It’s 12.53am. I am exhausted. My body feels leaden, battered. But my mind, cruelly, is alert and vigilant. I’m scanning the horizon of my consciousness for threats, isolating one worry, settling on it, and then moving on to another. The impact the Covid-19 pandemic will have on my parents. On my relatives. On my husband. On our finances. The impact of social isolation on my children’s mental health. On their education.
I pick up my phone to check if I have missed any late breaking news updates. Of course I have. If you look away for 15 minutes, you’ll have missed another dire headline.
During the days, I work at a desk set into the space that used to be occupied by a wardrobe in the spare bedroom, interrupted by regular breaks to care for my children or check the news. In the evening I take a 40-minute walk alone, a reward for getting through the day. As I walk, I make a wide berth around walkers; or they step into the road to avoid me. I try to catch their eyes and smile. Some look at me and smile back, but mostly they stride past, heads down. A month ago I walked this route shoulder-to-shoulder with friends. Now I pound the footpaths alone, coronavirus podcasts for company.
Back home, I turn on the news; one eye on the television, the other on my WhatsApp groups. My husband and I discuss the latest death toll. We’re all death trackers now. The children have taken to creeping silently into the room when a news programme is on, which is all the time. When the RTÉ News sig tune starts up, all levity drains out of the house.
When I eventually close my eyes, I fall into a deep, grateful state of unconsciousness. Three hours later, four if I’m lucky, I jolt awake from a vivid dream in which I’m driving through a fairground full of people in a car with no brake. I reach for my phone, telling myself I’ll just quickly check in. But as I lie there scrolling, sleep slips away.
In the current situation it is the status quo and our health that is threatened. This leads to a cascade of reactions in our body, releasing stress hormones like cortisol
The Covid-19 pandemic has created “a sleep perfect storm”, says sleep physiologist Motty Varghese.
“Everything about this time is disruptive. We’re in a heightened, stressful state of mind. We are working from home. We are isolated. We’re not commuting, so we have a little bit of extra time on our hands. Some of us have job-related insecurities.”
We’re out of normal routines. We’re worried about our health, and the health of loved ones. On top of this, we don’t have access to our usual outlets: exercise classes, going to the gym, having a night out with friends.
“Stress is a basic preservation instinct. In the current situation it is the status quo and our health that is threatened. This leads to a cascade of reactions in our body, releasing stress hormones like cortisol, which elevates our response to the threat.”
The physiology of sleep is particularly cruel. Those of us who frequently suffer from poor sleep are all too familiar with the pattern. We worry because we’re not sleeping enough. Because we’re not sleeping enough, we worry.
The constant, low-level state of exhaustion means we’re less able to regulate our emotions or to deal with our anxieties. A few days or weeks into a cycle of bad sleep, the second stage kicks in: the worry about whether or not we’ll be able to sleep that night begins to creep into our waking hours. We start anticipating the bad night’s sleep we fear we’re going to have. Sleep performance anxiety grips us. The worry about the fact that we’re not sleeping becomes one of the things keeping us awake.
“Under normal circumstances we know that worry and anxiety about sleep is the main predictor of not being able to sleep as well as we would like. It’s a classic vicious circle where you can’t get to sleep; you stare at the ceiling, worried about not being able to sleep because you’re worried about the consequences of not being able to sleep,” says Prof Andrew Coogan, head of the Department of Psychology at NUI Maynooth and a professor of behavioural neuroscience.
You start to remove the thoughts that cause the anxiety and cause the rumination. That can be very effective for a lot of people
“You’re worried you won’t be able to do whatever it is you have to do the next day. And now you’ve got even less chance of getting to sleep.”
But often, he says, “that vicious cycle is driven by what we call dysfunctional beliefs about sleep, things we believe about sleep that aren’t necessarily true. We hear a lot about the fact that everyone needs to get between seven and eight hours’ sleep a night. On average, that’s true. But there are a fair few people who are absolutely fine with six hours. There are other people who need eight or nine hours’ sleep.
