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Why We're Still Struggling With Sleep

If the pandemic did a number on your slumber, you're not alone. Here's what experts recommend now

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There were many nights last summer when Anne-Claire France did not sleep at all, her body exhausted but her mind alert, recounting the stresses of a life upended by the pandemic.

Lying awake beside her sleeping husband in their Houston home, France, an experimental psychologist, tallied all that needed to be done at work to support doctors, nurses and administrators across the country. She worried about her brother, furloughed from his job. And she feared for her mother, 90, who was isolated in a continuing-care retirement community.

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France, 62, had long been what she described as a “fragile sleeper,” easily awakened by noise, movement or light, challenges that worsened with menopause. But until the coronavirus pandemic, she'd been able to manage it. Now her thoughts consumed her each night: Her brother needed her financial and emotional support. Her mother needed companionship beyond her twice-weekly visits to France's home. France feared for her stepdaughter in Jersey City, New Jersey, near the epicenter of the pandemic at the time, and worried about how she could effectively do her job over Zoom, leading classes with more than 200 health care workers.

“From my perspective it was just so massive,” France recalls. “How could I possibly take care of all these people?” And so she lay there, night after night, exhausted but alert.

Sleep issues track with the pandemic

France is among the millions of Americans who have spent this past year tossing and turning. Some call it COVID-somnia, a sleeplessness wrought by a collision of stressors. The pandemic has disrupted every corner of our lives, affecting our finances, our health and our emotional well-being, causing anxiety that can keep us up at night. With millions working and studying remotely, the lines between work and home have blurred, undoing routines that kept circadian rhythms intact. Even as the worldwide health crisis wanes, the sleep troubles that surfaced over the past year may persist, experts say.

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"We've never experienced stress like this in our lives — ever — and so our bodies don't necessarily know how to handle it,” says Michael Breus, a clinical psychologist and a fellow of the American Academy of Sleep Medicine.

A study published in January in the Journal of Clinical Sleep Medicine revealed a global surge of sleep problems as the pandemic shut communities down, with 58 percent of participants feeling unsatisfied with their sleep. By contrast, normally about 15 to 25 percent of Americans are affected by sleep issues, according to the study's authors. Older Americans with chronic health conditions who experienced high levels of pandemic-related stress were particularly vulnerable to trouble, according to a March study published in the American Journal of Geriatric Psychiatry. Sleeping-pill usage was up 20 percent since the start of the pandemic, a study published in the Journal of Clinical Sleep Medicine found.

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"Anxiety, depression, social isolation, stress is all associated with the pandemic as well as interruption in people's sleep-wake schedules,” says Clete A. Kushida, M.D., a neurologist and the medical director of Stanford University's division of sleep medicine, whose clinics have been busy throughout the COVID-19 crisis. The problem at this stage, he notes, “is really multifactorial.”

While some neurologists, psychologists and sleep coaches have noticed the pace of new patients slowing as the pandemic wanes, others say their waiting rooms are still busy. Those who keep working from home may find this drawn-out schedule continues to rattle their circadian rhythms, while others may think that life has begun to resemble normal again but their sleep hasn't caught up. Part of the reason, experts say, is that the longer sleep problems persist, the harder they can be to undo.

"We've opened up this Pandora's box with this change in our lifestyle,” says Ajay Sampat, M.D., an assistant clinical professor of neurology and sleep medicine at the University of California, Davis. “And that probably is not going to end when the virus goes away."

This may be particularly true for older Americans, who are vulnerable to sleep problems under normal conditions, with roughly half experiencing insomnia before the pandemic, according to the American Psychological Association. The culprits vary, including menopause, prostate conditions, and the aches and pains that can come with aging. What's more, sleep quality also tends to diminish as we age, as melatonin production falls and circadian rhythms change. Add to the mix a pandemic that was particularly dangerous for older people and you have a recipe for doing a number on slumber.

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When COVID-19 itself is a factor

And there's another wrinkle on the pillow: More than 32 million Americans have contracted COVID-19, and for many of them, complications from the disease itself may have affected their sleep.

Jen Singer, 54, a writer in Red Bank, New Jersey, contracted the coronavirus in February 2020, before widespread testing was available. The disease triggered a rare inflammatory condition, sarcoidosis, that affected her heart. Singer, a cancer survivor, endured a nine-month course of steroids to treat it but ended up needing a pacemaker after experiencing heart failure.

Pumped up on 40 milligrams a day of steroids to treat the sarcoidosis and try to reverse her heart failure, Singer could not sleep. “I would be up, sometimes for hours, at night,” she says. The high dosage of steroids “felt like being a kid hopped up on a lot of sugar at a birthday party all of the time."

She spent her nights reading books, painting her house and getting ahead with work. She also chronicled her treatment and recovery on Facebook, sharing favorite songs and selfies as she painted late into the night and finding a community of people awake alongside her in the wee hours.

