COVIDsomnia: How to Sleep Better During the Pandemic
Feeling like your sleep is deteriorating? Or simply having a harder time falling or staying asleep? Today, we talk with Dr. Chuck Crew about why this is happening, what we can do to handle stress, and how to set our sleep up for success as we get closer to “normal.”
The days blur into one. The nights are restless. The uncertainty and burnout and isolation build up during the day, and we toss and turn, trying to let it go at night so we can get some sleep.
Ten percent of American adults already dealt with insomnia before the COVID-19 pandemic, and perhaps many more have been showing up in clinics (or on WebMD) with newly developed difficulties with sleep. Some in the sleep healthcare world have called this COVIDsomnia (aka, sleep troubles in the era of COVID). Why is this happening? Is there any hope? What can we do to help ourselves sleep better?
I talked with Dr. Chuck Crew, a clinical health psychologist at the Baylor College of Medicine and Michael E. DeBakey VA Medical Center (MEDVAMC). He provides comprehensive Behavioral Sleep Medicine services and conducts research on correlates and consequences of insomnia in chronic medical populations. He provided insights on sleep changes during the COVID-19 pandemic and highlighted his favorite tips for improving sleep. Below is an abbreviated transcript of our conversation:
Jade Wu:
Dr. Crew is an extra special guest today because we actually know each other. We are colleagues at the Society of Behavioral Sleep Medicine, where we try to get the good word out there about non-medication methods for improving sleep. Dr. Crew, welcome to the Savvy Psychologist.
Dr. Crew:
Thanks Jade. Thanks for having me.
Jade Wu:
You’re the perfect person to talk to about pandemic sleep because you are actually the lead author on our society’s position paper about this. The paper was titled, “The Society of Behavioral Sleep Medicine COVID 19 Task Force: Objectives and Summary Recommendations for Managing Sleep During a Pandemic”… which is a long mouthful. Basically it says—here’s what we think would be helpful for pandemic sleep. And you were the lead author on that. So let me just start out by asking you, how has the pandemic affected people’s sleep? What have recent studies shown? What have you noticed in the clinic?
The pandemic is just a perpetual Saber Tooth tiger on the horizon, putting us on edge.
Dr. Crew:
It’s a great question. How hasn’t sleep been changed by the pandemic? Recent studies have really demonstrated that stress is increased. Sleep kind of goes in the backseat. So it happens less because we’re focused on other things. We’re supposed to be focused on the thing in front of us, the stressor. We’re managing a lot more in terms of responsibilities, filling several roles–we’ve got parents, we’ve got jobs, we’re trying to work from home. And a lot of people are required to work extra hours. And so in all these ways, we’re kind of being pulled in different directions.
Jade Wu:
So it’s almost like because sleep is designed to be stretchy and adaptive, it takes a backseat because if there’s a Saber Tooth tiger on the horizon … we’re not going to be sleeping, we’re going to be fired up and ready to run or ready to fight. So it’s almost like the pandemic is just a perpetual Saber Tooth tiger on the horizon, putting us on edge.
Chuck Crew:
Yeah. Precisely, and I love that analogy. And another reason why we see a lot of sleep issues cropping up during the pandemic is because the things that are taking a back seat are actually important for sleep … like diet and exercise. A lot of people aren’t necessarily eating as well as they did before or exercising as much, spending a lot more time indoors. Sunlight exposure is critical, right?
And so oftentimes in those cases we tend to see sleep kind of drift or become less reliable. Initially it’s stress that the person’s responding to, but then it’s stress created by the sleep issue itself. And so it’s this perpetual cycle that oftentimes when we see it, it can be really hard to know where to intervene. Where do I jump in so that I can get things back on course?
Jade Wu:
So it sounds like we might fall into a vicious cycle.
Dr. Crew:
Yeah. It’s a huge negative feedback loop. In a lot of ways, for some folks they’re just focused on either getting sleep tonight, or, you know, just trying to make it through the day–to feed their family and to remain safe. And so oftentimes the critical kind of steps that we might need to take to get sleep back on track aren’t able to occur mostly because it’s just tunnel vision. In a lot of ways there hasn’t really been a chance to hit the reset button.
Jade Wu:
So when you talk about hitting the reset button or getting sleep back on track, what are some of the most basic or fundamental things that we should do, setting aside for a moment that we might not be able to do all of these things perfectly? What ideally would you do if you could?
Dr. Crew:
As we mentioned, stress … making sure that you are taking time to actually allow for sleep to occur. If we’re go, go, go up until we want to crash at the end of the day, you’re probably not going to do so successfully. If you’re going 80 miles an hour down the highway, and you get to your exit and continue going 80 miles an hour, you’re probably not going to make it in one piece. And so allowing some time to wind down at the end of the day is super critical.