“So this lying in bed thinking, ‘Oh my God, I’m not going to get my eight hours’ sleep, I’m not going to be able to function’, that might not be true for you at all.”
Insomnia is defined as difficulty falling or staying asleep. Acute insomnia happens over a brief period, usually caused by life circumstances – like a viral pandemic, for example. Chronic insomnia is disrupted sleep that occurs at least three nights per week, and lasts at least three months. It is usually due to changes in the environment, unhealthy sleep habits, shift work, clinical disorders or medications.
“The main treatment for insomnia is what is called cognitive behavioural therapy [CBT] for insomnia. The cognitive piece of that targets those dysfunctional beliefs about sleep,” says Coogan.
“You start to remove the thoughts that cause the anxiety and cause the rumination. That can be very effective for a lot of people.”
But what happens when you just can’t rationalise away the worries? When the anxiety that’s keeping us awake is not in response to imaginary threats but is a perfectly logical response to a real and potentially imminent one?
We are in a serious situation. But, as some virologists have said, it’s not the zombie apocalypse
“There’s a couple of things going on now. First of all there’s a natural anxiety about Covid-19. It’s completely understandable. It’s amplified by the 24 hour news cycle and social media,” Coogan says.
On top of this, “our routines are being disrupted. A lot of the anchors around which we build our sleep behaviours are probably gone out the window as well. The sudden randomness of it has been unsettling. We know it will be a finite event, but what does that mean? A couple of months? A year? People like certainty.”
He pauses, keen to phrase this properly. “We are in a serious situation. But, as some virologists have said, it’s not the zombie apocalypse. There’s a tendency in all of us to catastrophise, to think of the absolute worst-case scenario.”
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Psychotherapist Siobhán Murray says that, in the early days of the lockdown, “everyone went into trauma-panic mode. They were trying to get the home office set up. They were trying to ‘home-school’ their children, and I say that in quotes, because it’s not home-schooling. They were trying to do a full eight-hour day working from home. They were trying to ensure everyone was eating well. They were trying to get used to social distancing. They were overwhelmed. So when they went to bed, their minds were racing: did I do a good enough job at home-schooling today? Did I get enough work done? Even leaving aside Covid-19, the circumstances we have been thrown into, and navigating the physical practicalities of it are what’s causing anxiety.”
With all of that going on in our heads, there’s no wonder so many of us are having trouble sleeping.
Because of the relationship between sleep and anxiety, all of the experts I speak to for this article are keen to tread carefully when I ask them about the short-term and long-term health repercussions of sleep disruption, and in particular its impact on our immune system. All believe sleep should be a key part of public health messaging about fighting Covid-19.
But when it comes to sleep, scaring people is not a solution. It is much more likely to exacerbate the problem. So if you’re already sleeping poorly because you’re anxious about your health, the next paragraph is unlikely to help.
Good sleep leads to better memory formation; better ability to learn things. Our task effectiveness is better. Our reaction time is quicker
“Routinely sleeping less than six or seven hours a night demolishes your immune system, more than doubling your risk of cancer,” British neuroscientist Matthew Walker writes in his book Why We Sleep. “Insufficient sleep is a key lifestyle factor determining whether or not you will develop Alzheimer’s disease. Inadequate sleep – even moderate reductions for just one week – disrupts blood sugar levels so profoundly that you would be classified as pre-diabetic. Short sleeping increases the likelihood of your coronary arteries becoming blocked and brittle, setting you on a path toward cardiovascular disease, stroke, and congestive heart failure … Sleep disruption further contributes to all major psychiatric conditions, including depression, anxiety and suicidality.”
Rather than focus on the deleterious effects of disrupted sleep, Varghese suggests, it is more helpful to talk about all the positive ways sleep impacts on the immune system.
“It goes against the grain of what I do [to talk about the negative health impacts], because I’m worried that it may cause more anxiety. The other way to look at it is, what are the effects of good sleep? Good sleep leads to better memory formation; better ability to learn things. Our task effectiveness is better. Our reaction time is quicker.” If we haven’t slept well, “all of those things are going to suffer”, he says.
