Sleep and insomnia in the Covid-19 pandemic

Five ways to avoid insomnia and excessive daytime sleepiness and get quality sleep despite the Covid-19 pandemic. Without drugs, gimmicks or physical exhaustion.

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I went to the hardware store the other day to make a curbside pick-up of something I had ordered online. It was one of only a few times in the last couple of months that I have been out in public. Wife Chris and I are trying to keep ourselves isolated and out of the way of any odd Coronavirus that might be cruising around looking for its next victim. We take walks in our neighborhood, observing social distancing guidelines (you know, six feet and all that). But only rarely do we get in the car and actually go somewhere.

When I got to the hardware store I phoned to let them know I was waiting at the curb. As I stood by my car waiting a customer came out of the store headed for the parking lot. To my surprise he walked by me as close as he could. He made it obvious he was doing it on purpose.

He was big, about six five, in his early thirties, and clearly arrogant as hell. I instinctively started to challenge his effrontery but stopped myself just in time. I was afraid. Confrontation of any kind is likely to involve physical proximity and that is exactly what I wanted to avoid.

My lifelong penchant for bearding bullies was in conflict with a more important (and more mature, I grudgingly admit) need to maintain social distance. Which is to say, six or more feet from others. We just don’t know who might be contagious with Coronavirus. We don’t even know how to refer to this as of the time of this writing. Novel Coronavirus. C’virus. SARS-CoV-2 (evidently the correct label for the virus itself). Covid-19 or COVID-19 (the illness caused by SARS-CoV-2). And so on.

But what are we supposed to do about people who refuse to keep their distance? Carry a cattle prod?

I keep thinking about Gary Lindorff’s trip Like his trip, mine was also to pick up supplies for a vegetable garden. We don’t have a lot of confidence that the food supply chain won’t break. to Home Depot and his comment that not everyone wears a mask. That’s not all they don’t do. What would I doA day or two later I went back to the same hardware store and — guess what? — a guy started walking toward me almost like before. He seemed just oblivious, not malicious, so I started coughing into my elbow to see what effect that might have. It got his attention. He looked at me in alarm and gave me a wide berth. “Noted,” as British comedian Sarah Millican says. , for example, if I were out somewhere in public and someone (like, say, the same dickhead from the hardware store) was coming straight toward me sneezing or coughing with what might be symptoms of Covad-19? I’d try to get away from that person, I guess. And wish I really did have a cattle prodI grew up in cattle country and once had a battery-powered cattle prod that was about three feet long. It packed a wallop, almost as debilitating to a human as a stun gun (like a Taser)., one with a long reach.

Should we carry no-touch thermometers so we can take the temperature of people around us? Would I be offended if someone pointed a thermometer at me?

On the one hand my body temperature is pretty personal and taking my temperature without my permission would seem an egregious violation of my privacy. On the other hand anyone with a temperature is potentially a very dangerous person, especially to older people.

We are in uncharted waters here, as they say. Social rules have not emerged yet to govern how we act responsibly in the unique circumstances in which we now find ourselves. New rules will appear soon; there is never a shortage of people willing and eager to tell us how to act.

A question more fundamental, and of considerably more interest and relevance to me, is, How are we supposed to be psychologically and philosophically preparing ourselves? With this the uncharted waters get even deeper.

They are certainly not being plumbed by the plethora of well-meaning but totally insipid kinds of advice like “get involved with constructive projects.” “Do something you enjoy,” they say, like concentrate on a hobby, or learn to play a musical instrument. Those kinds of things can be tough to do in the focus-killing situation we are in.

From a clinical and neuroscientific perspective the first order of the day is adequate, undisturbed sleep. With all of the problems confronting us during the Covid-19 pandemic, sleep problems are right up at the top of many people’s list of what is bothering them most.

Distressed sleep is a common problem even in the best of times. I have already addressed one aspect of how to improve sleep with my article on progressive relaxation. Practicing deep — “progressive,” that is — relaxation will go a long way toward insuring a good night’s sleep. But for many that will not be quite enough. Almost everyone’s schedules and daily demands have undergone huge changes.

