What changed for me during the pandemic wasn’t the quantity of my sleep, but the quality of my sleep. While I was still getting seven to eight hours per night, I would wake up almost every morning feeling mentally exhausted, not rested or refreshed. The first time it happened, I chalked it up to a long day. But when it started to occur over and over again, with a “time to make the donuts” kind of regularity, I began to feel unsettled. I had never experienced anything like it before.
As a doctor, I often look at my own life like a medical detective: I always try to connect the dots between events or behaviors and signs and symptoms. But I didn’t need to put my super sleuth hat on to decipher this one. When I took a moment to step back and analyze my life, all I saw was the pandemic: I was living in the pandemic, reporting on the pandemic, and helping care for my patients in the pandemic. And while I assumed the pandemic wasn’t impacting my sleep like it was for others, I was having dreams about the virus almost every night. Some were nightmares, like the one I described in chapter 2 when I dreamed that I was intubated in the ICU with COVID-19. Most, however, were simply virus dreams—that I was reading about the virus, talking about the virus, thinking about the virus. I wasn’t alone: The phenomenon of pandemic dreams has become a vivid reality for many Americans, interfering with the sleep quantity and/or quality of millions of people.
After I stopped to analyze what these dreams were and how they were affecting my sleep, I began to realize that I wasn’t taking the time to download the uncertainty and stress that was happening all around me and inside my head. Instead, I was plowing forward without acknowledging my anxiety, forcing my mind to work overtime to try to subconsciously process the stress at night. As a result, my brain wasn’t powering off, running on a 24/7 cycle of uncertainty and anxiety that manifested in a nightly picture show of pandemic dreams. No wonder I was waking up feeling mentally exhausted.
While I no longer suffer from pandemic dreams, I know that waking up in our new normal not feeling rested is an ongoing issue for many of my friends, patients, and social-media followers. The problem may seem paradoxical because many have more time at home now, with fewer reasons to go out or get up early. But this lack of a consistent schedule is just one reason why many aren’t getting the quantity or quality of sleep they need.
For this reason and several others, sleep may be more nuanced than other aspects of good health, especially in a time of crisis. For example, while you can eat less and move more in theory to see results, you can’t always sleep more to improve your health. If good shut-eye was so simple, after all, we probably wouldn’t have an almost $90 billion industry dedicated to sleep-promoting aids and technology.2
Because it isn’t always possible to “see” the results of more sleep in the same way we can with other kinds of wellness, it may be easy to overlook how the new normal is impacting our sleep. But what’s become even more clear to me now during the pandemic than ever before is that sleep is in desperate need of an image overhaul. There is nothing luxurious or expendable about sleep, no matter what may be occurring in the world. It’s a medical necessity. Without sleep, human beings can’t survive. Suboptimal sleep leads to a decline in physical and mental health in almost every possible way—many of those ways imperceivable to the patient because suboptimal sleep deludes the brain into thinking you’re okay when you’re not okay.
All this has been exacerbated by our new normal. Parents who have to stay up late to finish work for their jobs because they are busy caring for children during the day are missing out on critical sleep. Unemployed people who suffer from restlessness at night because they’re worried about paying their bills aren’t getting the shut-eye they need. Older Americans who are afraid of getting sick are tossing and turning or waking up too early after a sleepless night. The pandemic has given many people new reasons to lie in bed awake, to sacrifice sleep for something else, or to avoid it altogether. And whether we realize it or not, this altered sleep quality comes with a very real health cost.
In this chapter, I want to show you how and why nearly everyone’s sleep has been impacted by our new normal. Sleep can be a huge window into our psychological and physical condition, and if we pay attention to the signals it sends us, we have the potential to address and respond to minor issues before they become major ones, just like taking care of fraying wires before they can cause a short circuit.
