During this special time of the COVID-19 pandemic and related restrictions, all of us are affected in many ways. This sudden change to daily life, combined with any stress and worries we have, can cause changes to our sleep and mental health. One of the first things to keep in mind is that it is normal for our sleep to change during times of stress and uncertainty. It is very common to not sleep well, for instance, when we stay in a new place. This is partly because our brain is not sure what threats there might be in a new place, so it remains more alert during sleep in case we need to act. The trouble is, we have been in a state of uncertainty for a while now, and this is likely to continue, so while it is normal for sleep to be disrupted in the short-term, this won’t be helpful for us in the long-term. Here are some suggestions for managing in the weeks and months ahead – there is a lot of information in this sheet, and it might be easier to read the sections that are most relevant to you first.
The 3 Pillars
There are many things that contribute both to good sleep and good mental health. Some of the key things are described as The 3 Pillars of health: diet/nutrition, activity/exercise (and light), rest/sleep.
Diet/Nutrition: What we eat and when we eat can impact the quality of our sleep, and how we sleep can impact our food choices. A number of studies have found that diets containing plenty of fresh fruit, vegetables, fish and unprocessed foods help improve mental health and the amount and quality of sleep people get. Other studies have shown that when we sleep less or are awake for long periods during the night (such as doing shift work), hormones that tell us when we are full and hungry become disorganised. We can end up feeling the urge to eat often, not get the usual signals to stop eating and have a tendency to choose foods that are not so helpful for us (often processed foods high in fats, sugar and salt). Food and drinks can also be a source of comfort, and when we feel stressed or worried, we might eat more and make not so healthy choices. Increasing alcohol intake (and some forms of recreational drug use) can interfere with both sleep and mental health. These may help people fall asleep, but can mean that sleep is of poor quality and disrupted. Caffeine can make some people feel more anxious and also affects sleep.
Activity/Exercise (and light): Keeping physically active is a really important part of sleep and mental health. Physical activity during the day can help the quality and amount of sleep we get. Some of us will have more time to take walks or do other activities with reduced work hours or commute times. Being active outdoors, especially in the morning, means exposure to bright light. Bright light signals the body clock to help keep it in a 24-hour rhythm, and this rhythm plays a big part in how we feel, including our mood and anxiety levels. Bright light in the first two hours after waking up (for at least 30 minutes) also helps set the timing of our next sleep.
Rest/Sleep: sleeping well helps many aspects of mental health, including concentration, memory, and “self-regulation”. Self-regulation includes being able to switch off from troublesome thinking and worrying, motivating ourselves to keep up with beneficial habits like activity and healthy eating, noticing our feelings and managing them as best we can, and making more accurate judgements about how others are feeling and choosing how we deal with them. During sleep, the brain also processes what has happened during our day, sorting and reorganising information and experiences. The brain goes through a recovery process during sleep and gets rid of “waste” molecules that build up during the day.
Consistency – a 4th pillar
An important way that our mind, brain and body are kept healthy is through the body’s internal biological clock. There are rhythms to many human processes, including when we are most alert and most sleepy, when our mood is at its lowest, when we produce hormones and when we can digest food.
Uncertainty and sudden changes can mean we lose track of our usual patterns and rhythms, such as work, meal and activity times. This can contribute to stress and anxiety because our brain prefers predictability and rhythm. Keeping some regular patterns to your days and weeks can help with this consistency, including regular bedtimes and mealtimes. Scheduling some activities each day, that you can then tick off, helps the mind feel there is some predictability in the world, increases your sense of control and gives a sense of achievement (even if this is as simple as walking around your garden or sending a message to a friend or colleague).
Snacking
When we talk about health, the term “snacking” can be related not just to eating, but also to other habits like exercise, media use, and watching the news – it means doing things little and often. It can be helpful to limit some snacking habits: try and stick to regular meal times and limit other food snacking times, especially in the evening; try and limit news snacking (or bingeing) if this triggers worries for you – your mind needs a break from this type of information, especially if it is worrisome or bad news; using social media to access news also means your mind can’t get a break from sad, bad or worrying news, so think about checking in just a few times a day – switching off notifications can help this.
It can also be helpful to increase some snacking habits: getting exercise in little bites often can be more achievable than finding big chunks of time. Even 7-10 minute bites of exercise have been found to help improve mental health. Reducing stress helps improve sleep, and improving sleep helps reduce stress. Yoga and tai chi have been shown to be helpful for some people struggling with sleep, but doing anything active that you enjoy is likely to be a help.
