Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.
In today’s COVID-19 update, AMA Chief Experience Officer Todd Unger speaks with Ilene Rosen, MD, MSCE, about “coronasomnia,” an emerging phenomenon that helps explain sleep disturbances people experience during COVID-19.
Learn more at the AMA COVID-19 resource center.
- Ilene M. Rosen, MD, MSCE, sleep medicine physician, Penn Medicine
Unger: Hello, this is the American Medical Association's COVID 19 Update. Today, we're talking with Dr. Ilene Rosen about coronasomnia, an emerging phenomenon that helps explain sleep disturbances people experience during the pandemic. Dr. Rosen is assistant dean for graduate medical education and vice-chair for education in the Department of Medicine at Perelman School of Medicine at the University of Pennsylvania in Philadelphia. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Rosen, we've heard the term in the media, but can you tell us exactly what is coronasomnia? How's it differ from insomnia? And how did it become recognized as a legitimate health concern?
Dr. Rosen: Well, we know that insomnia is a major crisis in this country in general and actually worldwide, and we also know that insomnia is exacerbated during times of a pandemic, but specifically in this pandemic with all that we are going through and hearing and what's coming at us from all directions and the uncertainty we're feeling, it got its own nickname, coronasomnia.
Unger: So, it sounds benign and a little bit funny, but it's not. There are real health implications. Can you explain those?
Dr. Rosen: Yes. So insomnia, when it's chronic and causes a significant sleep deprivation or significant sleep restriction, we should say over time, it is associated with hypertension, the development of hypertension, other cardiovascular diseases, like having a heart attack, and it can even have effects on your metabolism and change the way you process insulin. It doesn't actually cause diabetes, but it's definitely associated with insulin changes that are similar to when someone has diabetes or develops diabetes.
Unger: Are people physically doing something different or is this anxiety that's carrying forward into their sleep?
Dr. Rosen: So it's a combination of things. So we know from surveys that have been done since the pandemic started, even from some data that came from China and Italy and some other places, that there's an increase in trouble sleeping and many other psychological feelings that we might be having around the pandemic. But typically, insomnia in and of itself is simply that the brain is hyper-aroused and doesn't have normal processes so that it can turn off at night the way, or get the signal right that it might from the sleep switch.
Unger: How do current events, let's say the election for instance, on top of the pandemic and that kind of anxiety play into coronasomnia?
Dr. Rosen: So maybe we could have an electionosomnia as well, might come out of this, but no, in all seriousness, I think that what we're going through, people have from coronavirus there's financial concerns, there's emotional concerns, your distanced from other people on a routine basis now, and then life is unpredictable. And what we might see on the TV about racial injustice or what's going on with the election, and plus people's general personal and professional concerns, it all kind of gets added into the mix and can really affect how people sleep.
Unger: What do you tell patients who have a routine, you shut off the television, but their thoughts continue to race and prevent sleep?
Dr. Rosen: So we could talk about many different things, but the first thing is get back to basics. So right now, particularly given the fact that we don't really have the same schedule and the same cues we always had, you really need to set a schedule. When is bedtime? When is wake time? And then before you even get to the point that you're lying awake in your bed, you might want to think about having a one- or two-hour period, maybe longer, depending on how much it's affecting you, where you're not engaging with the news. You're not engaging with TV, and maybe you're not engaging with any screens at all. So starting from starting with that is a good place to go.
Unger: Is that in your kind of range of factors that affect sleep, kind of number one at your list, is that screen engagement right before bed?
Dr. Rosen: Yeah. So it's a yes, I would say for two reasons. The one is what I told you, just the content is distressing to many people and some people get more amped up from it than others. It may just not be the time when you're supposed to be winding down to get yourself wound up. But the other thing is that screens in and of themselves, we've been saying this for a long time, our screens are so sophisticated now from our phones, our tablets, and our televisions, that they emit the exact wavelength of blue light that comes from the sun.
And so you're actually signaling to your brain, don't really go to bed now, it's time to be up. So now you have a situation where your normal social cues about wake and sleep are off. We're amped up before we go to bed and we're getting stimulations into our brain that says, hey, it might not be time to go to bed because it's kind of light out there. So these are things to think about as just simple things to do. Once you're awake during the night, there are other things you can focus on at that point in time.
