Have you had trouble sleeping during the pandemic? If so, you’re not alone. Consider the following facts from last year:
- Google search: Google search for the term “insomnia” increased nearly 60% in 2020. The peak time for searching this term occurred at 3 a.m., likely when most people were struggling to sleep.
- Sleep meds: Between mid-February and mid-March 2020, there was a 14.8% increase in sleep medication prescriptions in the U.S.
- Insomnia rates: Rates of clinical insomnia increased 37% from before to the peak of the pandemic.
- Healthcare workers: Nearly 40% of 33,000 healthcare workers surveyed were affected by pandemic insomnia.
Since the start of COVID-19, more people are struggling with anxiety, depression, panic attacks, suicidal ideation, post-traumatic stress disorder-like symptoms and sleep disorders. Insomnia, which is the inability to fall or stay asleep, is the most common sleep disorder. In fact, 30-40% of adults in the U.S. will experience symptoms of insomnia at some point in any given year.
Dr. Shizuka Tomatsu, a psychiatry resident physician with Atrium Health Behavioral Health Services, shares insights on underlying issues and risk factors for pandemic insomnia. Plus, she provides simple strategies that can help you start sleeping better tonight.
Risk factors for insomnia
In general, insomnia tends to be a sign of an underlying medical condition and/or a sign of psychological distress. It’s usually a symptom of something else going on in the body.
“We’re seeing that COVID-19 tends to be the psychological stressor that’s causing insomnia,” Dr. Tomatsu explained. “If you have an underlying mental or physical condition, it tends to increase the severity of the insomnia. Patients are under a lot of stress worrying about their exposure to the virus as well as the health and safety of their loved ones. This constant distress makes it difficult to get good sleep.”
Based on current trends, you’re more likely to develop pandemic insomnia if:
- You’re female.
- You’re living in an urban area, so you’re not used to periods of prolonged isolation like someone living in a rural area would be.
- You’re a healthcare worker.
- You’re in contact with someone who has or had COVID-19.
- You lack a support system (or at least perceive that you do).
- You have preexisting mental or physical health conditions.
The trouble with TV
To cope with isolation, many rely on electronics for entertainment. “Since there’s no actual social interaction through the screen, we’re actually isolating ourselves more and blurring the lines of reality,” revealed Dr. Tomatsu. “The more isolated we feel, the more we want to entertain ourselves using screens. But that leads to more feelings of isolation, which triggers more binge watching.”
From studies unrelated to insomnia, watching TV actually increases activity in the brain. This can impact your rapid eye movement (REM) sleep phase, which occurs most prominently during the second or third part of the night. “During REM sleep, your brain consolidates all the information from your day’s activities and stores details in your memory,” Dr. Tomatsu said. “If you’re activating your brain too much with TV, especially right before bedtime, your body won’t have sufficient REM sleep for processing. If you don’t get enough REM sleep, you won’t feel rested or refreshed the next day.”
Tips for better sleep
The following guidelines are designed to improve the quantity and quality of your sleep:
1. Maintain separate spaces for working, lounging and sleeping: Keeping these areas separate conditions your body to respond appropriately when you’re occupying them. “This separation is crucial to helping your body relax at the end of day,” noted Dr. Tomatsu. If your living space is limited in size and does not allow you to define physical barriers (e.g., you live in a studio apartment or share space with roommates), at the bare minimum, separate your sleeping area from everything else.
2. Get your exercise: Doing some physical activity during the day will help you sleep better at night. It also boosts your mood. Just be sure to avoid exercising 30-60 minutes before bedtime as this can reactivate your brain.
Outdoor exercise is beneficial because it gives you light exposure, which helps support a healthy circadian rhythm (your body’s way of regulating the time you are awake and asleep). For outdoor exercise, take walks when other people are less likely to be outside their homes. If you go for an outdoor run, wear your mask. If you can’t get outside, fitness apps and videos are available for indoor exercise.
3. Practice sleep hygiene:
- Establish a strict sleep schedule and stick to it. That means going to bed and waking up at the same time, even on weekends.
- Have a consistent nighttime routine. Give yourself 30 minutes to wind down before going to bed. Try stretching, reading a book, mediating or doing another quiet activity you enjoy.
- Unplug all electronics at least an hour before bed.
- Reserve your bed for sleep and sex only. Don’t use your bed for activities such as eating or working.
- Minimize napping. If you need a nap, take it between noon and 2 p.m., and keep it under an hour.
- Manage your use of substances, including nicotine, caffeine and alcohol. If you smoke, reducing the amount of nicotine you consume will improve the quality of your sleep. Don’t have caffeine after noon. Avoid using alcohol to help you sleep. While alcohol makes you drowsy, it also decreases your REM sleep.
- Don’t eat late. Try to eat your last meal or snack at least 3 hours before bedtime.
4. Consider getting a pet: Besides providing companionship, pet ownership helps encourage consistent scheduling and activity habits that promote healthy sleep. Especially when training a pet, you have to be consistent in setting a routine. This includes when you wake up to take them outside and when you go to bed. Pet ownership also tends to increase your physical activity, which helps you sleep better.
Before getting a pet, consider the amount of time and responsibility involved in case you tend to become overwhelmed easily or your schedule does not permit it. Additionally, most pets require considerable start-up costs for food, supplies and vaccinations. These factors could increase your anxiety levels, which could interfere with your sleep.
Healthcare workers dealing with pandemic insomnia will benefit from applying the above guidelines. In addition, healthcare workers should continuously educate themselves on COVID-19, including risk factors and safety measures, to help alleviate fear and anxiety. Getting vaccinated as soon as you’re eligible will also help. There are several resources available for promoting mental health and well-being during the pandemic.
The danger of long-term insomnia
If left alone, prolonged pandemic insomnia can lead to:
- Reduced immune function, which makes you more likely to contract an illness, such as COVID-19.
- Emotional problems, including depression and anxiety.
- Strained relationships with your spouse, family members, friends and coworkers.
- An increased risk of using substances to cope.
To prevent these problems, do what you can now to start improving your sleep habits and hygiene. “Every day is a new day to try something new in sleep hygiene,” explained Dr. Tomatsu. “Maybe you were up all night on social media. Don’t shame yourself for it. Just start over today. From the moment you wake up, you can start making choices that will help you start sleeping better.”
Follow-up care for sleep issues
Be sure to follow up with your primary care doctor if you're having trouble sleeping. If needed, your doctor can refer you to a therapist or sleep medicine specialist for further evaluation and treatment.
If you or a loved one is struggling, call Atrium Health’s Behavioral Health Help Line at 704-444-2400 for 24/7 mental health crisis assistance. We can help. You are not alone.
