While sheltering in place has wrought havoc on daytime routines, nighttime sleep should have remained unchanged. But for many, it has not. Sleep problems, particularly insomnia, are currently on the rise. The uncertainties and fears associated with COVID-19 contribute to increased anxiety and stress, which subsequently increases the likelihood of sleep-related disturbances. Working from home and staying indoors limits exposure to essential morning light beneficial to effective functioning. Inconsistent routines and managing multiple activities in discrete settings throughout the day can alter day/night cycles and disrupt circadian rhythms (Czeisler and Wright, 1999). Viewing sleep systemically reflects that any one person’s sleep in the family system has effects throughout the system. This is especially relevant during times of increased stress and disruption. In addition to CBT-I (Cognitive Behavior Therapy for Insomnia) (Oaseem et. al., 2016), the following discussion introduces some specific recommendations that may not be presented elsewhere and are based on my practical work with clients, my understanding of family systems and the theories and science of sleep psychology.

Shifting your bedtime

If you are not working or have flexible work-at-home-hours, consider shifting your bedtime up to an hour later than usual and wake up an hour later. While the sleep advice is still to keep to a schedule, many pre-COVID-19 early commuters may find that shifting to a later bedtime will help them go to bed quicker and sleep more consistently through the night. Limit the switch to no more than an hour in order to retain your circadian rhythm. Children's bedtime schedules can be adjusted as well if they can get up an hour later.

Writing

Panic at night can be extreme, especially related to health and financial matters. If you are in experiencing this, try writing down actions you can perform the next day to reduce your uncertainty or deal with the new reality. Do this three hours before your desired bedtime, then trust the unconscious to work it through overnight with the hope that new creative options will come to mind after a restful sleep. Remember that sleep solves many more problems than repetitive worry. Sleep is our deepest source of creative problem solving (Eichenlaub et. al., 2019).

Instituting family nap time

Institute family nap time. If everyone is in the house, a snack around 2-3pm followed by a 20-30 minute power nap can reset everyone for the next phase of in-the-house activities. Make sure the naps are brief and that everyone is up and moving before 4pm so that you will be sleepy at the desired bedtime.

Helping anxious children

If children are anxious or wake up with nightmares, it is preferable to go into their rooms or beds as to not reinforce coming into your bedroom. If you like a family bed, this is the time to use it. Nighttime vigilance can be calmed by your physical and tactile presence, back-rubbing, singing, offering reassurance and empathizing with fears.  

Cuddling

If you cannot sleep - cuddle. If you are alone or with a partner who needs space, bring on the pillows, weighted blankets, transitional objects, etc. Anything that connotes comfort.

Being intimate

Initiate physical intimacy with your partner. If arguing from too much togetherness, make up and make love. If alone, consider self-pleasuring. While not for everyone, orgasm can help promote sleep and be an important tool in the toolbox (Lastella et.al., 2019).

Reading and meditating

Read poetry before bed. Sign up for poem-a-day and read it as part of your nighttime routine.  Consider it a five-minute meditation that does not require any meditation skills. Think of it as a backrub without touch. 

Brainstorming

Review each person’s sleep issues at a family meeting and brainstorm how you can help each other sleep better. Ask about dreams since so many people are having very vivid dreams about COVID-19.

Walking

Get an hour of outdoor natural light whenever possible. Since many are cooped up indoors most of the day, it is best to do a morning walk (Bootzin et.al., 1999).

Making the bed

Wash the sheets and make the bed. During stressful times, it makes the bed more inviting, even if it never bothered you before. The rest of the housework can slide, but try to treat yourself to that initial feeling of "ahhhhh."

Limiting news

Institute a “no COVID-19 news or discussion after 8pm rule” for at least half of the week. 

Taking sleep aids

If you have never taken prescription or OTC sleep aids – do not start now. COVID-19-related sleep problems are best treated behaviorally (Oaseem et. al., 2016).

Imagining

Invent a happy place. Fantasy is one of the most adaptive coping mechanisms for people in various circumstances of confinement; it can be a game changer. Create a world of your liking and populate it in any way you want. You are entering your own dream world while you are awake. This is also a useful strategy for teens and children.

Trying cognitive behavioral therapy for insomnia

If you have persistent insomnia and have never tried CBT-I, there are many good and free apps. My favorite one was developed by the Department of Defense for servicemen and women as well as veterans. It is called the CBT-I Coach App and it can be downloaded for free.

References

Bootzin, R.R., Lack, L., & Wright, H. 1999.  Efficacy of bright light and stimulus control instructions for sleep onset insomnia.  Sleep 22 (1 Supplement): 153. 

Czeisler, C. A., & Wright, K. R., (1999).  Influence of light on circadian rhythmicity in humans.  In F.W. Turek and P. C. Zee, eds. Regulation of Sleep and Circadian Rhythms. New York: Marcel Dekker, 149-180.

Eichenlaub J.B., van Rijn, E., Phelan, M., Ryder, L., Gaskell, M.G., Lewis, P.A., P. Walker, M., & Blagrove, M. (2019).  The nature of delayed dream incorporation ('dream-lag effect'): Personally significant events persist, but not major daily activities or concerns. Journal of Sleep Research Feb; 28(1):e12697. 

Lastella, M., O'Mullan, C., Paterson, J., & Reynolds, A. (2019). Sex and Sleep: Perceptions of sex as a sleep promoting behavior in the general adult population. Frontiers of Public Health, (04) March. https://doi.org/10.3389/fpubh.2019.00033

Qaseem, A., Kansagara, D., Forciea, M., Cooke, M., & Denberg, T. (2016). Clinical Guidelines Committee of the American College of Physicians. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. Jul;165(2):125–33.