How and Why the Coronavirus Pandemic Is Messing with Your Sleep
Your sleep might be taking a hit from social isolation, job loss and health concerns...or you might be relishing sleeping in without the morning commute.
When we're not in the midst of a pandemic, getting enough restful sleep at night is already a challenge. The National Institutes of Health (NIH) reports that approximately 50 to 70 million Americans suffer from sleep or wakefulness disorders.
But now that our lives have been completely upended by the COVID-19 crisis, our sleep is taking an even bigger hit (weird dreams, anyone?). Whether it's the anxiety of becoming infected with the virus or the stress of job loss, there are many reasons you might not be sleeping well.
"This pandemic is an unprecedented event in our lifetime," says Alcibiades J. Rodriguez, M.D., director of the NYU Langone Sleep Center. "Everybody responds to stress in a different way. Some people get headaches, others eat, and some people develop insomnia, for example."
Sleep Standards, an independent sleep news outlet run by health experts, recently published a coronavirus and sleep survey, in which they asked 1,014 adult Americans to fill out a questionnaire about their sleep habits since the start of the coronavirus pandemic. According to survey results, 76.8 percent of participants said the coronavirus outbreak has affected their sleep, and 58 percent of respondents said they sleep at least one hour less every night compared to before the outbreak started.
The Effects of Coronavirus On Sleep
Stress levels have been particularly high due to health concerns, family responsibilities, and financial hardships, says Fariha Abbasi-Feinberg, M.D., director of sleep medicine at Millennium Physician Group in Fort Myers, Florida, and neurologist on the American Academy of Sleep Medicine's board of directors. "Any stressors can impact your ability to fall asleep or stay asleep, and we are certainly at a very high-stress level," says Dr. Abbasi-Feinberg. "It's not at all surprising that some people have developed sleep issues."
In fact, the COVID-19 pandemic has had such a monumental impact on sleep that researchers are starting to study its effects. Melinda Jackson, Ph.D., a senior lecturer who specializes in sleep disorders at the Turner Institute for Brain and Mental Health at Monash University in Melbourne, Australia, is heading up one of the first studies on the impact of the COVID-19 pandemic on sleep and insomnia. (Sign up here to participate.)
"We're interested in determining the societal impacts of COVID-19 and self-isolation on sleep, stress levels, and mood," says Jackson. "We're particularly interested in understanding these effects as a result of working from home and changes in job and financial security. We're hoping to look at how the COVID-19 pandemic impacts sleep-wake and psychological functioning in individuals, and whether there are particular factors, such as chronotype, resilience, personality, and loneliness, which may be protective for sleep, or in fact, detrimental," she explains.
Jackson says preliminary results show that about 65 percent of respondents report moderate-to-high distress about their financial situation. "It also seems that those who already had a pre-existing mental health issue are struggling more with their sleep now, so these are the people we need to target for intervention," she says. (Related: What an ER Doc Wants You to Know About Going to a Hospital for Coronavirus RN)
It's not just the stress and anxiety around the coronavirus that might be keeping you up at night. The pandemic has forced Americans—and millions around the world—to be in physical isolation, which also deeply affects your sleep. Social support is a natural zeitgeber (a circadian rhythm regulator), but the quarantine keeps us away from our family and friends. "Our sleep circadian rhythm depends mostly on sunlight, but it's also related to social interactions and meal times—so disrupting this will disrupt sleep," says Dr. Rodriguez.
While there isn't a direct relationship between social interactions and circadian rhythms, Dr. Abbasi-Feinberg says that there are other biological clocks in the body, such as food intake, exercise, and taking medications, that affect your circadian rhythm. "When you're social, that's when you tend to eat and drink (think about grabbing lunch with co-workers or going out to dinner with friends), but if you're isolating alone at home, then you tend to eat and drink whenever you feel like it, which can affect your circadian rhythm," she says. (See: What Are the Psychological Impacts of Social Distancing?)
Moreover, not spending as much time outside means you might not be getting as much light exposure to regulate your sleep-wake cycle. "If you aren't getting the same amount of light exposure at the right time of day, especially morning light, then this can affect the resetting of your internal biological clock," says Jackson.
That said, here are some of the most common ways the coronavirus pandemic might be messing with your sleep— or better or worse.
You're having trouble falling asleep—and staying asleep.
