COVID-19 keeping you up at night? Keep a routine, ditch the alcohol

It’s estimated that a third of Americans are experiencing high anxiety levels right now, according to the Pew Research Center. And nearly all have some level of psychological distress. So, we're guessing a lot of readers may be having trouble sleeping.

Dr. Michael Howell, a sleep medicine physician with M Health Fairview, joined MPR News host Tom Crann to offer tips for catching some z’s during the pandemic.

You can hear their conversation using the audio player above or read a transcript of it below. It has been lightly edited for clarity and length.

How many people are dealing with this?

It’s a challenging question because a lot of people don’t feel like they can access their providers right now. But what I can tell you just by talking to my neighbors is that about a third more people are struggling with sleep than normal.

Generally, is it all anxiety or are there other factors?

There are a lot of other factors. Probably most important is what an individual's 24-hour circadian rhythm is. What that means is, in your body there is a clock that is letting you know what time to fall asleep or wake up. If your circadian rhythm gets misaligned, which it easily can once you start losing control of your routine and your schedule, if you have too much light later in the evening, it's difficult to fall asleep naturally at the time you want to.

So it sounds like one of the things we should be doing, even with all of the upheaval in our lives, is sticking to a predictable schedule.

I think that's really important. Keep to the schedule not only on a day-to-day basis, but [on a weekly basis]. So if you normally go to a spin class or do yoga on Monday, Wednesday and Friday, get up at the same time, get some exercise [and] get some sunlight first thing in the morning. Try to hold to some kind of routine.

It’s the same thing with bedtime; in the evening, try to dim the lights down, especially after the sun goes down, try to avoid spending too much time on screens and just prepare your brain, mind and body for some restful sleep.

What are some tips for falling asleep once you’re in bed, and is that different from when you wake up at 2:30 in the morning and can’t fall back asleep?

If you're the kind of person who struggles falling asleep at night, what I want you to do is start thinking about what happens in the morning. Do you have trouble getting up in the morning or are you hitting the snooze alarm on the on the weekends? I want you to focus on getting up at a consistent time in the morning, getting bright light in the morning. Over time, usually you're going to start getting sleepy earlier in the evening. So by working on consistency in the morning, you can actually make your evenings better.

If you're waking up through the course the night, one of the best things you can do is a technique called the cognitive behavioral therapy for insomnia. The two key rules are: Never go to bed if you're not sleepy and don’t fall asleep outside of your bedroom.

I don't care how tired you are, how exhausted you are, how much you want to sleep, unless you're going to be falling asleep, do not go to bed. All of that time spent lying in bed trying to sleep is stressful. Nobody ever laid awake in a dark room, stared at the ceiling and thought about how great their life is.

If you're not falling asleep, get out of bed. Go do something you enjoy. Don't do work. Be mindful when you do get sleepy and then go to bed.

The other rule is don't fall asleep outside of the bedroom. So if you're not sleeping in the bedroom, then you go and sit on the couch and you fall asleep there, then you're conditioning yourself to a separate problem.

By following these two rules, what will happen is that for a few days you're not going to sleep that much. But what you are doing is you're getting good, restful sleep when you are in bed and then you can build on that. So, four hours of good sleep turns into five hours of good sleep, which turns into six.

What about people who might take a supplement like melatonin or an over-the-counter medication like acetaminophen to help them fall asleep? Is that OK?

Melatonin is not a sleeping pill. It is a circadian rhythm component. It's a cue for darkness that lets your body know when the sun has gone down. So for many people, especially those of us who are kind of bathed in all of this light in the evening on screens, it can be really useful.

But in general, people tend to use too much. I just advise taking a milligram, sometimes even less. And think of it like a circadian vitamin. Just go ahead and take it every night for a couple of weeks, a couple hours before bed. And if the problem is a circadian rhythm problem, you're going to be sleeping better, especially if you combine it with consistent wake up times, bright light in the morning and exercise in the morning.

Most over-the-counter agents that you see there are a little sedating, but they often wear off fairly quickly. So if you're struggling with insomnia, those agents are probably not going to solve the problem. They may work for a day or two, and then all of a sudden you take them and you feel like they're just Skittles or M&Ms, where you don't feel any benefit from them at all.

What about saying, ‘I'll just have another glass of wine or another beer or cocktail before I fall asleep. That makes me drowsy.’

It absolutely is a little sedating, but guess what? An hour and a half or two hours later, you are now more awake. Your heart is beating a little bit faster, your blood pressure is a little higher. So if you're struggling with sleeping through the night or having frightening dreams at night, try going a week or so without any alcohol, even in moderation at night.

And what’s going on with the vivid dreams people are having right now?

Dreams are a manifestation of the emotional tone that we're going through during the day. So if you are going through a lot of stressful experiences during the day, your dreams are going to feel more stressful.

It's worthwhile to point out that nearly all of us have the state of sleep when we dream vividly, called REM sleep. Many of us are blissfully unaware that we are dreaming, but we are dreaming nonetheless. And there is something about the stressful experience that makes us more aware of these dreams. So, you know, dealing with a family member who may be sick, [or feeling] paranoid that we may catch something by going to the grocery store, we're very likely to either relive these experiences at night when we're dreaming or imagine some scenario related to them.

One thing that you can do is minimize alcohol use. Alcohol notoriously makes dreams more vivid and distressing.

This reporting is part of Call To Mind, our MPR initiative to foster new conversations about mental health.

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