Even those who think they are getting an adequate amount of sleep (like I was) may not be getting the quality they need. We’ll also talk about the widespread phenomenon of pandemic dreams and what experts whom I’ve interviewed say you can do to overcome the issue. Most important, I want to show you what you can do to sleep your best in our new normal, with tips on how to identify and treat the sleep issues that have now become common in the pandemic era.
How Sleep Has Changed in the Pandemic Era
In medicine, we use the word sequelae to describe the chronic health problems often caused by a primary condition. Sequela means “sequel” in Latin and is easy to understand when you put it into context: Migraine headaches, for example, can be sequelae (sequels) of concussions; acid reflux can be a sequela of pregnancy. And in our new reality, sleep problems are sequelae of the coronavirus pandemic.
In my opinion, sleep problems were one of the first sequelae we experienced after the outbreak began—and they might be one of the last sequelae to dissipate if and when we adapt to our new normal. That’s because sleep problems are like an obnoxious dinner guest who doesn’t understand party etiquette: always the first to arrive and the last to leave. Sleep problems can be insidious and cyclical as well, causing a cascade of physical, mental, and emotional issues that make it even more difficult for the troubled sleeper to get the necessary shut-eye over time.
Given these facts, it’s not surprising to learn that 98 percent of Americans say they’ve developed sleep problems since the pandemic began.3 The majority of us are also going to sleep later and spending less time in bed, with 67 percent saying their sleep was healthier before the outbreak began.4
There are several factors for our collective tossing and turning, according to statistics. The primary one, however, is the stress and anxiety the coronavirus pandemic has caused or aggravated in the majority of Americans.5 While anxiety levels may have redlined in the early days of the outbreak, when the virus was new and highly mysterious, the pandemic has proven that massive medical, social, and economic disruptions can happen at any time, flipping our sense of normalcy upside down at a moment’s notice. This realization—that there’s always a lurking and latent threat of significant status quo disruption—is momentous and may haunt us longer than the virus remains a danger to human health.
While fears over the virus may have subsided somewhat since the pandemic began, there is still a persistent and pervasive sense of uncertainty in our new normal. Many people don’t know when they will find a job, return to an office, ride on an airplane, or take a vacation to a new city. We think twice about many things that used to be everyday activities, such as sending our kids to school, taking a subway or bus across town, or going out to a crowded restaurant or bar. Some are more anxious now about money, job security, or their children’s future; others are continually concerned about elderly or sick relatives. What’s more, everyone’s daily habits have been upended, and no one can say for sure if and when we’ll regain a sense of a regular routine.
Unfortunately, this overwhelming sense of uncertainty doesn’t just dissipate after we drift off to sleep: The stress and anxiety can keep running through our brains, causing us to wake up at night and feel less rested when we get up the next day. Sleep problems caused by the pandemic are so pervasive, in fact, that sleep neurologists have coined the term COVID-somnia to refer to the surge in outbreak-related sleep issues.6
Even if you aren’t aware of feeling a sense of uncertainty, there’s still a part of our brains that knows when things aren’t “normal” and may stay switched on while we sleep. For example, after I did
n’t see my boyfriend for the first two months of the outbreak, we were both struck by how well we slept together when we were finally able to meet again and share a bed. The improvement was massive and significant, which goes to show how the subconscious brain can be aware of what’s happening when we sleep, even when we’re not. If things are uncertain in your life, as they are in the world, your subconscious mind may be processing it even if your conscious mind isn’t aware.
Other emotions in addition to anxiety and uncertainty are also fueling our inability to get a good night’s sleep, including feelings of depression, loneliness, hopelessness, and aimlessness. The relationship between sleep and mental health is also mutually dependent, meaning inadequate sleep can also trigger or aggravate these emotions.
Another factor disrupting our sleep is the lack of a consistent daily routine. With millions working from home and others unemployed, many people can now go to bed and wake up whenever they want, trading in their pre-pandemic alarms and strict bedtimes for an erratic sleep schedule. While getting rid of your daily alarm may feel like freedom, it can actually create a new kind of cage, trapping you in the toil of being out of sync with your body’s natural circadian rhythms.
