Updated October 26, 2023, Eric Suni National Cancer Institute

Since the World Health Organization’s declaration of a global pandemic in March 2020, COVID-19 has pushed the world into uncharted waters. More than 430 million people worldwide have been infected by the SARS-CoV-2 virus, which has contributed to over 5.9 million deaths. The WHO coronavirus (COVID-19) dashboard presents official daily counts of COVID-19 cases, deaths and vaccine utilisation reported by countries, territories and areas.

The ripple effects of COVID-19 have reached virtually all aspects of society. Lockdowns, school closures, mask wearing, working from home, and ongoing social distancing have spurred profound economic, social, and cultural disruptions.

In light of this turmoil, the importance of sleep has often flown under the radar. As the pandemic has unfolded, though, researchers have demonstrated that it has had serious effects on sleep.

Three years after the pandemic was declared, COVID-19 continues to affect millions around the world, and, at the same time, society is attempting to adapt to a new normal. At this critical juncture, sleeping well is an important priority and can offer meaningful health benefits.

Sleep is critical to physical health and the effective functioning of the immune system. It’s also a key promoter of emotional wellness and mental health, helping to beat back stress, depression, and anxiety.

Whether you’ve had sleeping problems for years or if they’ve only started during the pandemic, there are concrete steps that you can take to improve your sleep and support your overall health.

What Are the Challenges to Sleep During a Pandemic?

Millions of people suffered from insomnia before COVID-19, and unfortunately, the pandemic has created a host of new challenges for them and for people who previously had no difficulty sleeping.

“Coronasomnia” is a new term coined to refer to sleep challenges related to the pandemic. Over the past two years, doctors and sleep scientists have documented a wide range of ways that COVID-19 has changed and disrupted sleep patterns. 

Some people report getting more total sleep during the pandemic, but sleep quality has typically suffered. A growing number of people describe struggling to initially fall asleep, being bothered by sleep disruptions, having disturbing dreams, and feeling sleepy during the day.

Although for certain people the end of lockdowns enabled improved sleep, many others have had ongoing sleep problems as multiple waves of COVID-19 have contributed to long-term stress and pandemic fatigue. Short-term sleep disturbances can become chronic, creating risks for lasting sleep difficulties for millions of people.

Of course, the COVID-19 pandemic doesn’t affect everyone in the same way. Patients with the virus and front-line medical workers face the brunt of the direct impacts of the disease. But the consequences have spread far and wide, posing diverse and significant barriers to sleep.

Infection and COVID-19

COVID-19 is the disease caused by infection with the SARS-CoV-2 coronavirus. Research has shown that people with COVID-19 frequently have sleeping problems  

Sleep disruptions have been seen in people with severe COVID-19 as well as non-hospitalized patients. Additionally, many people with long COVID, which involves persistent health effects months after infection, describe having lasting sleep difficulties.

Disruption of Daily Life

Social distancing, school closures, quarantines, and working-from-home all bring profound changes to normal routines for people of all ages and walks of life. Not surprisingly, these changes can contribute to sleeping problems for various reasons:

• It can be difficult to adjust to a new daily schedule or the lack of a schedule.
• Keeping track of the time, and even the day, can be hard without typical time “anchors” like dropping kids at school, arriving at the office, attending recurring social events, or going to the gym.
• Changing schedules may lead to fluctuating bedtimes and wake times, which may either reduce time to sleep or trigger oversleeping, both of which can lead you to feel groggy, irritable, or unfocused during the day.
• Being stuck at home, especially if there are low levels of natural light inside, may reduce light-based cues for wakefulness and sleep, known as zeitgebers, which are crucial to our circadian rhythm.

Caregiving

You may be thrust into a caregiver role if a family member or friend gets COVID-19 or has to isolate or quarantine. Caregivers during the pandemic have struggled with impaired sleep that may result from stress and worry. Performing caregiving tasks can also decrease time available for uninterrupted sleep.

Even without a sick loved one, sleep can be affected by increased family responsibilities that occur because of school closures and an increase in time spent at home.

Excess Screen Time

Whether it’s checking the news on your phone, joining a Zoom with family, binge-watching Netflix, or putting in extra hours staring at a computer while working-from-home, the pandemic can provoke a huge increase in screen time.

Excess screen time, especially later in the evening, can have a detrimental impact on sleep. Screen time can stimulate the brain in ways that make it hard to wind down, and the blue light from screens can suppress the natural production of melatonin, a hormone that the body makes to promote healthy sleep.

In addition, researchers have found that trying to keep up with news about the pandemic can play a role in worsened sleep.

Anxiety and Worry

Worries abound in the COVID-19 pandemic. Naturally, many people fear becoming infected with SARS-CoV-2 because they don’t want to get sick or spread the virus to other people. Most people have close friends or family who are older or in high-risk groups because of preexisting conditions, spurring worries about their health and safety.

