The New Normal

by Jennifer Ashton, M. D.

  2. Take a tip from your dog, part I. Your dog knows exactly what time breakfast should be every morning, which is why he’ll whimper or slobber all over you if you happen to sleep past the hour. In pandemic times, take a page from Fido’s playbook and get up at the same time every day. While being out of work or working from home has prompted many to jubilantly toss their morning alarms and sleep as late as they want, following an erratic sleep schedule is one of the worst things for sleep health and hygiene. Adopting a consistent sleep schedule in which you go to bed and wake up around the same time every day is imperative to restorative sleep, even if you average seven to eight hours per night.

  To adopt a consistent sleep schedule, set a bedtime alarm on your phone that reminds you when to power down at night, and a morning alarm seven to eight hours later. For those without a concrete reason to wake up, like work or school, alarms may feel arbitrary at first. But remember that the reason you’re doing this isn’t on a whim: You’re resetting your internal clock in order to overhaul your sleep and improve your health in our new normal. Over time, you’ll start to naturally feel tired around your set bedtime, sleep better throughout the night, and wake up without an alarm the next day, feeling more refreshed and ready to go.

  3. Take a tip from your dog, part II. When you take your dog to the park and he runs around with all his canine buddies, do you see how he sleeps like a log after he finally settles down for the day? Yeah, well, humans are no different: Our bodies and brains often need to be tuckered out to sleep well. But the actual act of getting tuckered out is tricky these days when so many of us have less physical and mental stimulation than we did before the pandemic began. Most of us are exercising less frequently and not engaging as much with friends, colleagues, strangers, and the outside world as we did before the outbreak began.

  What to do? Two things: (1) Start exercising. For logistical tips and mental tricks on how to do this in the new normal, see chapter 5. (2) Get your mind active. Take on new projects at work or aggressively target a new job search. For mental stimulation outside work, join a book club (virtual or otherwise), learn a new language, start writing your great novel, pick up a challenging hobby like playing the guitar or chess, devour new books, and/or cook new recipes. (This last hobby can satisfy multiple healthy objectives in our new normal—see here for more details.)

  4. Retrain your mind. My sleep got disrupted after I started having pandemic dreams, which was happening because I wasn’t downloading all the things happening around me and inside my head. And I wasn’t downloading all the things happening around me and inside my head in part because I wasn’t taking the time to meditate.

  I’ve meditated on and off for years, and when I’m on, I feel less anxious, irritable, and stressed and more relaxed, mindful, and joyful. In the early pandemic days, I stopped meditating because I thought I didn’t have the time since I was working fourteen to sixteen hours a day for TV while also seeing patients virtually whenever I had a quick break. This was a mistake. If I had taken just twenty minutes to meditate, I would have had fewer disruptive dreams (or none at all), improved my sleep quality, and increased my productivity and focus, all of which would have more than made up for the time.

  Whether you have pandemic dreams or difficulty falling asleep, or just can’t wake up feeling rested, I’d encourage you to try some form of meditation on a regular basis. In my experience, it’s one of the best ways to quiet the mind. Studies show that mindful meditation—focusing on your breath and how you feel in the moment—can help treat insomnia and improve sleep quality and quantity while also reducing feelings of depression, anxiety, and loneliness.14

  5. Channel your inner Freud. If you’re having disruptive dreams, the ultimate solution is to try to reduce your anxiety and stress levels. While you try to do that, you can take other steps to mitigate the effects your dreams are having on your sleep. When I spoke with Harvard Medical School’s Dr. Deidre Barrett about it, she suggested writing your dreams down with an old-fashioned pen and paper that you keep by your bedside so it’s immediately handy when you wake up (but doesn’t emit blue light like your phone, which will worsen your sleep problems). Keeping a dream diary can help you normalize the experience and identify patterns like whether your dreams make you feel scared, anxious, isolated, or uncertain.

  According to Barrett, you can also try to control your dreams with a technique called dream incubation. To do this, think about what you want to dream about before you go to bed, whether that’s basking in your favorite vacation spot, playing a sport with friends, or spending time with someone special. Visualize yourself doing the activity as you drift off to sleep; if helpful, you can also place a photo by your bedside that reminds you of the activity. Just believe that the technique will work. College students who practiced dream incubation in one of Barrett’s studies dreamed about what they wanted to approximately 50 percent of the time; when they didn’t have ideal dreams, they didn’t remember what they dreamed about, which means those dreams weren’t vivid or intense.15

  6. Channel your parents. When you were growing up, your parents likely switched off the TV when it was time to go to bed. Well, today, it’s time to channel that discipline and turn it inward because we’re watching much more TV now than ever before—and it’s sabotaging our sleep.

