How Pandemic has Affected Sleep

Sleep is a vital physiological process that is critical to biological wellness, be it mental emotional as well as behavioural wellbeing or effective functioning of immune system and overall humoral homeostasis.

Sleep empowers immune system & streghthens body defense mechanism, it heightens brain functions, improves complex thinking, learning, and memory. In kids, regular and adequate sleep promotes their mental and physical development, sharpens their mind and helps them adjust better to the newer home schooling routines.

Sleep is also a key mood enhancer. Lack of sleep plays a major role in anxiety disorders, PTSD, bipolar disorders and is the main reason behind irritable behaviour, lack of concentration as well as interest in work and daily life.

The advent of covid pandemic has brought with itself various disruptions in our day to day life, one of the most important being changes in sleep duration, quality and patterns. Increase in anxiety related to covid, depression consequent to the various mishaps worldwide and loneliness associated with social distancing and isolation has established a direct relationship with sleep duration and quality. A US based study conducted on 5175 participants showed that about 58% participants reported a change in sleep duration, with 17% having 'less than usual' sleep and the remaining 37% sleeping 'more than usual'. Younger population, females, urban residents, people who had children, those who were divorced/seperated/single, those who were employed were affected more. The change in sleep duration with 'less than usual' had an inverse relationship with age, with older individuals sleeping lesser. Amongst the ones sleeping 'more than usual', females especially ones divorced/belonging to a higher educational background/single predominated the findings.

'Coronasomnia' is the new term that refers to sleep problems related to the pandemic.

Stress:

One of the most important reasons for altered sleep patterns is stress and the most important reason for the rising stress levels is the pandemic itself. Persistent stress results in stimulation of the autonomic nervous system that leads to release of cortisol and adrenaline. As a result the body goes into a state of fight or flee response which inhibits sleep initiation and maintenance resulting in insomnia. Lack of adequate sleep due to insomnia leads to rebound stress forming a vicious cycle. Economic deprivation due to the pandemic, managing kids at home due to homeschooling, fear of contracting the infection, grief and fear for loved ones, social distancing and isolation, getting into the new routine of work from home all contribute to pandemic related stress.

Pandemic lifestyle:

inconsistent sleeping schedules and daytime structure leads to difficulty in adjustment to the new pandemic lifestyle which contributes to altered sleep habits.

increased screen exposure:

Excessive exposure to screen because of work from home, video conferences and calls, keeping kids engaged with online homeschooling schedule, online streaming, binge watching and 'doomscrolling' leads to increased blue light exposure which inhibits an important hormone Melatonin in our body. Melatonin is important for maintaining the circadian rhythm, without which naturally the sleep cycle and patterns go haywire.

Antistress triggers like alcohol and sleep medications:

The pandemic has seen a rise in usage of sleep medications and antidepressants to cope with the situation throughout the world. Also consumption of alcohol as a stress buster has contributed to altered quality of sleep like increased non-rem sleep and decreased rem sleep. Rem portion of sleep is the major contributor to a relaxed sleep, mental development, memory consolidation and body homeostasis. Deprivation of deep sleep results in fatigue, excessive daytime sleepiness, grogginess and irritablility throughout the day.

Altered daytime schedule:

Exposure to sunlight is very important for moods and circadian rhythm. Limited exposure to sunlight because of the newly emergent concept of work from home, social distancing, travel bans, lockdown and curfews, outside ventures have almost come to a standstill. This is ultimately resulting in various mental disorders like depression, anxiety, behavioural disorders and inadequate coping mechanisms, altered sleep wake patterns due to inhibited light cues to the body and hence the overall disruption of the normal circadian rhythm.

TIPS FOR BETTER SLEEP:

1. Maintain a regular routine:

A structured daytime schedule and establishing a regular work and sleep routine will bring a sense of normalcy in these abnormal times. Fixing the waking time and winding down time, getting ready for work be it bathing and dressing even though you are at home will let the the body in getting a regular start to the day and maintaining consistent bedtime.

2. Avoid napping excessively:

Excessive daytime napping because of either no other engangements to be busy with during the day or because of disrupted sleep wake cycle due to late onscreen working hours at night, can exacerbate the sleeping problem and hence should be best avoided.

3. Exercise:

Maintaing physical activity like light exercises, stretching, yoga, relaxation techniques like deep breathing, mindful meditation keep the body agile and mind active during the day and therefore contribute to effective diurnal routine.

Also exercising should be avoided before bedtime hours because adrenergic stimulation of the body due to physical activity can inhibit falling asleep soon.

4. Limiting News intake and doomscrolling:

Limiting the number of times and time of the day of scrolling through news feed about the pandemic can help in reducing exposure to the myths and misconceptions about covid disease. It can also help protect our family and community from false information that stirs unnecessary anxiety and fear related to the pandemic. Doomscrolling is scrolling through tragic news from online platforms and it must be mindfully avoided. Only trusted and evidence based sources like WHO, CDC, new england journal of medicine, ICMR should be referred to incase of any query related to the disease or the pandemic.

5. Adopting Good sleep habits and maintaining sleep hygiene:

Limiting the blue light exposure at bedtime, adopting sleep promoting habits like listening to calming music, quiet reading as a presleep ritual can improve sleep initiation, quality and duration of sleep. Also keeping sleep hygiene like regular changing of bedsheets, fluffing of pillows, using bed for no other activity other than sleep/sex can help in improving sleep.

6. Adopting hobbies and new coping strategies:

Learning new skills, adopting new hobbies, keeping in touch with close ones via social connections, scheduled phone/video calls, can serve as effective strategies to keep pandemic related stress at bay and thereby helping to maintain work-life balance.

7. Avoid alcohol: Though alcohol is thought of as helping in falling asleep, what it actually does is that it increases the duration of non-rem sleep and reduces the duration of rem sleep or deep sleep. Therefore alcohol affects the quality of sleep which can serve as a trigger for insomnia and various other sleep as well as behavioural disorders.

8. CBT (Cognitive Behavioural Therapy):

If insomnia and sleep related problems are persistent, seeking a professional help is advisable. Cognitive Behavioural Therapy is one of the many other commonly used professional methods that can help in overcoming probleme related to sleep effectively.

Article By:

Dr Deepanjali Sharma

MBBS, MD (Pulmonary Medicine)

Senior Resident at Sir Sunderlal Hospital, Banaras Hindu University, Varanasi, India