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.  

Lend Me Your Ears

Okay, so I made it clear in my last post that I do not like really big, long term change. That’s just me. That being said, I have been in a maelstrom of rapid, relentless, major, workflow altering change, much as many of you have, over the last two weeks now. Sort of like that frog in the pot of water that is unaware that the temperature is rising until he starts to boil, we have been the recipients of a slowly gathering storm, pushing a tidal wave of change on us from way out at sea, knowing that it is coming but not having a clue exactly when it will hit, how much damage it will do, or whether we will survive it.

On top of that, we are now seeing reports of people actually dying from this COVID-19 infection and disease, not just getting sickened or inconvenienced by it. A young lady. A middle aged media executive, a child, an infant, a renowned neurosurgeon, a country music artist. In other words, people like us or people that we love and care about. Ouch. Much too close to home. Anxiety, More stress. Worry. Paranoia. Enforced isolation which leads to functional isolation which leads to real isolation even at home. Not good for the psyche. Not good at all.

I can handle this, I tell my bad self. I will not get sick. This could never happen to me. I’m too young to die. I’m in my prime. My brain, smart as it is in the area of fact assessment and reality testing, is also super duper good at deception. The person it is the best at deceiving is me. I do not feel sick, therefore I cannot get sick. I am able to handle this stress, and even more stress, without feeling it physically. I will not notice a thing, not one little thing that will give me a clue that maybe my physical or emotional systems are overloaded. Right.

A couple of weeks ago, my left ear started to feel a bit stuffy. Annoying, but not terribly debilitating. I chalked it up to the myriad allergens in the air in the southern United States at this time of the year. I had felt this before, sometimes saw it turn into a mild cold, and had developed a way to cruise through it. Daytime and nighttime cold medicine at the very start of this syndrome, plus nasal spray to keep me breathing enough to work and be productive, all for about a week or so, had always worked before. Dutifully, at that first little feeling of stuffiness and discomfort, I embarked on my standard regimen. I thought little more about it.

A week later, things were worse. The ear was more stopped up, I could not hear well on the left side, and there was an uncomfortable feeling of having one side of my head in a barrel. I knew best, I told me, and I continued to doggedly prosecute my tried and true regimen. More liquicaps, more spray, more time. Nothing doing, my ear said, we will not budge. The left side of my head, down onto my neck, around to my cheekbone, got numb. When I would talk to colleagues, albeit from six feet away, I felt that I was shouting. Conversations at the island in the morning with my wife were unsatisfyingly one sided unless I turned my head towards her and practiced a mixture of something like torticollis and lip reading. “This is one bad allergy season!” I pontificated. All the while, this was really starting to drive me nuts, with the changes at work, schedules upended, my wife getting back on planes to fly germs, I mean passengers, around the country.

Then I remembered an episode a few years ago when a similar thing happened, but a time that I felt that I lost ALL the hearing in the same ear. Total hearing loss. Nothing. Scary. I ended up going to an urgent care center that time, and as you may have guessed by now, I had a monster, hard, obstructive impaction of cerumen, that’s ear wax to you and me, in that ear canal, completely and utterly obliterating any path for air or sound to travel one way or the other down my ear canal. A little soaking and a splashing shower of irritation, I mean irrigation into a small metal pan, and I could hear! I had never felt that happy in my entire life.

Fast forward to this week. No hearing, numbness in my face, unsteady on my feet, oh my God do have a tumor somewhere kind of angst running amok among the COVID-19 particles , I finally remembered that episode. I go to Walgreens, buy some ear wax nuking stuff (No, they still don’t have hand sanitizer), and get to work. I won’t bore you with the tedious details, but after three nights of this intervention, one evening in the midst of a showering royal flush, out came an ugly piece of wax that had bugged me for days. I could hear! I was no longer numb! It was a miracle!

Funny thing, though, the right ear, the one that had felt pretty normal through all this, felt a little stuffy itself once the left one was crystal, drive a gondola down the ear canal clear. Oh, no, migratory aural tumor, I thought to myself, and had to smile. Really? Really? More wax nuking drops, two more days, then blessed relief. I am virtually normal now, if I ever was.

So, I quipped to my wife at breakfast the next morning, sitting at the island, and NOT turning my head as I could already hear her replies, I wonder if increased stress and anxiety can cause one to create more ear wax? Ever at the ready to end wanton ignorance in our little world, she snatched up her iPhone and searched for an answer.

I’ll be damned.

Turns out, increased stress and fear can cause the body to produce more cerumen.

WHAT?

PRODUCE MORE CERUMEN!

SEASON WITH CUMIN? WHAT?

NO! EAR WAX. EAR WAX!

Oh……

We are all overloaded right now. We are frogs in a pot. The temperature is rising, and we are in jeopardy of boiling if we are not careful. We think that we have seen it all, done it all, figured it all out because we are smart, successful, resourceful people. We have all the answers. We are large and in charge.

Wrong.

This is bigger than us. Tiny viral particles, too small for us to see, have brought our world to its knees. Our economies are reeling. Our social institutions are paralyzed. Some of us are sickened. Some of us are dying. Our bodies know this, the ancient parts of our bodies and those cells and systems that really HAVE seen it all and survived, they know this, even if our younger, smarter, more resourceful brains cannot accept it.

Listen to your body. It will tell you when you are maxing out your biological credit line. It will tell you when to slow down, when to meditate, when to eat, when to rest. If you do not heed it, it will find a way to get your attention.

Thanks for lending me an ear while I waxed eloquent.

Yes, I really went there. Be well.