In an interview for Elemental magazine, I had the chance to chat with Dr. Indra Narang on how COVID-19 has disrupted our sleep and mental health. Here, she presents the latest evidence in the field of sleep medicine and provides ways to mitigate the effects of the pandemic.
Can you give us an overview of your background and research specialty?
“I completed all my undergraduate training in the UK. I first trained as a paediatrician followed by subspeciality respirology training in the UK. In 2006, I completed further training in Sleep Medicine at the Children’s Hospital of Philadelphia. In 2007, I was appointed as the Director of Sleep Medicine at the Hospital for Sick Children, Toronto. As well as my clinical role where I look after children with complex sleep disorders, my research foci include 1) advancing a personalized approach for the management of obstructive sleep apnea in children and 2) understanding the consequences of chronic sleep deprivation on the developing brain and neurocognition.”
Why is sleep important? What are the recommended hours of sleep?
“Sleep is one of the most fundamental necessities of life and inextricably linked to physical, psychosocial, mental health, and wellness. Lack of sleep in adults is associated with increased risk of cardiovascular disease, diabetes, anxiety and depression. It also leads to falling asleep while driving and associated motor vehicle accidents; cravings for sweet, salty and starchy foods predisposing to weight gain; memory impairment and difficulties with concentration and dementia in older adults.
The National Sleep Foundation posted the latest recommendations for each age group. In adults, sleeping less than 6 hours a night is defined as short sleep duration.”
How has the COVID-19 pandemic affected sleep?
“COVID-19 has impacted individuals in many unique ways. We have observed different patterns, including difficulty in falling asleep and staying asleep; fragmented sleep and poor sleep quality due to multiple night awakenings, partially due to anxiety; delayed or disrupted circadian rhythm with later sleep times and later wake up times, and evidence for staying in bed longer and over-sleeping.
These changes can be attributed to many factors including a lack of regular routine or schedule; disrupted circadian rhythm due to reduced exposure to natural light and excess screen time; anxiety, stress and rumination, and increased sedentary behaviour, food consumption and weight gain.
However, some people may experience improved sleep duration and quality due to greater flexibility of sleep schedule that enables a schedule more aligned to circadian rhythm and more sleep, for example, in night owls. Night owls have a tendency to sleep later and wake up later so factors such as not having to commute does in fact mean they have more time to sleep in the morning.”
Do these changes in sleep have an effect on mental health? If so, how?
“Yes, there is increasing evidence to suggest that altered sleep—specifically, chronic sleep deprivation which encompasses sleep restriction and impaired sleep quality, may have adverse effects on mental health, particularly anxiety and depression. In animal models, chronic sleep restriction for more than a week was shown to lead to alterations in the neurotransmitter receptor systems—such as the serotonin-1A receptor and corticotropin-releasing hormone receptor system—and neuroendocrine stress systems—like the hypothalamic-pituitary-adrenal axis. These changes are similar to those reported for major depression and underscore the importance of good sleep for improving mental health.”
Are there any symptoms of disrupted sleep that we should be aware of?
“Key symptoms may include difficulty falling asleep and staying asleep, difficulty waking up in the morning, feeling unrefreshed on waking up, daytime fatigue and sleepiness, and the need for daytime naps. Other symptoms include irritability, lethargy, an inability to concentrate and emotional dysregulation. Some adults may also have obstructive sleep apnea which is associated with night-time snoring, pauses in breathing and fragmented sleep which together can significantly impair daytime performance.”
What are some coping strategies to improving sleep during this pandemic?
“The National Sleep Foundation have some thoughtful recommendations.1 Some of the keys ones to share are:
1. Set Your Schedule and Routine
Establishing a routine can facilitate a sense of normalcy even in abnormal times. Health experts have recommended avoiding major variation in your daily sleep times.
Your daily schedule should include:
- Wake-Up Time: Set your alarm, bypass the snooze button, and have a fixed time to get every day started.
- Wind-Down Time: It can involve things like light reading, stretching, and meditating along with preparations for bed like putting on pajamas and brushing your teeth.
- Bedtime: Pick a consistent time to turn out the lights and try to fall asleep.
2. Reserve Your Bed For Sleep
It is important to create an association in your mind between your bed and sleep. It’s recommended that sleep and sex be the only activities that take place in your bed. This means that working-from-home shouldn’t be working-from-bed, and avoid bringing your laptop into bed to watch movies. If you’re having a hard time falling asleep, don’t spend more than 20 minutes tossing and turning. Instead, get out of bed and do something relaxing in very low light, before heading back to bed.
3. See the Light
Exposure to light plays a crucial role in helping our bodies regulate sleep in a healthy way. As you deal with disruptions to daily life, you may need to take steps so that light-based cues have a positive effect on your circadian rhythm.
- Spend some time outside in natural light. Even if there’s little sun, natural light still has positive effects on circadian rhythm.
- Open windows and blinds to let light into your home during the day.
- Be mindful of screen time. The blue light produced by electronic devices have been found to interfere with the body’s natural sleep-promoting processes. To help, there are device settings and special apps that reduce or filter blue light.
4. Be Careful with Naps
If you’re home all day, you may be tempted to take more naps. While a short power nap early in the afternoon can be useful, it’s best to avoid long naps or naps later in the day—it can hinder nighttime sleep.
5. Stay Active
Regular daily activity has numerous important benefits, including for sleep. If you can go for a walk while maintaining social distances, that’s a great option. If not, there are many fitness live streams online during this pandemic.
6. Practice Kindness and Foster Connection
Kindness and connection can reduce stress and its harmful effects on mood and sleep. Try to find some positive stories, such as how people are supporting one another through the pandemic. You can use technology to stay in touch with friends and family to maintain social connections during the pandemic.
7. Utilize Relaxation Techniques
Deep breathing, stretching, yoga, mindfulness meditation, calming music, and quiet reading are just a few examples of relaxation techniques that you can build into your routines. Check out smartphone apps like Headspace and Calm that have programs designed for people new to meditation. Additionally, avoid becoming overwhelmed by coronavirus-related news. Some examples:
- Bookmarking one or two trusted news sites and visiting them only during a limited, pre-set amount of time each day.
- Cutting down the total time that you spend on social media. To help, a number of apps can monitor and even block your time on social media sites or apps each day.
- Scheduling phone or video calls with friends and family to focus on topics other than the coronavirus.
8. Watch What You Eat and Drink
Keeping a healthy diet can promote good sleep. Be cautious with alcohol and caffeine, especially later in the day, as both can disrupt the quantity and quality of your sleep.
9. Contact Your Doctor if Necessary
If you have severe or worsening sleep or other health problems, it is advisable to be in touch with your doctor”.
It was a pleasure to be in touch with Dr. Indra Narang and we thank her for the important insights we can incorporate into our lives.
1. Hirshkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation’s updated sleep duration recommendations: final report. Sleep Health. 2015 Dec;1(4):233–43.
Edited by Emma Syron & Curtis D'Hollander