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Woman lies awake on phone in bed at night
Apparently when your world is turned upside down, you do things like eat an entire bag of [insert comfort food of choice], binge-watch [insert TV series of choice], and scroll through scary headlines on your phone. Right before bed. Or in bed, for that matter. And apparently these activities are not conducive to good sleep, according to Nicholas Benson, MD, a pulmonary and sleep medicine specialist with HealthPartners. But he’s not here to judge. Dr. Benson admits to indulging in more late-night snacks himself lately (his weakness is Ben & Jerry’s). So with an empathetic approach, he offers some of his best tips for getting better rest during a pandemic.
Increased Anxiety is Bad for Sleep: How to Get Off the Worry Train
Q: Whether laid off or furloughed, nervous about making mortgage payments, worried about parents or grandparents, scared to go to the grocery store, or just plain lonely and hopeless—is it any surprise that people who don’t normally suffer from insomnia are having trouble sleeping?
A: Not at all. Many of my patients who don’t normally have insomnia have been telling me they’re having anxiety surrounding the pandemic and trouble sleeping as a result. I have been experiencing trouble sleeping myself lately. Worry and ruminating can make it difficult to fall asleep at night or get back to sleep if you wake up in middle of the night. The bad news is that it can easily become a vicious circle. Poor quality sleep and the resulting tiredness can make it more difficult to cope with anxiety and stress. Also, as we become more fatigued, we may become less active, change sleep patterns, socialize less, or indulge in unhealthy habits, all of which can exacerbate both insomnia and anxiety.
Q: What can we do about it?
A: There are several things we can do so we don’t fall into this cycle. The most important is to try to keep a regular routine both during the day and at night. I know this is especially hard as we shelter in place, but it’s critical, so hear me out. Maintaining good sleep habits, what we call sleep hygiene, is especially important now that we are all out of sync with our normal lives. Part of this means going to bed at the same time every night and waking up the same time every morning.
Maintaining structure during the day can help make things feel a bit more normal and even give us a better sense of control. It also can give us a sense of accomplishment which helps boost our mood. Having more things planned for the day can keep us from having too much extra time on our hands which can increase our risk for worry and stress. It also reduces the temptation to check the news more often, which can lead to more worry.
But if you are having a lot of anxiety that is making it hard to sleep much at all or function during the day, or is making you feel depressed, I recommend seeking professional help for it.
Lack of Routine: Why it Matters and How to Ease Back into One
Q: Why are daily/nightly practices so necessary for our health and well-being?
A: A sleep routine is very important for our internal biological sleep clock. We have a circadian rhythm, an internal sleep process, that regulates our sleep-wake cycle. It determines when we are most likely to fall asleep and when we will feel alert during the day. Every cell in our body has a genetically determined sleep clock and having them all in their proper rhythm is like having a well-tuned machine. Many functions of our body are influenced by this rhythm, including hormone secretion, cell regeneration, gut function, mood, concentration. So not only can it affect our sleep but can influence our health during the day.
When we get exposed to light, eat, exercise, and go to bed, it can all influence our sleep clock. When it is out of sync it can lead to significant sleep problems. Light exposure has the strongest influence on our sleep clock. Melatonin, the most important sleep hormone our brain makes, is influenced by light. Light exposure in the evening inhibits melatonin secretion and makes it harder to fall asleep.
Getting exposed to light in the morning at the proper time is very important in keeping your sleep clock in sync. This is best achieved by exposing yourself to sunlight in the morning. You want to make sure you are exposing yourself to the light at the same time each morning, preferably within ½ to one hour of waking up
I would recommend just start by easing back into a routine. Start with getting back to a regular sleep schedule. Wake up and expose yourself to light and have your breakfast. Now we can do it outside which will make it much easier. Plan out your day while enjoying this bit of quiet time. Be sure to shower and get dressed every day. Eat your meals at the same time roughly each day. I would also recommend avoiding the temptation to keep working late into the evening. Be sure to try to set an end time for work as you would otherwise. Play and rest are important for mood and sleep. Finally, slowly add back more routine activities like exercise and socializing safely.
Burning Question: Should We Let Teens Sleep in?
Q: Without the need to wake up and get ready to literally go to school, many parents are wondering whether to let their teens sleep in, as long as they can still get their distance learning schoolwork finished. What's your opinion?
