SEPTEMBER 3, 2020
Sara Tibebu tried bubble baths. She curated playlists of low-fi beats, followed guided meditation videos and paid for virtual therapy. In desperation, she even plucked and dried lavender to make sachets to place inside her pillowcase.
“The lack of sleep is just driving me crazy,” said Tibebu, 36, a technical writer who lives in Takoma Park, Md., where most nights her eyes snap open around 2 a.m., and she begins to obsess over everything from the dismal U.S. response to the pandemic to the sorry state of her love life.
As if the novel coronavirus has not already wrought devastation aplenty on the world, physicians and researchers are seeing signs it is doing deep damage to people’s sleep. “Coronasomnia,” as some experts now call it, could prove to have profound public-health ramifications — creating a massive new population of chronic insomniacs grappling with declines in productivity, shorter fuses and increased risks of hypertension, depression and other health problems.
It’s easy to see why people can’t sleep, experts say. The pandemic has heightened stress and upset routines.
Bank accounts are strained and children are home. Days lack rhythm and social interaction. The bedroom, which sleep experts say should be an electronics-free sanctuary, also now serves for many as a makeshift office. The news is gripping, bad and breaking around the clock in blue light that discourages shut-eye. The future is uncertain, the end of the crisis indiscernible.
“Patients who used to have insomnia, patients who used to have difficulty falling asleep because of anxiety, are having more problems. Patients who were having nightmares have more nightmares,” said Alon Avidan, a neurologist who directs the UCLA Sleep Disorders Center. “With covid-19, we recognize that there is now an epidemic of sleep problems.”
Even before the virus, lack of sleep was a simmering public-health crisis associated with a suite of maladies. Roughly 10 to 15 percent of people worldwide were suffering from chronic insomnia, the struggle to fall or stay asleep at least three nights a week for three months or longer. Crises such as natural disasters or terrorist attacks are known to trigger short-term sleeplessness. But experts say the pandemic’s unprecedented global impact and protracted nature threaten to expand the rate of chronic insomnia, which is much harder to treat.
“Insomnia is not a benign problem. … The impact of insomnia on quality of life is enormous,” said Charles M. Morin, director of the Sleep Research Center at Université Laval in Quebec, who has called for large-scale campaigns about the value of shut-eye to stem a coronavirus-era sleep crisis. “We hear a great deal about the importance of exercising and good diet, but sleep is the third pillar of sustainable health.”
Morin is leading a 15-country project to measure the pandemic’s impact on sleep, but there is already evidence of broad deterioration. Prescriptions for sleep medications jumped 15 percent between mid-February and mid-March in the United States, according to Express Scripts, a major pharmacy benefit manager. At the UCLA Sleep Disorders Center, the number of patients complaining of insomnia has risen 20 to 30 percent, and more of them are children.
Web-based studies in China, France and Italy found insomnia or poor sleep in about 20 percent of respondents, particularly during pandemic-related shutdowns — which, Italian researchers wrote, seemed to cause people to lose track of days, weeks and time itself.
While such surveys are not methodologically robust, they provide “an important signal, especially when it’s consistent across countries,” said Orfeu M. Buxton, a sleep researcher at Pennsylvania State University, who said it’s important to view anxiety and sleep troubles as appropriate at a time like this.
“We evolved these brain mechanisms to help us react to literally existential threats, and they’re piling on right now, especially for the less advantaged,” Buxton said. “The circumstances are such that sleep is a sentinel, a sign that things are really wrong in our country and the world.”
‘I can’t continue living this way’
The word Buxton uses to describe the unprecedented confluence of stressors is dread. Dread about the future is often imagined, he said, but not now. “This is dread that’s real,” he said.
It is also the word Cheryl Ann Schmidt uses for the heavy, knotlike feeling that hits her solar plexus every time she lies down at night, and even when she tries to nap.
“I get this sense of dread, like I’m not going to wake up, like something is seriously wrong in the world,” said Schmidt, 65, who lives in East Lansing, Mich.
Schmidt’s sleep woes began when she was sent home from her job as a recycling director at a Styrofoam company in April. They only got worse a month ago, when she was laid off. For two terrifying weeks before Medicare kicked in, she had no health insurance and didn’t leave the house for fear of injury or illness.
Now, Schmidt said, she lies awake fretting about finances and lost retirement plans, then chastising herself for self-pity when others are dying of covid-19, the illness caused by the coronavirus. Most nights, she waits in the darkness until she hears the thump of the newspaper hit her front door around 4:30 a.m. That’s when she gives herself permission to rise and read about the country’s latest crises at her dining table.
“Sometimes, the thought goes through my head that maybe getting this virus really is inevitable, that I should just get infected and get it over with. And if I die, I die,” Schmidt said. “It’s not that I really have a death wish, but in the middle of the night, I think to myself, I can’t continue living this way.”