Get up at the same time every morning – have a healthy meal, get outside, take a walk, get some sunshine.
Also, definitely getting up at the same time each morning. And that’s actually the piece that a lot of folks can do in reverse, or they spend a lot of focus trying to get into a routine where they’re going to bed around the same time, but they may not necessarily be ready for sleep at that time. And so for that reason, we do see a lot of insomnia. And that would be times that you’d like to be asleep and you’re not sleeping maybe because your body’s not ready for it. So what we actually recommend is just getting up at the same time every morning–start your routine, be active, get some food in yourself, get outside, take a walk, get some sunshine.
Sleep will fill in eventually if you have the same routine and you’re active and you’re going through the same motions during the day, then sleep will have to occur because by, by definition, it’s kind of a consequence of everything that we do during the day. And as long as we are staying active and being social, and really earning sleep, then it will eventually continue to occur naturally.
Jade Wu:
I really like a couple of really important points here. One–instead of focusing all on the bedtime and going to bed at the same time, you’re saying we should get up at the same time. And I like that because getting up at the same time, it might be hard to begin with, but at least that’s something we can control.
Dr. Crew:
Yeah, precisely. And I think that this is a really important point to consider when we’re talking about how sleep might’ve actually improved during the pandemic. When you think about all the demands that we had prior to the shutdown, right? It’s that we had to be go, go, go. We had to drop kids off at school. Then we had to drive to work. And then we had to wait in traffic. And there was just all of these additional sort of time sucks. And now many of us don’t necessarily have to deal with this as much anymore, because maybe we have the chance to work from home. And so for that reason, some folks are actually able to get a little extra sleep.
So in a lot of ways, especially when we see children’s sleep and we also see adults sleep, we see that they are able to get some more hours of sleep overall. Now, if we’re chasing this early bedtime we might lose out on the fact that we can actually sleep in. And so if we’re going to bed a little bit later, and when our bodies naturally are telling us it’s time to go to sleep, then we might find that we’re actually able to get more restful and restorative sleep.
Jade Wu:
Yeah. That’s so true. I actually, I have a brother who’s a teenager and he’s been able to sleep in more in the mornings and everybody in the family is happier. I mean, there are very few of these in this pandemic, but this might be one silver lining for people who are able to take advantage. So you’re saying, go with your body’s rhythm, figure out if you might be a little bit more of a late sleeper. And if you can pull that off with work, go with your body, work with it, instead of against it, see if you can sleep in a little bit more and be consistent on the morning end.
Dr. Crew:
Oh, definitely. Or maybe you’re getting up around the same time, but you’re more proactively using your mornings to engage in meaningful activities. And that can also include–make yourself a healthy well-balanced meal, things like that, like think about how you want to utilize your morning and how that can set up potentially the rest of your day.
Jade Wu:
I think sometimes for people who have insomnia, the ideas are flipped, right? It’s like, “How can I force more sleep and hack and manage more sleep so that I can feel better and live my life?” But really you’re saying we ought to just live our lives to the fullest and sleep will follow.
Sleep is like a cat in a lot of ways. Wants to be left alone. Doesn’t want you chasing it around. It’ll come find you if it wants food or if it wants to be pet.
Dr. Crew:
Right. And it can be really difficult to put that blind faith in it that sleep will fill in. Sleep is like a cat in a lot of ways, right? Wants to be left alone. Doesn’t want you chasing it around. It’ll come find you if it wants food or if it wants to be pet. Sleep, this natural process that if we chase, oftentimes it becomes elusive and it runs away.
Jade Wu:
I think the cat analogy is my new favorite sleep metaphor.
Dr. Crew:
And I think another important thing to think though is if we’re going to allow sleep to happen, naturally it has to happen under the right circumstances. We need to be taking time to manage stress and really, you know, get it all out of our system. Because if we’re waiting, if we’re feeling perpetually stressed and waiting for sleep to happen, it may not happen as readily.
Jade Wu:
Yeah, you’re right. Stress is that overriding button, like you said earlier, where even if you do want to sleep and your body does feel tired and sleepy, too much stress can override that. So what are your favorite tips for managing stress on a day-to-day basis?
Dr. Crew:
Well, number one is to find a time during the day to get it all out of your system, to just sort of stare stress in the face. Sit down, go to a place that’s not a place where you enjoy or is relaxing, but find a workplace–maybe it’s into your office, or maybe it’s just your dining room table, and sit down and have maybe a notebook, or you can record a voicemail to yourself and spend some time going over all of your worries. All of the things you have to do tomorrow that you’re planning for and spend some time prioritizing what you want to address, because right now there’s umpteen different reasons why we feel stressed.
