Feeling anxious? Here's what two experts recommend for better shut-eye.

Julie Jones
October 20, 2020
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Sleep can be elusive for many of us. Even pre-COVID, more than 50 million Americans suffered from some form of a sleep disorder, according to the American Sleep Apnea Association. Add to that the increased stressors surrounding the coronavirus pandemic, and sleep specialists have seen a recent uptick in sleep disturbances. Psychiatrist Howard Maziar, M.D., DLFAPA, says, "When people tell me that they are having trouble sleeping right now, I tell them I'd be worried if they weren't having trouble sleeping during these times."

Scott Leibowitz, M.D., DABSM, FAASM is a specialist in sleep medicine who says he was surprised when many of his patients reported sleeping better during the first few months of the COVID-19 pandemic: "They were working from home, they had more flexible schedules, they didn't have the same stress and pressure dealing with traffic, they didn't have to wake up at 5 a.m. to make sure they could beat traffic and be at work on time. This meant they could go to bed later, when they were actually sleepy. They could really align their behavior and biological sleep periods more closely, and as a result, they were sleeping better."

However, as the pandemic has continued, this positive sleep trend has unfortunately declined. Leibowitz noted that the increase in sleep disturbances that people are now reporting—termed "COVID-somnia"—correlates to additional stress and anxiety brought on by the pandemic. "Mental health issues are growing exponentially every month as COVID continues," he says. "So the first thing to look at is your global state of being, your mental health and wellness."

Both Maziar and Leibowitz agree that anxiety is a common trigger of sleep issues (whether it's related to COVID or not). Maziar recommends that when someone has prolonged episodes of sleeplessness, they should go to see a physician to rule out medical issues that may be the underlying cause. But, he says, "Most often, it's stress- and anxiety-related."

Leibowitz agrees: "A lot of people will feel like they don't have anxiety until they lay down at night. During the day, one of our coping mechanisms is distraction—that's how we survive. If we sat around and thought about the reality of life, now especially with COVID, we wouldn't leave our house, we wouldn't leave our bed!"

He adds that we have mechanisms to help us cope with what's going on around us, but at night we don't have access to them. "They go offline," he says. "So you are just left, in the dark, with an awake brain, doing nothing but thinking. And that is a very, very fertile landscape for difficulties with falling asleep."

So what can we do to treat the stress and anxiety that are causing the vast majority of our sleep issues? Maziar encourages his patients to focus on the three M's: meditation, movement and, when needed, medication.

How to Deal with Sleepless Nights Due to COVID-19 Anxiety

The first steps are to look at the ways that meditation and movement can help us manage those sleepless nights.

Meditation

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Leibowitz believes that meditation is an underappreciated and underutilized tool. "It doesn't 'fix' sleep problems," he says, "but it helps you develop the tool of going to a place and blocking out the things that are constantly barraging us—internet, computers, TV, news—all of those things are the opposite of what we need for sleep. So you have to draw some boundaries and have a hard stop of when you are going to disconnect."

Research suggests that practicing mindfulness, including meditation, can improve sleep quality in populations with sleep disturbance.

And it's easily accessible, Maziar says: "Meditation is really helpful. With the onset of so many apps that are available for doing meditation, it's really quite easy. You don't have to take an hour. You don't have to buy a new wardrobe to do it. You don't have to go sit on a mountain in India to do it."

Maziar is a proponent of the Headspace app—especially their one-minute meditation and their meditation for when you wake up in the middle of the night and can't go back to sleep. He says that he used that particular meditation one night when he woke up and couldn't go back to sleep. He admittedly was skeptical until he started the meditation and then woke up the next morning with his headphones askew on his pillow.

Maziar also suggests a common-sense approach to sleep hygiene: Don’t do anything too strenuous just before bed (for example, don't watch a horror movie or go over your finances right before bedtime). He also suggests trying an easy mindfulness technique that could be helpful not just with sleep, but also with general stress and anxiety.

He says, "Some people don't slow down until they get in bed and that's when they start going over the day's events … what they have to do tomorrow. That's not conducive to good sleep. I will sometimes recommend that if the person wants, take 30 minutes before you're going to go to bed and worry. Do all your worrying before you get into bed and then you will have done it."

With this allotted "worry time," you can download your day and plan for the next day so that you are able to go to bed knowing that you have a plan.

Leibowitz agrees, and he takes this technique one step further. He suggests that you sit and divide a page into two columns. On one side, you write down all of the things you are worried about—big and small. On the other side, you write down the action items you can take to solve each of these problems.

"It's not going to resolve all the issues, but it's a means for you to say, 'I have a plan.' It grounds all your worries. So that when you get into bed and your mind wants to go to that place to worry, you can actively say, 'There's nothing I can do right now. I've already actively taken care of all of the worries I can, and the others I have to let go.'"

Movement

"I will write a prescription for exercise," Maziar says. "And I emphasize that because it is just as important as medication is."

A wealth of research suggests that people sleep better and feel more alert during the day if they exercise. In fact, a recent study from the Sleep Foundation indicated that we only need 150 minutes of exercise each week—that's about just 21 minutes a day—to significantly improve our sleep quality.

Liebowitz agrees. "I always advise exercise. It improves people's quality of life, it improves their general sense of wellness and, as a rule, it helps people sleep." He suggests including both intense aerobic exercise and resistance training once or twice a week (there's some research that links resistance training to reduced anxiety). And, he advises, "Fit your exercise into your schedule wherever you can, as long as it's not too close to bedtime."

And remember, strength exercises and resistance training doesn't have to mean equipment and weights. Bodyweight exercises are strength exercises, and there are a number of ways you can incorporate these exercises at home using little to no equipment.

What to Do When Meditation and Exercise Aren't Working

It's important to know that if you have a true sleep disorder or underlying medical condition, even meditation, exercise and perfect sleep hygiene may not work without additional help.

Leibowitz suggests that if you've been experiencing sleep disruptions three to five times each week for more than 30 days, or if your sleep disturbances are causing you distress, then it's time to see a doctor.

To find a sleep specialist in your area, you can visit SleepEducation.org to find an American Academy of Sleep Medicine-accredited physician.