For many Americans, sleep problems aren’t new. More than one-third of Americans haven’t received enough sleep on a regular basis for years. Lack of good sleep is such a widespread problem that the CDC has called it a “public health epidemic.”
Sleep-deprivation was already a problem, then, COVID-19 happened. With the stress, grief, and anxiety of COVID-19 and its impact on daily life, people are reporting more sleep problems than ever before. Around four in ten people have reported trouble sleeping during the pandemic. Brought on by the stress of living in a global pandemic, sleep experts have labeled these sleep problems “coronasomnia,” a portmanteau of coronavirus and insomnia.
Dr. Abinav Singh, board-certified sleep medicine and internal medicine Medical Director of the Indiana Sleep Center, calls coronasomnia one of several “tandemics”, which he explains as, “an epidemic caused by, made worse by, and runs in tandem with the pandemic.” Another example of a tandemic is the increase in mental health problems, such as anxiety and depression.
Coronasomnia is characterized by an increase in sleep problems during the pandemic, as well as symptoms of anxiety, depression, and stress. While insomnia is often linked to anxiety and depression, coronasomnia differs from traditional insomnia because it’s related to the COVID-19 pandemic.
For many, the symptoms of coronsomnia started or intensified during the pandemic. Also, several of the causes of coronsomnia, which range from the loss of a daily routine to increased media consumption, are unique to living in a global pandemic. Dr. Singh has summarized these stressors into the mnemonic device “FED UP”:
Distance from others
Symptoms of coronsomnia include:
Throughout the COVID-19 pandemic, various studies have documented increased rates of insomnia and mental health disorders. Prior to the pandemic, about 24% of people suffered from sleep maintenance insomnia, or difficulty staying asleep. During the pandemic, that increased to 40%. Among individuals with sleep onset insomnia, or difficulty falling asleep in the first place, the prevalence jumped from 15% to 42%. Overall, experts estimate the number of people with any form of insomnia has increased 37% from pre-pandemic levels.
At the same time, four in ten people have reported at least one mental health symptom during the pandemic. Compared with 2019, the number of people with symptoms of anxiety has tripled. For depression, it’s quadrupled.
People’s sleep habits have also changed during the pandemic. People are spending less time sleeping at night and napping more during the day. They’re also pushing back their bedtimes and wake times, by as much as 39 and 64 minutes, respectively. As a result, sleep quality has suffered.
Anyone can develop symptoms of coronasomnia, but certain groups of people have an increased risk, including:
Patients with COVID-19 are most likely to report sleep problems, due to symptoms of the illness that make rest difficult, such as breathing and coughing. 75% of patients have reported trouble sleeping.
Frontline medical workers, particularly those working directly with COVID-19 patients, have significantly higher rates of poor sleep quality, insomnia, anxiety, depression, and disturbed sleep.
These individuals have greater exposure to COVID-19, and, therefore, have increased anxiety over infection, as well as higher levels of work-related stress due to supply shortages. Up to 80% of these medical workers report disturbed sleep — twice as many as those who don’t work directly with COVID-19 patients. Female workers were 40% more likely than male workers to experience insomnia.
Compared with the general population, healthcare workers have been more than twice as likely to report anxiety and depression during the pandemic. Those with depression, in turn, have a twofold risk of disturbed sleep.
Healthcare workers already have a higher risk of poor sleep, especially those who work longer and overnight shifts. With poor sleep, their immune systems become compromised and cognitive performance suffers, putting them at an even higher risk of becoming infected and impairing their ability to do their jobs.
Unpaid caregivers also suffered worsened mental health during the pandemic. From May to June of 2020, unpaid caregivers were over three times more likely to start or increase their substance abuse, or have thoughts of suicide. Substance abuse can exacerbate symptoms of insomnia, which can increase the risk of relapse.
Students and young adults with coronasomnia display more extreme symptoms than adults, particularly in the delay of their bed and wake-up times. During the pandemic, the average student has pushed back their bedtime by 39 minutes, which is more than twice as long as the delay by the average adult.
For some of these students, delaying their bedtime has allowed them to follow a sleep schedule more in line with their natural circadian rhythms. Adolescents experience a circadian shift, during which they naturally feel tired later. This makes it harder for them to get adequate sleep when they have to wake up early for school. During the pandemic stay-at-home orders, though, university students have been able to go to sleep and wake up at later times, resulting in about 30 minutes more sleep each night.
For other students, however, the pandemic has contributed to poorer mental health. The percentage of people with mental health problems increased from 23% before the pandemic to 37% in April 2020. The increases were more pronounced among young adults and women, two groups already more likely to suffer from anxiety, depression, and sleep problems. Researchers attribute this to the effect of social isolation on younger people, which increases the sense of loneliness and vulnerability and can lead to symptoms of depression and anxiety.
The COVID-19 pandemic has upended nearly every aspect of our daily lives. Parents and children adjusted to remote schooling while millions of workers transitioned to remote work, were furloughed, or lost their jobs entirely. People have lost loved ones and experienced sickness. There is an ongoing state of uncertainty over job security, health, and when things will return to normal. With so much changing all at once, it’s no wonder people are having trouble sleeping.
Major stressful life events — from natural disasters to terrorist attacks — take a toll on psychological well being and create sleep problems that can last for months afterwards. A worldwide pandemic qualifies as one such event.
Even everyday emotional stress can alter your sleep architecture, reducing the amount of time you spend in restorative slow-wave sleep. However, major stressful life events have more pronounced effects on sleep. After a majorly stressful event, people experience decreases in slow-wave sleep, increases in rapid eye movement (REM) sleep, and an increased likelihood of waking up during the night. These effects can last up to 2 years after the event.
Stress increases your levels of cortisol, a hormone that operates inversely to melatonin, the sleep hormone. Cortisol rises in the early morning to energize your body for the day, and lowers in the evening, as melatonin production begins to prepare you for sleep. When your cortisol levels remain elevated, melatonin production gets disrupted, as does the restfulness of your sleep.
The pandemic has introduced many stresses to our lives, but being stuck at home is a stressor all its own. This stress increases if you’re sharing your home with a limited number of people, you’re dealing with increased work and parenting obligations, and there’s less newness in your life to keep you engaged. Being at home all day can also reduce your sleep drive, since you get less exposure to natural light — a key regulator of your sleep-wake cycle — and have more opportunities to sleep in and nap.
Due to social distancing guidelines, many “normal” parts of life, from hobbies to social events, disappeared over night. The loss of these activities increases our sense of social isolation and can negatively impact mental health. Normal activities also served an important function in relation to our sleep. Commutes, meals, exercise classes, and social events were all time markers (i.e., zeitgebers) that helped reinforce our circadian rhythms, or sleep-wake cycle. After the COVID-19 outbreak, these routines were suddenly flexible, or even gone.
For some people, these changes contributed to a phase-delay insomnia. They started going to bed later and waking up later. They also reported lower sleep quality, despite spending more time in bed. These symptoms were more pronounced for people with higher rates of depression, anxiety, and stress.
Without a daily routine, it’s tougher for your circadian rhythm to stay on track. When the circadian rhythm gets disrupted, it’s not just sleep that’s affected. Your circadian rhythm regulates a host of biological functions, including your digestion, appetite, immune response, and more.
As a result, the poor sleep and anxiety caused by coronasomnia become a self-fulfilling cycle. People receive less sleep, which increases their stress levels, worsens their mood, and causes grogginess. Some people may take a nap to wake up, but this can lead to more sleep problems later that evening. Sleep deprivation can also decrease your motivation to exercise and increase your appetite for unhealthy foods. These changes can then lead to weight gain, which increases your risk for sleep disorders.
Left unchecked, chronic sleep disruption can lead to long-term health consequences, such as cardiovascular disease, obesity, depression, and stroke.