Changes of the magnitude we are experiencing cannot help but mess up circadian rhythms. This throws internal timing systems off and disrupts the sleep-wake regulatory cycle. Time seems to both speed up and slow down in demanding circumstances. The increase in negative emotions causes a subjective sense of time slowing down with days or nights that may seem like they will never end. But complex processing tasksDealing with kids; worry about the future; money problems; trying to work at home; worry about being furloughed; stuff like that. have the reverse effect: time speeds up.

If however that is inward directed time slows down and satisfactory accomplishments seem out of reach. The result can be massive internal confusion with the result that we don’t sleep well.

Many people complain that for the first time they are unable to sleep at night, yet struggle with daytime sleepiness. Their insomnia causes excess sleepiness — excessive daytime sleepiness — that disappears at dusk. Night after night they have trouble sleeping. When they do finally manage to drop off to sleep they are plagued with bad dreams and nightmares.

One interesting aspect of dreams during a time of stress and anxiety is the emotional flavor they can have. A seemingly innocuous dream can leave the sleeper with ominous feelings of dread, or just a case of the blues, the next morning. Overall it might not feel like it was a “bad” dream. But it has the effect of having been one. In other words a dream with otherwise neutral content or action can produce morning despondency. Or in some cases outright depression.I am extremely hesitant to use the term “depression” because the term implies a clinical presentation of a very complicated neuropsychiatric disorder. Here I use the term in the street sense of being very despondent. As for clinically defined depression, The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists more than 35 symptoms of clinical depression. For a brief overview, see this Mayo Clinic article.

As to why it matters what kind of sleep you get, and whether or not you get enough of it, there is plenty of information online about the importance of sleep. Don’t sell it short. For now I will just say that you absolutely must get enough good sleep or you will have all kinds of unnecessary problems, especially now under the stress and strain of the C’virus pandemic.

Please do not make the common but nonetheless idiotic assumption that you can get along just fine with less sleep than you really need. Most people need somewhere around eight hours of sleep a night. Not getting enough sleep causes sleep deprivation. Which is cumulative; it just keeps adding up. And once you have a sleep deficit it takes a good while to catch up once you return to getting enough sleep. One good night’s sleep won’t do it. If you have been depriving yourself for a while it can take several months to catch up.

Here is a good test to see if, and by how much, you have a sleep deficit. Lie down in a quiet place, be still and do nothing except try to stay awake for 15 minutes. How soon you fall asleep will give you a subjective sense of how sleep-deprived you are. The seriously sleep deprived usually fall asleep within a minute or so.

If you inevitably drift off whenever you sit or lie down, you are probably sleep deprived. If the practice of deep relaxation and the exercises that follow don’t make it possible for you to more easily stay awake, you should ask your physician for a sleep test. Until recently a sleep test required one or two nights spent at a sleep lab. Now a sleep test can be performed from your own bedroom.

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Find deep relaxation instructions here:
Stress Management and covid-19

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Five problem sleep areas and how to fix them

In my own research over the years there have been five loosely delineated problem areas of sleep. These are the non-clinical aspects of sleep problems that you should be able to fix yourself. I’m about to show you how, one problem area at a time. This will give you some leverage to control whether a night’s sleep is good or bad. And, of course, whether or not you get enough of it. Before we get into the five problem areas and how to deal with them, I make the assumption that

• you have done some research and are not creating unnecessary problems for your sleeping, such as eating or drinking late or any of the myriad other sleep hampering behaviors — that is, you are not violating good sleep hygiene, and
• you are not napping during the day or early evening; that you are able to stay awake until it is time to go to bed, and
• yours is not pseudo insomnia; that is, you actually slept okay although  you thought you’d been tossing and turning all night. It is not uncommon for people to feel like they are not sleeping when in fact they are.

