Q&A: Improving sleep during COVID-19 pandemic

Stress, anxiety and working from home amid COVID-19 could contribute to another adverse health effect of the pandemic — loss of sleep.

Studies have shown that losing sleep and poor sleep quality are linked to a variety of conditions, including Alzheimer’s disease, glaucoma and obesity.

A “light fitness routine” could help address issues like anxiety and insomnia, according to Mariana G. Figueiro, PhD, director of the Lighting Research Center at the Rensselaer Polytechnic Institute. To learn more, Healio Primary Care spoke with Figueiro about the role light plays in sleep quality, and advice physicians can offer their patients to help them sleep better during the COVID-19 pandemic. – by Erin Michael

Q: What could cause patients to lose sleep during the COVID-19 pandemic?

A: I think, right now, stress is the number one issue associated with sleep loss. People are stressed about how they’re going to pay their bills and if they’re going to lose their jobs. In addition, they now have to manage kids and work in one space, that is, at home. Related to the work we do, which is to deliver light and dark to keep our biological clock in sync, is the fact that people are not going out as much because they are asked to shelter in place. Some may be staying at home all week without stepping outside for a few minutes to get fresh air. The issue is that home lighting tends to be dim during the daytime hours and, perhaps, too bright during the evening hours. And that may throw your biological clock off because we all need to be exposed to bright days and dark nights. More specifically, we need to be exposed to morning light daily to resync our clock to the 24-hour solar day. If we don’t get enough daytime light, we run the risk to slowly drift our sleep to later and later times, so it’s going to become harder for people to wake up at their desired times. We take it for granted, but the light we get on the commute to work, for example, or while we’re waiting for the school bus to come is crucial to keep us in sync with our watch. And that lack of robust light/dark pattern has been shown to disrupt our sleep and make us groggy the following day. To add to that, people are spending too much time on screens during the evening hours, which is probably a lot of light that they shouldn’t be getting before bedtime because it may further delay our sleep times.

Q: What is a light fitness routine, and how does it impact health?

A: I think the most important thing is to get a lot of light during the day and minimize the amount of light we get a couple of hours before bedtime. If you can go for a walk in the morning — if you have a dog, go walk your dog after sunrise. If you can’t get out for whatever reason — you have to be working early or you don’t have the time to do it — open up the shades and let the daylight come in spaces where you spend your mornings, try to sit facing a window. If you work in a basement without windows, for example, increase the amount of fixtures you have around you; if you have one table lamp, I recommend you add three more during the daytime. If you can, sit outside on a porch or make that phone call in your backyard — anything you can do to increase the amount of light during the day will help you. The opposite is true for the evening hours; turn off those additional lights in the evening and minimize the use of screens a couple of hours before bedtime. More importantly, keep this light fitness routine every day to keep you in sync. When working at home, we tend to relax our routine because we don’t need to catch that bus or that train to go to work. Keeping a routine, especially when it comes to exposing yourself to bright days and dark nights, is underrated.

Q: How does this routine improve patients’ sleep?

A: We’ve shown — and others have shown, too — that if you increase the amount of light you get during the day, you sleep better at night. It’s just a matter being more in sync with your watch and falling asleep at times when you want to fall asleep and waking up at times that you have to wake up. If you don’t have that, you’re going to be drifting every day, not falling asleep at your desired time — you can go to bed at 10:00 at night, but you’re not going to fall asleep until 11:00 or 11:30, and yet, you’re still going to get up at the same time. Sleep has been shown to strengthen your immune system, which is what you want during this time. Sleep deprivation has been shown to increase risk for depression, anxiety, diabetes and obesity, to name a few negative the side effects of curtailing sleep — on the other hand, there’s a lot of positive effects of keeping that regular light/dark rest activity pattern and being able to sleep at the same time every day and wake up at the same time every day. And daytime light can help you get there.

Q: What else can patients do to improve their sleep during the pandemic?

A: I think that the most important thing is to continue on your regular schedule. Even if you’re unemployed — don’t sleep in, don’t get out of your routine. Force yourself out of bed, go outside. Keep a regular schedule, stay active, get light during the day — that will help you be ready to go back to work when time comes.

Q: Why is improved sleep quality particularly important during the COVID-19 pandemic?

A: Most importantly sleep helps strengthen your immune system, and this is what we want right now. It also reduces stress and depression. And it helps you eat less. Sleep is crucial for your overall health. In fact, it’s been shown that reduced sleep, especially if done for many years, is associated with an increased risk for diabetes, obesity, cardiovascular disease, cancer and even Alzheimer’s disease. Sleep cleans up the debris in your brain that accumulates during waking hours. The more time you spend awake, the more debris you accumulate and if you don’t sleep enough, you’re not cleaning up that debris. In the short term, all you may experience is a brain fog, but, in the long term, plaques that are associated with Alzheimer’s disease can accumulate in your brain faster. If you sleep better and longer, you’re going to feel better, perform better, and have more energy the following day. I think we as a society underrate the importance of sleep. Some may think that sleep is a waste of time. But keep in mind that if a person doesn’t sleep enough, this person is just not at maximum capacity, both mentally and physically. It is as simple as this: Keep it regular, get your daytime light and get your nighttime sleep — that’s the light fitness routine.

Disclosures: Figueiro reports no relevant financial disclosures.