COVID-19: Managing stress and sleep

The current COVID-19 pandemic has led to significant stress for individuals, families, and communities. In following recommendations to stay home as much as possible and other preventive protocols, many people are finding themselves without the structure of work and school that helps anchor a normal day and night routine. This lack of routine coupled with increased stress is a perfect storm for sleep problems.

Sleep is one of the most important health behaviors affecting immune function, mental and physical health, and quality of life. The Centers for Disease Control (CDC) and American Academy of Sleep Medicine recommend the follow sleep guidelines:

• Adults: 7 or more hours of sleep
• Teens: 8-10 hours
• School-age children: 9-12 hours
• Preschoolers 10-13 hours (including naps)
• Toddlers: 11-14 hours (including naps)

Biologically, stress and sleep don’t play well together. In times of stress and uncertainty it’s even more important to engage in strategies that can help to manage stress such as regular exercise, healthy meals, relaxation and mindfulness, self-care, and personal connections (within the COVID 19 guidelines for social distancing). Each of these health behaviors enhance how well you sleep.

In addition to a focus on healthy behaviors, here are some things you can do that can lead to better sleep.

• Create and maintain regular daytime and nighttime routines. Get up about the same time each morning and go to bed about the same time each night. Set regular mealtimes and exercise and play times.
• Prioritize getting outside each day for at least 30 minutes, preferably before noon. Consider a walk around the block in the morning or breakfast outside. Bright light exposure helps our bodies maintain a regular 24-hour rhythm, which is crucial for quality sleep.
• Avoid worrying, working, answering emails, watching movies, or hanging out in bed — and help your kids do the same. A strong association between the bed and sleep can help you fall asleep faster and get back to sleep during the night.
• Go to bed when you feel sleepy and don’t try to make yourself go to sleep. If you go to bed and can’t sleep, get up and do something relaxing until you’re sleepy, then go back to bed. Avoid falling asleep on the couch, in the recliner, or other places that aren’t your bed.
• Adopt calming and soothing bedtime routines for yourself and your kids. Here are some suggested activities:
  • Reserve the hour before bed for activities that are positive, relaxing, and create a sense of safety and ease.
  • Read a positive but not too exciting book
  • Take a shower or bath
  • Review things you’re grateful for
  • Talk with friends or loved ones.
• Dim the lights in the evening and avoid screens one to two hours before bed. Bright lights and screens send a signal to the brain that it’s daytime, which can lead to more difficulty falling or staying asleep and more fatigue the next day. If you must be on a personal electronic device before bed, enable the night mode or download a blue light blocking app to help filter some of the light that negatively impacts sleep. Blue light blocking glasses can also be used for evening screen use.
• If you find yourself worrying or having trouble quieting your mind at night, take some time a couple of hours before bed to write down the things that are concerning you. Set aside a “worry time” the next day to focus on the things on your list. Keep a pad of paper by your bed so you can write things down.
• Try relaxation exercises, such as slow, easy breathing — performed on your own or with the guidance of an app or recording — at bedtime. Frequently used apps include Insight Timer, Calm, Breethe, and Headspace.
• Pay attention to healthy sleep habits:
  • Avoid caffeine after noon
  • Avoid alcohol in the evening
  • Avoid the use of alcohol for sleep. While it can be associated with falling asleep faster, it leads to waking more often during the night and poor-quality sleep
  • Keep your room cool and dark
  • Avoiding eating meals within two hours of bedtime
• Be careful about napping. For adults, short naps (15-20 minutes) in the midafternoon can feel refreshing and provide a daytime boost. However, longer or later naps can interfere with nighttime sleep. It’s usually best to avoid long naps if you’re having trouble sleeping at night. However, if you’re ill, napping and extra sleep may help your recovery, so get that extra sleep if needed.
• Take sleep medications only as prescribed and avoid frequent or long-term use of over-the-counter sleep aids.

Remember that in times of stress, sleep often becomes temporarily disrupted but will return to normal in time. If you’re experiencing a lot of distress about your sleep, talk with your medical or mental health provider.

QUESTION: If I’m sick, should I sleep in the same bed with my partner?

To minimize the risk of transmission, the CDC has recommended that ill family members limit their contact with others by staying in a single, separate area of the home.

QUESTION: I’m coughing all night long and it’s keeping me from sleeping. What can I do?

Talk with your medical provider about the cough and any other symptoms you have. In addition to contacting your medical provider, the CDC recommends using a humidifier at night, staying hydrated, and considering cough drops (but NOT for children younger than four). Ask your pharmacist — via appropriate distancing/isolation precautions — about over-the-counter remedies. Avoid going to bed with a cough drop in your mouth to avoid accidental choking if you fall asleep.

QUESTION: Working from home and online school for the kids has demolished any sense of routine at our house and no one’s sleeping well. What can we do?

• Set age-appropriate, consistent bedtimes and wake-up times for everyone in the family.
• Consider involving everyone in setting up the routine. It will help to have buy in from the kids (especially teens).
• Set regular meal and exercise/play times.
• Aim for bright days including time outside and dim/dark nights to help maintain the natural 24-hour rhythm.
• Set a “power-down hour” in the hour before bed that includes relaxing positive routines as described above. Screen-free is best.

QUESTION: I have sleep apnea. Is it OK to continue to use my CPAP machine if I’m sick?

The American Academy of Sleep Medicine has some educational tips for CPAP users. If you suspect or it’s been confirmed you have COVID-19, it’s important to talk with your sleep medicine provider about continuing with CPAP. It’s possible that using CPAP could increase the risk of spreading the virus to those around you. Talk about this risk when you talk with your medical provider.