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Sleep is nature’s medicine

Shut-eye in the time of COVID.

This content originally appeared on the Psychology today blog.

Within the animal kingdom, sleep is a universal experience. Giraffes find unique ways to doze off, monkey brains are restored by a good night’s rest, and whales dream. Like our mammalian relatives, humans have a biologically driven need for sleep, which means our brains are highly motivated to help us drift off. But during the COVID-19 pandemic, that biological drive has come up against significant environmental and societal challenges that have led to sleepless nights for many people.

The unprecedented scale of this crisis has affected every single one of us

It’s hard to overstate how the upheaval over the past 18 months has affected mental health, including sleep. For example, roughly 40% of Americans have reported symptoms of anxiety and depression during the pandemic, which is up significantly from 2019. While sleep can help regulate our mental health, good sleep can be difficult to achieve, even in the best of times. During the pandemic, it’s become even harder. In an August 2021 survey of over 2,000 Americans half of respondents said their sleep has been disrupted during the pandemic. These disruptions have created a vicious cycle of poor sleep at night and worsening mental health during the day.

Among catastrophes, however, COVID is unrivaled in its scope because it’s not a single event. It has effected the entire world and every single one of us in multiple ways.

Dr. Colin Espie, Big Health’s Co-Founder and Chief Scientist

Historically, catastrophic events such as natural disasters, crop failures, and the events of 9/11 have been known to affect sleep. Among catastrophes, however, COVID is unrivaled in its scope because it’s not a single event. It has affected the entire world and every single one of us in multiple ways. When we look back in history, even the World Wars didn’t impact every country the same way as the COVID-19 pandemic.

Even if we haven’t personally contracted the virus, or don’t feel we’ve been directly impacted by the disease, its shockwaves can be felt by nearly everyone. Professional uncertainty, financial challenges, and family stress are just a few ways in which the virus has triggered our brain to be on high alert. Unfortunately, for many of us, our brains remain there.

Sleep hasn’t let us down

As a result, our days are filled with activation of uncertainty and hyperarousal, which makes it hard to unwind when it comes time to sleep. In addition, many of our lifestyle patterns — when we go to bed, when we get up, when our work days begin and end, how our weekends are structured — have changed during the pandemic. All of those things affect our sleep, because our circadian rhythms require pattern and regularity.

The good news is that our research findings show that sleep hasn’t let us down. Even during the pandemic, the restorative properties of nature’s medicine have enabled us to perform our everyday mental functions…

Dr. Colin Espie, Big Health’s Co-Founder and Chief Scientist

In 2020, myself and a group of researchers from around the world formed the International COVID Sleep Study (ICOSS) with the goal of researching the pandemic’s effects on sleep. We established a systematic approach to measuring sleep in all countries, and then translated that measure into various languages so that we could pool data and look at wider patterns across cultures and nations. While some studies are ongoing, many have been completed and published.

The good news is that our research findings show that sleep hasn’t let us down. Even during the pandemic, the restorative properties of nature’s medicine have enabled us to perform our everyday mental functions such as paying attention, learning, accessing memory, and performing tasks. One study found that “social jetlag” — the difference between sleep time on work days vs. free days — has decreased during the pandemic. That means sleep-wake times are more consistent, perhaps because people are freer to choose their own sleep schedules.

The bad news, however, is that it’s a challenging time for sleep, and many of us aren’t getting enough of it. One study found that COVID-19 is associated with higher rates of anxiety, depression, and insomnia — and that people who are confined, live alone, or live with five or more people are at higher risk for insomnia. Of the 13 countries studied, the United States had the highest rates of insomnia symptoms (59.8%) and probable insomnia disorder (31.4%). Another study found that dream recall frequency — the ability to remember what you dreamed — increased during the pandemic. That recall was associated with nightmares, sleep maintenance issues, and even PTSD symptoms.

How to counter COVID’s effects on sleep

If any of this sounds familiar, or if you’ve been grappling with insomnia during the pandemic, I have good news: You can do something about it. Here are a few tools, skills, and insights to help you improve your sleep almost immediately.

  1. Develop a personalized sleep schedule: Take the time to experiment with and figure out your natural body rhythms. Forcing yourself to go to bed early or stay up late when it feels unnatural is counterproductive and can cause stress and worsen sleep problems.
  2. Work to be more sleep efficient: Are you spending nine hours lying in bed, but only six actually sleeping? If so, your sleep efficiency is 66%, and could use some improvement. If you get frustrated by actively trying and failing to fall asleep, get out of bed and do a relaxing, non-stimulating (no gadgets!) activity such as reading or meditating before getting back in bed and trying again. And if you naturally wake up at 5:00am feeling rested, you should feel empowered to get up and start your day. As your sleep efficiency increases, you’ll get good insight into your personalized sleep schedule.
  3. Find ways to cultivate productive sleep: Put your day to rest! By spending 10 minutes or so in the evening tying up loose ends from your day — such as making a list of everything you need to do tomorrow — you can quiet a racing mind and fall asleep faster. This is an excellent example of cognitive behavioral therapy for insomnia, which is a scientifically proven approach that can help you sleep better. Another good behavioral approach is creating a wind-down routine, which may include things like breathing exercises, reducing blue light (from TVs or smartphones), and intentionally relaxing as you settle into bed.

Finally, take comfort in the knowledge that, even though the pandemic is an ongoing cause of stress, you don’t have to wait for the world to return to “normal” in order to improve your sleep. Remember, our brains are much smarter than we are. They know we need sleep as much as we need food, water, and air and, if you trust and allow it, your brain will ensure that your body gets the rest it needs. And when that doesn’t happen naturally, effective care is available. Cognitive behavioral therapy is the recommended first-line treatment for insomnia proven to help you fall asleep faster, stay asleep longer, and wake up feeling rested.

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About the Author

Colin Espie, Ph.D.

Colin Espie, Ph.D.

Co-Founder and Chief Scientist

Professor Colin Espie is Co-founder and Chief Scientist of Big Health and Professor of Sleep Medicine in the Nuffield Department of Clinical Neurosciences at the University of Oxford. A world-renowned sleep expert, Professor Espie is focused on improving the clinical assessment and treatment of sleep disorders, particularly using Cognitive Behavioural Therapeutics (CBTx), and studying sleep’s relationship to mental health. He has published over 300 scientific papers in his career and has been elected as a Fellow of the British Psychological Society, the Royal Society of Medicine, and the American Academy of Sleep Medicine.

Prior to founding the University of Oxford’s Experimental & Clinical Sleep Medicine Research Programme in the Sleep & Circadian Research Institute in 2013, Professor Espie was the founding Director of the University of Glasgow Sleep Centre. In 2015, he was appointed an Honorary Fellow of the British Association for Behavioural & Cognitive Psychotherapies, was given the Mary A. Carskadon Outstanding Educator Award by the Sleep Research Society in 2017, and was awarded the Society of Behavioral Sleep Medicine’s Peter Hauri Career Distinguished Achievement Award in 2021. A highly sought after public speaker, Professor Espie regularly shares his latest research on sleep and sleep disorders, and serves as scientific expert in television and documentary interviews.

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