Human beings are exquisitely conditioned to do certain activities at different times of the day, all based upon our circadian rhythms, which is a fancy word for the body’s twenty-four-hour internal clock. When you disrupt your circadian rhythms and, say, eat at four in the morning or exercise at eleven at night, your body has a tough time adjusting, since it’s conditioned to cuing your digestion or increasing your energy levels at certain times of the day. When it comes to sleep, going to bed and getting up at irregular hours makes it almost impossible for your body to settle into its circadian rhythms, which can cause you to experience difficulty falling asleep, staying asleep, and feeling rested when you wake up.
The pandemic has disrupted our circadian rhythms in myriad ways, as many of us wake up, work, eat, exercise, look at screens, socialize, and go to bed at different times of day than we did before the outbreak began—and oftentimes, at wildly different times now than we did the day before. That leaves our bodies and brains struggling to figure out if it’s day or night or whether we should be preparing to go to sleep or amassing the energy to tackle a workout or work project.
We’re also spending more time staring at our computers, smartphones, laptops, tablets, and TVs in the pandemic era. According to one survey, children in particular are spending 500 percent more time staring at technology.7 Not only can this amount of screen time be detrimental to your mental health, increasing the risk of depression, anxiety, and loneliness, but exposure to the blue light emitted by screens also disrupts the body’s natural production of the hormone melatonin, which helps regulate sleep.
Other factors that are part of our new normal are also affecting our sleep, including the fact we’re drinking more alcohol. While booze may help you fall asleep more quickly, it’s a proven sleep disrupter, shown to block rapid-eye movement (REM) sleep, reduce deep sleep, and cause you to wake up more often. What’s more, we’re getting less physical activity, which isn’t exactly helping us drift into dreamland and stay there.
The Phenomenon of Pandemic Dreams
Millions of people say they’ve had highly vivid or unusual dreams since the pandemic began, with surveys estimating that 87 percent of all Americans have experienced the phenomenon now known as “pandemic dreams.”8 These dreams can be literal—you or someone you know gets sick with the virus—or metaphorical, like being chased by a mob or attacked by bugs. Pandemic dreams can also revolve around safety concerns such as being in crowds, wearing masks, or washing your hands. Some can even be pleasant, like finding a cure for the virus or seeing a loved one you haven’t been able to visit in months. But what our pandemic dreams have in common, researchers say, is that they’re preventing us from getting a good night’s sleep and are proof we may need to do more to address our anxiety.
When I was having my own pandemic dreams, I interviewed one of the top experts on the phenomenon, Dr. Deidre Barrett, a psychology professor at Harvard Medical School and author of the book Pandemic Dreams (Oneiroi Press, 2020), for Good Morning America. She told me that many people are now able to recall their dreams because they’re waking up more often during REM, which is the sleep stage when vivid dreaming is most likely to occur. And we’re waking up more often because we’re anxious about the pandemic to such a degree that it’s manifesting in our subconscious thoughts.
This isn’t the first time dream scientists like Barrett have seen an uptick in vivid, disruptive dreaming. After 9/11, for example, many Americans also reported having more intense or unusual dreams. And while these disturbing dreams can eventually subside on their own, you can take steps to limit them and mitigate their effect on your sleep.
Why Sleep is More Important in Our New Normal
I’ve told you about my three pillars of good health that form what I believe to be the bedrock of disease prevention and optimal well-being: nutrition, physical activity, and sleep. After reading the last two chapters, you already know how critical diet and exercise are to our physical and mental health in our new normal.
But in my triad of pillars, sleep may be the most vital component. If you’re not getting adequate sleep, how well you eat or how much you exercise may not matter as much: Your body’s ability to burn fat, build muscle, increase immune function, and reap all the other benefits of proper diet and exercise will be hampered. That’s why the first question I always ask patients when they detail a troubling symptom or condition is “How are you sleeping?” Sleep is that powerful and that important.