Sleep, he says, “has to be seen as another line of defence” in public health messaging, along with handwashing and social distancing.
Some of the negative effects of poor sleep will be familiar to most people. “Poor sleep increases your stress levels, and your stress levels are going to impact your ability to get a decent night’s sleep. If you’re not sleeping, your cognitive reasoning is out the window. You don’t have the energy to go for the walk that might help you clear your head. You’re snacking all day. You’re physically and mentally exhausted,” says Murray.
When we’re not sleeping, adds Coogan, “our concentration suffers. Our ability to control our emotions is affected. We become more emotional and more reactive. We’re more likely to have mood swings.”
But one of the side effects of disrupted sleep we might not notice is its effect on our psychomotor vigilance. “That’s your brain automatically scanning the road so that you have the ability to react quickly if someone cuts you off on the road. It’s happening underneath the hood and we’re not really aware of it. Those processes can be particularly impacted by sleep loss.”
There is a mounting body of research to show that “sleep restocks the armoury of our immune system, helping fight malignancy, preventing infection and warding off all manner of sickness,” writes Walker.
“Sleep fights against infection and sickness by deploying all manner of weaponry within your immune arsenal, cladding you with protection. When you do fall ill, the immune system actively stimulates the sleep system, demanding more bed rest to help reinforce the way effort. Reduce sleep even for a single night and that invisible suit of immune resilience is rudely stripped from your body.”
In those sleeping five hours on average, the infection rate was almost 50 per cent
One study quoted in Walker’s book seems particularly timely. Dr Aric Prather at the University of California, San Francisco, measured the sleep of more than 150 healthy men and women. Then he quarantined them and proceeded to “squirt a good dose of rhinovirus, or a live culture of the common cold virus, straight up their noses”.
The participants were separated into groups on the basis of how much nightly sleep they got in the week prior – less than five hours; between five and six; between six and seven; and seven or more – and monitored over a week.
“There was a clear, linear relationship with the infection rate,” writes Walker. “The less sleep an individual was getting in the week before facing the active common cold virus, the more likely it was that they would be infected and catch a cold. In those sleeping five hours on average, the infection rate was almost 50 per cent. In those sleeping even hours or more a night in the week prior, the infection rate was just 18 per cent.”
It’s hard to overstate the significance of those findings in the midst of a global pandemic or a virus against which our only weapons are hygiene, staying away from one another and our own immune systems.
Walker, writing in 2017, put it this way: “No matter what immunological circumstances you find yourself in – be it preparation for receiving a vaccine to help boost immunity, or mobilising a mighty adaptive immune response to defeat a viral attack – sleep, and a full night of it, is inviolable.”
We still don’t even really know what the purpose of sleep is. But we do know this. It is vital to our wellbeing. And that applies both in terms of our long-term health and our short-term ability to fight off something like a novel coronavirus.
But if the very thought of that novel coronavirus – and the side effects of the abrupt derailing of normal life – is the thing giving you sleep-interrupting anxiety, what can you do?
Control the controllables, is the advice of all three experts.
“Anxiety and sleep problems go hand in hand. They’re nearly inseparable from each other. We shouldn’t be worried about the pandemic; we should be cognisant and mindful of it and think about what we can do,” says Coogan.
“We can affect it through our behaviour. Through staying at home and social distancing, we can affect both our own chances as individuals of contracting it and we can have an impact at population level. This is not a hopeless situation.”
Disengaging from the endless news cycle and social media is a key part of sleep hygiene generally, adds Coogan. “Limit your sources of information to reputable ones. There’s a calm reassurance to be found in experts. Get out and expose yourself to sunlight in the morning. While following the social distancing advice, get out and exercise. It relieves stress, and it helps you to sleep. Before bedtime, do something non-Covid-19 related.”
Varghese agrees it’s important to focus on the fact we do “have certain controllables: washing our hands, isolating ourselves, social distancing or physical distancing, limiting our social media use and looking for credible sources of information.”
