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May 22, 2020

Q&A: UW’s Teresa Ward talks us through sleep troubles during the COVID-19 pandemic

“Stress weighs on us, and it’s hard to shut stress off because our world is rocked right now,” said Teresa Ward, professor and Co-Director of the Center for Innovation in Sleep Self-Management in the UW School of Nursing.

And for many of us, that means disrupted, reduced and/or fragmented sleep.

“We haven’t experienced a pandemic before and there is a lot of uncertainty,” Ward said. “Parents trying to manage working from home, helping their children with homework, financial stress, uncertain of job security, lack of childcare, disruption of our daily routines (sports, going to the gym), and worry about loved ones at risk for COVID-19 — there’s a lot of disruptions and uncertainty and this doesn’t sit well with people. And uncertainty disrupts our sleep, whether we take a little longer to fall asleep, waking up a little bit more or going to bed a little later.”

Bottomline: We’re not getting the usual amount and/or quality of sleep.

Ward sat down with us to provide some perspective on sleep during the pandemic and what we can do to help ourselves and our families get through this time a little more well-rested.

UW News: What is circadian rhythm and how can we keep it?

Ward: Circadian rhythm is a cycle governed by an internal biologic clock that helps us with regularity and cues for routines. For example, sleep-wake cycles are circadian rhythms, as are body temperature, hormone release (growth hormone, cortisol), eating meals and light and darkness during the day and night. Eating meals at the same time each day, exercise and maintaining a regular bedtime and sleep-wake routine are important because they help us maintain circadian rhythms. These activities help keep our body in synch. The reality is you may go to bed a little later (15 or 30 minutes later) and the same thing for waking up — but keeping your bedtime and waketime within a 30 minutes window of your pre-COVID sleep routine is important for your body’s circadian rhythm.

UW News: What about those able to work from home?

Ward: It is really easy to lose track of time when you are working from home because we are confined to the home all day and don’t have the daily reminders or cues of picking children up from school or going to the gym after work. One thing you can do is set a timer to remind you to go outside for a walk, run or exercise class and when it’s time to shut off the computer for the day. It’s really easy to continue to work throughout the evening and lose sight of time.

Get outside at least a few times a day for a walk or run. This exposes you to light, which is important for your circadian rhythm and sleep. For individuals who do not want to go outside, exercise inside. YouTube and Facebook have all types of exercises and workouts that are free for children, adolescents and adults. Here and here are examples.

For individuals who are using their bedroom as an office, be sure to remove your computer and work-related material from the bedroom several hours before bed so you are not tempted to continue to work late in the evening and/or in the middle of the night.

UW News: How is screen time likely influencing sleep?

Ward: The light from the computer screen can alter or disrupt your melatonin. Melatonin is a hormone of darkness and this increases a few hours before bed, and it’s important for sleep onset. Light from computers can stop and/or disrupt melatonin secretion which impacts your sleep. Even though many of us are using screens more right now (ZOOM meetings, for example) because of COVID-19, we can adjust in the evening and shut off screens. Monitor how much screen time and when you are using your screen time. If you’re on your computer or phone close to bedtime, start dialing that back a bit and find another activity for that time such as listening to relaxing music or reading a physical book.

Download soundbite audio here:

UW News: Are naps a good idea?

Ward: It depends on the timing and duration. In the absence of an underlying sleep disorder (sleep apnea, narcolepsy) consistent daytime naps are a marker of chronic sleep deprivation. A short power nap — 20 minutes — is refreshing and can be a good thing. A one-off nap in the morning or early afternoon is okay if you went to bed several hours later or just slept lousy the night before. If naps are taken during the late afternoon and for long durations (2 hours) this is not good because naps interfere with your bedtime and when you fall alseep.

UW News: Children may shift their sleep schedule later into the evening. Is that a problem? How address it?

Ward: Shifting sleep later to the evening is a problem because it can impact your circadian rhythm, that internal biological clock monitoring sleep-wake activity, temperature, and other cycles. (See below questions about routines.)

UW News: Is it okay for teenagers to sleep in?

Ward: Teenagers undergo puberty and in turn hormones are secreted which delay bedtime. Hormones have a strong effect on sleep in that they delay bedtimes (regardless of homework, employment, or computer use). So, sleeping in once in a while or on weekends okay, but every day — it’s a problem. Some would even argue weekends are a problem. I tend to be more pragmatic in that parents need to pick their battles.

UW News: What’s the best way to deal with nightmares or just very engaging dreams?

Ward: Nightmares and dream are different. Nightmares occur during REM sleep and you often remember them. You often wake up from sleep, are startled and it takes some time to fall back asleep again. Whereas, dreams occur every night, and some individuals remember their dreams whereas others often do not remember their dreams.

UW News:  Clearly exercise is good. What are the best exercises that help with sleep, just any?

Ward: Exercise is good not only for our physical health but also our mental health. Keep in mind sleep is connected to both our physical and mental health. I don’t think there is a “best” exercise for sleep. Exercise for some individuals is walking, for others it is swimming, running, Pilates, dancing or biking.

Exercise is good as long as you exercise three to four hours before going to bed. You don’t want to exercise too close to bed because it pumps up our adrenaline — gets us excited — and it can take several hours to wind down, which can interfere with your usual bedtime.

UW News:  Suggested bedtime routines for adults and kids?

Ward: Continue to keep your bedtime routines as much as you can. Routines are important because they help maintain structure in our day, evening and daily activities. Kids like structure, and most individuals like structure. So, eat meals at the same time each day and maintain your bedtime and sleep-wake routine. The bedtime may be five to 25 minutes later, which you can live with, but really try to discipline yourself in holding to routines. I realize this is easier said than done, but there are huge benefits to our mental and physical wellbeing.

UW News:  Watching news, talking about the pandemic or economy (personal, regional, national) impact how we sleep, sure, but what can we do about it? Worry must impact sleep, but how do we stop worrying?

Ward: Yes, there is a lot of uncertainty right now about the virus, finances, economy and job security. In light of COVID-19, some individuals may now suffer from acute insomnia because of changes in life circumstances — loss of employment, financial hardship, worry about a loved one diagnosed with COVID-19, lack of childcare, online school and/or confined to the home/apartment for most of the day — that are stressful, unexpected and create a lot of uncertainty. There is still so much we do not know about this coronavirus. And worry impacts our sleep.

So what can we do about it? Monitor how much news you are reading and/or watching, for one. Some tactics for reducing stress include relaxation techniques such as deep breathing, yoga or gentle stretching. Try drawing or knitting, listening to relaxing music or waterfalls, writing a poem, reading a book (with an actual book in hand). In bed, put on a fan to block out white noise, cuddle with a pet or create a “worry diary” where you write down everything you are worried and stressed about in the evening a few hours before bed.

UW News:  Alcohol, cannabis use … thoughts on these?

Ward: I don’t recommend either of these substances for sleep. Even though one may fall asleep quickly with alcohol or cannabis, these substances actually fragment your sleep by causing more restless sleep, awakenings and alters the amount of REM sleep.

UW News:  What about those of us in live-in relationships and/or with roommates? Ideas for these situations?

Ward:  See above with respect to routines. With respect to roommates or live-in relationships it really depends on space and the entire situation. It’s important to respect one another’s space and routines, AND adjust to being considerate of roommate’s and/or partner’s needs when it comes to sleep.

Tag(s): Center for Innovation in Sleep Self-Management • COVID-19 • population health • School of Nursing • Teresa Ward

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