Improving Sleep Hygiene During the Covid-19 Pandemic

Daniel Barone MD, FAASM, FANA, discusses why many of us have not slept well since the onset of Covid-19. He shares how coronavirus anxiety may be contributing to insomnia and offers some great tips on how to practice better sleep hygiene. He emphasizes the importance of restorative sleep and why it is so vital to our overall health, especially during these challenging times
Improving Sleep Hygiene During the Covid-19 Pandemic
Featuring:
Daniel Barone, MD, FAASM, FANA
Dr. Daniel Barone received his medical degree from New York Medical College in 2006 after graduating summa cum laude from Fordham University in 2001. 

Learn more about Dr. Daniel Barone
Transcription:

Melanie Cole: Welcome to Back to Health, your source for the latest in health, wellness, and medical care. Keeping you informed, so you can make informed healthcare choices for yourself and your whole family. Back to Health features, conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine. I'm Melanie Cole and today we're discussing sleep hygiene during quarantine. Joining me is Dr. Daniel Barone. He's the Associate Medical Director of the Weill Cornell Center for Sleep Medicine. Dr. Barone, it's a pleasure to have you on with us today and what an amazing topic so important right now. As this pandemic becomes the new normal, how is it affecting our sleep habits? What have you seen and what are you seeing happening as a result of the strain of COVID-19 on people's sleep habits?

Dr. Barone: Back the COVID has had on sleep has been pretty wide ranging. I work in Manhattan. So most of my patients are now working remotely. I think that's probably across the board and that can have two effects. On one hand, I've seen many of my patients say I'm actually sleeping better, believe it or not, because they don't have to worry about going in and commuting and actually going into the office. So working remotely has actually helped them, but I would say the probably that's maybe a third, the other two thirds they'll probably have said that their sleep is worse. And the reason for that is because being in quarantine and not being as active, not getting out, not exercising, those things have impacted their health, not to mention the anxiety and stress and watching the news and being inundated with all this information, has it impacted on their anxiety and stress levels and that's impacted their sleep health as well.

Host: Along a general question about sleep, how does a lack of sleep affect a person's immunity, Dr. Barone, are there some health conditions you can speak of briefly that result from poor sleep habits, especially now?

Dr. Barone: There's actually been several studies published out there over the last 15 years or so indicating that those who don't sleep well or that could be either quantity or quality are increased risk for even something as simple as a common cold. Okay. So that's in the acute setting. So if we're talking immunity, okay. And in which case, let's say COVID, for example, being a virus, we want our immune system to be as strong as possible. Not getting enough quality or quantity of sleep can potentially increase the risk of, you know, catching that if you're exposed to it. So that's one thing. Secondly, if we're talking about just big picture stuff, low quality or low quantity of sleep can lead to heart disease, increased risk for diabetes, increased risk for hypertension, strokes, and heart attacks. You know, a lot of the chronic things that we don't want can be tied back to, I mean, not, you know, not singularly, but, but can be tied back to a lack of sleep, at least partially.

Host: Well, one of the things I've noticed as an exercise physiologist and people are telling me that they're more sedentary and even people who were regular exercisers are more sedentary as a result of the quarantine. Maybe they're not going to their health clubs. How does that affect our sleep? Even when we hear things like you're not supposed to exercise too close to bedtime and things along those lines, but how is this new sedentary kind of normal that so many people are experiencing effecting us?

Dr. Barone: Well, the way we think of it is it is we're designed to move. We're not designed to sit around a desk or sit on a table or whatever working continuously or even just watching TV. We're not meant to do that. We're meant to move. And when we're not able to do that on a regular basis, sleep gets impacted. You know, one of the things we think about in terms of chronic insomnia, people who have difficulty maintaining sleep, or getting to sleep, we think of that as a 24 hour disorder. And yes, the consequences are at nighttime. These people have trouble sleeping, but a lot of times that ties back to, they're not burning off, quote, unquote, that extra energy or whatnot in the morning time. So I think if somebody has a predisposition to insomnia, a situation like we're living in right now where they're not getting enough physical activity, whatever that means, even just walking to a subway, let's say, can impact sleep

Host: Well, that's a good point. As people are working from home and you said, they're not getting in their cars, they're not walking to the subway. They're not going up and down the stairs. There's things that they're just not doing now, along the working from home lines, Dr. Barone, give us some advice about what we can do to set up our space. Some healthy tips that we can maintain our good sleeping habits. Because one of the problems from working from home for people that are not used to it is they think that they're going to be, you know, working more, they're working more hours, they're on their computer and email when they wouldn't have before. So tell us what to do about that?

