Quar-insomnia?
Most of us anticipated that there would be some challenges associated with the shelter-at-home directives put in place to protect us from COVID-19. Maybe we’d have to negotiate over who gets the spare office and who has to work from the bedroom at home, who takes the dog for their midday walk , and just how many walks can the dog tolerate in one day. While these day-to-day logistics consumed our attention, other unforeseen consequences of shelter-at-home have quietly mounted outside of our awareness. One such consequence that has impacted many people is increasing difficulty with producing sufficient restful sleep - insomnia.
But how could shelter-at-home possibly be related to insomnia? Wouldn’t people sleep better since they probably have more time (now that they aren’t commuting and running as many errands) to prepare for quality sleep? Well, in many cases, no. Here is my theory why many people have had increased insomnia during the pandemic.
Welcome to My Office/Bed
Ok, I know that not everyone is working from home, but how many of you have started spending more time in bed awake while doing activities OTHER than sleeping? With the whole family at home and limited space, we are often driven to seek our private spaces in our bedrooms. And our beds are just so comfortable - why not watch a movie there? Zoom some friends? Or, gasp, even start working from your bed! This all seems totally benign until you consider the fact that it could actually be reducing your sleep quality! This happens because as we introduce other activities into our bedroom and bed, these activities start to break down the conditioned learning in our brains that associate the sensations of lying in bed with drowsiness. For instance, let’s say you were playing an exciting video game in your bed routinely. Each time you do this, you are decreasing the strength of the association between your bed as a stimulus and the response of feeling drowsy. Now you have actually created one association between your bed and alertness - which is definitely problematic if you have difficulty sleeping. In summary, there are really only two things that you should be doing in bed - both start with “s” and one is sleep. Move other activities to another location in your room, or preferably, to another location in your house. Remember to reduce screen time prior to bed too!
What Day is it Anyway?
Many people have noticed that days and weeks are blending together such that some people don’t even realize what day it is. For those of us fortunate enough to have kept our jobs during the pandemic, we still have some cues telling us “be online at 9am” or “work ends on Friday”. Even with these cues in our lives, many of us have been able to wake up later and go to bed later because we don’t have to commute to the office or drop the kids at school so early. This situation is probably even tougher for those who have become unemployed. There are often very few cues in your environment about when to be awake and when to go to sleep if you don’t have a job to help give you these cues! If you live alone and are unemployed, there may actually be no social cues for when to wake up and when to fall asleep. This lack of cues can send your circadian cycle into a spin - especially if you are prone to insomnia. To correct for this, you will have to do your best to create your own cues for waking and sleep. First of all, determine a sleep-wake schedule that makes sense for your current goals. If you hope to get a job, for example, then setting a sleep-wake schedule that mimics the typical schedule of that job that you want is a good idea. Most smart phones actually now have a “bedtime” function that will give you alarms to remind you when to prepare for bed and when to wake up. Keep in mind that if your sleep-wake schedule has shifted significantly, it can take several weeks - or even months in severe instances - to shift your schedule back to a regular one. If you are sleeping at really unusual times or are having significant insomnia, make sure to consult with a psychologist or physician who specializes in sleep.
Lights off, Brain on
Have you ever had the experience of being ready to drift off to a night of much-needed sleep only to find that once the lights go off your brain starts jumping from worry to worry? Your body may start to feel restless. Perhaps you have the thought “oh great, now I’ll never be able to fall asleep” and you start to feel anxious or frustrated about the night ahead and the day of fatigue that will follow. Unfortunately, this is not an uncommon experience, especially with all the added stressors of living with the pandemic. The problem with worrying in bed is that this increases stress hormones, which decrease our ability to produce and sustain sleep. So what are we to do about this? I mean, you can’t just turn off your mind. If only it were that simple. One strategy that has been helpful is to actually keep a small worry journal on your nightstand. When you are ruminating on worry thoughts while trying to sleep, simply jot down a few bullet points that describe the problems that you are ruminating about. Don’t move to problem solving. Just describe the problem and put the journal back on your nightstand. Then practice mindfulness of your breathing or body (practice following your breath or do a brief body scan meditation) and allow worry thoughts to slide off your mind as though it was teflon coated. If your mind moves back into worry rumination, make a few more bullet points and commit to yourself that you will problem solve these issues in the morning when you will have more cognitive ability to generate wise solutions. This can help break the worry chain and get you back to sleep!
Be Your Own Sleep Scientist
If you are having persistent difficulty with sleep, one of the first and most important things to do is to start tracking your sleep. Not only can this help you self-correct the course of your sleep, but it will help inform your treatment for insomnia if you decide to see a CBT-I (Cognitive Behavioral Therapy for Insomnia) therapist or a sleep-trained physician. I recommend using an app that was developed by the US Department of Veterans Affairs called CBT-I Coach. This app will help you track sleep and will even give you some awesome pointers on how to improve your sleep. Finally, the app will allow you to share your data with your therapist or physician, which is critical data for the effective treatment of insomnia.
Just to say it one last time - if these self-help strategies aren’t working, please reach out to a sleep-trained psychologist or physician.