Sleep

Good Sleep Is Needed More Than Ever in Stressful Times

Research shows good sleep is especially important for coping with major stress.

Posted Mar 31, 2020

As I write this, I am approaching two full weeks of lockdown. So far, I have no symptoms of COVID-19, but I will feel better tomorrow when the full 14-day incubation period is over and I remain symptom-free.

All of the local sleep centers are closed, as medical directors have made the difficult decision that the risk to patient health would be greater if the patients were to come into the office, than if they were to stay home and not be evaluated for a number of weeks. Research projects are on hold at this time as well. My other work has continued due to the availability of online services that can be used for psychotherapy, supervision, and meetings. 

New Haven county currently has the second-highest number of COVID-19 related deaths in the state. Connecticut, a relatively small state in both area and population, has the fourteenth-highest number of cases in the country. I am sad to say that some patients with other illnesses are not able to be seen while resources are necessarily focused on those with COVID-19 and on trying to prevent further spread of the illness. At the same time, it is good that many other patients are able to get services due to the technologies we have today that allow us to work from a distance. 

I am very thankful for all of the medical personnel on the front lines of this pandemic and for all the people keeping the system functioning by keeping the lights on, the water flowing, the groceries arriving, and the trash collected. These people deserve our deepest thanks. They are all critical to maintaining a society that functions as well as is possible.

Much of the work of the psychotherapist recently has been to help people, including those health care providers and workers keeping basic services operating, to cope with stress, fatigue, worry, and anxiety. Among the most important coping strategies at this time is getting good sleep. I am sure people recognize the need for good sleep and also the difficulties of sleeping well at this time. Fortunately, there are online resources for practical tips on getting good sleep.

More and more articles are appearing on the impact of all this stress on sleep and health. More stress often results in less sleep which results in worse functioning and worse health.

So I wanted to take just a moment to review why good sleep is so important. First, will be the bad news. All the negative things that we know poor sleep contributes to. Then, the good news, the many positives that good sleep brings us.

There are a number of well documented negative health effects of getting insufficient sleep. A major concern, and one that I am probably most often concerned about with patients, is the increased risk of accidents associated with insufficient sleep. This is especially relevant for driving and for the operation of heavy equipment. A brief microsleep can be long enough to result in a serious motor vehicle or industrial accident. There is mounting evidence that poor sleep is associated with certain illnesses such as obesity (Loachimescu, & Loachimescu, 2017), diabetes (Hall et al, 2017), and heart disease. Most of us are probably familiar with the carbohydrate craving that comes with poor sleep and prolonged stress such as what we are currently experiencing. 

A common complaint given by patients with poor sleep is a loss of libido — a lack of or decreased interest in intimacy. This is mostly explained by fatigue and low mood but there may also be a physical component in that. For example, testosterone levels have been found to be low in men with sleep apnea (Luboshitzky et al., 2002). Studies have shown a U-shaped association between increased mortality due to cardiovascular and non-cardiovascular causes with both decreased and increased sleep (Ferrie et al, 2007). Oversleeping may be as dangerous as not getting enough sleep.

Psychologically, insomnia, sleep apnea, and insufficient sleep are all associated with negative mood states such as anxiety, depression, and irritability. Poor sleep typically results in poor attention and concentration and this can negatively impact learning.

This is an important consideration at a time when many students around the country, from middle school to graduate school, are being switched to online classes and dealing with the stress of being confined at home. Being stuck at home during hours when they would previously have been in transit, attending classes, socializing on playgrounds or in student unions, eating with friends, or just hanging out, is experienced as onerous by a great many! Combine this with fears and uncertainties about how COVID-19  might impact them and their families, and you have a recipe for less than optimal sleep. 

