Stress-induced insomnia could imperil public health
Experts say they are now seeing ‘an epidemic of sleep problems’ as pandemic inspires feelings of existential dread in adults and children
Sara Tibebu tried bubble baths. She curated playlists of lo-fi beats, followed guided meditation videos and paid for virtual therapy. In desperation, she even plucked and dried lavender to make sachets to place inside her pillowcase.
But every night, she still found herself staring at the ceiling — wide awake. For five months, all Tibebu has wanted is a decent night of shut-eye.
“The lack of sleep is just driving me crazy,” said Tibebu, 36, a technical writer who lives in Takoma Park, Md., where most nights her eyes snap open about 2 a.m. and she begins to obsess over issues ranging from the U.S. response to the pandemic to the state of her love life.
As if the coronavirus has not already wrought devastation aplenty on the world, physicians and researchers are seeing signs that it is doing deep damage to people’s sleep. “Coronasomnia,” as some experts now call it, could prove to have profound public health ramifications — creating a new population of chronic insomniacs grappling with declines in productivity, shorter fuses and increased risks of hypertension, depression and other health problems.
It’s easy to see why people can’t sleep, experts say. The pandemic has heightened stress and upset routines.
Bank accounts are strained and children are home. Days lack rhythm and social interaction. The bedroom, which sleep experts say should be an electronics-free sanctuary, now serves for many as a makeshift office. The news is gripping, bad and breaking around the clock in blue light that discourages shut-eye. The future is uncertain, the end of the crisis indiscernible.
“Patients who used to have insomnia, patients who used to have difficulty falling asleep because of anxiety, are having more problems. Patients who were having nightmares have more nightmares,” said Alon Avidan, a neurologist who directs the UCLA Sleep Disorders Center. “With COVID-19, we recognize that there is now an epidemic of sleep problems.”
Even before the virus, lack of sleep was a simmering public health crisis associated with a suite of maladies. About 10 percent to 15 percent of people worldwide were suffering from chronic insomnia, the struggle to fall or stay asleep at least three nights a week for three months or longer. Crises such as natural disasters or terrorist attacks are known to trigger short-term sleeplessness. But experts say the pandemic’s global impact and protracted nature threaten to expand the rate of chronic insomnia, which is much harder to treat.
“Insomnia is not a benign problem. … The impact of insomnia on quality of life is enormous,” said Charles Morin, director of the Sleep Research Center at Université Laval in Quebec, who has called for large-scale campaigns about the value of shut-eye to stem a coronavirus-era sleep crisis. “We hear a great deal about the importance of exercising and good diet, but sleep is the third pillar of sustainable health.”
Morin is leading a 15-country project to measure the pandemic’s impact on sleep, but there is already evidence of broad deterioration. Prescriptions for sleep medications jumped 15 percent between mid-February and mid-March in the United States, according to Express Scripts, a major pharmacy benefit manager. At the UCLA Sleep Disorders Center, the number of patients complaining of insomnia has risen 20 percent to 30 percent, and more of them are children.
Web-based studies in China, France and Italy found insomnia or poor sleep in about 20 percent of respondents, particularly during pandemic-related shutdowns — which, Italian researchers wrote, seemed to cause people to lose track of days, weeks and time itself. In Greece, researchers reported that more than 37 percent of 2,427 people surveyed in April had insomnia.
While such surveys are not methodologically robust, they provide “an important signal, especially when it’s consistent across countries,” said Orfeu Buxton, a sleep researcher at Pennsylvania State University who said it’s important to view anxiety and sleep troubles as appropriate at a time like this.
“We evolved these brain mechanisms to help us react to literally existential threats, and they’re piling on right now, especially for the less advantaged,” Buxton said. “The circumstances are such that sleep is a sentinel, a sign that things are really wrong in our country and the world.”
Dread about the future is often imagined, he said, but not now. “This is dread that’s real,” he said.
Dread is also the word 65-year-old Cheryl Ann Schmidt uses for the heavy, knot-like feeling that hits her solar plexus every time she tries to rest.
“I get this sense of dread, like I’m not going to wake up, like something is seriously wrong in the world,” said Schmidt.
Schmidt’s sleep woes began when she was sent home from her job in East Lansing, Mich., as a recycling director at a foam company in April.
Now, Schmidt said, she lies awake fretting about finances and lost retirement plans, then chastising herself for self-pity when others are dying of COVID-19, the illness caused by the coronavirus. Most nights, she waits in the darkness until she hears the thump of the newspaper hit her front door.
The unusual, toxic mixture of pandemic-era stresses that degrade sleep is so strong that physician Abhinav Singh, director of the Indiana Sleep Center, coined a mnemonic to explain it: “FED UP.” The letters stand for financial stress, emotional stress, distance from others, unpredictability, and personal and professional concerns.
When shutdowns were imposed in March, freeing people of commutes and meetings, some of his patients began sleeping better. Months later, they’re seeking help, as are former patients and many new ones.
“The unpredictability of when it’s going to end is starting to weigh back on people,” Singh said.