What’s keeping you awake? your guide to better sleep during the COVID-19 crisis
Advice on how to plan around shift patterns, cope with insomnia and anxiety, and make time for rest in a busy schedule
- Insomnia is described as difficulty getting to sleep or maintaining sleep, early wakening, or non-restorative sleep
- Some healthcare staff in the UK and overseas have reported insomnia associated with the COVID-19 pandemic
- Tips for eliminating factors that lead to poor quality sleep, and making time for rest despite a busy home life
This article was updated on 17 March 2022
The health benefits of a good night’s sleep have been emphasised by scientists for decades.
Sleep helps support wound healing and repair, helps us maintain a healthy weight and hormonal balance, and helps control blood sugar levels.
Nurses feeling the effects of disturbed sleep during the pandemic
In terms of mental health, it helps safeguard against stress and depression. A disturbed night’s sleep can affect our short-term memory and reaction time.
- RELATED: CPD – Promoting healthy sleep
But as nurses find themselves in unprecedented times both at work and at home due to the COVID-19 pandemic, it's perhaps unsurprising that many have reported having trouble sleeping.
'I'm so sick and tired, literally tired, of COVID-19-related insomnia,’ one UK nurse wrote on Twitter during the first wave in April 2020. ‘Anyone else suffering?’
1 in 3
of 1,563 medical staff surveyed in China amid the initial COVID-19 outbreak there said they experienced insomnia symptoms
Source: 2020 study, Frontiers in Psychiatry
Insomnia is described by the National Institute for Health and Care Excellence (NICE) as difficulty in getting to sleep or maintaining sleep, early wakening, or non-restorative sleep. It can result in poor concentration, mood disturbance and fatigue.
The impact of COVID-19 on health professionals’ sleep quality
One 2020 study looked at sleep quality and the incidence of insomnia among medical staff in China during the initial COVID-19 outbreak there, including front-line staff in Wuhan, where the coronavirus originated in late 2019.
It found that more than one third of the 1,563 medical staff surveyed said they experienced insomnia symptoms.
Related factors included education level, working in an isolation unit and psychological worries about the COVID-19 outbreak, and the authors called for interventions for insomnia among medical staff.
What causes insomnia?
- Diet – late-night sugary snacks, for example
- Using electronic devices before going to sleep
- The sleeping environment – too hot or too cold
- Too much fluid intake
The pandemic-related factors that can hinder sleep
Sleep is crucial, especially during periods of high pressure and stress. Another study of 300 people living in Wuhan and surrounding cities at the end of January and beginning of February 2020 found those with higher quality sleep patterns reported fewer post-traumatic stress symptoms.
A study led by New York University’s Rory Meyers College of Nursing, published in Feburary 2022, found more than half of nurses had difficulty sleeping during the first six months of the pandemic, increasing their odds of experiencing anxiety and depression.
The study included a survey of 629 nurses in the US and interviews with 34 nurses in the summer of 2020. More than one in five (22%) of those surveyed experienced depression, 52% experienced anxiety, while 55% experienced insomnia. Sleeping for five hours or less before a shift increased the odds of depression, anxiety and insomnia.
Nurses described how they were kept awake worrying about work and issues such as staffing shortages, being redeployed to a COVID-19 unit, lack of personal protective equipment and numerous patient deaths. Changes in work patterns – such as working extra hours or abruptly switching between day and night shifts – also led to nurses getting less sleep.
Practical and emotional support from employers and those around you is an important factor; studies have shown that staff need high levels of social support to improve self-efficacy and sleep quality, reducing levels of anxiety and stress.
A Chinese study looking at the mental health of healthcare staff treating patients exposed to COVID-19 found that 34% of the 1,257 respondents reported symptoms of insomnia, 45% symptoms of anxiety, 50% depression and 71% symptoms of distress. Overall, nurses, women and those working in Wuhan reported more severe mental health symptoms than fellow healthcare staff.
Nurses who are having trouble sleeping should speak to their line manager in the first instance and seek medical advice if needed.
In addition, adopting the following simple strategies while at work, and when you get home, can help improve your sleep.
Review what you eat and drink – and when
Try to reduce your caffeine intake while at work and particularly before bedtime, as it inhibits the work of dopamine, the neurotransmitter that help us head into a sleep state.
When time is short and pressure is unrelenting, it is completely understandable to opt for a quick and convenient sugary snack while at work. Yet high amounts of sugar can result in more restless sleep. Try to offset this where possible by filling up on nutritious foods at home, if healthy food is in short supply at work.
- RELATED: Plan your way to healthier eating
If you do find yourself opting for sugary foods, try wholegrain snacks, such as foods containing oats, and air-popped plain popcorn. Wholegrain foods help keep you fuller for longer and release energy more slowly than sugary foods. Wholegrains foods are also high in fibre, which is also associated with a more restorative slow-wave (or ‘deep’) sleep.
You could also try eating foods containing tryptophan, an amino acid the body converts into serotonin, the chemical which helps regulate mood and sleep. Tryptophan is found in turkey, chicken, bananas and dairy.
