How to safeguard your sleep from insomnia over COVID-19 worry

At this point in the pandemic, it may not come as a surprise that the impacts of COVID-19 have included increases in mental health issues such as depression, anxiety, and substance use. Along with those issues, recent reports show that sleep has been impaired as well. The pandemic has fueled a significant increase in insomnia—with roughly 60 percent of people reporting an increase in problems sleeping since the start of the pandemic.

New findings published in the Journal of Sleep Research show that it's not just COVID-19 disease itself (its symptoms or exposure to the virus), but worries surrounding COVID-19 have significantly contributed to insomnia.

Penn Medicine researchers led by Lily Brown, Ph.D., an assistant professor of Psychology in Psychiatry and director at the Center for the Treatment and Study of Anxiety, evaluated associations between COVID-19 exposures, COVID-19 worries, and insomnia. They found that greater severity of COVID-19-related worries was associated with elevations in insomnia symptom severity more than COVID-19-related exposure was—meaning worries about COVID-19 were a more consistent predictor of insomnia than COVID-19 exposures.

"We've found that worries about COVID-19 worsens insomnia, regardless of actual risk," Brown explains. "These finding impact the care we can provide. It's helpful because exposure to risk may or may not be modifiable—depending on one's job, for instance—but changing how one manages worries is very do-able."

Future research will look into strategies to simultaneously treat insomnia and increased worries, to see if that improves outcomes.

Struggling with increased worries yourself? First of all, Brown notes that worrying is not the same as problem-solving. Sitting and stewing on the catastrophes that could come your way will not help you prepare for them. Second, Brown recommends catching yourself when you notice getting stuck in a worry spiral. Third, redirect your attention back to the present moment using mindfulness strategies. Fourth, note whether the worries that come up again and again are potential problems vs. actual problems. However, if chronic worries are impairing your life in any way, consider seeking help with a therapist.

And for those struggling with sleep, there are evidenced-based (meaning researched-backed) strategies to help tackle insomnia. These recommendations can be a fit for anyone who is trying to improve their sleep schedules and habits.

"Often in pop culture and even in health care settings, we throw around the term 'sleep hygiene' as the kind of behaviors we hope to achieve to improve sleep," Brown says. This often looks like behavior changes, such as limiting phone use while in bed or decreasing caffeine intake.

The reality is that many struggling getting enough sleep already know these rules. So while sleep hygiene is important, it's often not enough to sufficiently address sleep disorder symptoms, Brown explains. But the good news is there's more that can be done, thanks to strategies backed in cognitive behavioral therapy for insomnia to improve sleep.

The first tip might sound counter-initiative, but Brown actually recommends limiting time in bed.

"There's a common pattern people with insomnia fall into. They go to bed earlier and earlier because they get less and less sleep. For example, perhaps they couldn't get to sleep until 3 a.m., so they go to bed around 8 p.m. to try to get more sleep, but they end up just spending more time awake in bed," Brown explains. "Instead, focus on sleep efficiency. You want the amount of time spent in bed to be close to the amount of time asleep."

To achieve this, push back your bedtime, while keeping the time awake the same. It may seem paradoxical, but when people get tired earlier and earlier, it allows them to get more sleep over time. However, if you use this strategy, Brown notes it's important to wake up at the same time every day.

One other tip involves avoiding sleep to help improve sleep at night—skipping out on naps. Brown recommends limiting naps, especially if one is pushing back their bedtime to fall asleep sooner after getting into bed. "You need to make sure you're not countering efforts with increased nap time, otherwise this can backfire and you're not actually going to get more sleep," Brown says. "It might seem counterintuitive, but if you stick to a schedule and you don't nap, you will eventually become tired enough to fall asleep at a more reasonable hour."

Of course, there's the recommendation many may have heard about limiting screen time. This can come into play a few ways. First, if you haven't fallen asleep after 15 minutes, it's important to get out of bed and do a quiet activity like reading a book. But Brown stresses the importance of avoiding reading or browsing on your phone or watching television due to the impact of screen light on sleep. Second, doomscrolling—continuing to read upsetting news—can take a toll on sleep. But by putting your phone down before bed, you can prevent getting wrapped up in upsetting content, which could affect your sleep.

"These are just some of the tips we talk about in cognitive behavioral therapy," Brown says. "So if you're following this advice and still struggling, don't hesitate to reach out to a professional to help."