How a pandemic impacts sleep and behaviors

Photo Cred: Kristin Vogt/Pexels

By Catherine Darley, ND

The novel coronavirus (COVID-19) has increased occurrences of stress behaviors. Patients are generally off-schedule as they try to adjust to a new normal, and we’re experiencing shifts from alcohol sales increasing significantly, more snacking throughout the day, compulsively checking the news, worrying about the future, and struggling with isolation.

These types of behaviors can disrupt sleep, which many practitioners may see in their clinics. In fact, consumer research in the United States by the Better Sleep Council shows a sharp increase in the number of people who were sleep deprived from January 2020 to March 2020, just before COVID-19. As sleep plays a significant role in immune response, many practitioners are calling for the World Health Organization to include sleep recommendations in their pandemic guidance.

Here are some of the common stress behaviors I am seeing among patients and recommendations to improve sleep and wellbeing.

Regulate Alcohol Consumption

Many patients regularly turn to alcohol as a coping mechanism for both stress reduction and as a sleep aid. Although alcohol can help a person fall asleep initially by decreasing core body temperature, as it is metabolized, core body temperature increases and may cause a person to sleep lighter or wake up in the middle of the night.

My recommendation is no alcohol within three hours of bedtime.

Establish Routine

A key to both sleeping well at night and being alert during the day is to maintain a robust circadian rhythm. One of the key zeitgebers or cues in regulating the body’s circadian rhythm is mealtimes. This is in part due to the effects of digestive processes triggered by a meal. When a person is grazing throughout the day, the digestive system is always “on” and the circadian cues are not clear.

 An optimal lifestyle to strengthen the circadian system, which will in turn promote healthy sleep, alertness, and mental health, should feature wake, meal, and sleep times at roughly the same time, within one hour, each day.  

A healthful routine should also incorporate time in bright light within 20 minutes of waking and throughout the day, exercise, social time, and wind-down time without electronic devices at the end of the day. Here is a sample routine I use as an example for patients:

• 7 a.m. Wake up
• 8 a.m. Breakfast
• 10:30 a.m.: Light break
• 1 p.m. Lunch
• 3 p.m.: Light break
• 5 p.m. Exercise
• 6 p.m. Dinner and light break
• 7 p.m. Social time
• 10 p.m. Wind-down time
• 11 p.m. Bedtime

For patients who are struggling to establish a routine, I find a worksheet that they can fill in with times that suit their lifestyle to be very helpful.

Nourish Thoughtfully

Across the U.S. stores are now running out of flour as many people are baking bread and other treats during stay-at-home orders. These “comfort” foods tend to be pro-inflammatory, which in turn can worsen sleep. Sleep deprivation itself shifts our appetite towards more simple carbs and fats due to decreases leptin and increases ghrelin levels. Encourage consumption of whole foods with vegetables, fruits, healthy fats, and lean proteins that are anti-inflammatory and promote better sleep.

Manage Stress

The Better Sleep Council found a 31 percent increase in the number of social media discussions pairing sleep and health, and 270 percent increase in posts pairing sleep and the economy. Given the news, worry is unavoidable. We can, however, help our patients learn skills to insulate their sleep from worry, so they are better able to cope.

One of my favorite effective strategies is to journal for 10 minutes about two hours before bed. Write down those thoughts that tend to come up in the night, with the intention of “putting them to bed.” The writing can take any format, from a full sentence narrative or problem-solution chart to simple thought bubbles or drawing.

Then, have an enjoyable wind-down for the remaining time before bed. If thoughts arise in the night, do some gentle thought-stopping along the lines of “I already thought about that, and will have time tomorrow, now’s time to rest.”

It may take practice for a patient to learn this internal limit setting. I usually ask people to journal every night for a month so they have the chance to figure out what works for them. The goal is to ensure time to process worry during the day, so it’s been taken care of, and does not emerge during sleep hours 

Limit Blue Light Exposure

The news can be compelling, and many people share that they are now checking it compulsively throughout the day. Not only can worry be triggered by the news, but the devices themselves can interfere with sleep, too. Use this opportunity to remind people how sensitive our melatonin system is to light, particularly blue light. One of the best methods I recommend is to set an alarm an hour or so before bed to cue wind-down time. By turning off the phone at that time, a patient can allow their melatonin to surge in preparation for sleep and their mind to rest.

Social Connection

For some people, especially people who live alone, these stay-at-home orders may in effect be an isolation order. We know that people sleep better when they feel secure, and when they have more social capital. Check in with patients—have they established routines to keep in touch with their community via phone, video calls or other methods and do they feel adequately socially connected? If not, discuss how they can keep connected and maintain their sense of community.

Follow Up

It’s been noteworthy to see reports of people setting aside other necessary medical care during this time. As patients share their concerns about sleep and daytime alertness, verify that they are still taking their medications as prescribed. For some people, the lifestyle changes they’re experiencing may make it difficult to maintain their medication and supplement regimen. Discussing new strategies that fit the new situation may be necessary. Those new strategies can be as simple as placing medications in a new spot, programming the smart phone with reminders, or shifting the timing of medications if possible.

As we all go into the next phase of the global pandemic response, it will be helpful for us get the sleep we need, both for immune wellness and mental health. Both the worry and lifestyle disruption make this more difficult, and more important. Use these strategies above to help your patients get the sleep they need now and as this crisis unfolds.

References

Better Sleep Council. (2020) Survey: The state of America’s sleep and COVID-19. Retrieved from: https://bettersleep.org/research/sleep-surveys/survey-the-state-of-americas-sleep-and-covid-19/

Mônico-Neto, M., Thomatieli dos Santos, R.V., Moreira, and Antunes, H.K. (2020) The world war against the COVID-19 outbreak: don’t forget to sleep. Journal of Clinical Sleep Medicine. Retrieved from: https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.8502