At the best of times, sleep comes with a long list of health benefits: It reduces inflammation, stress, and the risk of depression; improves cognitive function; and helps the body repair itself and ward off illness. Right now, amid COVID-19, a good night's sleep has never been more important—but many people are struggling to get their eight hours.
According to a recent report from Express Scripts, a prescription benefit plan provider, the use of anti-insomnia, anti-anxiety, and antidepressant medications have spiked, with filled prescriptions increasing by 21% between February and March 2020—that's after use decreased between 2015 and 2019. Those numbers peaked during the week of March 15—the same week the World Health Organization declared COVID-19 a pandemic and the US declared a national emergency in response to the crisis, per the report.
“The COVID-19 situation is unprecedented in our lifetime—it affects everybody, all the time," Alcibiades Rodriguez, MD, medical director of the Comprehensive Epilepsy Center-Sleep Center at NYU Langone Health, tells Health. "The news is pretty almost entirely related to this, and usually focusing mostly on the negative. Anxiety levels are high, which may lead to fragmented sleep, unusual sleep schedules, etc."
The effects of the coronavirus on people’s sleep habits is also fascinating researchers. At the Turner Institute for Brain and Mental Health at Australia’s Monash University, Dr Melinda Jackson and her team are running a study that’s specifically about insomnia symptoms during the pandemic. "The impact of this pandemic has huge economic, health and social impacts—all of which can influence the way we sleep," Dr. Jackson, a senior lecturer in psychology, tells Health. "We’re interested in determining the societal impacts of COVID-19 and self-isolation on sleep, as well as stress levels and mood."
Early results indicate there’s something of a dichotomy going on. “Some people are reporting poorer or less sleep than usual, whereas there are others who are relishing in the fact that they don't have to get up at a fixed time each day and are actually sleeping more,” Dr. Jackson says.
For those whose sleep habits are suffering, Dr. Jackson believes heightened anxiety associated with concern about our health and that of our loved ones, along with financial distress and job loss, may be major factors. “Being isolated at home can also impact on our usual routines,” she says. “For instance, it’s really important to be consistent with your wake up time, but this goes out of the window when we don't have to get up for the morning commute each day anymore.”
The relationship between stress and sleep issues is complex, but studies have shown that stress affects various neurotransmitters that impact the brain. “Increased cortisol, which is elevated as part of the stress response, may be of particular importance,” Brandon Peters-Mathews, MD, a sleep medicine doctor at Virginia Mason Medical Center, Seattle, and author of Sleep Through Insomnia, tells Health. “These chemicals may shift the sleep-wake balance in the brain, which may increase sleep fragmentation and lead to insomnia (habitual sleeplessness or inability to sleep) and increased dreaming.” Here's why you might be experiencing any (or all) of those sleep-related conditions right now—and what you can do to improve your sleep ASAP.
Dr. Rodriguez says insomnia often runs in families, but is also closely linked to mental health disorders, like anxiety. “The pandemic may exacerbate insomnia in patients that already suffer from it, or trigger new insomnia in others," he says. "As well as anxiety relating to the coronavirus, an abrupt change in daily activities and social isolation may contribute to changes in sleep patterns."
If you’re spending more time on your screens than ever—looking at news updates, reading COVID-19 advice, and staying connected to family and friends—this can make it even harder to fall asleep because the blue light from screens tells the brain to stop producing the sleep hormone melatonin, he adds.
Insomnia can also be depression-based. A consistent low mood, more downtime at home, and a lack of energy can increase daytime napping, which can ultimately make it harder to fall asleep at night.
If you can fall asleep without too much trouble at bedtime, but experience many brief arousals throughout the night, this is known as sleep fragmentation. It's often caused by major stressors, such as the coronavirus pandemic.
“The brain processes information during sleep,” Dr. Peters-Mathews says. “Many of our routines have been severely disrupted by COVID-19. As we spend more time at home, we may have increased familial or relationship stress. Our normal outlets to reduce stress—exercise, spending time with friends, going out to eat, seeing a movie, or being in nature—may be absent. As the brain processes this additional stress, we may have more nighttime awakenings.
Vivid, disturbing dreams (what most people call nightmares) are closely linked to frequent nocturnal awakenings, the sleep docs say. Dreaming is a characterization of rapid eye movement (REM) sleep, as well as a faster pulse rate and breathing, which happens at intervals during the night. “Waking from REM sleep will lead to the recall of these disturbing dreams,” Dr. Peters-Mathews says. “Stress may also cause increased dream recall.” So really, it may not actually be the case that you’re having more disturbing dreams—just that you’re remembering more of the dream content because you’re waking up more often through the night.
However, there’s still a connection between anxiety and disturbing dreams. “We see anxiety triggering extreme dreams in patients with post-traumatic stress disorder (PTSD),” Dr. Rodriguez says. While most people won’t experience PTSD as a result of the pandemic, it can’t be ruled out—particularly for frontline workers and those who have lost loved ones to the disease.
If it makes you feel any better, some studies suggest that anxious dreams aren’t all bad. A 2010 study published in Current Biology found that people who dreamed about solving a maze they’d been working on performed 10 times better than those who didn’t dream about it. And a 2014 study of students studying for the Sorbonne exam, published in Conscious Cognition, found that those who had anxiety dreams the night before the test performed significantly better on it.
How to improve your sleep:
The most important thing right now, according to Dr. Peters-Mathews, is keeping a regular sleep-wake schedule. “Try to get up at the same time every day and get 15 to 30 minutes of sunlight exposure upon awakening,” he says, adding to "go to bed feeling sleepy, but don’t spend more than seven to nine hours in bed.” While everyone has different sleep requirements, Dr. Peters-Mathews says most adults only need about eight hours. (Those sleep needs start to change in those under 18, however—teens ages 13 to 18 need about up to 10 hours a night, while babies ages 4 months to 12 months should get up to 16 hours of sleep a day, including naps, per the American Academy of Pediatrics.)
You should also be aware of how your daily activities can harm or benefit your sleep schedule. "Try to avoid naps, and be careful with your consumption of caffeine and alcohol, especially in the evening," says Dr. Peters-Mathews. Dr. Malow, on the other hand, stresses the importance of regular daily exercise, and says even a walk can be helpful for promoting sleep. “Try to move every hour and engage in regular exercise—outside if you can,” she says. And of course, it's important to limit your news intake right now, if that causes added anxiety. "Turn screens off close to bedtime, especially social media and the news cycle,” she says. The use of blue-light filter glasses may also help in minimizing poor sleep habits caused by our brain reception of blue light emitted from digital screens.
If you find yourself feeling stressed about not being able to work, go to the gym, or spend time with your friends, try to spend some of that free time on self-care. “Try to cultivate ways to reduce stress and reach out to others for support,” Dr. Peters-Mathews says. “If insomnia persists, consider cognitive behavioral therapy for insomnia (CBTI), which is a technique for treating insomnia without medications.”
But remember: Any coronavirus-related anxiety you’re feeling won’t always be there. "There is light at the end of the tunnel," Dr. Jackson says. "We just have to try and take the positive out of each day and focus on what we can do in the here and now."
The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.