Analysis

What’s keeping you awake? your guide to better sleep during the COVID-19 crisis

Advice on how to plan around shift patterns and cope with insomnia and anxiety amid lockdown

  • 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 outbreak
  • Tips for eliminating factors that lead to poor quality sleep, and making time for rest despite a busy home life
Image of a person lying in bed but unable to sleep due to thoughts such as 'PPE', 'social distancing' and 'work', shown as speech bubbles
Picture: iStock

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.

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 in April. ‘Anyone else suffering?’

View our COVID-19 resource centre

1 in 3 

of 1,563 medical staff surveyed in China amid the COVID-19 outbreak 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

A recent study looked at sleep quality and the incidence of insomnia among medical staff in China during the COVID-19 outbreak, including front-line staff in Wuhan, where the coronavirus originated late last year.

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?

  • Pain
  • Stress
  • Diet – late-night sugary snacks, for example
  • Using electronic devices before going to sleep
  • The sleeping environment – too hot or too cold 
  • Caffeine
  • Medication
  • Too much fluid intake

(Source: NICE)

 

What to do if you’re having problems sleeping

Sleep is crucial in these times. Another study of 300 people living in Wuhan and surrounding cities at the end of January and the beginning of February 2020 found those with higher quality sleep patterns reported fewer post-traumatic stress symptoms.

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. 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.

A woman standing looking at the contents of a fridge, choosing what to eat and drink
Picture: iStock

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.

6-9 hours

The average amount of sleep an adult needs each day

Source: NHS.uk

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

A woman trying to reduce anxiety by following a breathing exercise that starts with placing your hand on your heart and breathing deeply
The breathing technique starts with 
placing your hand on your heart
Picture: iStock

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.

A woman lying in bed asleep, wearing an eye mask to prevent sleep disturbance due to light levels
Wearing an eye mask might help to reduce sleep disturbance due to light levels Picture: iStock

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.

A woman jogging outdoors, which along with other forms of exercise can improve sleep quality
Exercise is a better option than alcohol
to wind down and improve sleep
Picture: iStock

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, lecturer, school of nursing and midwifery, Queens University, BelfastDeborah Duncan is a lecturer, school of nursing and midwifery, Queens University, Belfast

 

 


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