  With safety concerns restricting many social outings and activities, TV viewership has shot up, with Americans now watching an average of eight more hours of TV per week (more than one hour per day) than they did in pre-pandemic times.16 The majority of this increase is happening at night, with the biggest bump occurring between eleven P.M. and two A.M.17

  Not surprisingly, more late-night TV has meant a lot less sleep for most Americans. According to one survey, 37 percent of people would rather watch Netflix than sleep during quarantine.18

  But Netflix isn’t the only sleep saboteur inside your small screen: TV news is also stealing many away from the shut-eye they need. Since the start of the pandemic, TV news consumption has increased by 64 percent.19 While that might be okay if you love broadcast news like I do—it’s my industry, after all—for others, consuming too much news has contributed to their anxiety and, consequently, their sleep problems. If you find yourself particularly stressed by what you see on the news, shut it off during the day and at night for a while, take a break, or reduce how much you are viewing.

  7. Rethink pills, even the ones you get at a health-food store. Taking a prescription sleep drug like Ambien can be tempting when you’re desperate to get a good night’s sleep. But unless a medication is recommended by your doctor, I suggest you stick only to non-pharmacological solutions for your sleep problems. As a practicing physician, I know from experience that prescription sleep meds often cause more problems than they solve. Ironically, sleep drugs often lead to daytime drowsiness and lethargy, reversing the desired effects of a good night’s sleep, and many aren’t approved for long-term use, which can trigger dependency problems. There are also certain health risks with prolonged use of some sleep meds, including the increased risk of headaches, chronic fatigue, and digestive issues.20 For this reason, prescription sleep medication should be used intermittently rather than habitually and indefinitely.

  I also don’t recommend trying supplements like melatonin, valerian, or CBD unless they’re prescribed to you by a doctor. Unlike some physicians trained in traditional Western medicine, I believe dietary supplements can and do work—and because I believe they can work, I think they should be approached with the same caution as prescription drugs, if not more so, since supplements aren’t regulated to the same extent as prescription meds. When you take a supplement without doctor supervision, you’re also rolling the dice on what dosage you might need and whether it will interfere with any other medications you may take. For those who believe that supplements are harmless because they’re allegedly all natural, I can list about two dozen “all-natural” things that aren’t harmless, including cocaine, hemlock, tobacco, and opium poppy.
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br />   Sleep problems were prevalent long before the coronavirus pandemic began and will remain so for decades after this outbreak—and the next outbreak—ends. But just as the world around us influences how we eat, think, and play, it also shapes how we sleep, and recognizing which external factors might be interfering with your internal thoughts, emotions, and ability to sleep is key to adapting in our new normal.

  The first step in this process is to acknowledge that the world we live in is different now and that your sleep has likely been impacted as a result. Once you start to recognize and normalize our new normal, you will be better able to take the steps necessary to stabilize your sleep, too. Doing this won’t just improve your health and happiness, it can also help you view our new normal as a well-rested, well-refreshed person would: bright, in full color, and a hopeful place to be.

  Chapter 7

  Health Fears

  Kristin Whitfield, seventy-one, is an extraordinary woman. Vivacious and outgoing, she’s always been an intrepid adventurer, sailing big boats on Lake Huron during the week and dancing in jazz clubs with her friends on the weekends. She has traveled extensively, loves parties and meeting new people, and can mix martinis, shuck oysters, and bike with the best of them.

  Of course, this was all before the pandemic hit. Immediately after the coronavirus outbreak began, Kristin had to shut down her life like millions of other Americans—and rightfully so. In her early seventies with a heart condition, she is at high risk for developing complications with the disease.

  But after stay-at-home orders were lifted, Kristin wanted to restart life and began to plan a cross-country drive from her house in Michigan to her former home in Cape Cod. The only problem was that Kristen had now developed an acute fear of being inside anyplace other than her home, even if only for a few minutes. How would she make it all the way to Cape Cod? She vowed she wouldn’t stop at any public restrooms during the drive, relieving herself instead on the side of the highway.

  When I heard Kristin’s story, I was extremely empathetic. She has every right to be concerned about catching COVID-19 and should be taking all necessary precautions to prevent infection. But those precautions had now crossed the line from necessary to extreme, and if she had reached the point of peeing on the side of the highway, the concerns she had about her risk of exposure to the virus had become overly anxious. And that anxiety could actually harm her health.

  What if a car swerved and hit Kristen while she was stopped on the shoulder? That’s a genuine threat, with 12 percent of all interstate highway deaths due to shoulder accidents.1 Or what if she contracted Lyme disease—the most common vector-borne illness in the United States—by crouching in the woods to pee? Her trip took her through states with the highest density of deer ticks, which transmit the debilitating illness. Finally, what was all this anxiety doing for her heart condition? People who suffer from generalized anxiety disorder may have up to a 48 percent higher likelihood of dying of heart disease, according to studies.2

  In my medical opinion, these risks outweighed the possible perils Kristin would have faced by using a public bathroom while wearing a mask—an endeavor that epidemiologists consider to be low to medium risk for catching COVID-19.3

  Kristin wasn’t someone I expected to develop irrational fears about her health: She is very outgoing and didn’t have a history of anxiety or phobia. But pandemics can change people, including the fears we have about both our inner and outer worlds. And while her health concerns aren’t as crippling as what many now face in our new normal, her story illustrates how health anxiety can manifest in subtle and oftentimes potentially harmful ways.