Dr. Barone: Well, I think it comes down to a point where, where you really got to condition your brain to say, okay, this is my time for work. This is my time for relaxation. This is my time for sleep. Right? When those things get blended into one another, that's when insomnia or poor sleep habits can emerge. And that's when people can have deleterious consequences. So for example, let's say somebody who's on furlough. Let's say they're not even working right now. What they may have a temptation to do is kind of sit around the house and nap, you know, several times throughout the day, that will definitely make it harder for them to fall asleep at night. If we look at the reverse though, where somebody is working, you know, 12 straight hours or so, and no time for some sort of physical activity, you know, that their brain is not really given that time to decompress. And as a result of that, it may make it harder for them to fall asleep at night. So I think the key thing here is to even though it's, you have this temptation to do one of those two things, you really have to structure yourself and say, okay, from this time to this time is when I work from this time to this time is when I do whatever it is. And then from this time to this time is when I sleep. And I think it's important to not deviate from that.

Host: That's so important and so important for people to hear you say that. You mentioned a nap, Dr. Barone to nap or not to nap? I mean, if we are working and you're working long hours, does a nap really affect your sleep? That much? I love a good nap.

Dr. Barone: Yeah. That's a great point. I mean, the literature is pretty clear that a nap in the daytime, if it's in the right time and the right duration can have greater benefit. The problem though, is that when we start talking about naps, we're getting into the late afternoon, let's say for example, or early evening time. And it could be something as simple as I just fall asleep while watching TV for 10 or 15 minutes. That seems like an innocuous thing. But when we get later into the evening time, the way we sleep at night is we have what's called sleep pressure. And that gets built up over the course of a day. Right? So you can imagine if you're awake all day and you're physically active and all the things are done, right? The sleep pressure builds up. And then at nighttime, you kind of dissipate it. Okay. When you have a short nap, especially in the evening time, your brain kind of gets tricked to say, well, I just had some sleep. You know, I just released some of that sleep pressure. And it may make it harder to fall asleep at night, particularly if you're not getting any exercise. Or getting enough physical activity. So when nap, I would say in the very early afternoon, maybe by like 11, 12, o'clock the latest, and it should be maximum 20 to 30 minutes. And when you go over that, you get into what's called deep sleep and that can be difficult to wake up from, and it can really interrupt that sleep pressure we talked about. So this is why other countries have siestas is for this reason, you know, there's no harm per se in a nap. It's just, it can be a slippery slope and lead to insomnia at night.

Host: What about other things that could be a slippery slope, Dr. Barone, like certain foods or substances like caffeine or alcohol, obviously we're seeing people drink a lot more and is that affecting our sleep? What do you want us to do about that?

Dr. Barone: Yeah. Great point. So the big three, you know, alcohol, caffeine and nicotine, those three substances can definitely screw up our sleep in various ways. One is nicotine because it's a stimulant, right? So if people are, I mean, people should not be smoking at all, but if they do smoke particularly close to bedtime, that nicotine can interrupt their sleep. With caffeine, you know, who doesn't love a cup of coffee in the morning? The problem though is when it gets later and later into the day, the caffeine still hangs around our system. And in some people, it actually can have a half-life up to five hours or so, or even longer, which basically means that it's staying in your system even into the evening time. So caffeine, what I usually recommend is people not have a drink, a cup of coffee really after like 12 or one o'clock. Because that, even just having a little bit of caffeine in the system can trick the brain to say, I shouldn't go to sleep right now. And then alcohol what's going on with that is, you know, we're in this situation, everyone's under high stress. People are drinking more being at home. The issue with alcohol is that it actually can help people to get to sleep a little bit easier. Because it relaxes the brain. The problem though, is that after the first hour or so of sleep, as the body is metabolizing the alcohol out, that can cause many more awakenings throughout the night. And it can actually be very, very deleterious when we're talking about sleep quality when alcohol is in the system. So really what you want to do is make sure that you're not abusing these substances and really just using them in kind of the way we just talked about.

Host: So we've got a lot of topics to cover today. And thank you for that answer. Tell us a little bit about sleep hygiene. What is that? And give us your best advice regarding lifestyle. You already mentioned smoking and caffeine and alcohol. Tell us other things that might affect our sleep habits at this time.

Dr. Barone: The whole concept of sleep hygiene is kind of what I said earlier, where it's like, okay, I work between these hours. I relax between these hours. And I sleep between these hours. When that paradigm gets blended into one another, sleep can kind of be affected. Okay. So I think the key thing to say is it can be consistent as possible and say, this is my bedtime. This is my wake time. And that should go carry over into the weekends as well. You know, we tend to have this notion or I stay up later on the weekends. I sleep in and look, if you don't have any trouble sleeping, that's probably okay. But when you get into the realm of, you know, my sleep is not great, when you sleep in on the weekend, that makes it harder to fall asleep at night. And then the cycle just continues. For example, let's say you sleep in on a Sunday, right? You normally wake up at eight o'clock or so, and on Sunday morning, you wake up at 10, right? It's going to make the brain harder to fall asleep at nighttime Sunday night.

And then what happens is sleep deprived Monday. And you're exhausted all day. You're probably going to take a nap and then the cycle just continues. So it's really important to try to be consistent. The second key concept is you want to just use the bed in the embedded environment for sleep and intimacy. That's it? You know, especially when working from home in this type of environment, a lot of times people will have this temptation to kind of sit in their bed and work their emails, and be on the computer and the laptop all while in bed, while watching TV even okay. And all these things, what they do is they trick the brain to think this bed is not my place of sleep. This is my place of work. This is my place of entertainment. This is my place of whatever. And that believe it or not can also tip the balance to make your brain say, well, this bed is not my place of sleep therefore, I'm not going to sleep here. So we want to do is make the bed environment as much as you can. I mean, here in Manhattan, a lot of people have studio apartments. It's hard to kind of make that separation, but you really have to discipline yourself to say, I'm not going to touch my bed unless it's time for sleep. An important point

Host: Now with everything going on in the world, it's very stressful time. It's unprecedented. What about the things like watching the news, which can affect us in so many ways, it can be so upsetting our teenagers, sit there on their phones, on Tik-Tok and whatever else, using electronics, we're working from home as we said, feeling the need to answer everything right away. What's this doing to our psyche and thereby affecting our sleep and how can we pull ourselves away from that Dr. Barone and, and settle into a nice bedtime routine as opposed to what upsets us?

Dr. Barone: So there's two problems with that, right? So one thing, anything with a backlit display. So that could be a computer, a smartphone, a tablet, a what have you, all those devices that have that kind of backwards display and what I mean, what I mean by that? Is you can see it when the lights are off, right? So they are kind of self, the light comes from that from the device itself. They emit what we call blue light, blue frequency light. And what blue light does is it, it kind of tricks our eyes to trick our brain, that the sun is out. Okay. It's a very special frequency. And we're very attuned to that. Why that's important is because when that blue light comes into our retina, where our brain stops making melatonin, okay. So probably you have heard of melatonin as a supplement. People take it to help them sleep. Normally what happens is when it gets dark outside, our brain produces melatonin naturally, and that begins the neurochemical cascade let's say, to eventually get us asleep.

When we're interrupting that or preventing that from happening by watching these TV or computers before bedtime, what that's doing, it's kind of again, flipping the balance or shifting the balance to being able to make our brain fall asleep to now not. Again, if somebody has no trouble sleeping, this is not a big deal, but if they do this can be one of the X factors. So what I would say is a good 30 to 60 minutes, at least before bedtime, you want to have these electronic devices off. That's one thing. The second thing is the content. As you pointed out the news, right? Very stressful. It's not, you know, it's not meant to give us information in a unemotional way. It's meant to get people fired up. So the content is one. Two, if it's an email or work type situation, you're going to be probably more stressed or anxious as you're answering these emails. And these things can also keep you awake as you can imagine. Right? So I think for all these reasons you want a 30, 60 minutes before bed, keep your eyes away from this type of stuff.

What you can do instead, because this is a question I always get. What you can do instead is read on paper. Okay? Old fashioned stuff. Another thing would be to meditate. That's my personal favorite. So 10 or 15 minutes, mindfulness or guided meditation. And there's millions of apps and videos out there. Here I am saying, don't watch, don't watch these devices, but you can just listen. You can listen as the whatever is walking you through it. Okay. That would be great. Listening to a podcast such as this one, that would be fine listening to an audio book. That would be fine. Anything like that, that's going to take your mind and your brain and your eyes away from those kind of situations is ideal.

Host: Wow. That is great advice. And certainly something we can all look to. You know, we hear about things like chamomile, tea and lavender, and you mentioned melatonin. Do any of these help? And then I'd like you to go right into insomnia for us. Because if these things do help, do they help with insomnia? And you know, what happens if we have that, when do we see a professional?

Dr. Barone: These things can help. I'm a big believer in things that are natural, that are not going to hurt. That may help. In fact, actually in my, in my book that was published back in 2018, entitled, Let's Talk About Sleep. I discuss all these things, these over the counter substances. You know, melatonin, I'm a big fan of, they actually have delayed release melatonin, which can be great, you know, to help people stay asleep, chamomile, all these things valerian. They probably do have benefit, although they really haven't been studied the way a medication has. But you know, you always want to talk to your doctor. They're presumed to be safe, but you always want to discuss that with your medical professional. That being said, if somebody has, let's say trouble sleeping on, let's say Sunday night, for example. And because they're anxious about the next day or whatever, and they take a little bit of melatonin and they sleep well. And that's no problem. The issue becomes when these problems become chronic, right?

So chronic insomnia is described as at least three months where you have trouble, either getting to sleep, maintaining, sleep, or waking up too early. That's a situation where you want to go see a professional, either go to a sleep center like Weill Cornell Sleep Center, where I'm the Associate Medical Director or wherever you're wherever you live. The field of sleep medicine has really grown by leaps and bounds over the last 20 years. And now we have professionals that can really help all forms of sleep disorders, whether it be insomnia, or if there's something more profound, let's say like sleep apnea, where, where the bed, even the bed partner's affected because of the noise that the patient is making these, all these things can be addressed. So what I would say to people, especially during this time in human history, with COVID and whatnot, it's really important to have a low threshold, to go see a sleep specialist. Because as we said earlier in the talk, when you don't have quality sleep or don't have quantity of sleep that really can affect your immune system, it can also affect how you feel. And the consequences can be far reaching.

Host: If someone does come in for a sleep test to see you tell us the guidelines, tell us what you're doing to keep patients safe. And if sleep studies are safe? Tell us just a little bit about that.

Dr. Barone: That's a very common question. So what we're doing in our sleep center, and I think that this is across the US is we are taking extreme precaution to not only make sure the rooms are clean and sanitized and really ceiling to floor, but also we're testing all of our patients before they get a sleep test to make sure everybody's COVID negative. So we're really, I mean, that's, that's kind of a above and beyond due diligence to try to make sure that really everybody is safe. On top of that, our sleep techs, so these are the folks who are applying the electrodes and monitoring the patients overnight. They're wearing masks. They're also tested for COVID to make sure we're being as safe as possible. So the sleep test itself, whether it be in-lab here is safe, but we also have home testing, which is, as you can imagine, the patient will take the equipment home with them, all sanitized all clean and they can test from their from their home, from their own bed.

Host: Wow. That is really encouraging for people with sleep issues to hear. And before we wrap up, are you seeing other things like fragmented, sleep nightmares? You know, I know I've heard about that a little bit. Tell us about that and then wrap it up, Dr. Barone with your best advice on the recommended amount of sleep that we should be getting and your tips really to get us our best sleep, whether it's ambient room temperature, and you mentioned melatonin and chamomile, all of these things that we can do to get our best night's sleep at this unprecedented time.

Dr. Barone: So yes. I mean, to answer the first point, all these things that you mentioned, nightmares, fragments, and sleep, all that stuff is related to what we just mentioned. You know, the being inundated by this information, not being physically active, having this bed environment, that's kind of blended in with your you're watching TV or working in bed and all these things are impacting sleep. So yes, I've seen them. The key thing I think here with what we're dealing with is to make sure, like I said, that your bed environment is as sleep inducing as possible, and that could be making sure you have blackout shades or making sure that no light is coming in, making sure there's no TV or computer or external sources that can keep you awake. Making sure that you are getting some sort of physical activity, whether even be just doing things in your, in your living room to get your heart rate up, to try to do that in the morning, that could be helpful, not napping too late or too long.

You know, again, the biggest quote crime I see is that people will, will, will fall asleep after dinner while watching TV that can really screw up their sleep. And really just get into a habit where I'm very consistent with my schedule. And my brain is relaxed before bed. That's really, really important. Okay. So meditation, I think is very, very helpful and probably the most important point is to the patients out there you're not alone. You know, sleep troubles are very, very common. Fortunately, there are a lot of great sleep centers, like I said, the Weill Cornell one is fantastic. And I'm not saying that because I work there. But any place across the US that has sleep evaluators, you really want to have a low threshold to go get yourself evaluated because it can be really, really helpful, not only for your physical health, but also your mental health. If you do have chronic sleep troubles to have it evaluated, especially now during this unprecedented time.

Host: What a great point, really all great points, Dr. Barone, thank you so much for joining us and sharing your incredible expertise with this very important topic. And that concludes today's episode of Back to Health. We'd like to thank our listeners and invite our audience to download subscribe, rate, and review back to health on Apple Podcast, Spotify, and Google Play Music. For more health tips like these go to weillcornell.org and search podcasts. Parents don't forget to check out Kid's Health Cast. I'm Melanie Cole. Thanks so much for listening.

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