While COVID-19 has already caused devastation around the world, physicians and researchers are seeing signs that the pandemic is also causing damage to people’s sleep. This disruption is due to increased stress and anxiety, leading to what some sleep experts are calling “coronasomnia.” If this is not addressed, coronasomnia could prove to have profound public health ramifications, including elevated risks for high blood pressure, depression and other health issues long after the pandemic has ended.
“We’re a society that has a lot of trouble with sleep in general. Now we're in a situation where with the amount of anxiety and stress, there's no doubt that it interferes with sleep,” said AMA member Ilene Rosen, MD, MSCE, a sleep medicine physician and associate professor of clinical medicine at the Perelman School of Medicine at the University of Pennsylvania. “‘Coronasomnia’ is the term used for sleep problems related to the pandemic. It is the impact of the uncertainty and the barrage of information that we are getting.”
“That uncertainty is being carried with you into your bed and affecting how you sleep and thus how alert you feel in the morning,” said Dr. Rosen, who is also assistant dean for graduate medical education at Penn Medicine and past-president of the American Academy of Sleep Medicine.
With this new term, Dr. Rosen took time to discuss what physicians wish people knew about coronasomnia and how to overcome sleepless nights.
“People just need to get back to the basics about sleep that we somewhat take for granted,” said Dr. Rosen. It is about going to bed and getting up at the same time every day as well as getting “sunlight or bright light in the first one or two hours after waking up.”
“These are all things to remind your internal clock when it’s time to be awake,” she said, adding that people should also perform a nighttime routine 30 to 60 minutes before bed to wind down and signal “to your brain it’s time to sleep.”
“Even if people are sleeping at a different time than normal, just by doing a routine is a reminder; it’s classical conditioning that basically says, ‘Stuff is happening that normally happens when I go to bed,’” said Dr. Rosen.
“Our sympathetic nervous system is on overdrive with all that’s going on and that is why people are having trouble sleeping,” said Dr. Rosen. “We need to do things that relax our sympathetic nervous system.”
While many people think exercise helps, timing is everything. At night, a person’s core body temperature drops and “dips over the course of the night and when you exercise, you elevate your core body temperature,” she said. “Exercising is awesome, but it should be done in the morning or at least three hours before going to bed.”
It is also important to use mental health strategies, which is something Dr. Rosen uses with her patients with chronic insomnia. She recommends setting aside “worry time.”
“Take 10 minutes to write down all the things racing through your mind,” said Dr. Rosen. “This typically should occur one to two hours before bedtime in another room—doing it to close to bedtime may be associated with increased agitation and trouble falling asleep.
“Writing your thoughts helps to clear them from your mind. You can even rip the paper out, crumble it up and throw it away in a symbolic act of dumping the thoughts,” she added.
“At some point you have to stop watching and listening to the news,” said Dr. Rosen. “It's important to keep up with what's going on in the world, but if you’re lying in bed and the last thing you do before you go to bed is check in with your 24-hour news station, it is not going to help with the sympathetic nervous system.”
“Not to mention that the light from the TV itself is telling your brain to be awake, but now your brain is exposed to content which is incredibly anxiety-provoking,” she said.
Learn more about how news media is filling public health role during COVID-19.
Some people are saying that they are exhausted, but when they turn off the lights their thoughts continue to race. The worries may over something as massive as the state of the world or as personal as how to pay the bills.
“We need to engage the mind enough, not so that it's stimulated, but so that it's less likely to go through constantly looping thoughts. This is where noise really works,” said Dr. Rosen. She recommends the use of a desk fan or noise machine.
While individuals have been self-medicating with alcohol even prior to the pandemic, it is important to avoid using beer, wine or spirits for their sedative properties. People might feel like they fall asleep more quickly, but it won’t be restful.
“Alcohol will prevent lying awake for hours when you get in bed, but it changes the whole way your sleep architecture looks,” said Dr. Rosen, adding that alcohol use too close to bedtime decreases rapid-eye movement (REM) sleep, which is one of the deep, restorative stages of sleep, early in the night.
“Later in the night, as the alcohol wears off, there is an increase in REM sleep—called REM rebound, that is associated with vivid dreams and nightmares—which is, in turn, more anxiety-provoking,” she said. “Alcohol is also associated with increased awakenings during the night which is further disruptive to your sleep.”