Insomnia in the Time of COVID-19

I have talked about it before, but it bears revisiting this week. In the last three weeks that I have worked at home, I have heard several complaints repeated over and over again. One that is on everyone’s lips is this: “I can’t sleep.”

Now, I see a lot of folks who have depression, anxiety, trauma, grief and many other issues in my work, but there are certain kinds of symptoms that seem to be common across the spectrum of mental health illness or stress. When people get upset, their mood changes. They eat too little and lose weight, or they eat too much and gain weight. They notice changes in interest, motivation and energy levels. They isolate and have trouble connecting with those they love. They have a hard time focusing or paying attention to things that matter. Many of these symptoms might be present in anxiety disorders, mood disorders or even psychotic disorders. Still, the one thing besides a vague sense of anxiety that almost everyone is feeling, and complaining about in the midst of this pandemic, is the inability to get good, restful, restorative sleep. 

First, some normative data. What is normal sleep latency, the time that it takes most of us to drift off to sleep? Eight minutes is a good yardstick. How much sleep do we really need? One can read about numbers that vary wildly, but it still seems that most people do better with an average of seven to nine hours of sleep per night. How much of this needs to be REM (rapid eye movement) sleep, that stage of sleep where we actively dream? Well, if one gets nine hours of sleep and REM cycles repeat every ninety minutes or so, one could expect to have at least two good REM cycles per night. Twenty-five per cent of your total sleep time given to REM is about right for most people. 

Next, why is this important? Why do we need this much sleep anyway?  We think that sleep is important to maintain both good mental and physical health. While we sleep, our bodies repair and maintain organ systems and muscles and immune systems, and manufacture hormones. Memories and newly acquired information may also be cemented during sleep, so that this information can better be used later during waking hours. Getting the right amount of sleep may also be protective in guarding you against development of diabetes, weight gain, and heart disease. 

Why has sleep, or the lack of it, been such a constant complaint in the last few months as we navigate this COVID-19 pandemic? Many people are experiencing anxiety, which tends to make settling down, getting relaxed and falling asleep at night very difficult. This anxiety is low grade and chronic for many people, hard to describe but always there, and it tends to affect our ability to fall asleep, leading to what we call initial insomnia. This kind of anxiety and inability to fall asleep can build on itself night after night, becoming a chronic problem. 

Others may be battling depression, with superimposed grief over all the things that we have collectively lost because of the virus outbreak and its impact on our physical, emotional, vocational and financial lives. Depression sometimes leads to what we call early morning awakening. You are able to fall asleep just fine, as you are sometimes absolutely exhausted, but you find yourself waking up almost every night at four AM, not able to go back to sleep. 

Everyone wants to sleep. The quick fix, taking some kind of over the counter or prescription sleeping pill, seems to be the best answer. Not always so, I’m afraid. Sometimes one has to deal with the underlying anxiety, depression and grief that is depriving us of sleep in the first place. Sleep hygiene is also very important. You know, the steps that your doctor has told you to try, including not exercising in the evening, limiting late night eating and alcohol consumption, avoiding screen time for several hours before you go to bed. Regular bedtimes and awakening times are also crucial, as these rhythms tend to lead to more consistent and restorative sleep. 

During this pandemic, we are all a little out of sorts, our usual routines have been disrupted, our moods are different and our ability to relax is strained. Knowing what is normal, what is not and how to maximize our chances to sleep well each night will go a long way to help us not only weather this biological storm, but thrive as we get to the other side of it.  

To Sleep, Perchance to Dream

Sleep is way overrated.

At least that’s what I used to think, before I met my wife and before I started to get older and began to feel the very real consequences of not sleeping well or enough.

I went to college for three years, medical school for four years and then did a residency in psychiatry for four more years before I could start to work as a “real” doctor. All during that time, sleep was a very real luxury that one very quickly learned could be sacrificed for something else, like last minute cramming for a final, research that helped avoid a tongue lashing by a picky attending on morning rounds, or more coffee. We were basically trained by medical training NOT to sleep. In addition to my regular academic duties, I worked a third shift lab job in the hospital, had to go to class, had clinical rotations and had to read, like, all the time. Little naps were good, but an unbroken eight hours of sleep never happened.

Somehow, and I still don’t know quite how, that lack of sleep, perceived need for sleep, and inability to understand the need for sleep carried over into private practice and starting a family. As time went on, sleep deprivation became the norm. I’m sure it deprived me of some experiences and some moments of being fully awake.

As I age, I know in my head and my heart that I need more sleep, but I still begrudge the time lost. I love to sleep, but I hate to end the day and get to bed!

Funny thing is, if I get at least seven or eight hours of good sleep now, I can tell a night and day difference. I am sharper mentally, I feel much better physically, my tolerance is better and I am more creative.

I am trying to learn these key points:

Sleep is good for me. I need to sleep. A lot more than I do. Every night possible.

Routine is important, not just for my little grandchildren, but for me too. Get up at about the same time each day. Get to bed. Let the day end. You’ll have another brand new one tomorrow!

I have a feeling that if I do NOT learn these important lessons on my own, my aging body and brain will let me know in good time….