Why We're Still Struggling With Sleep

"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.

"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.

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."