Has the Pandemic Affected Your Sleep?

COVID-19 has undoubtedly affected every facet of our lives. From day-to-day stress and worry to the change in routine brought on by working from home, it's no wonder many Americans are not getting good sleep. Sleep experts Scott Bonvallet, MD, FCCP, DABSM, and Reuben Walia, MD, with Overlake Clinics – Sleep Medicine, answer your questions about how stress affects sleep and tips on how you can improve your sleep health during the COVID-19 pandemic.

Q: What can stress do to our sleep routine?

A: Dr. Bonvallet – Stress can affect our sleep in a lot of ways. One is that we ruminate and worry about things, particularly when we're not distracted by work or kids. So, when people go to bed, they're not as distracted and that's when they start worrying more. That can affect our ability to get to sleep and even stay asleep.

Dr. Walia – The COVID-19 pandemic obviously has thrown a lot of stress at a lot of people very quickly—whether it's job security, worrying about being infected or affecting family members—so a lot of people are pretty stressed out about those things. Stress can cause an increase in the hormone cortisol, which plays a role in our fight-or-flight reaction. As elevated cortisol levels stay in our body, they can disrupt our sleep patterns and our ability to get that deep, good quality, restorative sleep.

Q: What are some common sleep complaints?

A: Dr. Walia – I've noticed an uptick in patients having trouble falling asleep. I've also noticed some my patients who have traditionally had healthy, stable sleep are now having more issues staying asleep or falling asleep because of the change in routine and the stress this pandemic has put on them.  

Because people aren't able to work out as much or go to the gym, they're more isolated and that will then increase weight. Weight increase will put excess stress on joints, causing joint pain. Pain can disrupt sleep and excessive weight can contribute to obstructive sleep apnea, which will sabotage our ability to get deep, good quality sleep.

Q: I’m getting 8 hours of sleep, but I don’t feel rested. Why is that?

A: Dr. Bonvallet – When we're stressed, it's been shown that our depth of sleep is not as great. We have two different categories of restorative sleep. One is stage 3 sleep, where our brain metabolic activity is the slowest. The second is REM sleep, which is the rapid eye movement sleep. Interestingly, our brain metabolic activity and REM is greater than it is even when we're awake, but they're both reparative and restorative sleep stages. If we're not getting as much of those sleep stages, as a result, we will not feel as rested in the mornings.

Dr. Walia – Getting enough sleep but not feeling rested could be a sign of an undiagnosed or underlying sleep condition, such as obstructive sleep apnea or periodic limb movement disorder. Obstructive sleep apnea is a condition where the narrow area behind the nose and mouth gets a little bit too relaxed and will close off as people go into deeper stages of sleep, causing a dip in oxygen that causes the brain to wake up through the night. With this condition, you're not getting restful, restorative sleep. Periodic limb movement is a condition where people will have involuntary contractions of the leg through the night that could be significant enough to disrupt your quality of sleep.

Q: What steps can I take to get back into a good sleep routine?

A: Dr. Bonvallet – A lot of people are now working from home, and because of that they are sleeping in later, doing work later into the night and going to bed later. They aren’t getting that typical four to five hours before bed time to decompress from work.

Also, a lot of people working from home are not getting outside and being stimulated by sunlight. Sunlight helps regulate our circadian rhythm and helps our brain know when we're supposed to be awake versus asleep. Many people working from home are also not getting as much exercise, which also helps with our depth of sleep and our psyche.

It helps to try to simulate the environment you had work and get on a schedule like what you had previously at work. Start work, take your breaks, have your lunch and stop work for the day at the same times you would have when you went into the office.

Dr. Walia – It's important to get your brain in the zone that things are the same: Wake up at the same time, take a shower at the same time, and get dressed as if you were going to work. Doing so is important to help you get healthy, good quality sleep.  

Q: When should I reach out to a professional about my sleep health?

A: Dr. Bonvallet – If you're getting an adequate amount of sleep, are on a regular schedule, and still feel tired or sleepy, it's time to consider seeing a sleep specialist. If your partner notices that you snore or stop breathing in your sleep, you would want to consider seeing a specialist.

Dr. Walia – If you feel like your sleep disruption is significantly affecting your daytime activities, such as your ability to do work, if you're having excessive daytime sleepiness and unable to stay awake, or if you notice mood instability, then it may be worth seeing a sleep physician.

Q: Do you recommend supplements like melatonin?

A: Dr. Bonvallet – There aren’t any supplements out there that have actually been proven to promote sleep; although, melatonin is probably the most common one that is used. Our brain makes melatonin about two hours before our natural sleep cycles, so it helps synchronize our sleep cycle rather than directly promote sleep.

Anecdotally, I've had some patients who have found melatonin is helpful for them. This may be because there's a bit of evidence that melatonin supplements don't cross the blood-brain barrier, which acts like a filter between the blood and the central nervous system. That means in some people, it may cross that barrier more readily and may have more of an effect, while others experience no effect whatsoever.

Melatonin is a reasonable thing to try; typically, the dosages we recommend are 1.5 to 5 milligrams. If that doesn't help, more is not better. The problem with melatonin supplements is they're not under the scrutiny of the FDA, so you don't necessarily know what you're getting. Other supplements out there that claim to be helpful for sleep have not been proven as such—and some of them may actually be dangerous—so we don't typically recommend supplements outside of melatonin.

Dr. Scott Bonvallet and Dr. Reuben Walia are board-certified sleep medicine physicians with Overlake Clinics – Sleep Medicine, who are currently accepting new patients. Watch the video version of this Q&A below.

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