The unusual, toxic cocktail of pandemic-era stresses that degrade sleep is so strong that physician Abhinav Singh, director of the Indiana Sleep Center, coined a mnemonic to explain it: “FED UP.” The letters stand for financial stress, emotional stress, distance from others, unpredictability, and personal and professional concerns.
When shutdowns were imposed in March — freeing people of commutes and sprints to the school-bus stop — some of his patients began sleeping better. Months later, they’re seeking help, as are former patients and many new ones.
“The unpredictability of when it’s going to end is starting to weigh back on people,” Singh said.
No end in sight
Sleep physicians are seeing increasing delays of bedtimes and wake times. Avidan, of UCLA, said some of his patients are “living in L.A., but they’re on Honolulu time zone.” That disrupts the circadian rhythms that regulate sleep cycles, particularly by depriving people of exposure to natural light early in the morning, Avidan said. And it is exacerbated by the artificial light of screens — drivers of pre-pandemic sleep disorders and the way many now connect to work meetings, happy hours, entertainment and news.
Circadian rhythms are also affected by daily routines — and lack thereof, nowadays — such as meal times, riding the subway or hitting yoga class.
“Social cues are also circadian cues,” Singh said. And they have been ripped away.
Carliss Chatman, an associate law professor at Washington and Lee University, expected to get the best sleep of her life once the school closed. Her sleep had never been stellar, but she figured she would slide into her normal summer habits — working from home and sleeping a short night and a solid afternoon nap.
Before the pandemic, however, the self-described extrovert now realizes, working from home meant writing at coffee shops or libraries that are now shuttered, and lunching with friends. Now, it happens in an upstairs office at her house, where there’s no one to greet.
Chatman, 41, has eliminated her triple Americanos, limited alcohol and sugar, hung blackout curtains and kept up with exercise. Even so, she finds it impossible to nap. She’s left with sluggish afternoons and about four hours of fitful sleep at night, much of it spent ruminating on what would happen if she gets covid-19.
“I find myself contingency planning a lot,” Chatman said. “What happens to the class if I can’t teach it?”
For Karthik Kumar, an attorney in the Washington area, “a switch flipped” in May, as he realized there was no end in sight to the uncertainty. His slumber is now punctuated by apocalyptic dreams: He is stuck in a bunker, methodically counting how many food rations he has left, or wandering through an abandoned city as society crumbles around him.
Dramatic dreams are a consequence of heightened anxiety, according to clinicians who have seen a rise in patients reporting nightmares, night terrors and sleepwalking. Vivid dreams can also result from sleeping longer or later in the morning, when sleep is particularly dream-rich — but not necessarily restful.
“The one common thing in my dreams is that things are rapidly falling apart, and I’m attempting to survive,” Kumar said. “I wake up feeling like I spent the night being chased by a bear.”
Sanctuary in the woods
The rise in prescription medications, at least early in the pandemic, is not surprising, experts say. Many people approach primary-care doctors for sleep problems, and pills they prescribe can be effective and safe in the short term. But they are not recommended for chronic insomnia.
There is growing recognition in the medical field that the best treatment is cognitive behavioral therapy for insomnia, said Norah Simpson, a clinical psychologist at Stanford University’s Sleep Health and Insomnia Program, which provides non-drug treatments. But few therapists are trained in it, and insurance doesn’t always cover it. Physicians who specialize in sleep are also in short supply.
The good news, Simpson said, is that therapy can be administered virtually, and such services have expanded during the pandemic. But that requires an Internet connection, an awareness of treatment options and an available practitioner — a combination out of reach for many people.
Even without professional help, people can take steps to improve their sleep, experts say. Abstaining from electronics for at least an hour before bed, getting light exposure by about 8 a.m. and making time at night for sleep are critical.
Many experts advise prioritizing exercise and family time, and going on a media diet or fast. Simpson’s top recommendation: Rethink your consumption of news.
“When we are engaging with news that may be stressful or worrying in the last hour or two before bed, that can really have a negative impact on sleep,” Simpson said.
Tibebu, the technical writer in Maryland, said online therapy for anxiety helped somewhat. So did focusing on self-care — eating well, buying herself flowers.
But in the end, what gave her the most relief during a particularly maddening stretch of insomnia last month was grabbing her one-person tent and fleeing to a state park.
There, below glinting stars, surrounded by the buzz of cicadas and a crackling fire, she got her first full night of sleep in months.
Almost every weekend since, she has been sleeping outdoors, returning to her condo on Sunday night feeling restored enough to withstand yet another week of pandemic insomnia at home.
Never mind that “catching up” on sleep over weekends is a myth, according to research. For now, it’s all Tibebu has.
“That’s the only way I’ve been able to get through the last month,” she said.
Courtesy/Source: Washington Post