As Covid Recedes, Sleep is Improving, Right?

Sleep just isn’t what it used to be? Mind racing or heart-pounding when your head hits the pillow? Waking up at 4 a.m. unable to fall back asleep? Feeling drowsy and sleep-deprived no matter how many hours you spent in bed?

For many of us, sleeping challenges existed even before the pandemic. Before Covid hit, more than 50 million Americans suffered from a sleep disorder, most commonly insomnia.

Then came the stress, anxiety, and disruptions of Covid to our lives that made things even worse, giving rise to that novel term: “coronasomnia,” aptly describing the surge in sleep disturbances.

But recently, sleep experts became aware of a startling fact: Over a year into the pandemic, our collective sleep has only continued to deteriorate.

The American Academy of Sleep Medicine found in a survey of thousands of adults in the summer of 2020 that 20 percent of Americans said they had trouble sleeping due to the pandemic. But when the academy repeated its survey 10 months later, in March 2021, those numbers saw a dramatic rise.

Roughly 60 percent of people said they struggled with pandemic-related insomnia, and nearly half reported that the quality of their sleep had diminished — even though infection rates had fallen and the country was already opening back up!

“A lot of people thought that our sleep should be getting better because we can see the light at the end of the tunnel — but it’s worse now than it was last year,” said Dr. Fariha Abbasi-Feinberg, a sleep medicine specialist and spokeswoman for the American Academy of Sleep Medicine. “People are still really struggling.”

How Covid Has Impacted Sleep

According to experts, even after a stressful experience ends, sleep disturbances may continue. “Over the past year, we’ve had the perfect storm of every possible bad thing that you can do for your sleep,” said Dr. Sabra Abbott, an assistant professor of neurology in sleep medicine at Northwestern University School of Medicine in Chicago.

Studies show that people kept irregular sleep schedules during the pandemic, turning in much later and sleeping in longer than usual, which disrupts our circadian rhythms. We diminished our physical activity and spent more time indoors; ate more and drank more alcohol; and erased the boundaries that separate work and school from our homes and our bedrooms — all of which are proved to be damaging to sleep.

Most striking of all, stress and anxiety levels went through the roof, two root causes of insomnia. In a report published in May 2021, the American Psychiatric Association found that a majority of Americans were still quite anxious about their health, their finances, and the possibility of a loved one getting Covid-19. And 41percent of adults said that they suffered from more anxiety today than they had during the beginning of the pandemic.

The Hidden Cortisol Factor

Cortisol, a hormone produced by a complex network known as the hypothalamic-pituitary-adrenal (HPA) axis, is the substance most commonly associated with stress. Not as well known is its critical influence on sleeping and waking.

When a person experiences stress, the HPA axis stimulates cortisol release, which subsequently triggers several instantaneous threat responses: rapid heart rate, a spike in blood sugar, rapid breathing, and sharpened senses. Cortisol is behind the well-known flight-fight-freeze response.

Increased cortisol production by the HPA axis impacts sleep as well. Under normal circumstances, the production of cortisol in your body follows a circadian rhythm. It reaches its lowest point around midnight and peaks roughly an hour after you wake up. Researchers have found that HPA axis hyperactivity can disrupt your sleep cycles, which results in fragmented or shortened sleep, or insomnia.

Those sleep disturbances can trigger a vicious cycle by wreaking further havoc on your HPA axis, distorting your body’s cortisol production. Researchers have found that insomnia and other forms of sleep deprivation increase cortisol production as well, perhaps in an attempt to stimulate alertness. And in cases of chronic stress, the impact on your HPA axis and cortisol production can have long-lasting effects.

Is Chronically Poor Sleep Such a Problem?

While most of us find chronically bad sleep to be a nuisance, it is much more than that. Problems include weakening the immune system, reducing memory and attention span, and increasing the likelihood of chronic conditions like depression, Type 2 diabetes, and heart disease. Research suggests that people with insomnia are 10 times more susceptible to suffer from clinical depression.

Unfortunately, shorter sleep often means a shorter life span. And for people above the age of 50, less than six hours of sleep may even increase the risk of dementia.

“Once sleep is disrupted, it can impact mental and physical health, which may, in turn, cause further sleep disruption,” said Athena Akrami, Ph.D., a neuroscientist at University College London who is studying cognitive dysfunction in COVID-19, including sleep disturbances. “A vicious cycle may form that is very difficult to diagnose and treat properly.”

Expert’s Tips to Beat Insomnia

Although Americans have increasingly turned to over-the-counter sleep aids such as melatonin—increased sales of 42% in 2020, according to market research done by Nielsen, the best way to eliminate or reduce insomnia is to improve sleep hygiene or in more severe cases to enlist cognitive behavioral therapy.

Below are some of the most effective ways to improve sleep hygiene:

1. 25 Minutes and Then Surrender

If after being in bed for 25 minutes you still can’t fall asleep, or after waking at night you can’t get back to sleep after 25 minutes, then don’t stay in bed and continue to try. Get out of bed and do a quiet activity that calms your nerves and makes you drowsy.

“Just get up, don’t fret,” Dr. Walker said. “If you stay in bed awake for long periods of time, your brain thinks, ‘Every time I get into bed, this is the place where I should be awake.’ And you need to break that association.”

