What Is "Coronasomnia"?
Recently it seems that every one of the classes I teach (remotely) starts with a discussion of sleep problems. In one group, in which several members said they’d been awake at 3 am, someone joked, “We should just have class then, since we’re all probably more alert at 3 am than we are right now, after another night of not sleeping.”
The idea isn’t totally crazy, according to a leading behavioral sleep specialist Donn Posner, an adjunct associate professor at Stanford University School of Medicine and president of Sleepwell Consultants, who told me in a recent interview, “If you’re having troubles sleeping in the middle of the night, get out of bed, get up, and do something fun.”(But, it turns out, this doesn’t mean a planned weekly meeting. We’ll get to that in a minute.)
As Alon Avidan, a neurologist who directs the UCLA Sleep Disorders Center, said in an interview for the Washington Post, “With covid-19, we recognize that there is now an epidemic of sleep problems.”
After hearing similar complaints from clients, friends, family, and other colleagues, I decided to look into what makes it so hard for us to sleep right now, and what we can do about it.
Posner, who lectures about sleep all over the world, told me that the reason for getting up when you’re wide awake in the middle of the night is so that you don’t turn your bed into a trigger for being awake. And that’s exactly what you are doing, he said, “if you’re awake in the middle of the night, holding onto that mattress for dear life trying to make yourself go back to sleep.” This desperate attempt to make yourself sleep is called “sleep effort” – which, he says, is doomed to fail.
He told me that when he gives a lecture about sleep health, he always asks who in the audience falls asleep without difficulty. And then he asks them how they do it. He said that no one can ever answer that question, because sleep is a function of our bodies that we cannot control. He told me, “Just as you can’t make your heart beat or make yourself breathe, you can’t make yourself sleep. Good sleepers do nothing to make themselves sleep. Trying to make yourself sleep, becoming fixated on your sleep, is a perpetuating factor that keeps your insomnia alive.
So if it’s an automatic function, what makes it so hard for many of us to get a good night’s sleep? And why is the pandemic making it worse?
Posner explains his approach to insomnia on the podcast Ten Per-Cent Happier with Dan Harris. He tells us that we all have a bad night’s sleep from time to time. That’s normal. But when it lasts longer it can transform into acute (or short-term) insomnia, which, if it persists and is not addressed, can become chronic insomnia.
According to the National Institutes of Health, “Insomnia is a common sleep disorder. With insomnia, you may have trouble falling asleep, staying asleep, or getting good quality sleep. This happens even though you have the time and the right environment to sleep well. Insomnia interferes with your daily activities and may make you feel unrested or sleepy during the day. Short-term insomnia may be caused by stress or changes in your schedule or environment. It can last for a few days or weeks. Chronic (long-term) insomnia occurs three or more nights a week, lasts more than three months, and cannot be fully explained by another health problem or a medicine.”
Richard Barth, a sleep specialist in San Francisco who studied with Posner (who, full disclosure, is my brother) told me that “sleep effort” is one of the things that perpetuates sleeplessness, turning acute insomnia into chronic insomnia. And my PT colleague Boris Dubrovsky, a sleep specialist in New York City who is Board-Certified in Behavioral Sleep Medicine and an associate director at NY-Presbyterian Brooklyn Methodist Hospital writes that the three most common factors in making insomnia chronic are “spending a lot of time trying to sleep, spending a lot of time thinking about sleep, and spending a lot of time fearing not being able to sleep.”
Posner said that there are many precipitants of sleep problems. “You could probably open the dictionary, put your finger down on a word, and find something that causes insomnia.” Illness, physical pain, a change in your environment, a psychological stress like stress in your work, tax time, a change in your life. He adds that even good things can be stressors that interfere with sleep – getting married, expecting a baby, or other things that make us happy can also be stressful.
The pandemic, of course, is a major stressor accompanied by numerous other stresses, like worries about our own health and that of loved ones, financial concerns, new patterns (often not particularly pleasant) of working, crowded and tense home situations, loneliness, anxiety, and so on. The ongoing disturbance has created wakeful nights even for people who normally sleep well.
Not sleeping in times of danger is natural and, from an evolutionary perspective, even healthy. In an article published in last year in the journal Brain Sciences, a group of researchers from around the US and the UK wrote, “Evolutionarily speaking, …if it is not safe to sleep, one should not sleep (regardless of the duration of prior wakefulness and/or time of day).” They cite two early sleep specialists, Spielman and Glovinsky, who developed the initial model for CBT-I (Cognitive Behavioral Therapy for Insomnia), who wrote, ‘No matter how important sleep may be, it was adaptively deferred when the mountain lion entered the cave.’ But extended periods of not sleeping, as we all know, brings many other concerns, including inability to do our work, increased anxiety and depression, and possible health problems. So what can you do to get a good night’s sleep on a regular basis, despite the mountain lion of the pandemic at the front door?
I am neither a sleep specialist nor a cognitive behavioral therapist. But in researching ways to help clients deal with pandemic-initiated insomnia, I repeatedly encountered comments like this one from Dubrovsky, who writes that research shows CBT-I to be “the most evidence-supported insomnia treatment to date.”
Similarly, Brandon Peters, a board-certified neurologist and sleep medicine specialist writes, “Cognitive behavioral therapy for insomnia (CBTI) is …now recommended as the first-line treatment for chronic insomnia, even before the use of sleeping pills.”
In Part II of this discussion, I'll talk about some ways that you can get a handle on insomnia during the pandemic -- and outside of it, as well.