In an effort to keep up with the latest information on COVID-19, people have significantly increased their media consumption during the pandemic and now rely on a larger range of news sources. In almost all aspects, these behaviors have led to increased levels of mental distress. Spending more time consuming news media, as well as checking news more frequently, have both been associated with higher levels of anxiety. The more a person seeks out different types of media, such as TV or social media, the higher their symptoms of fear.
Problematically, people have particularly increased their media consumption at night, close to bedtime. As a result, people are also spending more time with their electronic devices, binge streaming and watching news. Increased screen time is linked to shorter and less restful sleep.
More screen time means more exposure to blue light. Your brain interprets blue light similarly to sunlight. Exposure to this light at night keeps your cortisol levels elevated while suppressing melatonin. In other words, you feel more alert and stressed out, instead of relaxed and ready for sleep.
Fortunately, there are many things you can do to combat coronasomnia and sleep better during the pandemic. Start by improving your sleep hygiene, establishing daytime and nighttime routines, and taking efforts to manage your stress.
Sleep hygiene is a term for the habits you have surrounding sleep. Just as dental hygiene focuses on flossing and brushing your teeth, sleep hygiene focuses on healthy habits that promote better sleep. Try these strategies to improve your sleep hygiene:
Routines provide our brains with cues for when to eat, work, feel alert, and feel tired. Establishing a daily routine and following it provides a sense of normalcy that can reduce stress. Routines also provide clear time markers in a work-from-home lifestyle that can feel monotonous at times.
Set clear times to begin/end work and eat your meals, and schedule time for regular breaks and exercise. If possible, spend those breaks outside. A morning walk outside can clear your head, re-energize you, and help reinforce your natural sleep-wake cycles.
Also, create separation between your work and sleep spaces. Your commute may just be from the bedroom to the living room, but that can still help your brain associate your bedroom with relaxation alone. Avoid working in your bedroom and bringing work-related objects into your bedroom. If you live in a small space, get a standing room divider to help break up your work space, and avoid working on your bed. Your bed should only be used for sleep and sex.
At night, follow a bedtime routine to help you unwind from the day. Performing the same set of activities every night also signals to your brain that it’s time to sleep. Stop using your electronics at least 1 hour before bed, and turn down the lights. Instead, enjoy a relaxing activity like reading a book or taking a bath. Listen to something calming, like a guided meditation or gentle music.
Stress makes sleep difficult, pandemic or not. Regular exercise, journaling, and taking a break from the news may help relieve stress and improve your sleep.
Daily exercise contributes to more restful sleep. Exercise is also a great reliever of stress and anxiety. Try to finish your workout at least 1 hour before bed. Vigorous exercise energizes and heats up the body, so leave enough time for you to cool off and calm back down before bed.
Our minds are being overloaded with stressful information during the pandemic. It’s easy to get caught up and overwhelmed by it all.
Help your mind stay calm and focused by setting a dedicated time to worry and take it all in. Then, write down everything that’s stressing you out. The act of putting pen to paper helps you flush the thoughts from your mind and reframe negative feelings with positive emotions, relieving anxiety. Schedule your worry time a few hours before bed, so the thoughts don’t keep swirling once you’re all tucked in.
Do what you can to prevent new stressful information entering your mind in the evening hours. Avoid watching the news or scrolling through social media. Sensational and worrisome news stories can activate your sympathetic nervous system, creating anxiety at a time when you want to be calming down. Plus, catching up on news likely means introducing your eyes to more blue light at night, which interferes with sleep.
Know that things may be tough right now, but they will get better. Getting the vaccine may also alleviate some of your stress. Until then, try the tips above to improve your sleep.
If your sleep problems persist, speak to your doctor. They can provide additional recommendations, such as cognitive behavioral therapy for insomnia (CBT-I), a proven treatment for insomnia. And, for those who are still practicing social distancing, studies show that CBT-I is just as effective when delivered via telemedicine vs. in person.