To treat it, we first have to understand the pandemic as a slow-moving natural disaster.
Since the NBA suspended its season on March 11 due to the novel coronavirus outbreak, I have had only three nights of good sleep unassisted by ZzzQuil. I can fall asleep fine, because I’m so tired from getting poor rest the previous night, and then putting in every isolating citizen’s requisite 15-hour shift of news-reading, texting, Zooming, and fretting. But between 2 and 4 a.m., I pop awake, and everything floods right in.
I flop around in bed trying to get comfortable as my brain upshifts, surging with adrenaline. The Wisconsin election fiasco! Layoffs in media and at museums, hiring freezes in academia! Health care workers putting their pictures on their PPE! Lines of cars at food banks!
When will it be safe to see my parents again? How much money will the
university that anchors our small town’s economy end up losing? One
particularly bad night this past week, this flood of worries came with a
musical accompaniment, as my brain repeated “Elmo’s Song” on a loop. (Toddler parenting during a pandemic: a delightful study in contrasts!)
Anecdotally, I know I’m not alone in my late-night vigil. “Does … anyone sleep anymore?” Scaachi Koul asked Twitter at 12:47 a.m. “Wide awake. Too sad to think. How can we small humans bear this?” Virginia Heffernan asked at 3:18 a.m. “If you tell me you’ve gotten a decent night’s sleep in the last month I’m going to assume you’re either a wizard or a sociopath,” Andi Zeisler joked at 3:20 a.m. “Insomnia is the most common sleep complaint even in the best of times,” Brandon R. Peters, a neurologist and sleep physician who’s the author of the book Sleep Through Insomnia: End the Anxiety and Discover Sleep Relief With Guided CBT-I Therapy, told me. “Periods of stress will definitely exacerbate it.”
Just how many people worldwide might be tossing and turning along with me? Researchers have confirmed that going through a natural disaster like a tsunami, earthquake, or hurricane can result in sleep disturbances, but this pandemic is a global disaster like no other. Judite Blanc, a psychologist and postdoctoral fellow at New York University School of Medicine’s Center for Healthful Behavior Change, has studied incidences of insomnia among survivors of the 2010 earthquake in Haiti. Blanc told me that researchers take a number of factors into account when assessing the effects of a disaster on an individual’s sleep: preexisting mental health issues or physical ailments, things like gender and socioeconomic status, and the person’s degree of exposure to the disaster’s effects. (And, Peters told me, a tendency toward insomnia in a given person may also in part be a matter of genes.)
But “we also take into account the characteristics of the disaster,” Blanc said. “An earthquake, it just happens so brutally, for 30 seconds. Compared to COVID-19, it’s very different. We heard about the virus, we knew it was coming, we had time to prepare our minds, but now … we are deprived of freedom. We fear for our lives, we feel hopeless, we feel powerless.”
There are now researchers looking at how sleep is working for people living through “the Weirds” (as podcasters Kumail Nanjiani and Emily V. Gordon have aptly dubbed these times). I spoke with Tony Cunningham, a postdoctoral fellow at Beth Israel Deaconess Medical Center, Harvard Medical School, and Boston College, who is working on a longitudinal survey study about COVID-19, stress, mental health, and sleep, run by Boston College’s Cognitive and Affective Neuroscience Laboratory. The study began on March 13, and the researchers have been having people keep sleep logs and submit dream reports; they now have 1,000 people enrolled from 24 countries and are looking for more. A separate group of researchers at Monash University in Australia is running a study that’s specifically about insomnia symptoms during the pandemic.
“Anecdotally speaking, if you look at disasters of all kinds, not just natural disasters but things like the Boston Marathon bombing, and how they affect the community, this is just different,” Cunningham said. I had asked him what kinds of results he might expect to see from this survey, given the previous literature on how disasters affect sleep. “Usually, change follows the curve of recovery, and this situation, this pandemic, is really unique because it’s so drawn out. It’s not like a typhoon or a hurricane, where the disaster lasts at most a few days. This could be months. It could change society forever.” (Yes, my 3 a.m. brain had considered that, thank you.)