Resist that impulse to check the clock. Calculating how much sleep you’re losing will invariably create more anxiety and, consequently, make it even more difficult to fall asleep.

2. Stress and Bedtime: A Toxic Mix

If possible, avoid discussing or dealing with stressful or anxiety-inducing situations just before bedtime. In the same way that exercise increases energy levels and body temperature, raising difficult topics increases tension and may trigger a racing heartbeat. Protect your sleep by keeping stressful topics away from bedtime.

Try to schedule downtime before bed. When you set aside time to unwind and quell the restlessness in your mind, it helps you to get into a sleepy state of mind. Taking a bath, deep breathing, listening to relaxing music, and meditation are great ways to calm down at night.

Along these same lines, sit down with a blank piece of paper an hour or two before bed each night. On that paper, write down everything you are thinking about, especially those things that are bothering you. It could be a difficulty with a relationship, a problem at work, a financial challenge, or whatever else is on your mind or in your heart.

“If most of what you’ve written down is stuff that you’re worried about, then crumple up the paper and throw it in the trash — that’s called discharging your thoughts,” said Dr. Ilene M. Rosen, a sleep medicine doctor and associate professor of medicine at the Perelman School of Medicine at the University of Pennsylvania.

The act of dumping your thoughts on a piece of paper and throwing it away is a symbolic gesture that empowers you and calms your mind, said Dr. Rosen. “You had those thoughts and now they’re gone,” she said.

3. So you Want your Screen in your Bedroom

One culprit of sleep deprivation over the past year is that many of us are sacrificing our slumber to catch up on many of the fun things that we missed out on during the day. This could be scrolling through Instagram and Facebook, or watching YouTube videos. (How often have you been unable to put down your phone way past bedtime?)

Despite the fact that most of us are aware that we should avoid looking at bright screens on our cell phones late at night, because the blue light that is emitted sends a message to the brain that it’s time to be awake, we do it anyway.

So the following guideline may help: If you are going to use your phone or device after your bedtime, then use it only while standing. And when you feel like sitting or lying down, it’s time to put the device away.

“You’ll find after about 10 minutes of standing up at your normal bedtime that you’re going to say, ‘I need to lie down,’ — and that’s your body telling you that you need to put the phone away and get to sleep,” said Dr. Walker.

4. Circadian Rhythms: Ignore them at your Peril

Waking up at different times throws our circadian rhythm out of whack. It would be much better to keep your wake-up time consistent. Try not to sleep in, even on the weekends. “When the alarm goes off, get out of bed and start your day regardless of how much you’ve slept,” said Dr. Rosen. “You may not feel great for a few days, but you’re reinforcing that when you’re in bed, you sleep.”

And keep your bedtime consistent as well. Minimizing deviation from your normal bedtime and wake-up time will improve the quality of your sleep. And while naps may be helpful here and there, try to avoid late afternoon naps as they can interfere with your nighttime slumber.

5. Here Comes the Sun: Now Don’t Let it Get Away

When you aren’t commuting to work, it’s only natural to spend your entire morning inside the house. But when you are inside, you are deprived of exposure to sunlight which serves an important purpose: shutting down the release of melatonin, a sleep-promoting hormone.

“Most brain fog in the morning is caused by continued melatonin production,” said Michael Breus, a clinical psychologist and the author of “The Power of When.” “When sunlight hits your eye, it sends a signal to your brain to tell the melatonin faucet to turn off.” Endeavor to get at least 15 minutes of sunlight bright and early every morning.

6. Exercise and Sleep: Just the Right Combination

Another liability of the pandemic has been the reduction of physical activity. But exercise is the easiest way to improve sleep, said Dr. Breus. “Sleep is recovery,” he added. “If you don’t have anything to recover from, your sleep isn’t going to be that great.”

No fewer than 29 studies have found that daily exercise, regardless of the type or intensity, helps people fall asleep faster and stay asleep longer. This is especially true among people who are middle-aged or older.

But be sure to end your exercise at least four hours before bedtime. Otherwise, it can interfere with your sleep by raising your core body temperature, said Dr. Breus.

7. Your Caffeine, Alcohol, and Nicotine Addictions: Time to Deal

It has been found that caffeine has a half-life of six to eight hours and a quarter-life of about 12 hours. That means that if you drink coffee at 4 p.m., “you’ll still have a quarter of the caffeine floating around in your brain at 4 a.m.,” said Dr. Breus.

Avoiding caffeine in the evening is a no-brainer. But what most people don’t realize is that, ideally, you should steer clear of caffeine after 2 p.m. so your body has sufficient time to metabolize and clear most of it from your system.

Because alcohol functions as a sedative, some people drink a nightcap to help them fall asleep faster. But limit yourself to two drinks in the evening with the final one at least three hours before bedtime. And alternate each drink with a glass of water.

This is because alcohol suppresses REM sleep and causes sleep disruptions, which will worsen the overall quality of your sleep. “The closer you drink to your bedtime, the worse your sleep is going to be,” said Dr. Breus.

And curb nicotine and caffeine use in general. These stimulants can make it harder to fall asleep and stay asleep, especially if consumed late in the day.

It’s Not So Difficult to Reclaim your Sleep

Although sleep was becoming more elusive even before Covid, the pandemic has only served to exacerbate the situation. But by following the expert tips above, you can begin to take charge of your sleep once again, and enjoy the rest that you truly deserve!