Social connection
The requirement for us to isolate ourselves means physical isolation from others – those outside our bubble – but this should not lead to social isolation. Regular social contact with others is vital at this time, especially for those who live alone or away from loved ones. Maintaining relationships and social support helps increase sleep quality and reduce stress and anxiety. Early research from China during the COVID-19 pandemic shows that health
workers who felt connected to others had less stress and better sleep quality. Phone calls, social media and messaging can help us connect in little and frequent ways.
Emotions
It is to be expected that we experience a whole range of different emotions at this time, including sadness, fear, and grief. This is OK. Trying not to have these emotions creates stress all of its own. Noticing that these things are coming up, giving them a name if you can (“ah, that feels sad”) allows the emotion to move along again, as it will naturally do. It also isn’t compulsory to have difficult emotions right now! Some people are finding that the increased time they have for themselves, their relationships, and their interests is leading to less stress and more positive feelings.
Humans have especially good threat detection systems that tend to notice anything negative – either inside us (feeling anxious or low) or outside (so much bad news, having to physically distance at the supermarket). This can impact sleep, and our threat-detecting, negative-viewing minds become more active when sleep is poor. We can help balance this by choosing to put our attention on things that are more pleasant, meaningful or valuable to us, for instance, learning something new, picking up old projects, writing (letters, journal/diary, cards, a CV for work), doing something kind, taking time to talk and listen – even cleaning!
Mental effort
It is important to be aware of the impact that this time of pandemic, and associated restrictions, can have on our feelings, mood and functioning.
We are now in positions where we have to consider our movements and tasks, and monitor our behaviour at a time when the guidance is changing. So making judgments and choices might be more challenging, for instance, choosing how often to go to the supermarket, or the effort of living in a bubble. This can make us feel anxious and exhausted. These feelings are natural considering all the effort and brain power we are using to contemplate and function in an ever-changing situation. Such feelings do not necessarily reflect problematic sleep. However, taking the time for mental breaks is important. This could include restful activities or taking a nap. During sleep, our brain works offline to process our waking experiences, so with time, sleep will help us to adapt to this situation and its challenges.
Dreaming
Dreaming is a normal part of sleep, even though some people have very little recall of their dreams. Lots of people are reporting vivid dreams at the moment, and some can be disturbing or upsetting – this is a normal response to stress. Dreams usually reflect our daytime experiences (which can include things that we have done, seen, heard or that have happened as well as our daytime thinking and emotions). They can also reflect our culture, beliefs and spirituality. They mostly occur during the part of sleep associated with processing memories and emotions (rapid eye movement sleep or REM). Dreams often include challenging situations, which at the moment could include being separated from others, fears around health, work and survival itself, or protecting ourselves or our loved ones. These kinds of dreams are natural and evidence of the mental work that is going on while we sleep to assist us in adapting to a challenging situation.
Staying in the present
When we feel stressed or our sleep is poor, our minds can become distracted by mental “time travel” – going over things in the past or projecting into the future. While a little bit of this can be helpful, too much can fuel anxiety, low mood and a sense of uncertainty. Although it can be hard, we do have control over where we put our attention. Checking in with ourselves throughout the day to see how much our minds are wandering is a useful strategy. We can do this by simply stopping for a few moments and noticing where our mind has been and how much, if any, it has been distracting us from what’s going on right now – a bit like driving somewhere familiar and arriving having no idea how we got there versus noticing the journey. Stopping a few times a day to take some full, deep breaths helps bring us into the present and reduce “what if” worrying or rumination, and this helps sleep.
Relaxation
In times of stress and uncertainty, finding ways to relax is something we need to pay extra attention to. People relax in different ways, and we often know what suits us but lose sight of this because our minds are distracted by other things. You might notice that you feel tired a lot at the moment, but sleep doesn’t come easily. What we do in the day affects how we sleep at night, so taking time to relax is part of good sleep health. It can also be useful to realise that feeling tired is not necessarily a sign that we are ready for sleep. Feeling sleepy (eyes feeling heavy, yawning, starting to “nod off”) is a more reliable indicator that sleep is near. Going to bed because we feel tired, but are not sleepy, can lead to long periods in bed awake. This can lead to frustration, which can then interfere with falling asleep. If you get into bed but sleep isn’t happening, try occupying yourself with something relaxing, such as reading, listening to music, an audiobook or a podcast. Unlike many other things in life where effort gets us closer to what we want, sleep seldom happens because we are willing it to.
It can feel difficult to turn off worries during uncertain times. The brain loves rhythm and can be “relieved” of constant worry duties by setting a regular time each day (not close to bedtime) to write down the things you are currently worried about. Spend no more than 15-30 minutes on this whole exercise. You could choose one item on your list and see if you can identify one or two ideas to help resolve or settle that worry, and otherwise attempt to postpone having your attention caught up in worrying until the next scheduled time.