A variety of factors can distract one during class time, but poor sleep is a major one. Lack of sleep reduces the ability to regulate emotions and think clearly and increases the chance of making poor decisions. Siblings may be quicker to argue, parents faster to chastise, and learning and cooperation can go out the window. Regarding decision making, Barger et al (2006) in a survey of first-year postgraduate medical residents found that “… extended-duration work shifts were associated with an increased risk of significant medical errors, adverse events, and attentional failures in interns across the United States” (p. 2440).

At a time when we are stressed and needing to make rational decisions about our lives, we need to combat fatigue as effectively as we can. This is especially true for all those health care providers and other workers in essential services who are putting in long hours under very difficult conditions.

Good sleep, on the other hand, promotes good mental and physical health (e.g., Epstein & Mardon, 2007). Alertness and performance are improved by getting sufficient sleep. This is especially important when so many people are needing to work from home, cope with the stress of being quarantined, or keeping the basic support systems of society functioning in especially challenging circumstances: for example, being able to stay focused and not get easily distracted can be especially difficult when spending hours each day focused on a computer screen doing demanding work from home. Memory is improved by good sleep, and during day after day at home, where one day can blend into the next, it is critical to get plenty of restful sleep in order to be able to clearly remember what needs to be done and have the energy to do it.  

"Yin and Yang" by Klem - This vector image was created with Inkscape by Klem, and then manually edited by Mnmazur.. Licensed under Public Domain via Wikimedia Commons
Taijitu
Source: "Yin and Yang" by Klem - This vector image was created with Inkscape by Klem, and then manually edited by Mnmazur.. Licensed under Public Domain via Wikimedia Commons

As I noted in my previous post, sleep has the potential to support host defense against infections and disease. As a support to all of the containment and mitigation strategies currently being used to minimize the impact of COVID-19, protecting yourself with good sleep is an additional important factor as it can help maintain your health.

We have longstanding evidence that improving sleep helps improve many aspects of health. For example, problems such as headaches, colds, and stomach upsets that can occur with short-term sleep loss often significantly improve when good sleep returns. That long-term sleep debt is associated with obesity, heart disease, and diabetes indicates that getting enough sleep is important for long term health. We want to maximize our likelihood for good long term health by practicing good sleep hygiene during this unwelcome pandemic. Sleep well, and stay strong!

References

Barger LK, Ayas NT, Cade BE, Cronin JW, Rosner B, Speizer, F.E., & Czeisler, C.A. (2006). Impact of extended-duration shifts on medical errors, adverse events, and attentional failures. PLoS Med 3(12): e487. doi:10.1371/journal. pmed.0030487 

Epstein, L.J. & Mardon, S. (2007). The Harvard Medical School Guide to a Good Night’s Sleep. New York: McGraw Hill.

Ferrie, J.E., Shipley, M.J., Cappuccio, F.P., Brunner, E., Miller, M.A., Kumari, M., Marmot, M.G. (2007). A Prospective Study of Change in Sleep Duration: Associations with Mortality in the Whitehall II Cohort, Sleep, 30 (12), 1659–1666, https://doi.org/10.1093/sleep/30.12.1659

Loachimescu, A.G. & Loachimescu, O.C. (2017). Endocrine disorders, in Kryger, M, Roth, T, & Dement, W.C. (Eds.), (2017). Principles and Practice of Sleep Medicine sixth edition, Philadelphia: Elsevier, Inc.

Hall, M.H., Fernandez-Mendoza, J., Kline, C.E., & Vgontzas, A.N. (2017). Insomnia and health, in Kryger, M, Roth, T, & Dement, W.C. (Eds.), (2017). Principles and Practice of Sleep Medicine sixth edition, Philadelphia: Elsevier, Inc.

Luboshitzky, R.,  Aviv, A.,  Hefetz, A., Herer, P., Shen-Orr, Z., Lavie, L., Lavie, P. (2002). Decreased Pituitary-Gonadal Secretion in Men with Obstructive Sleep Apnea, The Journal of Clinical Endocrinology & Metabolism, 87 (7), 3394–3398, https://doi.org/10.1210/jcem.87.7.8663