The five problem areas I will address (that cover at least 95 percent of all cases of idiopathic insomnia A sleep problem with no apparent cause such as a medical or psychological condition that can directly cause sleep problems.) are:

1. Onset insomnia. It takes a long time after going to bed to fall asleep.
2. Maintenance insomnia. You wake up frequently during the night and may or may not have trouble getting back to sleep each time you awaken. (This is sometimes called “middle” insomnia but I reserve that term for number 4 below.)
3. Early morning, sometimes called late, insomnia. You wake up too early in the morning and can’t get back to sleep.
4. Middle insomnia. You wake up usually around the middle of the night and it takes you a long time to get back to sleep.
5. Dreams (the emotionally negative ones) and nightmares. Not insomnia per se, but a problem nonetheless if they happen frequently.

Onset insomnia

Onset insomnia refers to the inability to go to sleep when you want to. If you lie in bed for quite a while at night trying to get to sleep, that is onset insomnia. It can be a temporary or it can be a long term disorder. Sometimes it is just a bad habit that has to be broken, but it can be caused by radically altered schedules, stress, and worry. In other words, what most of us are experiencing these days.

Self-treatment Protocol

1. Cortical conditioning. Once in bed, place a cool, damp cloth on your forehead and lie quietly for five to 10 minutes. Research has shown an abnormal elevation in frontal cortex metabolism associated with onset insomnia. Applying coolness to the forehead has the effect of reducing those abnormal elevations.
2. Cognitive conditioning. Sometimes it is a racing mind that makes it difficult to get to sleep. Slow the thinking down and substitute with sleep-inducing ideas.
   • Snatch one of the passing ideas from your racing thoughts to deconstruct. Analyze the pee waddin’A southern expression that refers to the pads (wadding) women used to keep in their panties to catch any little bit of urine that might escape when they laughed or exerted themselves (a common by-product of having given birth). It was a great embarrassment if it fell out. out of it. Slowly. This a boring mental exercise. It is supposed to be. If other ideas or thoughts try to intrude and get back to racing, force them out by continuing to focus on the idea you are in the process of deconstructing.
   • When you have succeeded in slowing down your thinking, hold the following thought in mind by repeating it over and over: “I am drifting down and becoming pleasantly limp.” This can be replaced, or supplemented, with anything that you find pleasant that has a lulling effect on you.
3. Aural conditioning. Consider using white noise. There are white noise generators specifically for this purpose, usually with several sounds available that range from simple white noise to the sound of waves breaking on a beach. You can also sometimes get an approximation of white noise with static from a radio or TV with the dial positioned between stations.

Maintenance insomnia

Sleep-maintenance insomnia is difficulty staying asleep, or waking too early and struggling to get back to sleep. It is a common problem during times of stress, especially for women. That is, middle-of-the-night waking occurs more often in women than men. But it can be a problem for anyone, especially in periods like this. As with any kind of insomnia, good sleep hygiene is important. Be sure you:

• Avoid caffeine too close to bedtime.
• Get plenty of exercise, but not too close to bedtime.
• Have a daily routine and stick to it. For most people this is a matter of getting up and going to bed at a regularly scheduled time.

You can also borrow any of the methods listed under onset insomnia that feel appropriate to your circumstances, such as white noise or thought deconstruction. Progressive relaxation is a particularly apt prescription for this kind of insomnia. Sometimes practicing it before sleep onset breaks the waking-up pattern. It can also be practiced whenever you do wake up but are not ready to get up.

You can also invent a sleep hut for yourself that can be helpful in dealing with any kind of sleeplessness. This is actually a form of cognitive conditioning you can use to go to sleep any time you want and stay asleep. Or get back to sleep if you happen to wake up at an inappropriate time. Taking on and solving these problem areas will involve some manipulation of powerful subconscious mechanisms that can do everything you need to fix your sleep.