A: There has been a strong push across this country for later school start times for adolescents. Teenagers normally develop a delay in their circadian rhythm. They also require more sleep during this part of their lives. As a result of this delayed rhythm it is often difficult for teenagers to fall asleep before 11pm. And because they need more sleep they will need to sleep in until 8 or 9am or even later depending on when they went to sleep. Research has shown that delaying school start times for adolescents even by ½ hour can improve grades. Studies done at the University of Minnesota have shown that for each additional hour of sleep, adolescents experienced almost a 1/3 reduction in those who reported feeling unhappy, sad, or depressed. More sleep has been associated with students reporting less alcohol, cigarettes, and other substance use. Fewer delinquent and risk-taking behaviors have also been demonstrated.
So I say: let them sleep in! It is important that they maintain a regular sleep schedule and are not staying up too late. I would even recommend parents take this time to observe their children and see if they notice any improvements in their mood, concentration, performance, and behaviors with this extra sleep. Given the additional stress kids are going through, it is even more important we help them get adequate amounts of sleep so they are as resilient as possible.
Increased Binge-Eating: How Indulging in Junk Food Affects Sleep
Q: Many of us are doing more late-night snacking, drinking, and coffee intake. How does this affect sleep, and do you have any (realistic!) recommendations for those with a weakness for such vices?
A: It is well known caffeine can make it difficult to fall asleep. It can last in our system up to six hours or more. It can make some of us feel more anxious. So it is best to limit consumption and keep it to the morning time. Alcohol can disrupt sleep as well. It can help us fall asleep but as our bodies process the alcohol we tend to get poorer quality of sleep. Alcohol can inhibit stage III sleep which is the most restorative sleep. Again, it is best to limit consumption and if you do have a drink, have it 2-3 hours before bedtime. Light snacks before bedtime are okay but a large meal close to bedtime, or one high in sugar, can disrupt sleep as well.
It is tough during times like these to avoid some of these vices. Making sure you are getting enough sleep is important as it is more difficult to resist vices when we are tired. Also consider buying smaller quantities of these items when you go out shopping. Involving others and making yourself accountable to them is another way that can help.
Screenland Is the Wild West: How it Inhibits Rest, and Ways to Rein it in
Q: Work life, school life, personal life have all gone virtual. Has all the blue light gone to our heads and ruined our sleep?
A: We were all already being exposed to a lot of screen time before the pandemic, but now as you mentioned it is even worse. The light from TV, smartphones and computers can all inhibit melatonin and make it difficult for us to sleep. Blue light is the color of light that has the strongest influence on inhibiting melatonin production and is the most prominent color coming out of our electronic screens.
Q: Any advice on what to do about it?
A: It is best to limit evening screen time and avoid it completely at least an hour before bedtime. If that is not possible, there are built-in features and apps for electronic devices that can limit the amount of blue light coming from your screen. There are even glasses you can wear that block out some of this blue light. These all may help.
I also recommend turning down lights in the house or even wearing sunglasses in the evening. It is important to reassess time to time if some reductions in screen time can be made. Consider changing some of your video calls to regular phone calls. The warmer weather should also help reduce the need for screen time for entertainment.
Lockdown Desperation: Why a Little Benadryl Isn’t the Answer
Q: With such a vicious circle—anxiety=bad sleep=anxiety=binge-eating=bad sleep)—is now the time to consider taking a sleep aid, even temporarily?
A: That is a difficult question. We sleep doctors tend to recommend avoiding sleeping pills as much as possible. Most often, if good sleep hygiene practices and a healthy lifestyle can be maintained, sleeping pills are not needed.
There are many non-medication strategies that can help with sleep. These are now recommended by medical guidelines for the first line treatment of insomnia. It is often tempting with trouble sleeping to want to lay there in the dark tossing and turning hoping you eventually fall asleep. One often thinks that at least they are resting and that should at least help. We know that this resting is not helpful. Lying awake in the dark in bed often makes things worse. It can make you frustrated or allow you more time to worry. It is best if you have not fallen asleep after 20-25 minutes to get up and go to a quiet room and read until you are sleepy. Do not get on your smartphone, work, or watch TV.
It is also important to not spend too much time in bed. If you are spending 8.5-9 hours or more in bed and your body only needs 7.5 hours of sleep, it is not surprising that you will be awake for an hour or more at night. It is best to only spend the amount of time in bed that you normally did before you began isolating at home. Avoiding napping during the day or sleeping in, which is also disruptive to sleep. Its best to pick a time you want to wake up every morning and not go to bed earlier than 7-8 hours before that time.
If these strategies are not helping, it isn’t unreasonable to use sleeping pills for a short-term period. But even over-the-counter sleeping pills need to be used with caution. They can interact with other medications, cause side effects, especially in the elderly, and in a small number of people make insomnia worse.
