Even under “normal” circumstances, 75% of Americans reported experiencing stress in the past month that resulted in sleepless nights at least once.1
In the midst of the COVID-19 pandemic, however, stress levels are peaking for many, with 88% of workers surveyed by Human Resource Executive reporting moderate to extreme stress in the last four to six weeks,2 and 69% saying the coronavirus pandemic is the most stressful time of their professional career, even more so than 9/11 and the 2008 Great Recession.
This stress takes a toll on mental health and physical health alike. Prescriptions filled per week for antidepressant, antianxiety and anti-insomnia medications rose by 21% from February 16 to March 15, 2020, and 78% of the prescriptions for such drugs filled during the week ending March 15, when COVID-19 was declared a pandemic, were for new prescriptions, which suggests they’re a direct result of COVID-19-related anxiety.3
Sleep has emerged as one of the latest casualties of the pandemic, with Donn Posner, president of Sleepwell Associates and an adjunct clinical associate professor at Stanford University School of Medicine, calling the COVID-19 crisis a “perfect storm of sleep problems.”4
How the COVID-19 Pandemic Is Threatening Sleep
With people around the globe facing unprecedented levels of stress and anxiety, ranging from financial worries and anxiety to loneliness amid social distancing, sleep quality suffers.
The link between stress and poor sleep quality is strong,5 and as noted in the Journal of Sleep Research, “In the current global home confinement situation due to the COVID-19 outbreak, most individuals are exposed to an unprecedented stressful situation of unknown duration. This not only may increase daytime stress, anxiety and depression levels, but also can disrupt sleep.”6
Stress, however, is just one outcome of the COVID-19 lockdown that’s affecting sleep. Being largely confined to your home influences many factors that affect sleep quality, including disruptions to daily routine. If you’re furloughed, unemployed or working from home, you may sleep later than usual, go to bed later or be more likely to have an alcoholic beverage in the evening, all of which can potentially disrupt your sleep.
On a deeper level, many people are experiencing drastic changes in their work life, combined with homeschooling children, and without the ability to engage in rewarding activities such as visits with friends or family, sporting events or other entertainment venues as an outlet.
“For those required to work from home, there may also be disruption to established daily routines and working schedules, leading to a deterioration of positive associations between the home, relaxation and sleep,” the researchers noted.7
Stay-Home Orders Disturb Light Exposure and Social Ties
For others, social distancing measures may mean spending more time indoors and getting less exposure to daylight, another important factor in sleep quality. This is especially true for those living in homes with small windows or no access to an outdoor area.
Light intensity is measured in lux units, and on any given day, the outdoor lux units will be around 100,000 at noon. Indoors, the typical average is somewhere between 100 to 2,000 lux units — some two orders of magnitude less. So, when you spend all or a majority of your day indoors, you essentially enter a state of “light deficiency.”
The reason why light intensity is important is because it serves as the major synchronizer of your master body clock, which is composed of a group of cells in your brain called the suprachiasmatic nuclei. These nuclei synchronize to the light-dark cycle of your environment when certain wavelengths of light enter your eyes. You also have other biological clocks throughout your body, and those clocks in turn synchronize to your master clock.
So, if you want to get good sleep, you have to have properly aligned circadian rhythms, and step No. 1 is to make sure you get a sufficient dose of bright light exposure during the daytime — something that’s difficult to do if you don’t go outside.
Further, your pineal gland produces melatonin roughly in approximation to the contrast of bright sun exposure in the day and complete darkness at night. If you’re in darkness all day long, your body can’t appreciate the difference and will not optimize melatonin production. People living alone, particularly seniors, may also struggle with social isolation and loneliness that makes sleeping difficult.
