Kathleen M. Pike, PhD

Trouble Sleeping?

I never have trouble sleeping. Well, almost never. During this pandemic, I have actually been able to sleep pretty well, but I have also had some restless nights, some nights that I have been up until the wee hours to get extra COVID-related work completed, and some mornings that I wake up uneasy and tired even though I had a reasonable night’s sleep. I know I am not alone. Many personal stories and emerging research studies suggest that COVID-19 is impacting many people’s sleep in one way or another.

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Some of us are sleeping better; some worse. Some are waking up early; some of us have lost track of bedtime. And many of us are having really intense dreams. It’s natural that sleep patterns have been disrupted by COVID-19, but it’s also really important that we pay attention to changes in our sleep to prevent damaging effects on our mental health. This is always true, and it is especially true now. To learn more about sleep and mental health in the context of this pandemic, I reached out to my longtime friend and fellow psychology graduate student back in the day, Mark Rosekind PhD, who is a world expert on sleep and former Director of the Fatigue Countermeasures Program at NASA Ames Research Center.

1. Sleep is Foundational to our Health, Safety, Performance, and Mood. According to Dr. Rosekind, “Getting the seven to nine hours of sleep required by our minds and bodies will strengthen immune function, help with physical and mental recovery, and enhance our health, safety, and mood. Insufficient sleep is costly and can degrade or impair basically all of our human capabilities. Even losing small amounts of sleep can build into a sleep debt (think of it like a bank account going into the red over subsequent days of sleep loss) and have negative effects on our lives.” This guidance is always relevant. It is especially important now given the threat of contracting COVID-19 and all the concomitant stresses.

2. Some Basic Tips for Good Sleep. The perennial recommendations for good sleep hygiene hold true during COVID-19. We have a strong evidence base of what works to support good sleep, but we humans often have a hard time doing what is good for us, even when it comes to sleep. According to Dr. Rosekind, we should: aim to get the sleep we need every night (for adults it is around 7-9 hours of sleep); keep a regular schedule of bedtime and wake time (even on the weekend), use a regular pre-sleep routine that is at least thirty minutes long to help us relax and prepare for bed and sleep; minimize alcohol, caffeine, and exercise within two hours of bedtime; use mental/physical relaxation skills to help us fall asleep or get back to sleep; control our sleeping environment (dark, quiet, cool temperature conditions are typically best); and minimize screen time prior to lights out. During this crisis, we especially need to practice these preparatory routines of unplugging because doing so will help us manage the emotional and cognitive stresses associated with the news overload. Remember, the blue light from screens inhibit production of the sleep hormone melatonin, which can lead to trouble falling asleep.

3. How is COVID-19 Messing With Our Sleep? Disrupted work, commute, and exercise routines all impact our sleep. No more walks to the subway. No more stairs to get to the office because the elevator is so slow. More hours sitting in front of a computer screen. Less time outdoors and in natural light. All these changes in physical activity can lead to increased fatigue so that we find ourselves getting tired earlier in the day. The skyrocketing amount of information coming at us nonstop – on our computers, phones, newspapers, television, and in virtually every conversation – is overwhelming. This is particularly true given the many unknowns and the constantly changing information and risk associated with COVID-19. Constraints on social activities and restrictions on our ability to spend time with loved ones limits access to activities that can enhance mood. It’s the perfect storm for elevated stress and depressed mood, both of which degrade sleep. And repeated nights of poor sleep wreak havoc with our mood and sense of wellbeing. It can be a pernicious cycle that increases risk for significant mental health concerns.

4. Coronavirus Dreaming. Around the world, people are reporting more intense, frequent, and bizarre dreams. Dream experts are finding that pandemic dreams are more likely to be characterized by stress and isolation and a swirl of negative emotions that set them apart from typical dreaming. Lyon Neuroscience Research Center in France reports that dream recall is up by 35 percent, with respondents reporting 15 percent more negative dreams than usual. Dream researchers from Italy report that individuals confined to stay at home during the pandemic are experiencing nightmares and parasomnias similar to symptoms of post-traumatic stress disorder. The dreams run the gamut, but one thing they have in common is how “weird” they seem to participants in the studies. For those who find that dreaming has become nightmarish, dream mastery techniques, including strategies like scripting different storylines for our dreams, can alleviate suffering.

5. Short-term Strategies for When We Don’t Get Enough Sleep. As Director of the Fatigue Countermeasures Program at NASA Ames Research Center, Dr. Rosekind had lots of experience demonstrating the importance of good sleep and also lots of opportunity to develop evidence-based alertness strategies for those circumstances when insufficient sleep could otherwise compromise our health and safety. To begin, Dr. Rosekind recommends strategic napping. In a NASA study, a forty minute nap opportunity with twenty-six minutes of sleep increased performance 34% and alertness 54%. Three key details are: keep the nap to forty minutes or less, allow for a ten to fifteen minute wake-up opportunity before returning to activities, and do not nap too close to bedtime. Second, he recommends strategic use of caffeine. Studies show that the effects of caffeine to boost alertness take about fifteen to thirty minutes to kick in and can last about three to four hours. He cautions that dosing is important and personal: “too little is not effective, too much has negative effects; and too often leads to tolerance.”  And finally, Dr. Rosekind strongly recommends activity breaks that get us “up and moving around every two hours for ten to fifteen minutes of aerobic activity to increase heart rate.” Such routines have been shown to reset focus and increase alertness.

As we continue to try to catch our zzz’s during the next few weeks and months, we need to remember to be patient with ourselves. Stress and anxiety may come out in our sleep patterns or dreams. But setting and sticking to routines can support our mental health now and far beyond the COVID-19 pandemic.

Picture of Kathleen M. Pike, PhD

Kathleen M. Pike, PhD

Kathleen M. Pike, PhD is Professor of Psychology and Director of the Global Mental Health WHO Collaborating Centre at Columbia University.

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