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By Bryan Lufkin
Disrupted routines and ongoing uncertainty are contributing to a surge in insomnia. What can we do about it?
A new year comes with resolutions. One of the most perennially popular goals is, unsurprisingly, getting more sleep. But there’s a problem: the ongoing coronavirus crisis has made getting a good night’s rest significantly harder. Some experts even have a term for it: ‘coronasomnia’ or ‘Covid-somnia’.
This is the phenomenon that’s hit people all over the world as they experience insomnia linked to the stress of life during Covid-19. In the UK, an August 2020 study from the University of Southampton showed that the number of people experiencing insomnia rose from one in six to one in four, with more sleep problems in communities including mothers, essential workers and BAME groups. In China, insomnia rates rose from 14.6% to 20% during peak lockdown. An “alarming prevalence” of clinical insomnia was observed in Italy, and in Greece, nearly 40% of respondents in a May study were shown to have insomnia. The word “insomnia” was Googled more in 2020 than it ever had been before.
Simple, more of us are now insomniacs. With the pandemic into its second year, months of social distancing have rocked our daily routines, erased work-life boundaries and brought ongoing uncertainty into our lives – with disastrous consequences for sleep. Our health and productivity could face serious problems because of it. Yet the scale of the problem could potentially bring change, introducing new elements into how we treat sleep disorders – and get our lives back on track.
Insomnia, whether in a pandemic or not, is difficult to live with. Consistently having trouble falling asleep, or experiencing poor quality sleep, can lead to long-term health impacts including obesity, anxiety, depression, cardiovascular disease and diabetes. Sleep insufficiency – which many health authorities classify as less than seven hours a night – also affects your work; many studies have shown that it makes you more likely to make mistakes, wrecks your concentration, increases reaction times and affects your moods.
That so many of us are currently experiencing sleeplessness comes down to the current configuration of challenging, “almost Biblical” circumstances, says Dr Steven Altchuler, a psychiatrist and neurologist who specialises in sleep medicine at the Mayo Clinic, one of the US’s largest medical research organisations. “If you’re having insomnia, you’re in good company – much of the world is, too. It’s a consequence of all the changes we’re experiencing in Covid,” he says.
Multiple factors are at play. First, our daily routines and environments have been disrupted, making it hard to keep our circadian rhythm intact. Normally, our days run to a schedule of alarm clocks, commutes, breaks and bedtimes – but Covid-19 has shaken all that up. “We lost many of the external cues that are present in the office meetings, the scheduled lunch breaks,” says Altchuler. “What you’re doing [during remote working] is disrupting your body’s clock.”
“Your brain is conditioned: you’re always at your workplace and working, and then at your home and you’re relaxing. There’s a differentiation there. Now, we’re all just home all the time,” says Angela Drake, a clinical health professor at the University of California, Davis who treats patients with sleep disorders and who’s written about coronasomnia. She also flags up the fact that when we work from home, we may be getting less exercise and potentially less exposure to natural light – both of which contribute to better sleep.
That so many of us are currently experiencing sleeplessness comes down to the current configuration of challenging, “almost Biblical” circumstances
There’s also the issue of work performance. Unemployment in many countries is the highest it’s been in years, so it’s no surprise those who are employed want to work hard to keep their jobs. The problem is that working from home can blur lines that used to be fixed, with many people reporting working longer or irregular hours. “We tend to have much less clear boundaries between home and work,” says Altchuler. “People tend to be staying up later.” For many of us, leaving “work at work” is now completely impossible, and disconnecting from the to-do lists and daily stresses of the workday is harder than ever.
Added to this is the fact that we miss our hobbies and friends – vital outlets for relaxation and destressing. Many of us are experiencing mental health problems, which can feed into sleep problems, or vice versa. Our general sense of uncertainty and lack of control can also feed into sleep issues, while the pandemic’s longevity is also a factor; what started out as a “hunkering down” period to play video games and stockpile toilet paper has become a landscape for life that feels semi-permanent. “Initially, people tended to feel motivated to get through the stress [of the pandemic]. But as it continues over time, most people become less able to cope, resulting in greater problems, including insomnia,” says Drake.
Some sleep problems will have become “chronic and long-lasting”, she adds, because the pandemic has created delays to getting treatment in some cases; people have only sought medical attention in emergencies, while some healthcare facilities have become short-staffed or overwhelmed with Covid-19 patients.
In fact, healthcare workers have been hit particularly hard by insomnia over the last 12 months. In December, the University of Ottawa analysed 55 global studies of more than 190,000 participants to measure the prominence of insomnia, depression, anxiety and post-traumatic stress disorder (PTSD) since the beginning of the pandemic. All disorders rose at least 15% among healthcare workers, with insomnia seeing the biggest spike at nearly 24%.
Altchuler points out that insomnia is “commonly associated with PTSD” and, whether you’re a frontline worker or not, it’s common for insomnia to spike after big, negative world events. In general, whenever someone experiences trauma – whether it’s a widespread health emergency like Covid-19, a public disaster like 9/11 or something more individual like a car accident – they can experience persistent sleep problems that go along with PTSD.
How to fight back
Experts say it’s important to seek help when sleeping problems persist – especially these days.
“As the pandemic has continued for a significant time period, not just a couple of months, there’s a high possibility that rates of insomnia won’t dip,” says Lisa Artis, deputy CEO at the Sleep Charity in the UK. “That’s because if people don’t seek help when they start to suffer with their sleep, the chances are their sleep issues become a sleep disorder, i.e., insomnia, and unfortunately there isn’t a quick fix… It’s difficult to break habits that have formed.”
It’s common for insomnia to spike after big, negative world events
But there is some good news. Twelve months into the pandemic, some experts think that it’s triggered advancements in treatment of sleep disorders. Altchuler points to the “rapid expansion of telehealth – virtual medicine and virtual visits” linked to quarantining and our inability or reluctance to visit medical facilities in person. The most common treatment for sleep problems is cognitive behavioural therapy for insomnia (known as CBT-I), which improves your “sleep hygiene” (no smoking or drinking before bed, for example) and trains your brain to associate bed with sleep only by behavioural changes (no working in bed). A University of Michigan study from last year showed that patients who sought CBT-I via telemedicine received just as effective treatment as they would have had in person, potentially opening up better access to assistance.
There are also things individuals can do to try and address the problem. “One of my big rules is you can’t work on your laptop in bed,” Drake says. “I don’t care how comfortable it is. Eventually, the brain pairs work with the bed – it’s a reinforcement kind of thing.” Also limit your news consumption to avoid anxiety that keeps you up at night, don’t use your phone as an alarm clock (another item associated with work – plus the “blue light” devices emit are bad for your sleep) and turn the clock on your nightstand around so you don’t get stressed as you try to fall asleep.
And remember, these circumstances are far from ordinary – so it’s not surprising we’re facing challenges. “The last time there was this kind of event was over 100 years ago,” says Drake. “This is not anything any of us have ever experienced before.”