As a physician with a specialty in sleep disorders and diseases of the lungs and respiratory tract who treats patients in the New York City area – the epicenter of the coronavirus pandemic – I’ve been hearing from many worried patients and colleagues.
“I can’t fall asleep,” many say. “I keep waking up in the middle of the night.”
“I just can’t turn my brain off.” “Can I have something to help me sleep?”
The common concern of many people who reach out to me is an overwhelming fear of contracting COVID-19 – the infectious respiratory disease caused by the coronavirus – and needing critical care. In their nightmare scenarios, they fear hospitals will be overwhelmed with COVID-19 patients and will be unable to provide enough mechanical ventilators or other critical care needed to keep them alive.
Some of my patients say they are worried they will be considered too old to receive critical care measures and afraid hospitals will have to ration care.
And the health care professionals on the front line of treating coronavirus patients – I’m one of them – fear becoming infected with the coronavirus and infecting our loved ones.
At the same time, the ravages of the economy have wreaked havoc on Americans’ anxiety. More Americans have lost their jobs in the space of a month than in the last decade.
The American Psychiatric Association recently polled Americans and found that more than one-third reported the pandemic affecting mental wellbeing, more than 57 percent are facing economic hardship, and almost 70 percent fear the American economy will be permanently harmed.
I imagine many of you reading this have experienced the same fears and sleeplessness regarding your health and your jobs. Such fears are understandable and quite normal, as is the resulting insomnia.
It’s human nature to want to feel in control of our lives. But many of us feel powerless because we have very little direct control over events as we shelter in place, socially distance, wonder how to pay bills without jobs and have no clue as to when things will return to normal.
The challenge we all face is to not become overwhelmed by a sense of panic.
There are a few simple remedies that will help you fall asleep even in these trying times.
The National Sleep Foundation has issued very useful guidelines to help focus your efforts in sleeping well during a pandemic. This is important because sleep boosts our natural immunity to diseases – and poor sleep quickly lowers our immunity.
It’s important to share your fears with others as the first step to coping with them. This can be done with friends and family by talking on the phone or by connecting over Skype or FaceTime, or by journaling.
Many times this is a good opportunity to reach out for psychological support. Clinical psychotherapists are currently widely available via telemedicine and many of them are volunteering their time to help as many people as possible.
It’s also important to optimize your sleep. Both anxiety and depression can cause sleep disruption in normal times – and these are far from normal times. Look at the news, talk to friends and family and the only topic seems to be the coronavirus. Is it any wonder we can’t stop thinking about this modern-day plague sweeping across the globe?
It’s also important that if you are on medication to make sure you remain on it and check in with your usual doctor. Many doctors, including me, are treating their patients via telemedicine whenever possible to minimize the chances of spreading the coronavirus.
The challenge we all face is to not become overwhelmed by a sense of panic.
In addition, improve your sleep hygiene as much as you can. Keep a regular sleep-wake schedule. Get out into the daylight when possible and walk in the sunshine without sunglasses. Light is the single most powerful stimulus that keeps us on a regular sleep-wake schedule.
Cut back or eliminate your caffeine intake. Caffeine can promote insomnia and also spiral anxiety levels, heart palpitations and agitation.
In addition, regular exercise promotes deep sleep. Anything that makes you warm and glow can be beneficial – a brisk walk, time on a stationary bike, doing some pushups and other such exercises at home all can benefit you.
But don’t do an intense exercise workout at bedtime. It will cause you to be alert and wired, so its best reserved for earlier in the day.
Before bed, plan to have a bedtime routine to signal to your brain that it’s time to wind down. Turn off televisions, computers and cellphones before bedtime because the light they emit causes our natural melatonin produced in the pineal gland in the brain to be turned off. When this happens, the brain doesn’t know night is coming and so cannot prepare for sleep.
A bedtime routine is an acknowledgment we are preparing for sleep, including saying goodnight to family members, washing and dressing for bed. Meditation or prayer can also calm the mind and may help us sleep.
Hot showers or hot baths before bed can also facilitate sleep onset. They help the body become warm and then allow the body to cool down. Sleep onset only occurs as our core body temperature falls.
Simple strategies of improving our sleep hygiene such as those mentioned above, and adding some long-acting over-the-counter melatonin if necessary one hour before your desired bedtime every day can also intensify the brain’s signal to sleep.
Melatonin is safe as long as it is not taken if you have liver disease – melatonin is metabolized in the liver. You should always check with your pharmacist and doctor about drug interactions that may occur when taking melatonin.
If none of the above actions help you, there are specialized behavioral sleep specialists who can retrain your brain to sleep and tackle your insomnia. They can perform cognitive behavioral therapy for insomnia in four to six sessions, often via FaceTime or Skype. This can help eliminate the “performance anxiety” associated with trying to fall asleep that can quickly develop during periods of insomnia.
These sleep specialists can also teach you new techniques to help fall and stay asleep – included guided imagery, self-meditation tapes and progressive muscle relaxation.
Nowadays there are even some digital apps that can provide self-directed programs that promote some of the same techniques gained through cognitive behavioral therapy, so be sure to check your app stores.
One thing that can make it harder to sleep is monitoring yourself on wearable tech. While counting steps and tracking food diaries are very helpful, when it comes to sleep an anxious person can become overly engaged with the app and often interpret data that is tracking movement (tossing and turning) more than sleep.
These devices can make an insomnia patient feel more anxious about sleep – not less – so it may be sensible to avoid wearing these items at this time.
There does come a time when medication may be needed – when all of the above actions seem not to lead to an improvement. Medications play an important role not only to mitigate insomnia, but also to prevent the development of long-term anxiety and depression that can be complications of chronic insomnia.
While long-term anxiety and depression can cause sleep disorders, sleep is beneficial to lessening anxiety and depression. In contrast, acute insomnia – meaning it persists for more than four weeks – can itself precipitate anxiety and depression in some patients.
So it is better to ask for help and discuss medication than to simply “tough it out.”
We need to accept that we cannot control much of our circumstances today. But we can control our sleep habits, recognize there is help available and in the process learn some excellent psychological, physical and environmental approaches to getting the best sleep in difficult times.
Realistically, we have to accept that we are going to be coping with the coronavirus pandemic for some time to come. The good news is we are learning how to cope with it and how to mitigate it. Our nation’s best minds are at work protecting our health and planning to reboot our economy.
We all want the coronavirus nightmare to end – and it will, without question. No one knows how long it will take for a vaccine and effective treatments for COVID-19 to become widely available, but they will. And at that point, we should all be able to sleep more soundly and return to the normal lives we all took for granted just a few weeks ago.