Category: Insomnia

What is Coronasomnia and What Do We Do About It?

Written by Sarah Jurick, Ph.D.

For most of us, the last year and a half has been difficult for many reasons. Many have lost loved ones, fallen ill, cared for sick individuals, found themselves out of work, and missed celebrations of important milestones with friends and family. Not surprisingly, these adjustments have led to ‘tandemics’—epidemics that run in tandem and are caused and exacerbated by the pandemic—such as increased rates of mental health disorders.

Poor sleep has been one of the many consequences of the COVID-19 pandemic, leading to the term ‘coronasomnia’, which is essentially insomnia that has been caused or worsened by the COVID-19 pandemic.

Sleep Changes During the Pandemic

Research studies have begun to document these changes in sleep. Perhaps, unsurprisingly, around one-third of healthcare workers report insomnia since the rise of COVID-19, with the highest prevalence among frontline workers directly working with patients diagnosed or at-risk of developing COVID-19 (Lai et al., 2020; Zhang et al., 2020). However, this is not unique to healthcare workers. Widespread complaints of sleep loss, poor sleep quality, and insomnia are also present in the general population (Cellini et al., 2020).

Effects of COVID-19 on Sleep

Additionally, a recent study found that 6 months following hospitalization for COVID-19, sleep difficulties were among the most common lingering concerns with 26% reporting continued sleep difficulties (Huang, 2021). The authors cited multiple possible reasons for sleep difficulties following COVID-19, including direct effects of the virus, the body’s immune response, corticosteroid treatment, staying in the intensive care unit, social isolation, and stigma related to contracting COVID-19.

The Role of Stress and Changing Work Schedules

In addition to the potential direct effects of the virus, the COVID-19 pandemic has impacted sleep through increased stress levels, confinement at home, and atypical work schedules (Morin et al., 2020). Specifically, sleep quality and duration are highly dependent on how long we are awake, daylight exposure, and routines that we engage in (e.g., rising at the same time each day with an alarm, meals, exercise, work, and social/leisure activities). Lately for many of us, routines have been thrown off by shift work schedules, remote work that can end up running late into the evening, and less exposure to daylight, leading sleep to suffer. In the short-term, poor sleep can cause low mood and decreased immunity. Consequences of long-term poor sleep include hypertension, diabetes, and depression.

“Sleep Hygiene” Techniques:

Fortunately, there are some relatively simple ‘sleep hygiene’ techniques we can engage in that have the potential to improve sleep in a big way. Adapted from Morin et al.(2020):

1) Maximize daylight exposure, particularly earlier in the day, by opening curtains, getting outside, and turning on lights. This will regulate circadian and sleep-wake rhythms.

2) Try to wake up and go to sleep as close to the same time each day. Having a consistent schedule with meal times and work will also help your body to know what to expect each day and make falling asleep and waking up easier.

3) Limit naps and if you need one, try to take a short nap (15-20 minutes) early in the day. This will help you feel tired when it is time for bed.

4) Avoid using electronics before bed as well as in the bedroom. The light from our cell phone and tablets sends signals to our brain that it is time to wake up, not go to bed.

5) Reserve the bed and bedroom for sleep and sex only. This will train your brain to associate your bedroom with sleep and not stressful things that keep your mind active.

6) Make sleep a priority and aim for 7-8 hours per night.

Although these behavioral techniques are helpful, if you are experiencing insomnia several nights a week, it will likely be necessary to seek professional help. Very effective, short-term therapies such as cognitive behavioral therapy for insomnia described here are available.

 

References:

Cellini, N., Canale, N., Mioni, G., & Costa, S. (2020). Changes in sleep pattern, sense of time, and digital media use during COVID-19 lockdown in Italy. Journal of Sleep Research (preprint).

Huang, C., Huang, L., Wang, Y., Li, X., Ren, L., Gu, X., … & Cao, B. (2021). 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. The Lancet, 397(10270), 220-232.

Lai J, Simeng M, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Network Open. 2020;3(3):e203976. doi: 10.1001/jamanetworkopen.2020.3976.

Morin, C. M., Carrier, J., Bastien, C., & Godbout, R. (2020). Sleep and circadian rhythm in response to the COVID-19 pandemic. Canadian Journal of Public Health, 111(5), 654-657.

Zhang, C., Yan, L., Liu, S., et al. (2020). Survey of insomnia and related social psychological factors among medical staffs involved with the 2019 novel coronavirus disease outbreak. Frontiers in Psychiatry.

CBT-I for Troubled Sleep

Having trouble sleeping lately? Whether it involves difficulty falling asleep, staying asleep, and/or feeling restless the next day, it is no wonder that with the ongoing pandemic, there has been a surge of troubled sleepers worldwide. Some experts are even coining the term “coronasomnia” for the increased COVID-19-related sleep issues, creating a vicious “insomnia-causes-stress-causes-more-insomnia cycle” (UC Davis Health, 2020).

 

A recent report from the National Institutes of Health (NIH; Morin & Carrier, 2020) emphasized a study that revealed increased rates of clinically significant insomnia along with more acute stress, anxiety and depression in response to the pandemic (Lin et al., 2020). There is sufficient evidence demonstrating how a lack of sleep can have a range of negative health impacts, ranging from depression to an increased risk for heart conditions. Of concern, is that these sleep disturbances may become chronic and endure well after the pandemic. Thus, the individuals who develop sleep disturbances during COVID-19 may be at greater risk for long-term adverse health outcomes, exemplifying the “call for concerted public health interventions” (Morin & Carrier, 2020). Correspondingly, the European CBT-I Academy Task Force has compiled some practical recommendations available to the public to help individuals manage sleep disturbances during the pandemic (Altena et al., 2020), you may find that article here.