  I want to be clear, though: Having some degree of fear or apprehension in our new normal is understandable, if not inevitable. Pandemics, by definition, are frightening times, and fear is a natural and primitive response. I’m a doctor, I understand disease pathology very well, and I deal with medical concerns every day as both a practicing physician and medical correspondent. But I’m not immune from feeling anxious about my own health from time to time (see here for my story).

  But what’s happening now for many isn’t a passing flash of anxiety. It’s an acute and lasting fear that’s caused millions of people to become preoccupied with the virus or another medical concern onto which they’ve transferred their fears. This ongoing preoccupation can begin to interfere with your everyday behaviors and basic well-being, causing a level of anxiety that increases your risk of depression, loneliness, and isolation, along with many physical ailments like high blood pressure and irritable bowel syndrome. Health fears can also prompt some to make very unsafe decisions such as washing food in bleach or, like Kristin, going out of their way to avoid the virus only to expose themselves to other potentially harmful risks. Others have become so preoccupied that they have or will get the virus that they’ve lost relationships, career opportunities, and/or the ability to function in our new normal.

  No matter how mild or acute your level of health anxiety may be, the good news is that the condition is largely treatable. You can learn to address your fears and enjoy life safely, even during a pandemic or similar health crisis. In this chapter, we’ll look at what health anxiety is, how to identify if you have a problem, and how learning to think like a doctor can help you better adapt to our new normal.

  I will carefully walk you through an explanation of why and how more is not better when it comes to anxiety about your individual health. I’ll also share concepts behind some of the key medical mantras that I’ve learned in the twenty years I’ve been a doctor. I’ve used them hundreds, if not thousands of times to help soothe many frightened and even panicked patients. I know these mantras helped them, and I believe they can help you, too.

  Are Your Health Fears Actually Harming Your Health?

  In medicine, being overly fearful that you’ll get sick or obsessing over your health is a condition known as health anxiety. Before the coronavirus outbreak began, researchers estimated up to 12 percent of all people suffered from this mental-health issue.4 The pandemic, however, has significantly increased this statistic, according to at least one study published in American Psychologist, affecting people with no known previous history of anxiety or hypochondria.5

  It’s not difficult to understand why so many of us may now feel overly anxious about our health. As a world, we’ve watched as entire countries have shut down and our daily lives have been upended, all because the coronavirus has posed such a continual threat to our collective health. Many of the places we used to go for comfort and enjoyment like restaurants, gyms, movie theaters, and churches have become potentially unsafe to enter without a mask. We might not even ever shake hands again, according to the country’s top infectious disease doctor, Dr. Anthony Fauci, because the virus is so highly transmissible.6

  Just because you’ve agonized over the coronavirus, however, doesn’t mean you have health anxiety. In fact, if you haven’t been worried about COVID-19 at one time or another, I might argue that you’re missing the body’s natural fear response. Similarly, it’s also entirely normal to feel pain or a troubling symptom and experience a momentary sense of panic that it could be something serious or spend a little too much time googling worst-case scenarios on the web. These are all natural reactions and responses.

  But worrying about COVID-19, some other illness, or your health in general becomes detrimental when these occasional concerns turn into persistent anxieties. This can happen when the rational part of your brain becomes paralyzed by fear, allowing the irrational thoughts you may have about a certain illness, your body, or your overall health to take over and dictate your decisions, actions, and/or emotions. These fears can become crippling, leading to acute anxiety, depression, and other mental-health issues, and allow you to make choices that could harm your health in other ways. Health anxiety can even interfere with your ability to function around others or in the world at large.

  It’s important to know that this kind of health anxiety can happen to anyone
at any time, even months or years after a traumatic event like a pandemic is over. The condition doesn’t discriminate based on intelligence or education, and extremely smart people with multiple degrees behind their name can and do develop health anxiety. You also don’t have to be older or at risk of serious COVID-19 complications to suffer. In fact, researchers saw a 133 percent increase in health anxiety in children and young people in the United Kingdom in 2020 compared to the year prior, according to a survey commissioned by the National Health Service.7 Health anxiety can affect the mentally strong and emotionally resilient as well as those who might otherwise appear to be calm and content.

  For example, I recently saw a twenty-four-year-old patient who was happily attending graduate school in Philadelphia when the outbreak began. As time went on, however, she developed so much anxiety about catching COVID-19 that she decided to leave school to move back home with her parents in New York City. While she hoped being ensconced in her childhood home would make her feel safer, her health anxiety didn’t dissipate. When she saw me, she was acutely frightened of contracting the virus, even though New York City had one of the lowest transmission rates at the time, my medical practice was taking all the appropriate COVID-19 risk-reduction precautions, and she had no risk factors for serious complications from the disease.