If you're tossing and turning more in bed, you're not alone. The Sleep Standards survey revealed that for 48 percent of the participants, anxiety around the coronavirus pandemic is the top pain point in falling asleep. "Insomnia is a chronic condition that we can keep under control but not totally cure," says Dr. Rodriguez. "This situation can provoke anxiety, which in itself is closely linked with insomnia. Even people with a new onset of anxiety might have a manifestation of insomnia." (Here are a few tips on how to sleep better with anxiety.)
You might also be experiencing fragmented sleep and irregular sleep during this pandemic, says Dr. Rodriguez. It's normal to wake up in the middle of the night (everyone wakes up once or twice each night for a few seconds) because you cycle through four stages of sleep every 90 to 120 minutes. The first two stages (NREM1 and NREM2) are when you have the lightest sleep and can easily be awakened by the heat in your room, for example, but you should be able to go back to sleep. It becomes an issue if you aren't able to fall back asleep. "Going into REM and going out of REM is when you might have awakenings, but most people don't remember these awakenings," says Dr. Abbasi-Feinberg. "As long as you feel good the next day, then these awakenings aren't really a problem," she says.
If you aren't able to go back to sleep, then it needs to be addressed with your doctor. What can help ease awakenings from coronavirus anxiety is to set a relaxing bedtime routine that doesn't involve watching the news or scrolling through your phone. Staying up-to-date on COVID-19 news is important, but Dr. Abbasi-Feinberg advises setting aside time to disconnect. "Try to avoid electronics for the last 90 minutes before bedtime and certainly turn off notifications on your devices," she says. Studies show that blue light emitted from phones, TVs, and computers negatively impacts sleep (and your skin, FWIW). "I advise watching the news only once or twice a day—in the morning and early afternoon—and avoid nighttime news," says Dr. Rodriguez. "This will help with preparing for sleep." (Related: These Celebrity Meditations and Bedtime Stories Will Lull You to Sleep In No Time)
You're getting more sleep.
While sleeping less seems to be the norm during the pandemic, some people are actually catching more zzzs. Jackson says early results from the Monash University sleep study shows that some people are reporting better sleep with the pandemic. "There are others who are relishing in the fact that they don't have to get up at a fixed time each day and are actually sleeping more," says Jackson. "In fact, some people with insomnia or delayed sleep phase disorder are actually sleeping better, now that the pressure is off for them to get up for school or work," explains Jackson. (Delayed sleep phase disorder is a circadian rhythm sleep disorder in which your sleep pattern is delayed two hours or more from a conventional sleep pattern, causing you to go to sleep later and wake up later, according to The Mayo Clinic.)
Dr. Abbasi-Feinberg says that some of her patients are getting more sleep because they no longer have to rush out of bed in the morning and commute to the office. "During many of my telehealth visits, patients are telling me they are getting an extra hour or two, and they admit feeling more refreshed and alert," she says.
Here's the problem, though: If you're not careful about setting routines, it could turn into an issue when you return to your regular schedule, says Dr. Rodriguez. Some people might also be staying up later knowing that they can sleep in more, but it only makes getting back into a consistent routine harder. "Try to keep your sleep schedules as normal as it could be, recognizing what was missing," says Dr. Rodriguez. "You should try to stick to a normal sleep quantity, which is seven to nine hours at night. With seven hours, most of people can function at 90-95 percent of our capacity," he says.
Dr. Abbasi-Feinberg also recommends sticking to a regular sleep schedule to keep your body operating at its best. "We all have an internal biological clock and our systems work best if we stay aligned with our circadian rhythm. This is an ideal time to work on your sleep habits and set up routines for the future," she says. As for taking naps, Dr. Abbasi-Feinberg says it's OK to nap as long as it doesn't prevent you from falling asleep at night. They should also be brief—20 minutes tops.
On the other hand, if you're getting enough quality sleep at night but are still feeling very tired the next day, Dr. Abbasi-Feinberg says it might be a red flag for a sleep disorder or medical condition, like a thyroid issue. "When someone has the opportunity to sleep and they are getting enough of it, they should feel refreshed," she explains. "If they don't, that's when something is going on. There are some days when you might still feel a little fatigued after a good night's rest, but if you are consistently feeling overly fatigued, then it needs to be evaluated." It's possible that it could be a case of sleep apnea, which is one of the main causes of sleepiness and tiredness. She also notes that during this time of extreme stress, there are more rates of depression, and some people with depression can feel very fatigued.