The timing of meals is also a consideration, particularly if you work shifts. Don’t go to bed hungry, but bear in mind heavier meals take longer to digest and could disturb sleep. The Sleep Council suggests avoiding large meals for three to four hours before going to bed.
Plan your sleep schedule around shift patterns
Studies have shown that different shift patterns can have an impact on the circadian rhythm – your internal body clock – and affect the quality of sleep.
The average amount of sleep an adult needs each day
The Health and Safety Executive (HSE) advises that if you are working nights, you try to work out a sleep schedule that suits you.
For example, try to have a short sleep before your first night shift, and when coming off nights have a short sleep and go to bed earlier that night.
Also, don't use your sleep time to do jobs around the home: the HSE advises planning domestic tasks around your shift schedule and, if necessary, changing the times or days when some jobs are done.
NICE also advises speaking to other members of your household about your need to have protected time for sleep – a conversation that is more important than ever if other members of your household are working from home during the day.
Create a bedtime routine
Different working patterns, social distancing and just dealing with the enormity of the situation we find ourselves in means your usual daily routine will likely have taken a backseat. If you are shielding at home due to an underlying health condition, you may be waking later in the day and getting up later.
One area where you can try to re-introduce a consistent routine is bedtime. NHS sleep advice points out that while few people manage to stick to strict bedtime routines, irregular sleeping hours are unhelpful for people with insomnia.
The NHS advice adds that adults need about 6-9 hours' sleep daily. Try to help your body recognise that bedtime is imminent by having a consistent routine, from putting on your nightwear to brushing your teeth, and reading a book.
A warm bath before bed can also help: the warm water increases your temperature and the rapid cool-down period immediately afterward has been shown to have a relaxing effect.
How anxiety may be affecting your sleep – and what can help
Scientists have found a direct correlation between anxiety and rhythm of sleep.
Anxiety causes an increase in heart rate, which overstimulates the brain and can in turn trigger other worries.
To combat this, try the following technique recommended by the Sleep Council:
- Place your hand on your heart and listen for the beating
- Breathe in deeply for four seconds, and then breathe out slowly
- Repeat this until you can feel your heart rate slowing, which in turn slows down your brain activity
Another strategy is the ‘speaking technique’, where voicing your concerns out loud overrides thinking and can stop negative thoughts.
Or try putting your thoughts down on paper before bedtime. A study by sleep scientists at Baylor University in Texas found taking five minutes to write down uncompleted tasks from the day can help induce sleepiness.
Mindfulness may also help: the meditation app Headspace is currently offering all clinical and non-clinical NHS staff free access to its resources.
A study examining whether a daily mindfulness practice helps people cope with anxiety and sleep during the pandemic found that those who completed a daily mindfulness activity had reduced anxiety. Furthermore, an increase in infections in the local community had significantly less impact on their sleep duration than it did on that of others not practising mindfulness.
Use lighting – and sunglasses – to get your bedtime cues
Use a dimmer switch in your living room and slowly dim the lights as bedtime approaches. Your body will slowly release the chemical melatonin, which makes you sleepy, when it receives the right cues from your environment.
Transition from light to dark from about 9-10pm.
If you are working night shifts, try introducing bright light in the evening before your shift starts, the Sleep Council advsies. Staff working nights can also reduce their exposure to the dawn or morning light on their way home by wearing sunglasses.
When to keep it dark – and when to let in the light
Darkness is essential for good sleep, so it might be worth invest in blackout curtains if you have trouble sleeping, says the Sleep Council.
An eye mask may also help, and aim to cut out as much extraneous noise as possible with a pair of ear plugs.
When it’s time to wake up, you need light. Special lamps that start with low-level light and gradually get brighter may help.
Switch off your electronic devices, and set an old-fashioned alarm
If you have a habit of checking your phone in bed, it could be disrupting your sleep. Devices such as smartphones and tablets emit short-wavelength blue light, which can supress the sleep hormone melatonin.
If you rely on your phone or tablet as an alarm, invest in an old-fashioned alarm clock instead, and put your phone on do not disturb until its time to wake up.
It also may be worth avoiding watching or reading the news just before bed. In current circumstances, the constantly developing news can be compelling, but one study from China suggests that for mental health and well-being, it is advisable not to spend too much time reading about the pandemic.
Remember that alcohol is linked to disrupted slumber...
Even though alcohol can promote the onset of sleep, the HSE advises against using it to help you get to sleep, as it is associated with earlier awakenings, disrupted sleep and poorer sleep quality.
Likewise, regular use of sleeping pills and other sedatives to aid sleep are not recommended as they can lead to dependency and addiction.
... while exercise can improve sleep quality
Exercise might be the last thing on your mind after a long, exhausting shift but it can improve sleep quality.
It also releases endorphins so can help improve mood.
However, NICE advises that you avoid vigorous exercise within four hours of planned sleep time.
Deborah Duncan is a lecturer, school of nursing and midwifery, Queens University, Belfast
- The Sleep Council: Shift work sleep disorder
- The Sleep Council: Sleep advice for shift workers
- NHS.uk: Sleep and tiredness
- NHS.uk: How to get to sleep
This article was originally published on 20 May 2020 and updated on 17 March 2022