Unger: So I can tell my wife, my advice to her, not to check her iPad before she went to bed is actually supported by a medical professional. And that sounds like a problem.
Dr. Rosen: That's right.
Unger: So when the average person walks in to see their physician, what should the physicians be telling those patients to do to help treat or prevent sleep disturbances?
Dr. Rosen: So I think the first thing that general physicians have to do is ask about sleep. It's not something that patients think to volunteer. They don't think their physician cares about their sleep. Obviously, I'm a sleep physician, so when they come to me, they know they're going to get to talk about that. But I think particularly a primary care provider, actually any specialist who has a routine, common relationship with a patient should ask, just like they're asking, what are you eating? Do you exercise? How's your sleep? Have any concerns about your sleep? How many hours of sleep do you think you're getting a night? And that often springboards into a conversation about sleep and sleep habits and sleep quality.
Unger: It makes sense given all of the things you outlined that are affected by not sleeping, that that would be an excellent conversation. Some people have sod stress relief from the pandemic through exercise or a nightcap or other ways, or both. Do these help with sleep?
Dr. Rosen: The answer is yes and no. So let's start with exercise. So exercise is excellent. You might not want to do exercise so late at night, or you want to tell patients not to do exercise too close to going to bed. We typically tell people one or two hours before going to bed because it affects the core body temperature and there's a process about the core body temperature that helps facilitate sleep, that usually drops. So when you're exercising, you're raising body temperature. If someone's having trouble sleeping, I tell them to exercise in the morning and to try to do it outside and get some light.
The other question is about having a nightcap or having a drink. So there's no question that alcohol will help people relax, and it may actually help them fall asleep initially. But what most people will notice is that they wake up several hours later and have a lot of trouble going back to sleep or that their sleep is very fragmented, very interrupted. And also that they're having strange dreams. And that's because the alcohol actually directly affects the sleep architecture or the pattern of sleep that individuals have. And so not using alcohol is sort of another one of the top do's and don'ts.
Unger: Okay. You mentioned earlier about people, for other reasons you were waking up in the middle of the night, can't go back to sleep. Do you have strategies for them?
Dr. Rosen: Yes. So in general, what we tell people who wake up in the middle of the night is to not spend a lot of time awake in bed, ruminating about not sleeping. The recommendation, if it's really becoming a chronic problem, is to get out of bed. If you're lucky enough to have the ability to move to another room, but certainly get out of bed, do something in a dimly lit room, don't get on your tablet, and do something that's a relaxing activity. So maybe there's a podcast or some music, or doing like a little craft that you can do in a dimly lit light. That's usually what recommend until you feel sleepy and you go back to bed.
Unger: Well, lastly, we know patients aren't always upfront about many issues, including their sleep. Are there certain signs that physicians should watch for that would indicate a patient may be suffering from coronasomnia?
Dr. Rosen: So really the only way you can find out directly is to ask about sleep. And we found that many people are willing to share, but if patients are just saying that they're feeling general fatigued, or that they have a lot of complaints related to their blood pressure being elevated, or even issues with such as weight gain, if there's been a recent rapid weight gain, asking how they're doing about sleep and diet and exercise might allow it to be a more general conversation.
Unger: So any advice for a random patients per se, that wakes up in the middle of the night, worrying about the election, about work, about anything, what do you counsel them to do?
Dr. Rosen: Yeah. So the other thing I would say that you can do in the middle of the night, in addition to getting out of bed, is we really need to do a lot to sort of dial down our sympathetic nervous system. How do we calm ourselves down, either if we by accident watched TV a little too close to going to bed, or if we wake up in the middle of the night, and deep breathing works really, really well. Just nice, slow, deep breathing. And there are several apps out there, some of which are free, which you can prescribe to your patients or use yourself that will actually talk you through, it's not quite meditation, it's just deep breathing and helping to take your mind off and lower the sympathetic nervous system. That's a good first start.
Unger: Well, great. It's been really great talking to you. I know a lot of people who are talking about this from personal experience, so we appreciate your advice and perspective. That's it for today's COVID-19 update. We'll be back soon with another segment. For resources on COVID-19 visit ama-assn.org/covid-19. Thanks for joining us, please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.