I’m not going to bother naming and labeling everything because knowing all that stuff would not be of much use to you. If you really want to know, I’ve written at length elsewhereIn You Can Do It with Self-hypnosis, and in Self Hypnosis for the Life You Want, and especially in All-In Selling about subconscious dynamics and how they work. Coming up with an imaginary sleep hut takes a little thought in the beginning but if you get it right you will have a great tool you can stick with. Be sure, as you imagine a place or other details about your sleep hut, that it is:

• Safe. Your image won’t do you much good if you do not feel safe and secure there.
• Peaceful. Trying to get to sleep while imagining yourself in a noisy or active place will be counterproductive.
• Comfortable. Self explanatory.
• Unique. Unique to you and your experience, that is. You don’t want a place that has a lot of memories or other baggage.
• Solitary. You might be goo-goo crazy about your sleeping partner but it is best not to include him or her in your sleep hut. This is a place just for you and you alone. Literally. Alone.

To use your sleep hut all you have to do is imagine yourself there. (When you are in bed and ready for sleep, of course.) Do this every night, or whenever you want to go to sleep. There is a practice effect; the longer you have been at it, the better you get. Within a few months you will be able to quickly slip into a comfortable slumber by imagining yourself in your sleep hut.

Middle insomnia

Middle insomnia is another term frequently used to refer to maintenance insomnia. I included it here because there seems to be some confusion about it in certain circles. There really is no need for different labels for waking up in the middle of the night and waking up too early in the morning. They can both be dealt with the same way; i.e., with the methods for dealing with maintenance insomnia.

Deep breathing exercise

Something that has proved very helpful to a lot of people with sleep disturbances is a deep breathing exercise. It can be used anytime you are having trouble getting to sleep, or getting back to sleep. It is also quite simple. Here are the instructions for deep breathing:

• Inhale deeply and slowly. There is no absolute speed of breathing, just do it more slowly than you normally do. And more deeply. Fill your lungs more than usual, but don’t try to break anything.
• Hold your breath briefly. About three seconds should be long enough, but the time you hold it depends on your comfort. Don’t make yourself uncomfortable.
• Exhale slowly. Not real slowly, just slowly. Purse your lips to create a slight amount of resistance to exhaling. Push as much of the air from your lungs as is comfortable, then start again with your next inhalation.

Do this breathing exercise for a few minutes. Anything beyond five or ten minutes is probably overdoing it. If you are healthy it is not likely to hurt you, but it can get boring to do it a long time.

Dreams and nightmares

A lot more is written about dreaming than is known about it. (Think about it. This is true about almost any subject you will find on the Internet.) The fact of the matter is that there is very little of a substantive nature known about this almost universal phenomenon. Most people dream (probably everyone does), and once in a while a dream will be obvious in its meaning. If you are scheduled for surgery and you dream about something related to it, for example, that’s pretty obvious.

But dreams seldom work that way. What they mean, if they “mean” anything at all, cannot be told. Sometimes we can figure out what a dream is about, but that does not tell us for certain what the purpose of the dream is. Don’t believe anyone who claims they can interpret, or teach you to interpret, dreams. But dreams seldom work that way.  Well trained and intelligent therapists ( not as common as you might think) can figure out certain things about a patient from their dreams, but they still don’t “interpret” them except in extremely obvious cases.

Lucid dreaming — being aware that you are dreaming while you are doing it — is a topic interesting to many, and it does happen. But in my research using undergraduates as subjects we were never able to consistently and reliably produce lucid dreaming. One thing that can be done, though, is influence (not control) what you dream about. This is especially helpful during times of stress and anxiety when nightmares are a common nighttime experience. Nightmares and emotionally negative dreams are directly correlated with the amount of stress and anxiety you are experiencing.

Stating it that way might make it sound like your stress levels are out of your control, that you are just a passive recipient of negative forces. But as almost everyone knows, stress is a response to threat, and how you respond is within your control. A large degree of stress management can come from the regular practice of deep relaxation. You can follow that link to see how to use progressive or deep relaxation to calm yourself. It is particularly helpful as a positive influence on dreaming.

One of the best, most consistent ways of influencing dreaming is cognitive conditioning. Doing it correctly can influence the quality and tenor of your dreams. This exercise in cognitive conditioning captures the power of imagination. Your imagination is, as you have probably noticed many times, extremely potent. Uncontrolled it can produce effects like blushing, jitteriness, anger, jealousy, and everything else all the way up to full blown anxiety attacks, which are imagination run amok.

