Break the Cycle of Insomnia

It’s 3 a.m. and you’ve been struggling for hours to fall asleep. Morning draws nearer and your anxiety about being exhausted the next day intensifies — yet again. If this sounds familiar, you’re not alone.

Among the many disruptions of 2020, insomnia may rank high on the list. Data on how the pandemic has affected sleep is limited because biomedical research can take years to shake out and most studies to date have been small. But evidence from China and Europe suggests that prolonged confinement is altering sleep in adults as well as children.

Doctors in the United States are seeing it too.

“I think Covid and the election have affected sleep and could be considered a kind of trauma,” said Nancy Foldvary-Schaefer, director of the Cleveland Clinic Sleep Disorders Center. “A lot of people that I talk to — patients and non-patients and colleagues and family — have more anxiety generally now probably because of these two stressors, and high anxiety is clearly associated with insomnia.”

Whether you’re suddenly tossing and turning at bedtime or waking up in the middle of the night, the first step toward better sleep is to figure out what’s triggering your insomnia. Once you do that, you can take action to prevent it from becoming chronic — a clinical sleep disorder that should be treated by a sleep-medicine specialist.

Stressful and upsetting experiences like the death of a loved one or the loss of a job — two widespread realities of Covid-19 — are known psychological triggers for insomnia. If your insomnia is tied to such an event, the quickest way to get help is to call your doctor. One thing many doctors suggest is cognitive behavioral therapy, or C.B.T.

C.B.T., or C.B.T.-I. for insomnia, is a standard treatment for both acute and chronic insomnia and includes a variety of techniques. Meditation, mindfulness and muscle relaxation can help people whose sleep problems are tied to a stressful event. C.B.T. for insomnia typically lasts from six to eight weeks and “works in about two-thirds to three-quarters of patients,” said Jennifer Martin, a psychologist and professor of medicine at the University of California, Los Angeles, David Geffen School of Medicine. “As a health care provider I love it because people get better fast and I think that, in and of itself, helps people feel good. It’s not drudgery.”

Dr. Martin also recommends an app called Insomnia Coach, which is free and offers evidence-based, self-guided help through tools like a sleep diary and trackers for sleep habits and hygiene.

Maybe your trigger is more subtle. Shifts in habits and routine — including many of the blurred lines between work and home that have resulted from the pandemic — can also lead to insomnia. Lack of exercise and structure, for example, can put both adults and children at risk. It may be comfortable and cozy to stay in your pajamas all day while working or attending school remotely, but C.B.T. experts advise getting dressed every morning. And don’t stay in your bed all day.

“One of the most important things about promoting good sleep and avoiding insomnia is not to use your bed for anything other than sleep and sex,” Dr. Foldvary-Schaefer said. The goal here is to separate your sleep space and habits as much as possible from your waking space and habits.

This applies to children and teenagers too, said Dr. Craig Canapari, a pediatric sleep physician and director of the Yale Pediatric Sleep Center. “Most situations with kids not sleeping are behavioral,” he said, though sleeplessness caused by leg discomfort, or what seem like growing pains, could be restless legs syndrome, a sleep disorder that may warrant further care.

Parents of young children may notice a “forbidden zone” phenomenon when it comes to bedtime, Dr. Canapari said. “Their child either needs to be asleep by 7:30 or they’re not asleep until 9.” The trigger here may be a later bedtime for your children that’s crept in this year. If this sounds familiar, try reverting back to their — and your — pre-pandemic schedule.

But a bedtime that’s not late enough can also cause insomnia. “Getting to bed too early can light a fire under anxiety,” said Dr. Helen Emsellem, director of the Center for Sleep & Wake Disorders in Chevy Chase, Md. It may seem counterintuitive, especially if you didn’t sleep well the night before, but getting in bed before you’re ready to fall asleep can set off the vicious cycle of wanting to fall asleep and then worrying that you’re not falling asleep.

“The bed becomes Pavlov’s bell,” Dr. Emsellem said. So instead of rushing under the covers, try taking a warm shower, or listening to music for a while, or stretching your neck and shoulders. Dr. Emsellem also recommends keeping a close eye on your mood for issues like depression and seeking professional help if things feel as if they’re worsening.

If you can’t identify a psychological trigger for your insomnia, it may be the result of something physical. An easy target is your favorite screen — including the television. “There is a very clear inverse relationship between screen time and sleep,” Dr. Canapari said. Screens are bad for sleep because they emit blue light, which can suppress the body’s natural secretion of melatonin, a hormone that regulates the sleep-wake cycle.

“Light functions like a drug, promoting wakefulness, yet many adults go to bed cuddling their laptops,” Dr. Emsellem said.

Dr. Canapari stresses putting away all screens in the evening: “I really cannot emphasize enough how important it is that children do not have access to devices in their room.”

He encourages parents to create a room for their child that is quiet and dark. For adults who can’t resist their phones or other screens at night, adjust your display setting to night shift, which shifts the colors on your screen to the warmer spectrum. Experts also recommend exposing yourself to as much daylight as you can during the day and dimming the lights in your home in the evening as part of healthy sleep hygiene.

Screens, usually come hand-in-hand with being sedentary, Dr. Canapari said, and exercise promotes healthy sleep. He suggests parents help their children get at least 60 minutes of vigorous physical activity every day, though not just before bedtime. “It’s pretty clear that’s going to help the sleep,” he said.

Maybe you have a cocktail in your hand instead of a screen. People drink in good times and bad, but evidence suggests that consumption has increased since the onset of the pandemic. Alcohol suppresses the central nervous system. It causes brain activity to slow down and produces a sleepy, sedative feeling. This can seem very relaxing for someone struggling with sleep, but as alcohol is metabolized through the night it actually creates trouble. It robs the body of crucial REM sleep and can trigger a “rebound effect,” waking you up in the wee hours after its sedative effects have worn off.

So should you never drink again if you want to sleep better? Not necessarily, said Dr. Martin. “Give it up for a week and see if you sleep better. For some people, one or two drinks doesn’t affect their sleep very much, but for other people — especially when we’re already experiencing a little more stress and maybe we’re a little more likely to wake up anyway — that’s enough to disrupt their sleep.”

If alcohol is affecting your sleep it may be causing you to consume another insomnia culprit the next day. Caffeine comes in many forms and, like alcohol, affects people differently. If you think it’s causing sleep problems, cut back. Parents whose children aren’t sleeping well should also read the labels on what they’re drinking. Sodas and chocolate contain caffeine, as do some sports drinks.

“Pretty much everybody should quit drinking or consuming any caffeine about five hours before they go to bed,” said Dr. Martin, though some people may be better off with 10 hours, she said.

In some insomnia cases, prescription drugs and supplements — particularly melatonin for children — may be helpful, but it’s important to talk to a doctor before going that route. The ultimate goal, Dr. Canapari said, “is to address the issue so you don’t need to use the medication long term.”

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