One problem with the traditional sleep hygiene advice given to insomnia sufferers, which is about schedule, habit, and environment, is that quarantine is upending everyone’s baseline. Peters said, “People experiencing insomnia now may have made changes to their sleep habits. So, say, you don’t have to go into work anymore. You’re waking up at inconsistent times”—not using an alarm clock and getting up at 5:17 a.m., like I used to do to get to morning CrossFit (now closed, like everything else). “Without that anchor, I think there are a lot of people maybe sleeping too much time in bed”—something that can lead to night wakings and difficulty getting back to sleep. But, as Cunningham pointed out, some people in quarantine might have nowhere else to be but their bed—if they live in a studio apartment, for example, where the bed is the couch, the dining room table, and the desk. There are also a lot of people who have had to violate the “don’t mix your workspace with your sleep space” dictum so they can put a door between their desk and the parts of their house where other people live.
But talking to Blanc, who mentioned the kinds of difficulties survivors living in shelters after a major event like the Haiti earthquake faced in getting good sleep, made me realize how lucky many of us are to still have so many sleep hygiene choices under our control. For starters, we in the coronavirus insomnia crew should be trying to go to bed and get up at the same time every day. Peters recommended getting morning sunlight—15 to 30 minutes, right when you get up—to set circadian patterns. Try to be physically active during the day, Peters said; be careful about drinking caffeine later than midday; limit alcohol, which makes you sleepy at first but “begins to fragment sleep” later on at night. Aim for seven to nine hours of sleep—the eight-hour recommendation doesn’t hold true for all adults, Peters stipulated, so don’t feel like you need to get eight hours if you feel fine with seven. Blanc added that eating well, drinking water, having a routine during the day, and trying to keep your sleep space dark are all important steps as well.
“It can feel like you’re releasing your vigilance, when you go to sleep.” — Martha Crawford, psychotherapist
I’ve experienced bouts of insomnia since my child was born a few years ago, and I’ve used a lot of these sleep hygiene rules to get it (mostly) under control. But the sleep-disruptive worries I’m experiencing now just feel so real—they’re not fears I can reason away or easily partition from the rest of my brain. I saw a thread from Martha Crawford, a psychotherapist who shared visualization ideas for coronavirus insomniacs, drawing a parallel between our situation and the time that she had found sleep “extremely challenging” while undergoing chemotherapy. “I realized I was falling victim to the age-old association between sleep and death,” Crawford wrote. “Death anxieties often fuck up our sleep.”
I spoke with Crawford on the phone, and she said, describing my experience exactly: “It can feel like you’re releasing your vigilance, when you go to sleep.” She recommended trying to understand the particular characteristics of your coronavirus insomnia in order to “talk to” the part of yourself that might be keeping you awake. Is your insomniac self afraid of economic hardship? Worried about becoming sick? Stressed at being quarantined in unbearable circumstances? Looking at my own case, I think my sleeplessness is triggered by a fear that if I go back to sleep, I will miss a chance to use the most powerful weapon I have—my brain—to have an idea that might save my family’s fragile life from the disaster that’s all around me. But I need to sleep. “Even if you’re being chased by a tiger,” Crawford reasoned, “if you have five minutes to rest in the bush, you take that five minutes, right? It’s part of your survival plan.”
The most useful advice I got was from Blanc: To have a designated “worry time,” where you get all of your conversations about the coronavirus out of the way. “You are listening to the news every day without any break,” Blanc said. “Of course your brain can’t handle it. You can’t let the worries occupy your mind all day long.” Tell yourself, she said, “I’m still living through this disaster,” but “worry time” is over. If a worry occurs outside of the window you’ve made for yourself, write the fear down in a journal, and then try to push it aside.
To this end, I’ve decided to mandate a “no COVID after 8 p.m.” rule. After I put my child to bed and sit down with dinner, there will be no texting with friends about our various domestic stresses, no talking to my husband about our town’s prospects, no watching the parts of Stephen Colbert’s show that include clips from Trump press conferences, definitely no Twitter. “You’re going to feel the difference,” Blanc promised me. I hope so.
Original article can be found here: https://slate.com/human-interest/2020/04/coronavirus-sleep-anxiety-insomnia-tips.html