Dealing with Insomnia during COVID19

The coronavirus pandemic does not affect everyone in the same way. Clearly, front line clinical workers face the direct effects of the disease on a daily basis, and insomnia is often seen in such workers.  This may be because of long hours working in ICU or the accident and emergency department, or constant changing of shifts , or working under high pressure with fears of being infected.  In addition, low levels of natural light, which are common in a hospital environment, may reduce effect of natural melatonin, which is responsible for sleep & wakefulness, this is very important to control the “circadian” rhythms. 

At the same time, there are a few key factors to consider:
  • What type of insomnia do you have? Acute or chronic?
  • Do you have difficulty falling to sleep initially?
  • Do you wake up in the middle of the night and are not able to get back to sleep?
  • Insomnia is not only problem at night; insomnia has negative consequent symptoms during the next day like:
    • emotional symptoms (irritability and anxiety)
    • cognitive symptoms (memory and concentration difficulties)
    • behavioural symptoms (naps, absenteeism)
Ample sleep supports the immune system, which reduces the risk of infection and can improve outcomes for people fighting a virus. Whether COVID19 has caused insomnia in an individual, or whether the pandemic has just made the problem worse, here are some tips to help cope with insomnia if this affects you.

1. Monitor and assess your sleep habits by using a sleep diary

Over the course of at least two weeks, try to record information such as:
  • What time you went to bed
  • The amount of time it took to fall asleep
  • What time you left the bed in the morning
  • Number of times you awoke during the night
  • How refreshing was the sleep overall
  • What may have disturbed your sleep (breathing troubles, leg movements, insomnia, etc.)
  • Number of caffeinated beverages consumed throughout the day
  • Number of other stimulating beverages consumed throughout the day
  • Medications taken during the day
  • Time spend exercising
  • Activities performed an hour before bed
2. Try to improve your Sleep Hygiene:
  • Make sure your bedroom is dark and quiet
  • Have regular bedtimes and awakening times
  • Avoid stimulants such as caffeine and nicotine close to bedtime
  • Avoid having a large meal close to bed time
  • Try to establish a bed time ritual e.g. bath, herbal tea, prayer, meditation
  • Try to leave worries out of the bedroom and keep your sleep environment peaceful
3. Stimulus control
  • reduce exposure to unhelpful stimuli
  • use your bed only for sleep
  • try not to do work in bed e.g. pay bills, eat, use your computer
  • try not to watch TV or talk on the phone in bed
  • remove distractions such as exercise equipment
  • use comfortable pillows and sheets
  • avoid staying in bed after 15 minutes if you cannot sleep
4. Relaxation training
  • Autogenic training
  • Biofeedback techniques
  • Breathing exercises
  • Guided imagery (mind-body technique)
  • Progressive relaxation
5. Positive imagery; for example:
  • focusing on pleasant memories like walking on a beach or sitting beside a mountain stream
  • Remember a fine day in early spring or summer with your family or friends
6. Cognitive Restructuring
  • Remember there is no gold standard for sleep – everyone is different
  • Some people only need a few hours of sleep and still perform well during the day
  • In people who do have symptoms of anxiety or depression, treating the underlying cause of these conditions will help improve sleep patterns
Dear colleagues: please try some of these methods I have just described. They can be really effective in helpful with improving sleep. However, if the problem is severe or it persists, please seek medical help.

Dr Layla A/Aziz Alishaq
Consultant in Psychiatry and Psychotherapy 

Additional sources: