In this article, clinical psychologist Dr. Vilija Ball presents us with the things that fuel our anxiety and disrupt our sleep during this time of uncertainty. Specifically, Dr. Ball:
- Identifies a number of ways that technology and our constant connection stir our anxiety and how they impact our sleep.
- Talks about the importance of sleep to our general well being as well as to immune functioning.
- Provides some suggestions for how to manage our anxiety in a healthy way (hint: start by limiting your sources of information!)
Contact Dr. Ball at 833-710-7770 ext. 3 for more information
It can be really difficult to find a safe place in our minds when our phones are constantly buzzing – signaling yet another text from a friend or workplace; another email about how some company is responding to the outbreak. An app signaling another article from a local newspaper. One more post on social media reporting that COVID-19 continues to spread from county to county. Schools closing. Restaurants and bars shut down. Scheduled events canceled. Grocery stores not being able to keep up with shoppers’ panicked hoarding of essentials. A national emergency! At worst, there are click-bait conspiracy theories and doomsday scenarios that vie for our attention.
If you survived all the moment by moment updates about the status of COVID-19, you might even be desensitized by the minute-by-minute, fear-inducing announcements and not paying attention to them anymore. If your fight-or-flight response was activated, you are going after the toilet paper, all that anti-bacterial stuff, and stocking up your food supplies. All these are predictable and natural initial reactions in this context where our mind and body react and prepare to defend us from a threat that can be as big as our perception of the emergency. The stress hormone adrenaline was released, which increased the heart rate, narrowed blood vessels, and expanded the air passages enabling us to tackle and overcome the threat. Therefore, people are using their increased energy and capacity in ways that might seem rational to them.
However, all the news we receive through the day and night hours seems to feed our fight-or-flight response and leads to physical symptoms of hyperarousal. Some of us might be more prepared for this crisis because we had opportunities to learn and practice more adaptive skills before, or we had fewer stress-precipitating events lately. Due to individual differences in personality traits, presence or absence of past traumatic experiences, and learned behaviors and conditioning, some people may find it more difficult to adapt to the current events and feel extremely stressed, intimidated, overwhelmed, or helpless and hopeless. Limiting updates to 1-2 reliable sources such as this one from the Centers for Disease Control [ https://www.cdc.gov/coronavirus/2019-ncov/prepare/get-your-household-ready-for-COVID-19.html] as well as limiting the frequency of negative news while increasing input from more balanced, empowering sources to help our minds process the day’s events in context and finding encouragement and relief can be one of the first steps we take in interrupting the cycle of anxiety. When we face complex and unfamiliar crisis-resembling stressors prompting us to act differently than during times of safety and our minds assess that our resources are depleted or inadequate, we might experience the extreme activation of our fight-or-flight response. Being mindful about such effects and using media information purposefully to learn new information to protect ourselves should guide the amount of our exposure to the anxiety-feeding stimuli.
Understanding what feeds our fear-producing thoughts is of utmost importance, and we should not embrace any of them as facts unless they are double-checked with comprehensive data that presents a broader picture of the situation. For example, you can remind yourself that the CDC estimated that from October 1, 2019 through March 7, 2020 there have been 36,000,000 – 51,000,000 flu illnesses and 22,000 – 55,000 flu deaths in the U.S. https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm . These numbers are not to encourage carelessness about COVID-19, but to reduce fears generated by the unknown about it, since our familiar influenza is not so friendly to us as well. It can also help to remember that the measures taken to enforce social distancing are reduce the number of serious cases at any one time so as not to overwhelm our medical system.
Neither apathy nor hyperarousal are helpful for coping with this crisis situation in the long run. In fact, if our initial reactions and associated thoughts are not examined and engaged on a conscious level, our suffering will be disproportionally high because we will be reacting to a distorted reality resulting from our hyperarousal-hyperactivation. Initially, anxiety can help us sprint on our feet and escape a dangerous situation, but later it should be channeled to finding reliable information and taking steps to follow the guidelines to do the best that we can with what is within our control and to find ways to build our resilience. Unexamined and unmanaged anxiety can be unproductive and even dangerous. It spreads faster than the virus itself, and it keeps us restless, consumed, and terrified even with many stacks of toilet paper and groceries.
What can be a more effective way to manage anxiety and the whole situation and to embrace that as a part of our plan and responsibility?
You might be indignant if my prescription for you is more quality sleep at this time. It might feel like sleeping is the last thing on your mind because you feel so consumed and responsible for so many things – your kids and your family – and that is why you follow all those updates without missing anything. You may be frightened, and the only thing you want to hear is someone with authority telling you that you and your family will be okay. You might long for something so basic and so easily accessible before – just a simple hug to comfort you. However, social distancing guidelines now make you cautious about hugs because they became associated with worries about potential exposure to coronavirus. It is important to stay engaged with other people who have an ability to view things in a larger context, process facts detached from emotions, and offer some validation and reassurance versus those whose emotional minds are setting the course through this turbulent time. It might be beneficial to explore the strengths of social media because it is vital to create your support system and maintain such connections while hopefully avoiding exposure to the negatives of social media where someone showcases glamorous selfies with their emergency stacks of supplies, which makes you feel bad about what you have.