 

What is CBT for Insomnia (CBT-I)?

If you feel that your insomnia is getting out of control and you are having difficulty sleeping lasting for weeks, you may benefit from Cognitive Behavioral Treatment for Insomnia (CBT-I). CBT-I was developed and tested by Dr. Gregg Jacobs at Harvard Medical School and the University of Massachusetts Memorial Medical Center (Jacobs, 2020). This treatment is a structured, evidence-based program which aims to help individuals relearn how to sleep. The program is brief (i.e., six weeks), which includes an initial evaluation followed by five sessions with a CBT-I certified provider. Furthermore, CBT-I is covered by most insurance companies.

 

During the CBT-I sessions, individuals are taught:

  • how to change sleep thoughts and behaviors.
  • lifestyle habits that improve sleep
  • relaxation skills

 

Moreover, CBT-I has been endorsed by the NIH, New England Journal of Medicine, the Lancet, American Psychological Association (APA), Consumer Reports, and the American College of Physicians as an effective and preferred method for treating chronic insomnia (Jacobs, 2020).

 

How Effective is CBT-I?

Research on CBT-I (Jacobs, Benson, & Friedman, 1996; Jacobs, Pace-Schott, Stickgold, & Otto, 2004; Morin, 2004; Morin et al., 1999, 2004, 2006; Wu, Bao, Zhang, Deng, & Long, 2006; Wu, Appleman, Salazar, & Ong, 2015) shows that:

  • 75% of insomnia patients experience significantly improved sleep
  • 85- 90% reduce or eliminate sleeping pills
  • CBT is more effective than sleeping pills

 

Find a CBT-I Therapist

If you are interested in learning more about CBT-I, please feel free to contact PNBC for additional information.

 

Written by Angela J. Patino, Psy.D. Dr. Patino is a bilingual clinical and forensic psychologist and CBT-I certified provider at PNBC. She is currently offering CBT-I telehealth sessions with select clients.

 

References:

Altena, E., et al. (2020). Dealing with sleep problems during home confinement due to the COVID-19 outbreak: Practical recommendations from a task force of the European CBT-I Academy. Journal of Sleep Research. doi: 10.1111/jsr.13052.

Jacobs, G. (2020). CBT-I Treatment. Retrieved from https://www.cbtforinsomnia.com/cbt-i-treatment/

Jacobs, G., Benson, H., & Friedman, R. (1996). Perceived benefits in a behavioral medicine insomnia program: A clinical report. American Journal of Medicine, 100, 212-216.

Jacobs, G., Pace-Schott, E., Stickgold, R., & Otto, M. (2004). Cognitive behavioral therapy and pharmacotherapy for insomnia: A randomized controlled trial and direct comparison. Archives of Internal Medicine, 164, 1888-1896.

Lin, L., et al. (2020). The immediate impact of the 2019 novel coronavirus (COVID-19) outbreak on subjective sleep status. Sleep Medicine, S1389-9457(20)30221-5. doi: 10.1016/j.sleep.2020.05.018

Morin, C. (2004). Cognitive-behavioral approaches to the treatment of insomnia. Journal of Clinical Psychiatry, 65(16), 33-40.

Morin, C., Bastien, C., Guay, B., Radouco-Thomas, M., Leblanc, J., & Vallieres, A. (2004). Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia. American Journal of Psychiatry, 161, 332-342.

Morin, C., Bootzin, R., Buysse, D., Edinger, J., Espie, C., & Lichstein, K. (2006). Psychological and behavioral treatment of insomnia: Update of the recent evidence (1998-2004). Sleep, 29(11), 1398-1414. doi: 10.1093/sleep/29.11.1398

Morin, C. & Carrier, J. (2020). The acute effects of the COVID-19 pandemic on insomnia and psychological symptoms. Sleep Medicine. doi: 10.1016/j.sleep.2020.06.005

Morin, C., Hauri, P., Espie, C., Spieldman, A., Buysse, D., & Bootzin, R. (1999). Nonpharmacologic treatment of chronic insomnia: An American Academy of Sleep Medicine review. Sleep, 22(8), 1134-1156. doi: 0.1093/sleep/22.8.1134

UC Davis Health. (2020). COVID-19 is wrecking our sleep with coronasomnia – tips to fight back. Retrieved from https://health.ucdavis.edu/health-news/newsroom/covid-19-is-wrecking-our-sleep-with-coronasomnia–tips-to-fight-back-/2020/09

Wu, J., Appleman, E., Salazar, R., & Ong, J. (2015). Cognitive behavioral therapy for insomnia comorbid with psychiatric and medical conditions: A meta-analysis. JAMA Internal Medicine, 175(9), 1461-1472. doi: 10.1001/jamainternmed.2015.3006

Wu, R., Bao, J., Zhang, C., Deng, J., & Long, C. (2006). Comparison of sleep condition and sleep-related psychological activity after cognitive-behavior and pharmacological therapy for chronic insomnia. Psychotherapy and Psychosomatics, 75, 220-228.