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Stress, lack of routine play large part in COVID-induced insomnia

Sleep disorder specialists discuss how coronavirus stressors can contribute to new sleep problems

<p>Naps after 2 p.m. or naps lasting more than 25 to 30 minutes are especially critical contributors of onset insomnia and generate what is called sleep phase delay, a disorder where one’s sleep is delayed by two or more hours past an acceptable, conventional bedtime.</p>

Naps after 2 p.m. or naps lasting more than 25 to 30 minutes are especially critical contributors of onset insomnia and generate what is called sleep phase delay, a disorder where one’s sleep is delayed by two or more hours past an acceptable, conventional bedtime.

To many, COVID-19 is synonymous with stress — the fear of being exposed or exposing others, financial uncertainty or stress from reduced social engagement. With constant access to news and social media full of coronavirus-related posts, people are constantly delving deeper into information of the crisis.

According to Daniel O’Hearn, a pulmonary and critical care doctor at the University who specializes in sleep disorders and sleep medicine, it is almost inevitable for people to encounter those fears and stressors when trying to sleep at night.

“It's just them, the darkness and their thoughts,” O’Hearn said. “A lot of times people will use this opportunity to think about things, try to handle their problems, try to work through their problems.”

Out of the light of day, these negative thoughts, worries and problems that accompany the virus become magnified at night, especially for those living alone or living with a good sleeper. 

“You don't need to read about COVID and all the bad things that are happening to people and to the financial markets, and to job loss, before you go to bed,” O’Hearn said. “That's not what you should be thinking about.”

Not only do these stressors lead to onset insomnia, but there have also been reports of more intensive dreaming as well, as seen in an article published by The Guardian. Though not much research has been done on the topic, O’Hearn theorizes that particularly stressed individuals are predisposed to nightmares and that COVID-positive patients experiencing fevers are also susceptible to more intensive dreaming. 

Eric Davis also works in the University’s Pulmonary and Critical Care Medicine, specializing in sleep disorders and sleep medicine. Davis agrees that coronavirus can play a factor in sleep loss, as the initiation of insomnia can often be traced back to a major life event or stressor such as a global pandemic.

Other than late-night thoughts keeping people up, lack of routine is another culprit. When it comes to staying home all day, most people are free to sleep in, wear pajamas all day, minimize exercise outdoors or simply have no routine at all. Not only does this prevent sufficient energy burning throughout the day to justify the need for a good night of sleep, but wearing pajamas from morning to night can also trick the body into feeling as if there was no active day in between.

“Good sleep requires a regular bedtime, regular wake up time and regular activities during the day,” Davis said. “Anything that disrupts our routine can worsen our sleep.”

Not only does lack of a busy schedule prevent proper energy burn-up, but it also makes staying in bed and napping more accessible, which in turn messes up healthy sleep schedules.

“We as a species need seven to nine hours of sleep per 24-hour period, so if we get the temptation to sleep in or not set an alarm in the morning, and we spend more time in bed, then we're going to inadvertently spend more time awake in bed,” Davis said.

O’Hearn added that naps after 2 p.m. or naps lasting more than 25 to 30 minutes are especially critical contributors of onset insomnia and generate what is called sleep phase delay, a disorder where one’s sleep is delayed by two or more hours past an acceptable, conventional bedtime. O’Hearn explained that this is why people should not expect to fall asleep more than seven to eight hours prior to their time of awakening. 

“If you're getting up at nine or 10 in the morning and you're trying to go to bed at 10 or 11 [at night], you could be lying in bed, tossing and turning, but your body's not really ready for sleep yet,” O’Hearn explained.

Reduced daily structure and workload might also free up time for increased electronics use, such as watching TV or scrolling through social media feeds, not to mention the increased need for technology as work and schooling have been moved online. When electronics are used late at night, the blue light emitted from screens can decrease melatonin levels, a natural hormone which tells the body when sleep cycles should start.

“[People are] immensely dosing themselves with blue light which can serve as a neural activator,” O’Hearn said.

As he explained the negative impacts of late-night blue light exposure, O’Hearn acknowledged the inability for students to cease technology use for an hour or two prior to bedtime when it comes to studying and submitting assignments on a deadline. Still, he urges students to give themselves at least 20 to 30 minutes to wind down prior to sleep. 

Though it can be hard to allow oneself relaxation time, the effects can be extremely helpful in the long run, as lack of sleep leads to caffeine intake the following day making it difficult to fall asleep or reinitiate sleep after waking up during the night. Basically, any action that prevents immediate sleep triggers an endless cycle of insomnia.

According to Davis, the gold standard treatment for insomnia is cognitive behavioral therapy, a stepwise program offered through the University Health System which helps patients think about what has led to their insomnia and strategies for improvement. The program is run by Amit Shahane, director of the Behavioral Medicine Center and associate professor of psychiatry and neurobehavioral sciences.

Shahane explained that the core components of this cognitive behavioral therapy are learning relaxation skills and identifying and challenging sleep related thoughts that get in the way of sleep, with the final goal of reducing the amount of time awake in bed.

“The idea is that how we think about sleep, and specifically what we tend to do right before sleep and during sleep, really leads to ineffective sleep,” Shahane said. “We focus on trying to get our brain to associate that the bed is for sleep and not for other kinds of things.”

In addition to the University Hospital, the Elson Student Health Center offers an online mental health tool program called SilverCloud, which is based on cognitive behavioral therapy principles. The self-guided program is only accessible to University students and helps users develop skills for managing stress, anxiety, sleep and depression.

Like O’Hearn and Davis, Shahane stresses the importance of getting up and going to sleep at the same time every day, though he understands this is not possible for those whose work shift changes, such as frontline workers in the health system. Nevertheless, Shahane consistently tells his patients to do two or three relaxing activities in the same order about 15 to 20 minutes before going to sleep — anything from listening to relaxing music to visualizing something or doing diaphragmatic breathing.

“There is a training of the brain, if you will, that happens,” Shahane said. “When people get into bed, we want their first association to be sleepiness so their brain knows that sleep is going to happen.”

As the COVID-19 pandemic continues to affect almost every aspect of life, Davis emphasizes how important it is to discuss sleep amidst the chaos in order to best pay attention to our health and well being. 

“Good sleep is really important to our emotional and physical health,” Davis said. “It boosts our immune system, and it helps our mood. I think that anything we can do to help our sleep will help us feel better during this difficult time.”