And if we continue to either allow them to just come and find us whenever they pop up or we just try to spend time ignoring them, we probably won’t ever go away. And a lot of the things that we find what we’re stressed about are things that we can’t necessarily solve right away. So those are things like, “How’s my family going to be next year?” These sorts of things are in the future that we can’t necessarily solve, especially not right before bed or as we’re laying down to go to sleep. So spending some time during the day, addressing, writing down, or planning through the things that are causing us stress and knowing when to cut it off–20, 30 minutes at the most.
And the other thing that I like to do is just to make sure that we are getting physical activity. Because we know that at the end of the day, sleep is this consequence of being active. And if the one thing that we’re worried about is actually getting good sleep at night, make sure you are getting that sweat out. And whether it’s just being active, going for a walk … oftentimes this goes with sunshine, right? If it’s not sunny, at least getting the juices flowing … so, going for a walk, a bike ride, anything that’s kind of got you on your feet and moving around, especially since we’re spending so much time indoors. And I think that those are the two critical tips that I would have when it comes to managing stress.
Jade Wu:
Those are two of my favorites as well. In terms of psychological wellbeing, physical wellbeing, there’s not really anything that’s made worse by exercise, but pretty much everything gets better with exercise. And the other thing that you described, do you call that the Worry Window? Or do you have a different name for it?
Dr. Crew:
I call it Scheduled Worry or Planning Time. It’s not just the worrying that’s taking place. It’s actually like, “I just need to spend some time planning out tomorrow because if I don’t actually start thinking about that and planning ahead, I’m just reacting to whatever’s going on.” And a lot of ways that’s where our sleep starts to slip. Issues start to develop when we’re just constantly reacting and all of a sudden sleep is drifting further and further away from us because we haven’t been really paying attention.
Jade Wu:
I definitely have insomnia patients who say they they’re go, go, go all day. They’re just trying to cram in activities and trying to get things done. And then by bedtime, they finally lay down, they take a deep breath and then they start planning tomorrow. And I think you’re right. The thoughts that we don’t address during the day, they’re kind of like young children right there. They’re trying to grab our attention. They’re tugging at our sleeve saying, “Hey, pay attention to me. I need attention.” But if we keep pushing them off until bedtime, when suddenly for the first time in the day, you have nothing else distracting you … You’re just in bed, in the dark. Now the worries or the planning or whatever the thoughts come out to play. And they really now take over because they’ve been pent up all day.
Dr. Crew:
Another important thing to emphasize is sunlight, because sunlight is so critical in establishing consistent sleep-wake patterns, what we call circadian rhythms. Those are things like digestion, physical activity, social activity … and sunshine is really just a hard reset button. So it’s critical for sleep to make sure that our body knows when it’s daytime and when it’s nighttime, so that sleep can happen when it’s nighttime. Sunshine during the day is such an easy reset.
Jade Wu:
And it’s free! So we covered a lot of good ground here. Any last parting words of wisdom, or even just a glimmer of hope for people who are struggling with sleep during the pandemic?
Dr. Crew:
I definitely think that sleep issues are probably more present now than they have been for some folks in the recent past, because this is one of the most stressful global experiences we’ve had in over a hundred years. There’s not a roadmap on how to cope with it, and if there are people out there–listeners who are having issues with their sleep and it’s been going on for a while, and some of those basic things that we talked about aren’t working … there are specialists like myself and Dr. Wu to reach out to. And so I would definitely encourage folks to ask whoever in their healthcare sphere they have contact with to see if they could meet with a sleep specialist to talk some more about this.
Jade Wu:
That’s a really good point. And by the way, our society’s website has a directory of folks like you and me who specialize in behavioral sleep medicine. And so you can find that at www.behavioralsleep.org. We have lots of resources.
And so with that, let me say a huge thanks, Dr. Crew. I really appreciate your time, and I hope that we can get this information out to more people. And I hope that everyone can just start to sleep better because it’s such a beautiful and wonderful thing.
Dr. Crew:
Yeah. Sleep’s kind of important, but at the end of the day, it will happen eventually.
Jade Wu:
Yes. Those are words of reassurance that I think many, many people need to hear.
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About the Author
Dr. Jade Wu was the host of the Savvy Psychologist podcast between 2019 and 2021. She is a licensed clinical psychologist. She received her Ph.D. from Boston University and completed a clinical residency and fellowship at Duke University School of Medicine.
