How Sleep Has Changed in the Pandemic: Insomnia, Late Bedtimes, Weird Dreams
By Sumathi Reddy
When Covid-19 cases and fears brought lockdowns to much of the nation, for many, schedules went out the window—and with that a good night’s sleep.
Aubrey Wolff, a 44-year-old teacher and mom in Teaneck, N.J., says she has difficulty falling asleep even when taking melatonin, a natural hormone that induces sleepiness. “I’m going to bed at 12 a.m. but I’m not falling asleep,” says Ms. Wolff, a first-grade teacher with three children, ages 8, 11 and 13. “I’m not in a routine plus I’m not moving around as much, and there’s the stress of all my to-do lists.” She tends to fall asleep as late as 2 a.m.
During the coronavirus outbreak, many people are struggling with insomnia, the sleep disorder that involves trouble falling or staying asleep. Fears of getting the virus, financial and economic worries and the pressures of schooling children while working from home—all concerns now familiar to many—are sources of stress that are disrupting sleep, experts say. Vivid and sometimes frightening dreams have become a part of the Covid-19 lockdown experience.
Preliminary results from a survey taken by around 1,600 people from 60 countries show that 46% reported poor sleep during the pandemic, while only 25% said they had slept poorly before it, according to Melinda Jackson, a senior lecturer at the Turner Institute for Brain and Mental Health at Monash University in Melbourne, who studies how stressful events affect people’s sleep. Forty percent also reported increased alcohol consumption.
She was surprised to find that 42% said they were getting better sleep, reporting a sleep-wake behavior more in line with their body clocks, or natural circadian rhythm. For those—including college students and those who tend to be night owls by nature—the opportunity to sleep longer and get up without setting an alarm clock brings positives. “Some adults who have a really late clock are really benefiting from not having to wake up from those early start times,” Dr. Jackson says.
Still, evidence that many are struggling to sleep during the crisis is apparent in a 14.8% increase in sleep medication prescriptions in the U.S. between mid-February and mid-March, according to data from Express Scripts, a pharmacy benefit manager owned by Cigna. Sales of melatonin, which is sold over the counter, are up 44% over last year in the period from late February to April 19, according to data from Spins, a wellness-focused data technology company based in Chicago.
“The biggest problem has been staying asleep,” says Philip Muskin, a professor of psychiatry at Columbia University Medical Center in New York. “People aren’t exercising, their days have no structure at all.”
Dr. Muskin says he is denying most requests for sleep medications, either new prescriptions or for higher doses. “I’m getting some real pushback from patients,” he says. Some of his patients have confessed to using medications they had saved for air travel.
Instead, he gives patients sleep-hygiene tips. Most important, he says, is getting up and going to bed at a consistent time. He advises avoiding naps and staying active. “Exercise enhances your immune system,” notes Dr. Muskin.
Those with new sleep problems are suffering from “acute insomnia,” defined as having difficulty falling or staying asleep a few times a week for three months or less, says Cathy Goldstein, a physician at the University of Michigan and an associate professor of neurology at the school’s Sleep Disorders Center. Up to a third of people will experience this at some point in their lives, and for most it stems from an identifiable stressor, she says.
The key is to prevent the sleep problem from becoming chronic, she says. It is important to avoid associating your bed or bedroom with a place where you are awake. Experts recommend that if you can’t fall asleep, or wake up in the middle of the night and are unable to go back to sleep after 20 minutes, get out of bed and do something relaxing.
During the pandemic, Natasha Bhuyan, a Phoenix-based family physician at One Medical and regional medical director for the national network’s West Coast offices, has found most patients’ sleep disruptions are caused by one of two things: a change in schedule or general anxiety caused by the pandemic.
For those dealing with stress, she talks about mindfulness and encourages meditation and exercise. Some patients are referred to cognitive behavioral therapy, a common treatment for insomnia. One Medical also has group visits for patients that focus on sleep and insomnia, and include virtual coaching.
In addition to maintaining consistent sleep schedules, she advises turning off smartphones and tablets at least an hour before going to sleep. “Make your bedroom a device-free zone,” says Dr. Bhuyan. “Rather than using a phone as an alarm clock, get an alarm clock.”
During this unusual period, both the insomniacs and those sleeping longer are reporting more vivid dreams, experts say. Among the most common: walking outside and realizing you don’t have a mask on, and bug attacks.
“During times of stress there’s a release of neurochemicals that can trigger these vivid dreams and nightmares in some people,” says Dr. Jackson.
Deirdre Leigh Barrett, a dream researcher at Harvard Medical School, has an online dream survey where more than 8,000 people have logged their dreams during the pandemic.
People who are getting more sleep may be remembering more dreams, she says. Sleepers generally dream every 90 minutes, and the dream period gets longer as the night progresses, she says. The first dream period—which correlates with rapid eye movement, or REM, sleep—is only 5 to 6 minutes, but by the eighth hour of sleep it may be as long as 30 minutes.
Waking up more often, or a fragmented night of sleep, can also increase the likelihood of remembering dreams, Dr. Barrett says.
On a reading of about 6,000 of the dream reports that have come to her from all over the world since March 24, she says they fall into a few main clusters: Those about getting Covid-19 or being afraid of having it; metaphors for getting the virus, most commonly involving bug attacks; lapses in safety measures, where people dream that they are in public and suddenly realize they don’t have a mask on or are too close to someone; or imagery stemming from stay-at-home orders and lockdowns, such as people locked in a jail.
Finally there are dreams imagining the future, she says. Some of these dreams are apocalyptic while others see a future with a cleaner, improved environment.
Sleep Tips From the Experts
•Go to bed and wake up at a consistent time every day.
•Eat at regular times, rather than snacking all day.
•Avoid napping or compensating for a poor night of sleep by going to bed unusually early.
•Limit caffeine and avoid alcohol.
•Avoid electronic devices one to two hours before going to sleep. If you do, use a blue-light filter and try to look at content that is not stressful.
•Exercise and try to get outdoors for fresh air.
•Get bright light in the morning.
•Try to find a workspace that isn’t in your bedroom.
•Stop working at a specific hour and make time for relaxing activities.
•Try a meditation app to relax in the evening.
•If you can’t fall asleep, get up and do something until you feel sleepy.