Americans were having trouble sleeping before COVID-19. Unfortunately, it only got worse when the pandemic isolated us from friends and family, closed our schools and offices, and sent shock waves through the economy.
According to a study of 22,330 adults from 13 countries published in Sleep Medicine in November 2021, one in three participants, had clinical insomnia symptoms and nearly 20 percent met the criteria for insomnia disorder-rates more than double what they were before the pandemic. Furthermore, sleep disturbances were linked to higher levels of psychological distress. Anxiety and depression rates were also considerably higher than pre-pandemic levels in the same survey.
"Just like our electronics need to be charged, sleep may recharge or reset the brain to optimize functioning," says Elizabeth Blake Zakarin, an assistant professor of psychology (in Psychiatry) and a clinical psychologist at the Columbia University Clinic for Anxiety and Related Disorders.
Columbia Psychiatry News spoke with Zakarin about the psychological impact of sleep deprivation, challenges brought on by the pandemic, the influence of food on our sleep patterns, and effective treatments for sleep difficulties.
Why is sleep so important to our mental health?
Many of us know that we feel better after "a good night's sleep" and more grumpy or foggy if sleep deprived. And there is now robust evidence similarly supporting that sleep is critical to not only our physical health but also our mental health. Poor or insufficient sleep has been found to increase negative emotional responses to stressors and to decrease positive emotions.
While more research is needed to understand the mechanisms underlying the connection between sleep and mental health, we know that sleep is important to a number of brain and body functions engaged in processing daily events and regulating emotions and behaviors. Sleep helps maintain cognitive skills, such as attention, learning, and memory, such that poor sleep can make it much more difficult to cope with even relatively minor stressors and can even impact our ability to perceive the world accurately.
What are the psychological effects of sleep deprivation? Is there a link between insufficient sleep, mental health disorders (also suicidal ideation)?
Absolutely. Not getting enough sleep or poor-quality sleep can increase risk for mental health disorders. While insomnia can be a symptom of psychiatric disorders, like anxiety and depression, it is now recognized that sleep problems can also contribute to the onset and worsening of different mental health problems, including depression, anxiety, and even suicidal ideation.
Sleep deprivation studies show that otherwise healthy people can experience increased anxiety and distress levels following poor sleep. Those with mental health disorders are even more likely to experience chronic sleep problems and, in turn, these sleep problems are likely to exacerbate psychiatric symptoms and even increase risk for suicide. The good news is that there are ways to improve sleep quality and quantity, so identifying and addressing sleep problems is critical to alleviating the severity of psychiatric disorders.
Do individuals vary on the amount of sleep they need? Are there really larks and owls?
The amount of sleep individual's need in part depends on their age. In general, children and teens need more sleep than adults. While there are certainly individual differences in the amount of sleep each adult needs, the American Academy of Sleep Medicine (AASM) recommends that adults sleep at least 7 hours on a regular basis to promote optimal health and functioning, with most adults needing somewhere between 7-9 hours. Teens typically need 8-10 hours and older adults (65 years and older) between 7-8 hours. Although the amount of sleep we get is important, good quality sleep is also essential.
In addition to the amount of sleep, there are individual differences in "chronotype" the natural inclination of your body to feel more alert at certain periods of the day and more tired at others. The two most well-known chronotypes are often referred to as "night owls" and early birds (or "morning larks"), though many people likely fall somewhere in between. Genetics, age, and other factors impact whether you are more likely an owl or a lark. As you can imagine, getting enough sleep with a typical work schedule may be easier to do for a lark than for a night owl.
The COVID-19 pandemic created a host of new challenges to sound sleep. What is "Coronasomnia" and how does it differ from insomnia?
Insomnia disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is characterized by difficulty falling asleep, staying asleep, or waking too early, resulting in daytime impairments. While insomnia symptoms and insufficient sleep were already a widespread problem pre-pandemic, people are reporting more sleep problems than ever before. The increase in insomnia and related sleep problems related to stress caused by the COVID-19 pandemic have been labeled "Coronasomnia."
We know that stress can interfere with sleep and understandably the global pandemic has significantly increased daily stress and uncertainty. Spending more time at home and changes to daily routine can also impact sleep patterns by limiting light-based cues for wakefulness that help keep your circadian rhythm on schedule. And more time in bed and less activity or exercise can also interfere with sleep by reducing sleep drive. In a survey by AASM, over half (56%) of Americans (and 70% among those 35-44 years old) say they have experienced sleep disturbances during the pandemic. Common sleep disturbances include problems falling or staying asleep, sleeping less, and experiencing worse quality sleep.
Are there foods that promote sleep, and foods we should avoid? And can sleeping more help you lose weight?
Reduced sleep has been linked with increased eating and higher risk for weight gain and obesity. Conversely, studies show that getting more sleep can lead to consuming fewer calories and improve weight loss.
While some foods, such as milk products, fish and fruit (for example, kiwis and tart cherries) have shown some sleep-promoting effects, research is too limited to draw definitive conclusions or recommendations about specific foods to help sleep. Growing research suggests that the quality of diet or having sufficient nutrients can impact the quantity and quality of sleep. Low fiber, high saturated fat, high sugar diets have been associated with poorer quality sleep. Another large study found that deficits in nutrients, like as calcium, magnesium, and vitamins A, C, D, E, and K, were associated with sleep problems. As such, it's likely most important to focus on eating a balanced and consistent diet and creating healthy food-related sleep habits, such as limiting caffeine intake in the afternoon/evening and trying not to eat large meals too late.
For some, skipping sleep is a sign of strength and productivity. But health professionals have called for a cultural shift in the way we think about sleep. Is that shift happening?
Unfortunately, we know that pre-pandemic and especially over the course of the last two years, a large percentage of the population continues to experience insufficient sleep. Longer work hours, constant access to social commentary and entertainment, and increased stressors all contribute to people getting less sleep. The good news is that there is increasing awareness of the importance of sleep for daily functioning and health. In order to see a shift in sleep behaviors, ongoing work is needed to promote science-based policies that help improve sleep health, such as encouraging employers to help promote healthy sleep and introducing later school starting times. And we need to increase access to care for individuals with sleep difficulties.
What treatments are most effective for sleep difficulties?
For some sleep difficulties, adopting healthy sleep habits may help to improve sleep. However, those with more chronic insomnia should seek professional help, including cognitive behavioral therapy for insomnia (CBT-I), which is recognized as a first line treatment for insomnia. CBTI involves educating people about sleep and aims to change their sleep-related behaviors and thought processes by teaching strategies such as stimulus control, sleep restriction, relaxation techniques and cognitive therapy.
If sleep problems persist or you continue to experience daytime sleepiness even after getting enough sleep, then it might be time to see a sleep specialist who can help determine whether you need cognitive behavioral therapy, medication, or another treatment.
In this video Dr. Zakarin discusses the relationship between sleep, mental health, and suicide in adolescents and steps we can all take to improve the quality of our sleep, which include some of the following:
