Sleep and the pandemic

Even before the pandemic, more than 50 million Americans suffered from a sleep disorder, most commonly insomnia — trouble falling or staying asleep, waking early or throughout the night, or poor sleep quality.

Since the pandemic began, two in three Americans report they are sleeping either more or less than desired.

Pandemic-related sleep problems have become so prevalent that sleep specialists coined the term “coronasomnia.”

Several factors have contributed to coronasomnia — upended routines, more screen time, increased alcohol consumption, and dissolving boundaries between work and private life.

As sleep deteriorates, so may physical and mental health, contributing to further sleep disruption.

If you have insomnia that has persisted for three or more months, occurring at least three times per week, you may benefit from strategies that help to relieve chronic insomnia.

Sleep experts would suggest that you try cognitive behavior therapy for insomnia (CBT-I) to improve your sleep. Here are some evidence-based strategies:

Stimulus control therapy removes factors that condition your mind to resist sleep — setting a consistent bedtime and wake time, avoiding naps, using the bed only for sleeping and sex, getting out of bed when you cannot fall asleep within twenty minutes, and then returning to bed only when you feel sleepy.

Sleep hygiene teaches you to change basic lifestyle habits that influence sleep such as smoking or drinking caffeinated beverages later in the day, drinking alcohol close to bedtime, not getting regular exercise, and implementing calming bedtime routines.

Sleep environment improvement prepares the bedroom for optimal sleep — keeping it quiet, dark, and cool, not having a TV in the bedroom, hiding the clock from view.

Relaxation training is used to calm the mind and body through meditation, imagery, or progressive muscle relaxation.

Remaining passively awake reduces worry about falling asleep by removing any effort to will yourself to dreamland.

Cognitive reframing and worry management

Falling asleep depends upon sleep pressure that builds up every hour that we are awake, and our circadian rhythm, which affects the timing of sleep.

According to Diane Macedo in her book “Sleep Fix,” worry and anxiety can trigger our brain’s arousal system, short-circuiting sleep pressure, resulting in insomnia.

Part of the problem is that our logical, problem-solving brain goes offline at night (even when we can’t sleep), leaving only our brain’s ability to ruminate about what’s bothering us, jacking up our arousal system, and causing disrupted sleep.

Several interventions might help you calm a worried mind:

• Constructive worry: A few hours before bed, write a list on the left side of a notebook page about anything worrying you; on the right side of the page write the very next step to resolving the problem.

• Journaling: Write a stream-of-consciousness account of whatever you’re thinking and feeling; if you need a prompt, start with “I can’t sleep because…”

• Gratitude journal: 15 minutes before bed write about how a recent positive experience made you feel or write down what you’re grateful for.

Some people misperceive how much sleep they get. A sleep study may reassure you that you’re getting more zzzs than you realized. You may also find it reassuring that despite a few nights of suboptimal sleep, you can still function adequately the next day.

Supervision from a sleep specialist may be warranted for the following strategies:

• Biofeedback teaches you how to lower your heart rate and reduce muscle tension in preparation for sleep. A biofeedback device may be sent home to record sleep patterns that affect sleep, to fine tune strategies.

• Sleep restriction: Your brain may associate going to bed with an inability to fall asleep, stay asleep, or get back to sleep. A sleep specialist may recommend restricting your sleep to six hours, with the idea that the following night you will feel so sleepy that you more easily fall asleep. When you become efficient at sleeping for six hours, increase sleep time by thirty-minute increments.

• A sleep diary or sleep study can be used to determine how many hours each night you are actually asleep. This figure can be used as an initial target for sleep restriction (but not less than five hours!).

Note: if you have a chronic health condition that might be exacerbated by restricting your sleep, you drive to (for) work or operate machinery, or are subject to falls, you should be supervised by a medical professional when practicing sleep restriction. Visit https://www.sleepfoundation.org/sleep-guidelines-covid-19-isolation