There are many ways to do this but one of the easiest and most reliably successful methods is eidetic imagery. (Eidetic as used here is slightly off-kilter, but it works.) Method 1. Everyone has a collection of pictures, digital or otherwise. Find at least two or three in your collection that meet these criteria:

• Positive, makes you feel good.
• People-free. There should be no people in the picture, including yourself.
• A scene that you can readily imagine yourself being in.
• Passivity. There should be no action portrayed in the picture—no traffic, trains, airplanes, moving animals, etc.

Two or three times a day at roughly equal intervalsThink Dr. Pepper: at 10 am, 2 pm, and 4 pm. This is just a suggestion. Spread out your viewing in any way convenient for you. look at these pictures and imagine yourself happily in them in a dream.

None of this has to be particularly elaborate. For instance, you could take a fast peek at one of your pictures at, say, 10 in the morning during a coffee break and just think, “I want to have a happy dream about this scene.” You can also use other pictures, scenes you find on photo sharing sites, from magazines or other publications, or anywhere on the Internet. Put a picture you like on your phone, for example, and view it instead of a physical picture (who has those anymore, anyway?). It could be argued that these pictures with which you have no personal history are preferable to pictures of your own that might have unsuspected subconscious baggage.

 

These are just a few pictures to illustrate that there is nothing tricky about finding your own dream-prompting images. None or all of these might appeal to you. But at a minimum you should immediately perceive that, like all of us, you have an immediate and visceral response to a picture. A gut feeling; go with it. If it turns out you have chosen the wrong pictures, simply change them.

One final point: a sleep diary. Memory is not very reliable about sleep, and very unreliable about dreams. Keeping a daily (nightly) record of your sleep and dreams can be valuable and in and of itself it can prompt change. There are lots of instructions online about sleep diaries, but you really don’t need to get deeply into it. Just keep a notebook in which you record your previous night’s sleep (quality, interruptions, rested or not rested in the morning, what you did the night or even the day before, and so on). As for recording dreams, there is one essential thing you need to know: When you first awaken in the morning, do not move until you have thought about any dreams you had. If you move before you have had a chance to fix them in memory, you will not be able to remember the dreams even a few minutes after getting out of bed. So

1. Wake up.
2. Review and remember your dreams.
3. Sit up and write them in your journal.
4. Get out of bed and go about your day.

You might be surprised by the insights you can achieve by keeping and occasionally reviewing a sleep journal or diary.

I have by no means exhausted the amount of information that pertains to the subject of sleep and dreams. With a simple Internet search it is possible to come up with reams of information. And that can be a problem because it can be confusing and, yes, just like every other subject, there is plenty of contradictory information available.

My suggestion to you is to stick with an empirical approach. Conclusions, recommendations, procedures, all must or at least should be evidence based. Just because some pimply adolescent with a computer squirreled away in his mom’s basement thinks dreaming about carrots means your homicidal, don’t buy it. Be judgmental about any source of information you find about anything on the Internet.

If none of what I have said works for you, or if you suspect you might have slipped over the line into the realm of full-blown anxiety because you continue to suffer from insomnia despite trying the methods presented here, you should contact a professional, preferably in the form of a psychologist who is a certified psychotherapist. For instance CBT-I (Cognitive Behavioral Therapy for Insomnia) is a fairly successful form of therapy for treating insomnia without medications. It is for more difficult cases of chronic insomnia. It includes regular, often weekly, visits to a clinician who makes a series of sleep assessmentsDon’t worry, the therapist does not actually have to observe you sleeping. And it is highly unlikely you would have to spend a night in a sleep lab. Assessment is done through discussion and your own record keeping related to sleep.. The patient is asked to complete a sleep diary and the therapist helps the patient change the way he or she sleeps. It’s not as easy as popping a pill and it can be work but it is preferable to drugs. If this sounds like something you might need, do an Internet search for “cognitive behavioral therapy” and you will find a lot of information. And listings for qualified people who do it.