Singer finished the course of steroids in April and is back to sleeping regularly, a new normal she calls “fantastic.” While she still wakes occasionally at night, anxious about her health and the future ("Who at 54 doesn't?” she says), she takes such briefer bits of sleeplessness in stride.

For France, the experimental psychologist in Houston, the weeks of insomnia turned into months. Although she was functioning during the day, her mind was foggy. “You develop anxiety about sleep,” she says. “It's a vicious cycle.”

Her doctor prescribed benzodiazepine, a class of drugs used for insomnia as well as anxiety and other conditions. But France did not want to take sleep aids. So in September she saw a cognitive behavioral therapist to help her settle her thoughts. In December she began working with Martin Reed, an insomnia coach based in Oregon, who gave her assignments, homework and lessons.

Realizing that she needs just 5.5 to 6 hours of sleep a night, she now limits the time she spends in bed, waking every morning at 5 a.m. and turning in when she feels sleepy, not tired. France still has relapses of insomnia, she says, but she practices breathing and meditation exercises to settle back down. “I know that in a few days I'll be back to sleeping well again."

Up at 3 a.m.? How to Get Back to Sleep

Turns out there’s an art — and science — to banishing those egregiously early wake-ups

Whether unwanted wake-ups are a new thing for you or more of a longer-term bane, there are better ways to get back to sleep than, well, freaking out that you’ll never be able to (though we’ve all been there). Here’s what experts recommend to convince your mind and your body to relax and surrender to slumber.

1. Banish the clock

The clock may be sitting beside you, but it is not your friend. If you wake in the night, resist the urge to look at it. Instead, remind yourself that it is normal to wake during the night — we all do — and that you will fall back asleep.

“One of the best things we can do is not worry or panic, because waking is a normal part of sleep,” says Martin Reed, an insomnia coach in Oregon.

Instead, make sure you are comfortable. If you need to go to the bathroom, do that. As Helene A. Emsellem, M.D., the director of the Center for Sleep & Wake Disorders in Chevy Chase, Maryland, says, “Don’t argue with your bladder.”

But on your way there, you want to avoid bright lights. If you cannot get to the toilet and back without turning one on, keep a pair of blue-light-blocking glasses on your bedside table and wear those to the bathroom.

When you get back into bed, you want to feel comfortable, relaxed and free of intrusive thoughts. So, set up an environment that keeps those thoughts at bay. Try a headband or a pillow with an embedded speaker that plays relaxing music or a podcast or a TED talk that is only mildly interesting.

“What you want the sound to do is cocoon you in your bed, in the dark, in a sleep-conducive environment,” Emsellem says. “Block out your environment and block out your inner thinking. If the thinking train is still going, you haven’t done enough to distract yourself.”

2. Get up and reset

Give yourself about 20 minutes to drift back to sleep (guess the time, don’t track it on the clock.) If you are still awake, get up and give your body a reset.

Move to a different room in your home and find a relaxing activity to clear your mind. Read something that you find slightly boring but pleasurable, color in an adult coloring book, meditate or practice breathing exercises. Listen to a podcast, perhaps one you’ve already heard before.

Michael J. Breus, a clinical psychologist and the author of The Power of When, suggests flipping through old photo albums to recall happier times.  

Return to bed when you feel sleepy or groggy, and not just tired.

3. Recognize changes in your body

Most bouts of insomnia are temporary and will resolve without intervention. However, if yours persists for several weeks or longer, it could be a sign of a more serious health issue, like depression or sleep apnea, for which you may need professional help.

Also, your sleep needs change throughout your life. Your struggles to sleep may be a sign that you need less sleep than before and may actually be spending too many hours in bed.

“Everybody thinks that sleep is static, but it’s not,” says Dianne M. Augelli, M.D., a sleep medicine specialist who teaches at Columbia University. Just because you needed eight hours at 20 does not mean you need as much at 60, she says, noting that our needs ebb and flow throughout life.

4. Don’t panic

Your body wants to sleep, even if it doesn’t seem that way at 3 a.m. But you can’t force it.

“Sleep is a lot like love: The less you look for it, the more it shows up,” Breus says. “There is nobody on this earth who will not fall asleep eventually. Nobody.” And consider this: An hour of rest while awake is about the equivalent of 20 minutes of sleep, he says, so the time spent trying to nod off is not entirely lost.

However, anyone who’s suffered through endless nights of insomnia knows how exhaustion makes it difficult to concentrate and increases your risk of an accident or injury. In the long run, people who do not get enough sleep have an increased risk of developing other health problems, such as weight gain or high blood pressure.

Breus suggests thinking differently about an early morning awakening to help take the pressure off when you find yourself wide awake for hours. “Flip the script,” he says, and celebrate that you have, say, two more hours before you have to start your day.

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