How the Pandemic is Affecting Sleep

I am seeing a spike in questions in around sleep difficulties since the pandemic started. Some of these problems are new or some are a return to past sleeping difficulties. Rebecca Robillard, director of clinical sleep research at the Royal Ottawa Institute of Mental Health Research, published a new study on sleep changes during the COVID-19 pandemic. Dr. Robillard collected her data through an online survey between April 3 – June 24 completed by 5,525 Canadians. More than half of the participants reported having trouble sleeping. Although I did not take the survey, I am one of those people. While the study was not an autism specific one (neurological conditions were not accounted for in the analyses), these findings can help us to understand the increased struggle parents, caregivers, teachers, support workers, EA’s and many others from helping professions are having as a result of disordered sleep during the pandemic, as well as for our individuals on the autism spectrum.

I am also hearing from the autism community that distressed behaviors are increasing. Could this be a result of the increased stress and anxiety many of us are feeling during the pandemic, resulting in a lack of sleep? Stress is transactional – we are appraising and evaluating the current situation and determining what to do. Using adaptive coping strategies can alleviate stress and help to remain calm; however, a lack of sleep can impair our ability to use effective coping strategies.

I experienced 10 years of chronic sleep deprivation when my two children with autism were younger. I had less than 4 hours of sleep a night and those 4 hours were not all together – they were scattered throughout the night. This sleep pattern affected my mood, judgment, cognitive functioning and ability to cope. The pandemic has brought a return to my former patterns of disordered sleep. I fall asleep sitting up at odd times of the day, I often can’t fall asleep at bedtime, and I wake far too early in the morning either after having vivid, disturbing dreams or my mind begins racing as soon as I open my eyes.

Some of the health implications of long term, untreated insomnia are depressive disorder, heart disease and type 2 diabetes. As the pandemic drags on, it can become more difficult to correct disordered sleep patterns because a viscous cycle builds up over time. A sleepless night can make you feel stressed, anxious and unhappy the next day which then leads to poor sleep the following night due to having those feelings.

The Effect of Physical Restrictions

Physical restrictions keep people from daylight and physical activity that support deep sleep. Working from home, receiving online education, and the cancellation of activities removes the markers we’re used to for going to bed and eating. Daylight is important for  regulating sleep-wake schedules. If you are in dim light all day long, your sleep-wake schedule become disrupted. My home office is located in the basement with very little natural light, which I am now aware is problematic for sleep.

I have written about the need to keep routines as regular as possible in order to help with regulation. Even with the loss of so many activities for both of my children, we have adhered to their regular pre-pandemic schedules as much as possible. As the weather becomes colder, getting outdoors for fresh air and exercise becomes more challenging so we’ll have to get creative with outdoor activities. My son’s mood greatly improves after a walk in the sunshine. I find having a destination for a walk increases the motivation to do it like going to a park or following the familiar route of our summer bike rides.

Increased Screen Time, Blue Light and Sleep

Exposure to blue light from laptops, tablets and phones can make it harder to fall asleep and more difficult to fall back asleep if you wake up in the night. Christopher Colwell, a professor at the University of California, explains in an article the effects the blue light from electronic devices has:

In the brain, light from electronic devices, among other sources, not only stimulates sight, but also activates a brain circuit that governs our ‘circadian rhythms’ — our daily cycles of arousal, mood and hormone secretion, among other body functions.

There is a set of photoreceptors in the eye that are not part of the visual system, but instead connect to other brain regions, including the suprachiasmatic nucleus in the hypothalamus. This nucleus is our body’s master clock, regulating the rhythms of the other body systems; light can shift or reset this clock.

Specifically, light exposure in the early night will delay the clock such that it is harder to wake up the next morning and go to sleep the subsequent night. So nightly exposure to even dim light can disrupt our circadian cycle and have broad effects on our biology.

The cells in the eye that connect to the clock are most sensitive to light in the blue-green part of the electromagnetic spectrum. These wavelengths are abundant in the light that shines from electronic devices.

One study on the use of electronic media before bedtime found that incorporating television and video games into the bedtime routine is associated with sleep onset difficulties among children with ASD. It may help not to have these devices in the bedroom and limiting their use in the evening close to bedtime. They should not be incorporated into the bedtime routine.

What Adults Can Do to Improve their Sleep During the Pandemic

Sleep On It Canada recommends the following for adults to improve their sleep during COVID-19:

1. Try and get 7 – 8 hours of sleep a night.
2. Keep a normal bedtime and waking time routines, even if your schedule has altered.
3. Establish a bedtime routine. This could be listening to calming music, taking a bath or meditating.
4. Keep tech devices out of the bedroom.
5. Expose yourself to natural daylight to help your biological clock stay on time.
6. Eat a balanced diet at regular hours, exercise, and drink enough water.
7. Prepare your bedroom for a sleep environment. Make sure the room is dark.
8. Try to avoid stimulants (coffee/tea), alcohol, fatty or spicy foods or planning activities for the next day just before going to bed.
9. Add exercise to your daily routine to reduce anxiety and maintain social ties to avoid isolation.

How Children Can Improve Their Sleep During the Pandemic

Several of the points above for adults can also apply to children such as limiting the use of tech devices before bedtime, sticking to a normal bedtime and waking routine, exercising and getting exposure to natural daylight. Add to this:

1. Reassure your child that things will be OK. Talk to your children about COVID-19, why we are taking the precautions like hand sanitizing, and the vaccine. A reassured child will sleep better. Our son gets quite panicked about COVID-19 and thinks it is right outside of the house. Talking about it takes away the mystery (although we try not to do this at bedtime).
2. Add some relaxation activities to the bedtime routine like simple yoga poses or reading a story.
3. Avoid talking about expectations or serious subjects close to bedtime which could cause rumination.
4. Maintain ties with people that are important in a child’s life like grandparents.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

If ongoing insomnia is a concern, there is CBT-I. It is a is a structured program that helps a person identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. CBT-I can help a person overcome the underlying causes of sleep problems. It works by teaching how to recognize and change beliefs that affect the ability to sleep. This type of therapy can help control or eliminate negative thoughts and worries that keep a person awake.

There are many on-going uncertainties, change and worries during this pandemic that are affecting sleep and other areas of health and well-being. Be patient and kind to yourself and others, and know that this pandemic will pass.