Her first piece of advice is to ignore all the advice telling you to seize this moment as an opportunity to become a better you
For a lot of us, our current state of anxiety is exacerbated by the sudden collapse of the structures that held our lives together: getting up in the morning and getting ready for work. Going to the gym. Taking the children to school. Driving, cycling or getting the train to the office. A day full of meetings and deadlines. Back home for dinner. Driving the children to football practice or taking the dog for a walk. Home in front of Netflix. Maybe a bit of exercise squeezed somewhere in between.
With all of that gone, there’s nothing shielding us from the tyranny of our own thoughts.
“Now we have this space, and the worries are running amok. Now we can’t push them back down again. We have to deal with the feelings. And nobody has ever educated us how,” says Murray.
Her first piece of advice is to ignore all the advice telling you to seize this moment as an opportunity to become a better you; to learn a new language, start baking again, lose 4kg in weight. “Right now, your focus should be on, how am I, with my family or my little pod, going to get through today? What am I eating today? When am I exercising?”
With her clients, she is focusing on helping to improve their sleep by controlling their anxiety from the time they get up in the morning using techniques based on CBT.
“Before, we’d work on separating fact from opinion. So a lot of people had an opinion like ‘I might lose my job’. Now that it’s more likely to be a fact; they might actually have been let go. So it’s about acknowledging the feeling that you have. It’s not about pushing it down. If you’re feeling anxious, allow yourself to feel anxious” – but don’t let it take over the whole day, she says.
One of the techniques she suggests to clients is to “get your head around a three-month plan for yourself. Sit down early in the morning and figure out what you’ll have to do to get through the next three months – even if it’s something as simple as use up all the food that’s lurking in the back of the freezer.”
Another technique is to write your worries on one side of a Post-it, she suggests. “On the other side, write down why you’re worried about it. And then fold it up, and put it into a jar or a bowl. Tomorrow morning, take them out, and go through them. Add a new one if you need to. And when you start to feel less worried about something, rip it up and chuck it out. It gets it all out of your head.”
Otherwise, she says, “people are going to bed after a day that’s been busy, but not particularly productive, and all the thoughts start running around in their head. But if you know that you’re going to sit down with a cup of tea tomorrow morning and go through it, you’re giving yourself permission not to worry about it at night. It’s self-management.”
Sleep is within our control, too. We can optimise our chances of sleeping by implementing good sleep hygiene measures, says Varghese. He advocates turning your bedroom into a cool, dark cave – have good blackout blinds on the window, sleep in room that’s not too warm, and is free of technology and distractions. He is not a fan of sleep trackers for most people, because they can exacerbate anxiety.
We need to signal to our body that the sun has set. We have to facilitate that process by eliminating any blue light exposure for at least two hours before bedtime
“See every night as a new night. If you had three or four poor nights, tonight is still a new night. And there are really three key factors that can influence your sleep on any night.”
The first is making sure you’ve been awake long enough to build up your “sleep drive”. “The second factor is limiting your light exposure close to bedtime. We need to signal to our body that the sun has set. We have to facilitate that process by eliminating any blue light exposure for at least two hours before bedtime.” That means putting the phone away – which should also help with your anxiety levels.
The third factor, he says, is to become aware of your own body clock. “We have a circadian clock, or a master body clock, in our brain which regulates the timing of everything that happens in our body. It makes you sleepy, and at a certain time, and you have to follow that pattern.”
This is crucial now people are working remotely from home and have more flexibility in their routine. “People should learn to observe their personal chronotype. Some of us are more of an evening type, some of us are a morning type; some of us would be intermediate. An evening type person might go to bed a bit later and get up a bit later; the morning type person is the exact opposite.”
Teenagers, Coogan suggests, should take advantage of current circumstances to get up at a time better suited to their body clock – he suggests 10am or 10.30am.
What will help us defeat Covid-19, says Coogan, “won’t be some innovative new tech or some pharma solution. They will contribute to it. It will be the old-fashioned principles of good hygiene, good nutrition and sleep. The reason they are old-fashioned is because they work.”
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