A good night's sleep. It's one of those things people don't appreciate until it's gone. But like much taken for granted prior to the COVID-19 pandemic, good quality sleep is harder to come by these days.
That's worrisome, health experts say, because poor sleep can lead to poor brain and heart health.
"We're seeing a lot of irregular sleep patterns now," said Dr. David Gozal, a professor and chair of the child health department at the University of Missouri in Columbia. He is among the researchers who are finding more troubled sleepers across the globe since the pandemic began.
Gozal's team reported in the Journal of Clinical Sleep Medicine that 58% of adults from 49 countries were unhappy with their sleep quality. Another study in the journal Sleep Health found more than a third of people surveyed across 59 countries reported increased sleep disturbances.
"One of the reasons sleep is important is that it impacts so many systems in the body," said Michael Grandner, director of the Sleep & Health Research Program and associate professor of psychiatry at the University of Arizona College of Medicine in Tucson.
Not getting enough sleep weakens the immune system. It can make vaccines less effective, according to the National Sleep Foundation. Numerous studies show inadequate sleep can increase heart disease risks, such as obesity, high blood pressure and Type 2 diabetes. One recent study in the journal Aging found older adults who got less than five hours of sleep per night doubled their risk for dementia and early death.
Under normal circumstances, more than 50 million U.S. adults struggle with sleep disorders each year. Another 20 to 30 million experience occasional issues with sleep.
The pandemic only made things worse, Gozal said. It disrupted work and school routines, increased financial and domestic stress, increased social isolation and left the world in a near-constant state of concern over a virus that has thus far killed more than half a million people in the U.S. alone.
None of that is conducive to good sleep, he said. "Bedtimes are oscillating all over the place. People are getting less physical activity, eating less healthy foods as a way of compensating for the extra stress and succumbing to the temptation of having less distance to get to the refrigerator."
Poor sleep can contribute to poor eating habits, said Chandra Jackson, a research investigator with the National Institute of Environmental Health Sciences, part of the National Institutes of Health.
When the body is sleep-deprived, it produces more of the hormone ghrelin, which is associated with hunger, and less leptin, the hormone that helps the body feel satisfied after a meal, she said. Poor sleep also activates the part of the brain associated with hedonic behavior, such as craving unhealthy sweet and salty foods.
Experts say there are many steps people can take to get better sleep – even under times of intense stress.
First, Jackson said, "Make sleep a priority and establish a sleeping and waking routine if you can since sleep is just as important as proper nutrition and physical activity."
The National Sleep Foundation recommends adults 18-64 get seven to nine hours of sleep per night, while those 65 and older should get seven to eight hours of sleep. It defines good quality sleep as waking up no more than once per night and falling asleep in 30 minutes or less and being asleep at least 85% of the time a person is in bed.
Grandner said those hours don't have to happen all at once.
"Sleep, like diet, doesn't have to be perfect for it to be perfectly fine," he said. "The bottom line is, getting most of your sleep during your biological night is important. But it doesn't have to be all of it."
Naps can help, but some are better than others.
Power naps – which last from 15-45 minutes – are best, Grandner said. "You wake up before you drop into deep sleep. That's why they work. You aren't waking up disoriented and groggy."
Sleep replacement naps can be useful for times when a person didn't get enough sleep the night before, he said. These last a full sleep cycle that may be as long as two hours. "They are less efficient than the sleep you get at night, but they work."
The third kind of nap – when a person starts nodding off during the day because they are so tired the pressure to fall asleep builds up – is not restorative, Grandner said.
Someone who is having a lot of trouble sleeping should consult a doctor to rule out – or treat – sleep disorders, such as sleep apnea or insomnia, he said. "These are more common than people realize and you can't fix them with teas or melatonin. You have to see a doctor."
One thing people shouldn't do, Gozal said, is become reliant on medication to get to sleep. His study found a 20% increase in the number of people who reported taking sleeping pills during the pandemic.
Sleeping pills, when appropriate, should only be a short-term solution, he said. "You should not be dragged kicking and screaming into unconsciousness."
For those who don't have a sleep disorder, removing barriers to sleep may be enough, Gozal said. Barriers can include a snoring spouse, environmental noise such as nearby construction, chronic pain, drinking too much caffeine or drinking it late in the day, or trying to sleep in a room with too much light.
Working on screens and devices too close to bedtime also can make falling asleep harder because it doesn't prepare the mind or body for rest, Grandner said.
Jackson recommends relaxing activities you enjoy such as meditating, reading a book in print or using an e-reader with a blue light filter, listening to gentle music, or taking a bath or shower "to wind down from the day. You should also use your bedroom for only sleep and connecting with your partner, which allows your brain to associate being in bed with those activities."
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