For serious sleeplessness, Hardin and Drake recommend what’s called cognitive behavioral therapy for insomnia. This is a structured, evidence-based program guided by a sleep therapist that helps you relearn how to sleep. The goal is to help you replace thoughts and behaviors that hurt your sleep with new behaviors and thinking that will help you sleep well.
— Angela Drake
But there are a number of things people can do on their own. It starts with taking steps to fight the stress of COVID fatigue. Here are more sleep tips:
- Keep a normal daily routine: “If you’re working from home, keep the same schedule as if you were going to work,” Hardin said. “Don’t sleep in or stay up late. When that alarm rings, as painful as is, get up.”
And give yourself a break during the day, just as you would in the office. Take a lunch break or go for a walk or just get outside.
- Create and keep a going-to-bed routine: “Slow down at the end of your day,” Drake said. “Begin turning down the lights about a half hour before bed. Bright lights will keep your brain from producing natural melatonin (a hormone that is part of our natural sleep cycle and helps us sleep).
- Avoid screens in the bedroom: The blue light from cellphones, tablets and computers signals our bodies to stay awake and not release melatonin. “I know this is hard for people, but please put down the electronics. TV is OK but it’s even better to read a book.” Hardin said. “You don’t want that light from a screen right in your face.”
- Don’t use your bedroom, and especially your bed, as your office: “You want to train your brain that this is the place where you rest,” Drake said. “You don’t want it saying, ‘This is where you work.’ If you have nowhere else to work, at least don’t work on the bed.”
- Get some exercise during the day: It reduces stress and keeps our bodies in their normal rhythms. It’s best, however, to finish the exercise a few hours before bedtime to give your body time to cool down and slow down.
- Don’t take naps: A short power nap won’t hurt, if it’s not too late in the day, but sleeping longer will throw off your sleep cycle. “That’s another reason not to worry about one bad night,” Drake said. “It’s better to be tired for a day and then get a good night’s sleep.”
- Get some sunlight: It helps keep our circadian rhythms in pattern so we produce melatonin at night, not during the day.
- Don’t eat dinner late: “If you’re going to bed at 11 p.m., try not to eat after 7 pm or so,” Hardin said. “You have to give your body time to digest it. When you go to sleep, your body wants to shut down all the metabolic work, including digestion.”
- If you wake up in the middle of the night and can’t sleep, get out of bed: A change of scenery helps you reset, but keep lights low and don’t do anything that gets you energized. “If you can’t sleep for more than a half hour, get up and leave the bedroom,” Hardin said. “Do something simple and monotonous in dim light.”
- Cut back on news and social media, especially in the evening: “I’ve had to limit the news consumption for some patients,” Drake said. “Our brains are not really wired to handle all the constant news alerts and headlines. They’re constantly ringing our alarm bells. It’s like the car alarm in our brain is constantly going off.”
- Go easy on the alcohol and caffeine: They both throw off your sleep patterns. Alcohol can help you fall asleep, but not necessarily stay asleep or sleep well. “Not all sleep is equal,” Hardin said. “We want the right sleep.”
- Be careful with sleep medication: Over-the-counter medication can give you fitful sleep or leave you drowsy in the morning, and prescription drugs can create an emotional dependence.
- Try learning to meditate with one of the many apps available: “I’m a big believer in meditation,” Drake said. “It can improve sleep and it emphasizes the importance of our mind-body connection. It does take a little practice, but it lowers our stress hormones. We have some new neuroimaging research that has demonstrated the positive changes in the brain.”
Both Hardin and Drake said that too often people don’t consider insomnia a condition that requires medical attention, as much as it’s making them miserable. Instead, folks tend to self-medicate with over-the-counter sleep aides or have an extra glass of wine.
“If your insomnia is chronic, if you’re not sleeping for weeks, you may benefit from treatment,” Drake said. “Discuss it with your primary care provider. There are effective treatments that don’t require medicine. We can help. Our cognitive based therapy can help.”