Audrey Fenske has always been a night owl. But even by her standards, the past few months have wreaked havoc on her sleep patterns.
Since March, when the COVID-19 pandemic upended most daily routines, Fenske, a program assistant with the Duke Career Center, has up woken up on many nights around 3 a.m., unable to fall back asleep.
“I’m a chronic over-thinker and over-worrier,” Fenske said. “So in the past when I’ve woken up in the night, my thoughts tend to go to things I’m worried bout. I’d probably exaggerate things in my mind. But now there are so many serious things going on in the world, it’s much more stressful.”
For many, the stress and anxiety brought on by the COVID-19 pandemic has made it harder to get a good night’s sleep. While some data shows that Americans may be getting slightly more sleep, likely due to the lack of a morning commute, other studies show that these uncertain times have increased insomnia in some populations by around 20 percent.
Duke Clinical Psychologist Meg Danforth, who leads the Duke Behavioral Sleep Medicine Clinic, said she’s seen a spike in people seeking treatment for chronic insomnia, which is defined as an inability to fall, or stay, asleep, since the pandemic began.
“It is a basic survival mechanism to not sleep well when we’re in danger, that’s evolution,” said Danforth, who pointed out the brain often unconsciously equates nighttime with danger. “In a very real way, with COVID-19, we’re all in danger. So it’s really natural to not be sleeping well.”
The Centers for Disease Control and Prevention recommends that adults get around seven hours of sleep per night. In addition to leaving you fatigued, irritable and unable to focus during the day, chronic insomnia can leave you at greater risk for developing depression and anxiety.
So if you’re having trouble with sleep, here are a few things to consider.
Three Simple Changes
For people facing sleep problems, Danforth recommends embracing three slight behavioral changes.
Avoid what she calls “social jetlag,” which is the effect irregular schedules can have on your internal clock.
“’Social jetlag’ happens when you keep different schedules on different days, especially on work days and days off,” Danforth said. “That creates a physical state that’s really similar to jetlag, because your body clock is trying to tell time but it can’t.”
You can help your body establish a defined internal rhythm by keeping bedtimes, wake-up times, meals and exercise on a somewhat consistent schedule. Danforth pointed out that each of these activities sends signals to the brain, which regulates the body’s internal clock and can cue the release of melatonin, a hormone that can relax the body and help you get to sleep.
Secondly, Danforth said it’s important to protect the connection between your bed and sleep. By spending too much time watching television, staring at your phone or doing work in bed, you can send mixed signals to your body about the purpose of being in bed.
“You want to make sure that your bed and bedroom creates a consistent cue for sleep,” Danforth said. “That means don’t go to bed unless you feel like you can fall asleep quickly. If you go to bed before you’re sleepy, you’re just setting yourself up for failure.”
Finally, try to install a buffer zone of at least 30 minutes before bedtime, during which you avoid things like bright or excessive light, worrying about work or watching intense television shows. If you can use the time to calm your mind and body, it can create better conditions for sleep.
Between pandemic worries, work stress and angst about the latest news headlines, there’s no shortage of sources for negative emotions. And when you’re trying to go to sleep, these factors stand in the way.
That’s why it’s important to begin the bedtime routine by finding a way to fill your mind with positive thoughts.
“Positive emotions undo the stress response,” said Carrie Adair, assistant director for the Duke Center for Healthcare Safety and Quality. “If you’re lying in bed and thinking about all the stressors you have coming at you tomorrow, your heart rate goes up, your respiration increases. But when we experience positive emotions, it actually relaxes all of those processes.”
Adair and her colleagues study the science of stress and provide resources, including one tool to improve sleep, for increasing resilience and reducing the risk of burnout. She said trouble sleeping is one of the first things brought up by people who are struggling with stress. Likewise, improved sleep is often the first sign that people’s ability to deal with stress is improving.
A tool that’s proven useful for people looking reach a more positive mental space at the end of the day is “3 Good Things.”
Developed as part of a study and now available to anyone over the age of 18, the “3 Good Things” program spans 15 days and asks participants to list three pleasant experiences from that day. With text message reminders and a short questionnaire, the requirements to take part are low. But Adair said the effect of spending mental energy dwelling on happy moments can be great.
“Asking you to reflect on events that you might not have taken much notice of during the day can help reduce the effect of stress,” Adair said. “If you do it within two hours of sleep onset, that actually gives you better likelihood of better sleep and longer sleep.”
When to Consider Treatment
According Danforth, most sleep problems only last a short time and often disappear when the stressful situation that brought them on clears up. But chronic insomnia occurs when someone has frequent trouble falling asleep or staying asleep for a period of longer than three months.
Why that matters is that once chronic insomnia takes root, it often lasts longer than the external stressors that may have caused it.
“With COVID-19, we’re now four-plus months into this,” Danforth said. “So if people started sleeping poorly back in March, and they’re still sleeping poorly in July, all of a sudden, they become at more risk for having that sleep problem stick around even once, God willing, we come out on the other side of this.”
When facing chronic insomnia, experts recommend seeking treatment. Duke has multiple places that treat sleep problems, including the Duke Sleep Disorders Clinic, which uses a nightlong evaluation to diagnose sleep apnea.
The Duke Behavioral Sleep Medicine Clinic, part of Duke Psychiatry and Behavioral Sciences, uses Cognitive Behavioral Therapy for Insomnia (CBT-i), an eight-week program - which is available via telemedicine – that addresses the underlying causes of a sleep disorder.
Danforth also recommends the free CBT-I Coach mobile app, which was developed for military veterans. Available for Apple and Android devices it can help create healthy sleeping habits.
“If you’re having sleep problems in the short run, it will probably get better,” Danforth said. “But if you’re having chronic sleep problems, remember that it is treatable.”
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