“In fact,” according to the report, “a very recent study reporting on citizens’ well-being during the COVID-19 outbreak in China showed that those who scored higher on a measure of social participation and a sense of belonging also reported better sleep quality.8 A lack of regular social interaction can indeed enhance stress and negatively affect sleep quality …”9 Further, COVID-19 combined with stay-at-home orders interferes with sleep by:10
- Keeping your mind racing, especially if you’re watching a lot of news, elevating your body’s arousal system response and triggering insomnia
- Exposing you to blue light from screens, emitted by cellphones and tablets as you check the news one last time; the blue light interferes with the production of the hormone melatonin, causing further sleep troubles
- Making you susceptible to depression, low energy and long daytime naps which may make it difficult to fall asleep at night
As noted by University of Chicago Medicine, “It’s not easy to function at our best without easy access to our usual coping skills (e.g., social support, exercise, etc.) while sheltering in place.”11
Strange Dreams and Risks of Sleep Problems During a Pandemic
Sleep is essential for life, and lack of sleep takes a heavy toll, raising the risk of chronic diseases, obesity and premature death. Sleep is also intricately related to immune function, with immune system activation altering sleep, and sleep altering the innate and adaptive arms of the immune system. When you feel sleepy during infection, it’s thought that sleep bolsters the immune system to defend against the pathogen.
Further, sleep is associated with a reduced risk of infection and can improve the outcome of infections if you’re ill.12 In short, sleep may help your immune system to prevent and fight COVID-19. According to University of Chicago Medicine:13
“Ample sleep supports the immune system, which reduces the risk of infection and can improve outcomes for people fighting a virus. On the other hand, sleep deprivation weakens the body’s defense system and makes people more vulnerable to contracting a virus.”
Mood disturbances are also likely and can lead to snowballing anxiety. If you’re anxious, it can make sleep difficult by activating your “fight or flight” response that keeps you on edge. Lack of sleep, in turn, can worsen anxious feelings.
Even modest, night-to-night reductions in sleep lead to increases in anxiety the next day.14 Matthew Walker, professor of neuroscience at the University of California, Berkeley, and author of the book “Why We Sleep: Unlocking the Power of Sleep and Dreams,” told WBUR:15
“When you wake up in the middle of the night, typically we have this sort of Rolodex of anxiety that starts to flood back into our mind and we start to ruminate or catastrophize. Unfortunately, we know that it’s a two-way street as well, that if you’re not getting sufficient sleep or good quality sleep, you’re more likely to feel anxious the next day, and it develops this vicious cycle.”
Walker also states that coronavirus stress could be triggering strange dreams, particularly as people sleep in later in the morning, increasing the amount of rapid eye movement (REM) sleep, during which dreams occur.
“REM sleep essentially provides the brain a form of overnight therapy [in which] dreaming helps process difficult emotional experiences. And we can think of that dream sleep like a nocturnal, soothing balm that takes the sharp edges off the emotional concerns and experiences that we’re having whilst we’re awake,” he said.16
That being said, if you’re having trouble sleeping, your ability to concentrate and be productive will also suffer. In one animal study, sleep-deprived mice lost 30% of the neurons located in their locus ceruleus, a nucleus in the brainstem associated with wakefulness and cognitive processes.17
Dealing With Sleep Problems During a Pandemic
Adults need an average of seven to nine hours of sleep a night, with most doing well with about eight. If you have trouble achieving this duration, or you wake frequently during the night, it’s time to take steps to improve your sleep. My 33 healthy sleep secrets details a comprehensive list of strategies for a better night’s rest.
For additional tips that can be applied specifically in terms of dealing with sleep problems during home confinement amid the COVID-19 pandemic, the researchers writing in the Journal of Sleep Research suggested the following, some of which mirror my own:19
Keep a regular bedtime and wakeup time; this will bring some structure to your day, especially for children
Schedule brief 15-minute times during the day to reflect about current events; use stress-relief tactics like journaling or the Emotional Freedom Techniques (EFT) to process and reflect so you’re less likely to face racing thoughts at bedtime
Use your bed only for sleep; if you’re working from home, avoid working on your bed
Use the current situation to follow your natural sleep rhythm; if you’re a night owl, for instance, you may naturally prefer to stay up later and sleep later
Avoid screen time close to bedtime; turn off your cellphone and do not bring it into your bedroom
Limit your exposure to news about COVID-19
Exercise regularly, preferably in daylight
Get exposure to daylight each day and keep light dim in the evening, transitioning to pitch black at bedtime
Engage in activities that you enjoy doing during the day, and choose relaxing activities, such as yoga or reading a book, in the evening
Make your bedroom a quiet, dark, cool and relaxing environment that’s conducive to sleep