In the pandemic era, sleep has become even more critical. Pandemics by nature are high-stakes times, both physically and mentally. Physically, you face the threat of a possibly deadly infection, in addition to all the other health risks that have always existed—everything from cancer to car accidents. Mentally, you’re experiencing a level of anxiety and uncertainty that is lasting longer than the fallout from any other traumatic global event, such as a natural disaster. If you’re not getting enough sleep in the new normal, you’re stepping out into the battleground of our world already a little incapacitated, a bit exhausted, and less likely to succeed.
Analogies aside, the body needs adequate sleep to be able to ward off viral infection. That’s why people who don’t sleep enough are more likely to get sick after being exposed to viruses like the common cold.9 In fact, research shows that those who average less than seven hours per night have three times the risk of infection from the common cold compared to those who get eight hours or more on a regular basis.10 Sleep is so imperative to fighting off viral infections that not getting enough can even reduce the efficacy of vaccines, according to studies.11
Inadequate sleep also raises the risk of diabetes, high blood pressure, and other comorbidities for COVID-19. Poor sleep can also contribute to weight gain or make it more difficult to lose it. From a mental-health perspective, those who get less sleep are also more prone to developing or aggravating existing feelings of depression, anxiety, loneliness, and other unpleasant emotions.
The Real Risks of Too Much Sleep
It’s not just sleeping too little that’s become a problem in the pandemic era. Lots of people are now sleeping too much. While everyone has unique sleep requirements, most healthy adults shouldn’t be averaging more than nine hours per night—a sign that something might be amiss with your physical or mental health.
Most of us associate getting too little sleep with health problems. But getting too much sleep, or more than nine hours per night, can increase your risk of the same ailments, including diabetes, high blood pressure, and the tendency to be overweight or obese. One study even found that sleeping too much may be worse for your overall health than sleeping too little.12 Similarly, spending too much time in bed can boost your risk of developing depression and other mood disorders. Getting too much sleep can also ironically make you feel mor
e tired and lead to lower energy levels throughout the day.
How to Sleep Better in Crisis Times
You probably know by now that you can’t just snap your fingers and make all the fears, anxieties, and worries that may be keeping you up at night go away. Similarly, you can’t hit the eject button and end all the uncertainty that may be causing you to wake up feeling exhausted in the morning. What you can do, however, is take the specific steps outlined throughout this book to control your anxiety, lower your stress levels, and learn to cope better with the uncertainty that is now part of our new normal.
For many, controlling anxiety, lowering stress, and coping with uncertainty often means finding ways to comfort ourselves at night, whether it’s keeping Netflix on autoplay, scrolling through social media in bed, or watching baking shows until all hours of the night. I’ve been guilty of doing all of these in our new normal to help take my mind off stressful things and find a little emotional solace. But the comfort you may feel with TV, social media, and other late-night distractions are only temporary—and unfortunately, these distractions can and do interfere with the ability to get to sleep and stay there. Remember that getting a full night’s sleep can provide a longer-lasting, far more beneficial form of comfort, so try to minimize these distractions before bed.
As you work toward controlling the emotions that may be interfering with your sleep, there are distinct things you can do to improve both your slumber quantity and quality. Here are seven steps to sleep better in pandemic times:
1. Practice Sleep Hygiene 101. You might expect your car not to run well if you knew the oil was low, the timing belt was shot, or the tires weren’t filled to full pressure. Similarly, if you know there’s an obvious problem with your basic sleep hygiene, you shouldn’t be surprised if you’re unable to get a full eight hours or you wake up often feeling tired. Sleep hygiene is the environment and behaviors you adopt when you sleep and includes tips many of us have heard before, like making your bedroom dark, quiet, and cold before you go to bed (the ideal temp for sleeping is around 65 degrees Fahrenheit).13 It also means taking certain steps like limiting your caffeine intake after lunch and pulling the plug on all screens at least one hour before bed.
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