Sleep Prescription
Going back to my sleep prescription, it is important to stress that chronic sleep loss is a risk factor as it negatively affects our immune system’s ability to function, and it can be as important as developing a frequent hand-washing habit for preventing infection with the coronavirus. Having an adequate amount of quality sleep has the potential to reduce problems associated not just with anxiety and depression, but to also protect from immune system impairment and to hopefully fortify our bodies against coronavirus. An uncompromised immune system can also increase our bodies’ ability to recover faster and with fewer complications. Research studies show that adequate sleep length and quality can have protective effects against influenza. Ensuring that we have enough sleep can boost our bodies’ homeostasis – its coordinated efforts to fight an infection. This is within nearly everyone’s controllability and can help us ground ourselves by setting our daily goals to take care of our nutrition, hydration, exercise, relaxation, and sleep. This goal by itself helps us to focus on life in the present instead of worrying about what if something terrible happens. Being immersed in the present moment can be an antidote against anxiety-induced anticipation about the future that rule our lives in the present. Why not entertain thoughts about what if you become healthier, since you are taking a better care of yourself; what if you learn how to master your anxiety, and it does not rule your life anymore; what if something good happens to you today, this month, or this year? There is so much potential in this very moment by not allowing anxiety about the future to take the very thing that you have – your present moment.
It appears that depression, anxiety, and psychological stress may account for approximately 50% of insomnia cases. Thus, it is quite understandable if you are having difficulties sleeping at this time. In many cases, your anxiety can be directly responsible for your insomnia and vice versa. Therefore, it is very important to intervene in this cycle in the context of coronavirus and create daily routines and safety-friendly thoughts that help to reestablish a sense of safety and wellbeing to ensure you are physically and psychologically healthy, strong, resilient, and prepared to handle adversity.
How can you break your cycle of worries and anxiety that directly interfere with your sleep, which results in even more worries?
Worries tend to weaken our sleep drive and directly interfere with the longevity and quality of sleep. More worries result in less sleep, which leads to even more worries interfering with reestablishing healthy sleep. You can find many suggestions about how to use strategies such as a buffer zone, incorporating more pleasant activities in your day, having a consistent exercise routine (ending 4 hours before bed), establishing some bedtime rituals, and so on. However, if you have worries on your mind and using these strategies tend to only distract you from the worries and not deflate them, they are going to keep your eyes wide open when you go to bed, or wake you up at night to face them again. Thus, it is important to address your sleep-interfering automatic thoughts and underlying, core beliefs that might be fueling them. If myriads of automatic, COVID-19 situation awfulizing thoughts – “We all are going to die.” “We’re going to run out of food.” “It is terrible, I can’t control this situation.” “I am going to lose my job because my employer will start laying people off.” – are tormenting you in bed, they are not just taking your ability to sleep and regenerate your vital functions, they are conditioning your brain to think that your bed is for worry and not for sleep. Observing these thoughts versus embracing them and then analyzing them for facts would weaken their ability to intimidate and keep you awake. It can be very important to determine what is your most feared outcome about which you might not even want to think of directly, but which has so much power to increase your bed time arousal and keep your mind racing. Then, you start worrying about your inability to sleep and your wellbeing. Perceived threat and anxiety associated with coronavirus will keep your mind active and body tense when you continue thinking about issues that were not addressed or resolved, and what you have to remember to do tomorrow as well as worrying about things that are outside your control. Sometimes, it is as simple as postponing worrying to a later scheduled time, which can help to dismiss the associated thoughts and reduce your arousal. Some people can experience increased longevity and quality in their sleep when they complete their ‘to do’ list before bed time and do not carry the responsibilities of the next day to bed. Good old journaling can be effective for others when they unload their worries and hopes on paper. Finally, finding effective relaxation techniques can reduce tension and anxiety and prepare your mind and body for sleep (CBT-I Coach app: https://apps.apple.com/ca/app/cbt-i-coach/id655918660 ). It is important to experiment and find a good fit that works for you and to practice daily (diaphragmatic breathing, progressive muscle relaxation, body scanning, meditation, prayer, self-compassion, self-encouragement, and nonjudgmental attitude about yourself and your circumstances). To be continued.Grupe, D. W., & Nitschke, J. B. (2013). Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nature reviews. Neuroscience, 14(7), 488–501. https://doi.org/10.1038/nrn3524
Ibarra-Coronado, E. G., Pantaleón-Martínez, A. M., Velazquéz-Moctezuma, J., Prospéro-García,O., Méndez-Díaz, M., Pérez-Tapia, M., Pavón, L., & Morales-Montor, J. (2015) The bidirectional relationship between sleep and immunity against infections. Journal ofImmunology Research. Vol. ID 678164. https://doi.org/10.1155/2015/678164
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U.S. Department of Health and Human Services CDC. (2019). CERC: Psychology of crisis. Available from URL: https://emergency.cdc.gov/cerc/ppt/CERC_Psychology_of_a_Crisis.pdf