How to Make Sleep a Priority—and Why You Should
Whether you're having trouble catching shut-eye or not, the best thing you can do for your sleep during this pandemic is to follow a routine that allows you to get seven to nine hours of quality snooze time. And here's why you should: "Several studies have shown the benefit of a good night's sleep for the immune system. Certain cytokines have been linked to NREM, aka non-rapid eye movement sleep," says Dr. Rodriguez. "Cytokines are substances that modulate the immune response and could be affected by sleep deprivation," he explains. During stage 3 of NREM sleep, which is also known as slow-wave sleep, research shows that more growth hormones, like prolactin—which helps with immunity—are released and cortisol levels are decreased, creating an ideal environment for immune cells to attack viruses, says Dr. Abbasi-Feinberg. This stage of sleep is also when your body gets into a restorative state to heal and repair. (And that includes repairing muscles after a tough workout.)
Moreover, cytokines are produced and released during sleep, so when you don't snooze enough, your body produces fewer cytokines, which can put you at risk for illnesses, according to the National Sleep Foundation. This is why you tend to catch more colds and experience prolonged periods of sickness when you're sleep-deprived. "We've all had the experience of feeling sleepy when we're sick," says Dr. Abbasi-Feinberg. "Why is that? It turns out that when we're fighting an infection, sleeping may be nature's way to allow our body to help fight infection."
Sleep is also essential for enhancing your mood and keeping mental illnesses at bay. People with insomnia are 10 times more likely to have clinical depression and 17 times more likely to have clinical anxiety than those who sleep normally. (Related: How Cognitive Behavioral Therapy "Cured" My Insomnia)
Here, experts share some ways you can start snoozing better tonight.
Wake up and go to bed at the same time every day. Establishing a wake-sleep routine will help you maintain some sense of normalcy when other things are beyond your control. Moreover, going to bed and waking up at the same time every morning and night will help you stick to your circadian rhythm, which will help you be more productive during the day. (See: All the Benefits of Morning Workouts) It helps to schedule a reminder on your phone so that you know when to start powering electronics down and slip into some PJs. When you get out of bed in the morning, Dr. Rodriguez recommends taking a walk outside to get more light exposure and squeezing in some exercise (trainers and studios are offering tons of free workouts right now). Like turning on a car engine, this will help get your body and mind revved up for the day.
Limit alcohol and caffeine. Don't let your Zoom happy hours get out of hand—after all, research shows too much vino can actually suppress the sleep hormone melatonin. "Drinking alcohol too late at night may cause sleep fragmentation and then tiredness the next day. You then compensate by sleeping during the daytime, and it creates this vicious circle," says Dr. Rodriguez. Avoid overdoing your new Dalgona coffee habit by not consuming caffeine six to eight hours before bedtime, says Dr. Abbasi-Feinberg. Remember, caffeine isn't just in coffee—it's in chocolate, tea, and soda, too.
Don't do work in bed. Working from home can be challenging during this quarantine period, and while that means you might have to do work in your bedroom, you should avoid doing it in bed. "Keep the bed for sleep and intimacy only," says Dr. Abbasi-Feinberg. "Even if 'the office' is in your bedroom, set up a separate area. Take frequent breaks to get up and walk."
De-stress before bed. Dr. Abbasi-Feinberg follows guided meditations via apps on her phone. "Though I usually say to avoid electronics close to bedtime, there are methods to prepare your devices to minimize light exposure so we can use this technology to help us sleep," she says. Listening to soothing music or podcasts can also help.
Be kind to yourself. Not everyone needs to come out of this pandemic newly invented. It's OK to embrace the fact that it is a tough time...for everyone, including you. Don't get wrapped up in all of the new hobbies, cooking videos, and workouts your friends are posting on Instagram. "This is fantastic for them, but it creates even more anxiety for those who are struggling," says Dr. Abbasi-Feinberg. "We don't have to come out of this pandemic 'better than before.' Let's come out as healthy as we can and that includes physical and emotional health."
Stay connected. Just because you are social distancing, it doesn't mean you should avoid all communication with family and friends. Join a Zoom workout class and check in regularly with loved ones. This quarantine might actually do your health and relationships some good. The social interaction will uplift your spirits, and in turn, help with sleep. "There is a light at the end of the tunnel, so we just have to try and take the positive out of each day and focus on what we can do in the here and now," says Jackson.