Economic concerns are affecting nearly everyone as well. Lockdowns initially stalled economic activity and caused sweeping job losses. Now, as economic activity rebounds, concerns about supply chains and inflation have many individuals and families worrying about their income, savings, and making ends meet.

Not surprisingly, then, the pandemic has been found to increase the prevalence of anxiety disorders  Long before the pandemic, it was well-established that anxiety can disrupt sleep as a racing mind keeps the body tossing and turning.

Even after three years, there’s still so much unknown about this pandemic —  whether new virus strains will emerge, how long vaccines offer protection, when life will return to normal — that it is likely that worries and anxieties will continue to affect people worldwide.

Depression and Isolation

A sense of crisis can trigger feelings of depression that may be even worse for people who have a loved one who is sick or has passed away from COVID-19. Trauma, grief, and depression can be exacerbated by isolation from others and are known to have the potential to cause significant sleeping problems.

Depression can be more than just feelings of sadness. Other symptoms may include a loss of interest or pleasure in activities, feelings of hopelessness or worthlessness, and a low appetite or overeating. Researchers reported that the rates of depressive symptoms tripled during the pandemic, while a decrease in sleep and an increase in alcohol and tobacco consumption were associated with spikes in the rates.

Depression and sleeping problems frequently occur together and may exacerbate one another. Depression can also occur along with anxiety and other mental health problems that combine to disrupt sleep.

Stress and Stress-Related Fatigue

Many people are under intense stress as a result of the pandemic, which frequently creates or worsens sleeping problems. Canceled vacations, reduced face time with family and friends, and an abundance of time spent at home can place a strain on anyone. Keeping up with work-from-home obligations, managing a house full of children who are accustomed to being at school, or trying to stay current on pandemic news and restrictions can all generate stress and discord.

Chronic stress can lead to a host of mental and physical symptoms, including impaired sleep, headaches, memory lapses, and digestive problems. Stress can also trigger fatigue that leaves you unmotivated and short of energy even if you are getting an adequate amount of sleep at night.

Altered Dreams

Multiple research studies have determined that dream activity has changed during the pandemic. The frequency of nightmares is higher in people who have had COVID-19, and in general, people are remembering more of their dreams, which often involve negative or bothersome imagery. Disrupted sleep may increase the likelihood of concerning dreams, which themselves may cause stress and anxiety that detract from quality sleep.

Why Is Sleep Important During a Pandemic?

Sleep is a critical biological process, and as we juggle the mental, physical, and emotional demands of the pandemic, it’s arguably more important than ever. For instance:

• Sleep empowers an effective immune system. Solid nightly rest strengthens our body’s defenses, which can help protect against infections. Studies have also found that lack of sleep can make some vaccines less effective.
• Sleep heightens our brain functions, and our mind works better when we get good sleep. A solid night’s rest contributes to complex thinking, learning, memory, and decision-making. For adults and children adapting to different work and school environments, good sleep can help them stay sharp.
• Sleep enhances mood. Lack of sleep can make a person irritable, drag down their energy level, and cause or worsen feelings of anxiety and depression.
• Sleep improves mental health. Besides anxiety and depression, studies have found that a lack of sleep is linked with mental health conditions like bipolar disorder and post-traumatic stress disorder (PTSD).

Experts agree that consistently getting the right amount of high-quality sleep improves virtually all aspects of health, which is why it is worthy of our attention during the COVID-19 pandemic.

Our Guidelines To Sleeping Well During the COVID-19 Pandemic

In spite of the daunting challenges, there are a handful of steps that can promote better sleep during the pandemic.

If these efforts don’t pay off immediately, don’t give up. It can take time to stabilize your sleep, and you may find that you need to adapt these suggestions to best fit your specific situation.

Set Your Schedule and Routine

Establishing a routine can facilitate a sense of normalcy even in abnormal times. It’s easier for your mind and body to acclimate to a steady sleep schedule, which is why health experts have long recommended avoiding major variation in your daily sleep times.

Sleep-specific aspects of your daily schedule should include:

• Wake-Up Time: Set your alarm (if you need one), bypass the snooze button, and have a fixed time to get every day started.
• Wind-Down Time: This is an important opportunity to relax and get ready for bed. It can involve things like light reading, stretching, and meditating along with preparations for bed like putting on pajamas and brushing your teeth. Given the stress of the pandemic, it’s wise to give yourself extra wind-down time each night.
• Bedtime: Pick a consistent time to actually turn out the lights and try to fall asleep.

In addition to time spent sleeping and getting ready for bed, it can be helpful to follow other routines to provide time cues throughout the day, including:

• Showering and getting dressed even if you aren’t leaving the house.
• Eating meals at the same time each day.
• Blocking off specific time periods for work, exercise, and/or other daily tasks or chores.

