June 4, 2020

How to fall asleep (when everything is so stressful)

Daily Briefing

    Editor's note: This popular story from the Daily Briefing's archives was republished on Nov. 4, 2020.

    Anxiety, disrupted schedules, and lifestyle changes driven by the new coronavirus pandemic have caused many people to experience sleep issues, research shows—but experts say there are a number of strategies you can employ to recapture a good night's rest.

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    All over the world, Covid-19 is keeping people up at night. But why?

    According to Melinda Jackson, a senior lecturer at the Turner Institute for Brain and Mental Health at Monash University, preliminary results from a recent survey of about 1,600 people across 60 countries showed that 46% of respondents reported experiencing poor sleep since the new coronavirus pandemic began. In comparison, just 25% of respondents said they slept poorly before the pandemic took hold. 

    Meanwhile, prescriptions for sleep medications increased by 14.8% between mid-February and mid-March, according to data from the pharmacy benefit manager Express Scripts. In addition, Spins, a wellness-focused data technology company, has reported that sales of the over-the-counter sleep aid melatonin increased by 44% from late February to April 19 when compared with the same period last year.

    Gary LeRoy, a family physician, said uncertainty about the new coronavirus has been a main driver of insomnia throughout the United States. "There is a kind of collective social anxiety about what [people] don't know about coronavirus, and so people are staying up, watching the news, talking with family and friends about it," he said.

    Experts also say the new coronavirus has added new sources of stress that can make it difficult to get a restful night's sleep. For instance, the Wall Street Journal reports that people may be worried about contracting the virus and losing their jobs amid the recent economic downturn. Many families also had to take on both work and schooling their children from home.

    These stressors, Jackson explained, can cause sleep disruptions and frightening dreams. For instance, the Journal reports that common dreams people are experiencing are "walking outside and realizing you don't have a mask on, and bug attacks," which are a metaphor for contracting the new coronavirus.

    Jackson explained that the dreams likely are caused by chemicals released in the brain during stressful periods. "During times of stress there's a release of neurochemicals that can trigger these vivid dreams and nightmares in some people," Jackson said.

    In addition, Philip Muskin, a professor of psychiatry at Columbia University Medical Center, said people could be having trouble staying asleep because of changes in their daily routines. "People aren't exercising" and "their days have no structure at all," Muskin said.

    How to get a good night's sleep

    Fortunately, experts say there are a variety of techniques people can employ if they're struggling to fall or stay asleep. 

    Cathy Goldstein, a physician at the University of Michigan and associate professor of neurology at the school's Sleep Disorders Center, said it's important to not associate your bed or bedroom with a place you spend time awake.

    Sonia Ancoli-Israel, a psychologist at the University of California-San Diego, said, "You want to help your brain learn that the bed is for sleeping." To do so, she recommends that, if you can't fall asleep or you wake up and you're lying awake in bed for 20 minutes or more, you should get out of bed and do something relaxing, whether that's listening to an audiobook, watching television, or reading—just as long as whatever you're doing isn't "going to suck you in."

    And when you're ready to get some shuteye, "[d]on't actively try to fall asleep," Ancoli-Israel said. Instead, "[s]et the stage for good sleep to occur."

    One way to do this is to focus on your breathing, she said. "Start concentrating on your breathing. Take a deep breath, inhale, and then exhale and count each breath. Now what often will happen is your mind is going to wander again, so you have to stop yourself and bring your mind back to thinking about your breathing and start counting from one again."

    Experts also recommend avoiding electronics late at night. "Make your bedroom a device-free zone," Natasha Bhuyan, a family physician at One Medical, said. "Rather than using a phone as an alarm clock, get an alarm clock."

    If anxiety is what's keeping you up, Ancoli-Israel recommends scheduling 10 minutes during your day to do nothing other than worry. "Turn off your phone, don't let anyone bother you, and just sit and concentrate on all the things that you are worried and anxious about," she said.

    According to Ancoli-Israel, the practice will help your brain learn to compartmentalize stress. That way, if you wake up in the middle of the night and start to worry, "you can say, 'Wait a minute—I have from 10 to 10:15 a.m. to do this tomorrow, and I don't have to think about it now," Ancoli-Israel said.

    Douglas Kirsch—a neurologist, sleep specialist, and former president of the American Academy of Sleep Medicine—recommends exercising regularly even you're limited to exercising in your home. Kirsch suggested using at-home, online exercise classes or even a jump rope. "Whatever you can do to get the body moving will help lead to a better night's sleep," he said.

    Kirsch also recommends keeping yourself in a daily routine that includes going to bed and waking up at the same time every day. Even if you realize you stayed up later than normal, you should try to wake up at the same time you do every other day to get yourself back on track, Kirsch said.

    "Your body likes to know when it's going to go to sleep and get up, and that allows it to function optimally," Kirsch explained. "When we change the schedule, that doesn't allow sleep to occur in the same pattern," and that can throw off your sleep habits and quality (Reddy, Wall Street Journal, 6/1; Neighmond, "Shots," NPR, 6/2).

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