The prevalence of anxiety in the US population was high (around 20%) before COVID. It has spiraled since then (current estimates are around 35%), with no signs of abating anytime soon. And if all that weren’t enough, as I write this, Minneapolis is literally on fire (part of a broader national emergency needing urgent attention and action, but for which I still can’t quite find words for).
With all of these factors swirling around, at the very least, 1/3 of us are experiencing anxiety right now for very legitimate reasons which will at best take months (if not years) to fix. I won’t pretend I can say anything profound about treating anxiety related to not feeling safe in your own skin in this country, or loss of loved ones and financial stability due to the state of things. But I would like to share a bit about the sleep coaching work I’ve been doing and how the pandemic has factored into that, since anxiety has played a role in nearly every encounter. I hope it may help a little.
For those in healthcare, being on the front line each day can put anxiety into overdrive. We have seen people step up and do amazing, heroic things. We have seen people dig their head in the sand and shut down. We have seen people spiral and lose their temper. And the truth is, we have probably all done all of those things and been that person at some point. We have recognized our own humanity and personal demons in this perhaps more than ever.
My day job shared this slide in the context of a call on resilience and wellness for healthcare workers.This slide is meant to be a framework for how people move through a “normal” disaster. That would be one that’s bounded in some temporal sense. A hurricane, a battle, a singular and discrete event.
The trick here is this is a chronic, ongoing disaster. Longer than many of us have experienced in our lives if we haven’t lived through a war or some other abject ongoing personal/societal tragedy. In the context of COVID, we are still in the impact phase. Experts anticipate we are months to years outside of the other side of the impact phase, and that there will be a subsequent surge in PTSD diagnoses and ongoing depression/suicide challenges.
Those of us who are most impacted may not have time or resources to address these long term impacts. My goal for the remainder of this blog is to share some recommendations I’ve been repeating to patients lately in the hope anyone can glean some useful tips as we all try our best to get through each day.
In my work with sleep coaching, anxiety is a top reason for insomnia (others include chronic pain, inconsistent schedules, and underlying other sleep disorders such as apnea). This was true before the world exploded. For many clients, their job plays a major role. A term two of them have used recently which I adore is the “Sunday Scaries,” that unique feeling of dread specifically which hits in anticipation of a new work week.
Past traumas can be another risk factor as well. It is beyond the scope of a sleep coach to offer mental health counseling, but I often find people at my door who have financial or access issues in establishing care, or who have tried therapy, or are even still in therapy, but still struggling with anxiety specifically at night. I do my best to encourage they seek out qualified therapists where applicable.
I start each new patient with a sleep intake questionnaire and ask about routines and habits. Lately, most responses have a before and after COVID answer. I went to bed at 10 before, but now it’s whenever. I drank 2 glasses of wine at night before, but now it’s 3. I used to work 8 hour days, but now I feel like it’s continuous. Even those who were hanging in there before all this have found their routines (a key anchor for good sleep) blown up by teleworking, home schooling, limited safe exercise options, and a million other surprises which we’re all still adapting to.
If there’s a low-hanging fruit kind of recommendation I can offer both to help reduce anxiety and insomnia, it is to do everything in your power to find some way to keep structure in your day. This includes consistent bedtimes and rise times. Routine can be such an anchoring approach when the world is spiraling out of control. It’s also a critical aspect of the behavioral portion of cognitive behavioral therapy. And from a neuroscience perspective, it is a key element in helping your body obtain good sleep.
How does our brain decide when it is sleepy? It’s actually chemical in nature. When you are awake for a certain amount of time, you accumulate hormones and neurotransmitters that build up over the course of the day. You need to have enough time pass since your last sleep phase for them to hit a critical level and tell your brain to sleep. If your sleep is all over the place, or if you’re having a weekend bender which means you sleep in until noon on Sunday, you are setting yourself up for a terrible week ahead; not just because of the likely hangover, but because you have shifted that hormonal signaling.
Anxiety-induced insomnia hits some people early in the night (can’t fall asleep because the mind is spinning with worry), and sometimes in the middle or end of the night. My advice for the early phase people is to try to find some quieting/calming routine before bed. Meditation is my go-to. But it’s not perfect. I did it myself last night and still had a brain spinning for a good hour afterwards.
That’s where self compassion comes in, and tamping down the instinct to catastrophize. We can sit there laying in bed thinking, “shit, another night of this, tomorrow is going to be a disaster.” Or we can try to rescript the inner narrative to something like, “here we go again, looks like I’m not shutting off, but it’s happened before and I lived and generally the world didn’t end… I can get through this again.”
This is the cognitive part of cognitive behavioral therapy. Interrupting the negative monologue in your head and trying to redirect. Or simply giving voice to your worst fears. Instead of laying there ruminating, take out a pad of paper and write down: “I am worried because I have no idea how I will pay rent this month.” That simple act can signal to your brain that you have recorded the worry and it will be there for you to pick up in the morning. Of course the problem with the rent is still there in the morning, but sometimes it can help shut off the monologue briefly enough to allow some rest.
These are just some small things you can try to help cope with ongoing challenges. If you are having more sleepless nights than not, if it is impairing your daytime functioning or impacting your relationships, it is probably advisable to seek out professional help via a therapist or sleep disorders specialist. I am a sleep coach and I don’t pretend that every night is 100% perfect, but I feel comforted in knowing the basic tools I can use each night when something goes off the rails.
There’s a lot these days we can’t change, but in the scope of things you can control, hopefully these tips can offer some relief for the many of us who may need it. As I tell my clients, I wish you all a good night’s sleep!
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