Reserve Your Bed for Sleep

Sleep experts emphasize the importance of creating an association in your mind between your bed and sleep. For this reason, they often recommend that sleep and sex be the only activities that take place in your bed.

This means that working-from-home shouldn’t be working-from-bed. It also means avoiding bringing a laptop into bed to watch a movie or series.

On any given night, if you find that you’re having a hard time sleeping, don’t spend more than 20 minutes tossing and turning. Instead, get out of bed and do something relaxing in very low light, and then head back to bed to try to fall asleep.

Frequently changing your sheets, fluffing your pillows, and making your bed can keep your bed feeling fresh, creating a comfortable and inviting setting to doze off. If you’ve been thinking of refreshing your bedroom setup with a new bed, make sure to choose the best mattress for your body type and preferences and consider looking for any other sleep accessories that need an upgrade.

Optimize Your Light Exposure

Exposure to light plays a crucial role in helping our bodies establish a stable sleep pattern, and it also promotes multiple other aspects of health. However, the timing and type of light exposure is important.

Natural light has the strongest effect on your circadian rhythm, and getting daylight exposure early in the day can help normalize your body’s internal clock. Even if the pandemic causes disruptions to daily life, certain steps may help create light-based cues to support healthy sleep:

• If you can, spend some time outside in natural light. Even if the sun isn’t shining brightly, natural light still has positive effects on circadian rhythm. Many people find outdoor time is most beneficial in the morning, and as an added bonus, it’s an opportunity to get fresh air.
• As much as possible, open windows and blinds to let light into your home during the day.
• Be mindful of screen time. The blue light produced by electronic devices, such as mobile phones, tablets, and computers, has been found to interfere with the body’s natural sleep-promoting processes. Try to avoid using these devices for an hour before bed. You can also use device settings or special apps that reduce or filter blue light.

Be Careful With Naps

If you’re home all day, you may be tempted to take more naps. Rather than approaching naps haphazardly, consider a more intentional and consistent napping schedule.

In addition to reducing sleepiness, strategic napping can improve learning, help with memory formation, and assist with emotional regulation. But it’s important to note that naps should be limited to just 10-20 minutes since longer naps can leave you feeling groggy and may interfere with your ability to fall asleep at night.

Stay Active

It’s easy to overlook exercise with everything happening in the world, but regular daily activity has numerous important benefits, including for sleep.

Going for a walk or doing another type of outdoor activity is a great option. Depending on your situation, you may feel comfortable returning to the gym to work out. There are also a wealth of resources online for all types and levels of exercise that can be done at home.

Practice Kindness and Foster Connection

It might not seem critical to your sleep, but kindness and connection can reduce stress and its harmful effects on mood and sleep.

While bad news can feel at once overwhelming and all-consuming, try to find some positive stories, such as how people are supporting one another through the pandemic. Even if you are practicing social distancing, you can use technology to stay in touch with friends and family and maintain social connections.

Utilize Relaxation Techniques

Finding ways to relax can be a potent tool to improve your sleep. Deep breathing, stretching, yoga, mindfulness meditation, calming music, and quiet reading are just a few examples of relaxation techniques that you can build into your routines. If you’re not sure where to get started, explore smartphone apps like Headspace and Calm that have programs designed for people new to meditation.

Another relaxation strategy during the pandemic is to avoid becoming overwhelmed by coronavirus-related news. For example, you can try techniques including:

• Bookmarking one or two trusted news sites and visiting them only during a limited, pre-set amount of time each day.
• Cutting down the total time that you spend scrolling on social media. If you want a hand in this effort, a number of apps can monitor and even block your time on social media sites or apps each day.
• Scheduling phone or video calls with friends and family and agreeing in advance to focus on topics other than the coronavirus.

Watch What You Eat and Drink

Keeping a healthy diet can promote good sleep. During times of heightened stress and uncertainty, it can be easy to reach for fatty or sugary foods or for happy hour to start bleeding into earlier parts of the day.

As a result, take as much care as you can to select nourishing foods and drinks. While the optimal diet can vary by person, you should generally aim for a diet rich in vegetables and fruits with some lean meats. Be cautious with the intake of alcohol and caffeine as both can disrupt the quantity and quality of your sleep.

Contact Your Doctor if Necessary

If you have sleep problems that are ongoing, worsening, or affecting you during waking hours, it is advisable to be in touch with your doctor. You should also talk with your doctor if you’ve noticed other physical or mental health issues, including severe or lasting mood changes, during the pandemic.

Your doctor may be able to propose specific treatments that can improve your sleep and help address other medical issues. Although the pandemic has at times made it harder to access care, many doctor’s offices and clinics have been able to move toward more normal scheduling.

Furthermore, health care providers have increased their availability via telemedicine to allow patients to discuss concerns without having to physically visit their office. In some cases, it may be possible for sleep-focused treatments, such as mindfulness-based therapies or cognitive behavioral therapy for insomnia (CBT-I) to be provided online.