Insomnia in the time of COVID

 

Insomnia has been part of the human experience for hundreds (if not thousands) of years, triggered by upheaval or significant stress; health or financial threats; change in routines; grief and loss.

 

Enter COVID. Homeschooling for the first time? Unemployment, under-employment, over-employment? Financial stress? Change in relationship status? Plans (remember those?) cancelled? Drinking more? Eating more? Napping more? Spending more time with children and partners with no hope of escape? This all likely sounds familiar. These changes alone often precipitate a bout of sleeplessness, even when all else is stable. And ironically, the very thing we may be craving—a respite, an ability to recharge, the elixir to life’s stressors – aka sleep, may feel out of reach, adding to our already long list of depleted personal resources. 

 

What is happening? It is likely that you are experiencing a bout of “acute” insomnia (symptoms that go on for days or weeks). This is distinct from chronic insomnia, when symptoms persist for three or more months. Why is this distinction an important one? Because most people can tolerate a few days or weeks of insomnia. While frustrating and unsettling, it can be considered adaptive, allowing our “fight or flight” response to kick in, perhaps granting us some extra time to get things done and make necessary adjustments amidst the crisis at hand. Acute sleep struggles will typically resolve on their own within a matter of weeks. However, if we respond by developing poor sleep habits, these compensatory behaviors can end up being counterproductive and perpetuate insomnia in the long-term.  

 

How do I avoid chronic insomnia? 

 

Keep the same rise (wakeup) time, no matter what. Yes, even on weekends and no matter how poorly you slept the previous night. This will help you stick to a regular rhythm, allow for morning light exposure, and allow your sleep drive (the intense sleepiness we need to have at night to enable good sleep) to take over on a regular basis.

 

Give up sleep effort. Our colleague Donn Posner, Ph.D likes to say that trying to sleep is like trying to digest food. The more you try and the more effort you expend, the harder it is to achieve. Frustration (and more sleep loss) ensues. What to do instead? Stop trying so hard. Get out of bed, go do something else (a pleasant, not stressful activity), and IF sleepiness returns, get back in bed and allow it to happen. If not, trust that sleep will return, if not that night, likely the next. And remember: no matter how poorly you sleep (even if you feel like you fell asleep just before your alarm goes off) get up at your usual wake time! 

 

Beware of over-extending your time in bed. Going to bed too early, sleeping much later than usual once you finally get to sleep at 3am, and napping as an effort to “catch up” on lost sleep, all serve to disrupt one’s circadian (biological) rhythm. These behaviors will dysregulate your sleep drive, siphoning away the high level of sleepiness you need at bedtime to produce sufficient sleep overnight. 

 

Practice stimulus control. If you are trying to work from home with kids around, your bedroom has likely become an office, a place to hide, an entertainment center, a snacking spot, etc. Bottom line: use the bed (and ideally bedroom) for sleep and intimacy only. Allow your bed to be a signal (aka stimulus) for sleep…not all of the other late-breaking COVID-news, Dr. Google, Tik-Tok viewing, etc. If you wake up during the night, get out of bed, go somewhere else, and do something else, until the sandman comes to knock on your door…then go ahead and get back into bed and see if sleep comes again. And, if not tonight, tomorrow night will likely be better. 

 

Be careful of the sleep “lies” you tell yourself. We often get attached to unhelpful beliefs and attitudes about sleep out of anxiety, experience, misinformation in the media, or just because they seem to make sense. Often we tell ourselves:  “My day will be completely ruined if I don’t sleep tonight,” “I am going to get COVID-19 if I don’t get sleep”, “I will never sleep again”. These types of thoughts are activating, make us feel anxious, and in turn, fuel our insomnia, making it even more difficult to fall asleep.  Realize that these thoughts represent your insomnia “talking.” Push back against it! What is the evidence for these statements? The evidence against? Try to “reframe” these statements  into healthier and more positive messages. Consider using mindfulness, meditation, and relaxation strategies to help calm your mind as well. 

 

Avoid the middle-of-the night snacking! We are all about comfort right now, and there’s nothing like a pint of Dulce de Leche or a bag of potato chips to soothe the soul. Using food to help you get back to sleep can create a slippery slope of sleep-related eating disorders and even more insomnia, leading to more maladaptive health habits that need breaking over the long-term. Keep it simple: don’t go to bed hungry, consider having a light snack an hour or more before bedtime, and avoid using food as a middle-of-the night pacifier. 

 

Be patient. Change doesn’t happen overnight (pun intended). It may take several weeks or even a month or two to turn things around, especially in this climate. By practicing healthy sleep habits you are more likely than not to find sleep again. It may be a little different right now, and that’s OK too, but the goal is to respond in a way that is protective and fosters healthy sleep behaviors. If you get discouraged, or feel overwhelmed, please know that there are many resources and experts out there to help.

Resources for Finding Cognitive Behavior Therapy for Insomnia (CBT-I) Therapists in your area:

Society of Behavioral Sleep Medicine

https://www.behavioralsleep.org/index.php/united-states-sbsm-members

Association for Behavioral and Cognitive Therapies

http://www.abct.org/Help/?m=mFindHelp&fa=dFindHelp

 

 

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