The stresses of the Covid crisis have caused many people to experience insomnia. Adopting some straightforward sleep hygiene measures could help them to solve this problem
The pandemic has had a serious impact on our sleep. Many more people have found themselves tossing and turning in bed at night over the past 15 months. Even for those of us who can still drop off easily, sleep no longer feels as restful as it was.
Insomnia has become far more prevalent around the world during the Covid crisis. In the US, for instance, Google searches for the word increased by 58% during the first five months of 2020 as the infection rate rocketed, according to Science Daily.
The first serious study into what experts have termed coronasomnia was conducted by two Canadian researchers in June 2020. Charles Morin and Julie Carrier found similarities between the effects of the pandemic and those of other traumatic events, such as wars and natural disasters, on people’s sleep.
“Such a major stressful life event is likely to have impaired sleep and circadian rhythms,” they concluded.
Once the Covid crisis starts to ease, sleeping patterns will probably still take some time to return to how they were before the pandemic. This means that people will have to take steps to readjust and learn to implement better sleeping practices.
Spotting the signs of poor sleep
To understand how to sleep better, we first need to know the causes of insomnia. Dr Abhinav Singh, a doctor on the medical review panel for the Sleep Foundation, believes that both extrinsic and intrinsic factors have been to blame.
Extrinsic factors include the reduction in exposure to sunlight resulting from the various lockdown restrictions that required many of us to stay at home for much of the day. This has altered people’s natural circadian rhythms. A decrease in physical activity and even a loss of routine at mealtimes have also had a disruptive effect.
Singh uses the acronym “Fedup” as a mnemonic for the intrinsic causes. This stands for financial, emotional, distancing, unpredictability and professional/personal. “All of these challenges have led to an increase in our production of stress hormones, which has further disrupted the onset and maintenance of sleep, reducing its overall quality,” he says.
Stephanie Romiszewski, a sleep physiologist and director at the Sleepyhead Clinic, agrees that there have been several connected factors.
“Key things – including fundamental mood-boosters – that keep humans functioning well have been taken away. This has blurred the line between being awake and being asleep,” she says, adding that the stress that people have been under hasn’t just been personal. “We’ve also had something other than our usual troubles to worry about: a global problem that we haven’t been able to escape.”
Dr Neil Stanley, an independent sleep expert, says that the effects of poor-quality sleep should not be ignored. These include problems dropping off, feelings of fatigue on waking up, extended sleep during days off work, an inability to concentrate for extended periods and a lingering sense of irritability and/or restlessness.
While people cannot change many of their circumstances, they are able to optimise their sleep hygiene – a term coined in the 1970s to describe the behavioural and environmental steps that can be taken to tackle mild insomnia.
How to sleep better
Even in times of heightened stress, there are things that people can do to improve their chances of a restful sleep, says Singh, who has developed his own protocol, which he calls the four-play method. This involves doing the following activities for 10 minutes apiece before bedtime: take a warm shower, which helps “to cool the core and support the release of the sleep hormone melatonin”; write a journal entry, which helps to offload worries; read a book; and meditate.
He says that such a routine helps to condition the brain and body for sleep, especially when combined with other measures, including the avoidance of caffeine consumption and exposure to blue light within an hour of bedtime. Keeping the bedroom as dark as possible is also recommended.
Romiszewski believes that following “obsessive ritualistic strategies” can actually do more harm than good, although she adds that “people have to do some consistent goalpost-setting that is influential to their body”.
“Rising at the same time each day and getting plenty of exercise and exposure to natural light and will positively affect a sleep problem far more significantly than, say, cutting out caffeine would,” she says. “But give yourself permission to go to bed a little later if you aren’t sleeping. The only way to induce sleep is by spending more time awake. Incurring mild sleep deprivation will boost the quality of your next sleep.”
Experts do agree that discovering whatever approach works best for you, rather than following prescriptive actions such as the avoidance of certain foods, is the most straightforward way to get a better night’s sleep. We’re all different – a few of us operate best on six hours of sleep, while an evening bath might wake some people up rather than wind them down. Trial and error is the best way forward: keep a journal to track the quality of your sleep and which of your actions seem to make it better. If certain measures clearly aren’t helping, don’t persist with them.
The role of technology
While conventional wisdom states that cutting out technology before bedtime aids sleep, there are many mobile apps that promise to promote better rest.
“To a certain degree, sleep apps are fine,” Singh says. “They tell me that the individual using them is starting to take their sleep more seriously and wants to know more. That’s great. If they help to change the person’s behaviour and expand their sleep opportunity to a healthy eight-plus hours, I’m all for them.”
But he adds that moderation is key, as obsessing over statistics isn’t healthy. Romiszewski agrees. “Ask yourself what you’re achieving by monitoring your sleep. If you’re using an app, ensure that you have a goal in place, along with strategies for achieving it. Don’t track for the sake of tracking.”
Many of us will still struggle to get enough high-quality sleep even after the pandemic ends. And, sometimes, good sleep hygiene will not be enough to solve the problem. Singh says that a good rule of thumb is that someone might need the help of a specialist if they are: struggling to sleep more than three times a week for more than three months; experiencing “suboptimal daytime performance, fatigue, increased irritability, anxiety and mood disturbances”; and/or relying on over-the-counter medication or alcohol to sleep.
Romiszewski agrees. “If your problem has been going on for longer than three months, it’s time to enlist some evidence-based scientific support from an expert with the right qualifications and, most crucially, good clinical experience,” she says.
This is important, because good sleep is integral to our wellbeing. “Sleep is one-third of your life. Compromising on it has significant consequences for the remaining two-thirds,” Romiszewski says. “Sacrificing sleep is like taking out a high-interest loan with steep repayments in the form of poor health and performance.”