How nurses can get better sleep during COVID times

Between the stress, odd and late hours, and sometimes trying to snooze while the rest of the world goes about their day, being a nurse has long presented extra challenges to getting a good night’s sleep.

Now that COVID-19 is here, that list of stressors has grown longer and more destructive. Top among the pandemic-inspired sleep-deprivation factors: increased anxiety and disruptions to already inconsistent personal schedules.

And if you feel like you have even more reasons to lose sleep than workers in non-medical professions, sad to say, you’re probably right.

A study of 1,563 medical staff in hospitals during the COVID-19 outbreak in China was published in Frontiers in Psychiatry in April 2020, for example. It found that more than one-third of the medical staff suffered insomnia symptoms during the COVID-19 outbreak.

“During a pandemic, concerns about personal safety, transmitting disease to family members, stigmatization from being infected, shift work, and interpersonal isolation coalesce to disrupt sleep health,” according to a letter to the editor of the Canadian Journal of Anesthesia from anesthesiologist Mandeep Singh, May 2020.

All that worry and drama can lead to “hyper-arousal states, as well as problems with anxiety and stimulus control,” the kind that make you think of your cozy bed as the place where you lay awake in panic, rather than drifting off to restorative slumber, Singh added. “Moreover, specific lifestyle modifications such as home confinement and self-isolation can also negatively impact sleep health.”

Those rising case figures and anticipating COVID-19′s effect on the economy are not nurse-specific worries, but they also take their toll, whether keeping you from falling asleep in the first place or waking you mid-sleep cycle with a nagging sense of dread. “Everything that’s going on right now can make people more vulnerable to insomnia,” Philip Cheng, a clinical psychologist and research scientist at the Sleep Disorders Center at Henry Ford Health System said.

“It’s a vicious cycle: when you lose sleep, your emotions can feel more intense,” Cheng told the HFHS blog. “Your ability to regulate emotions can also become diminished, so existing stressors become more stressful, and the ability to calm down becomes more impaired. Also, as you become more stress sensitive, your own thoughts become a trigger for stress.”

Could this list get any longer? Well, yes, You and your wide awake self are also coping with the loss of daytime structure that “can upset nighttime sleep schedules,” according to board-certified clinical psychologist Lisa Medalie, a behavioral sleep medicine specialist at the University of Chicago Medicine. She wrote in the UChicago Medicine blog, “Inconsistent bedtimes and wake times can shift the pressure, or urge, to sleep, making the ability to fall asleep less predictable. Finally, depressed mood, more downtime and low energy can increase long napping, making it harder to fall asleep at night.”

Ack! Maybe it’s some small comfort that you shouldn’t feel singled out. Fighting sleep right now is a natural reaction to both your work and after-hours situation. But like so many issues during the pandemic, this is not one you can afford to let slide. Nurses need their sleep!

“It’s not easy to function at our best without easy access to our usual coping skills (e.g., social support, exercise, etc.) while sheltering in place,” Medalie explained. “Adequate sleep can maximize your potential for having better days under these circumstances. Optimal sleep helps regulate mood, improve brain function, and increase energy and overall productivity during the day.”

Don’t think of this elusive sleep as one more thing to worry about and feel guilty that you’re not accomplishing, though. In fact, shedding that and some other ideas about “must do’s” can be a first step in getting better sleep in the days of COVID-19.

If you’re not getting what Cheng calls a “restful seven to nine hours of sleep,” give yourself a break. “Try not to get anxious about your sleep troubles, as worrying about insomnia will make sleep less likely,” he advised.

And also try a few other tactics recommended by sleep experts. They’re all things you can do now, no need to wait for a vaccine, or vacation days, or cooperation from your school-age children or whatever else is keeping you awake. Read 'em and sleep, nurse!

Stick to some structure. Sure, that’ll be easy (said no nurse ever). But to slay the no-sleep beast, it’s a good idea to “make sure you have a regular schedule and stick to your regular wake time,” said Cheng. That means even if the kids are doing virtual schooling in your living room or you’re picking up extra shifts when co-workers call out, you make every attempt to wake up and go to bed at the same time every day. That will encourage your body to anticipate when it’s time to sleep and time to wakey-wakey.

And look at sticking to a schedule the rest of the day as much as possible, too, Medalie added. “Commit to daily activities (e.g., exercise, meals, socializing) at certain times to build structure to your days. This will support a regular bedtime and wake time,” she said. “Set cell phone reminders to anchor your schedule, and as a reminder to turn off screens an hour before bedtime.”

Skip the naps, if possible. Even if you got little sleep the night before, try not to nap unless it would present a danger when you’re at work, Cheng advised. Without a nap, you’re more likely to be tired and able to sleep when your assigned bedtime rolls around.

Stay away from electronics close to bed, especially news updates. “People are spending every waking moment getting one last look at their screens (news updates, COVID-19 education, social connections),” Medalie added. “The blue light from these screens tells the brain to stop producing the sleep hormone melatonin, which can lead to trouble falling asleep.”

According to Cheng, you can catch a little television before bed, as long as it’s far enough from your face that it won’t interfere with your circadian rhythm. But he means television, not phones and laptops held close to your face.

Watch the bedroom temperature. Cheng recommends a dark room and the thermostat set between 65 and 70, ideally.

Exercise in the afternoon. Even if you struggle to find time or motivation to be active, don’t get inspired to do cardio right before you expect to go to sleep. It will raise your core body temperature, which will interfere, Cheng explained, recommending afternoon exercise instead. “Even more so than in the morning, there’s evidence that exercising in the late afternoon is helpful for deep sleep,” he said.

Cut back on late shift caffeine. Ideally, you won’t have any caffeine in your system at bedtime, even from energy drinks or sodas that you might tend to pound near the end of your shift -- and way too close to bedtime. “Caffeine can stay in the body for eight hours, which is longer than most people think,” Cheng said. “I cut off my caffeine intake around 2 or 3 p.m.”

Avoid alcohol within three hours of bedtime. No one is going to wrest that glass of wine away from you! But even if you won’t be driving because you’re staying in more during safer-at-home restrictions, don’t drink alcohol too close to bedtime. While it may make you sleepy at first, it will wake you during your sleep cycle as you metabolize it and need to urinate.

Don’t weaponize sleep. It’s important to remind yourself that while more sleep sure would be nice, you don’t have superpowers to guarantee that outcome. Try doing your best, but realize you might have to accept less than complete success. “While sleep is important, try not to fret about it!” Medalie advised. “Worrying about sleep just turns into more stress. Instead, just do your best to get to bed on time and follow these tips if there are problems. Remember to always come back to ‘controlling the controllables.’ You can’t control the outcome of your efforts, only the efforts themselves.”