Less sleep and more vivid nightmares during pandemic: Psychologist offers possible solutions

The COVID-19 pandemic has upended everything, even people’s non-waking hours. With extra stress and disrupted routines, people are sleeping less well and experiencing “coronasomnia,” as it’s colloquially called. An entire population of restless people could have serious public health consequences.

KCRW speaks with Kate Kaplan, a psychologist who specializes in sleep disorders, and a clinical instructor at the Stanford University School of Medicine. 

KCRW: Are you seeing coronasomnia in your patients a lot lately?

Kate Kaplan: “Absolutely. Yeah. I would say that lots of individuals are struggling with their sleep in different ways. People who've had insomnia prior to the coronavirus epidemic have seen their symptoms worsen. People who have not struggled with insomnia before are finding they’re having … nuanced set of cases. 

And then sometimes people are just putting pressure on themselves to optimize their sleep or make sure they get a good night's sleep in order to stay healthy. And that pressure that's placed on the sleep can actually be exacerbating or creating insomnia symptoms.”

Do you define insomnia as difficulty falling asleep, difficulty staying asleep, both? 

“We say difficulty falling asleep and/or staying asleep. And sometimes that includes … waking up too early in the morning and difficulty staying asleep as long as one would like. And this has to occur at least three nights per week. To meet criteria for chronic insomnia, it has to occur for three months or more. But even if it hasn't gone on that long, sometimes in the acute phases, it could still be pretty distressing.”

What's behind it besides our collective stress? Or is that it?

“It's certainly a big part of it. Yeah, there are a few things that are likely contributing. So first is this arousal system. All of us have an arousal system that can be biologically advantageous. Back in our early days, if we were sleeping in a cave, and I spotted fresh lion tracks right outside that cave, it might benefit me to have sleep that was lighter and more fragmented. 

And of course, where this breaks down is over a long period of time where that stress is no longer limited to that night, but instead occurs over many weeks or months. And of course, it no longer serves us to be vigilant in that way at night. 

There's also the tremendous impact that coronavirus has had on our rhythms. And when we see big disruptions in timing at which we might be getting up and going to sleep, or maybe we're working from home or maybe we're not working at all, these can have big impacts on our rhythms, and can also influence things like the timing at which we see light in the morning, the time that we might get outside, kind of our social activities, when we're eating. All of these things can kind of feed back into destabilizing our rhythms, which can then further disrupt our sleep.”

It's been a six-month disruption of our rhythms. Have people got used to it? Have they started new rhythms? Have they settled down a little bit?

“Unfortunately because without … predictability or stability of, let's say, leaving the house at a certain time to make it to work at a certain time, or changes in school schedules or work schedule, sometimes there is more variability just day to day, and sometimes that disruption in rhythms, especially if it's continuous, can actually just further the problem.”

How does this stress and disruption manifest itself while we sleep? Do we grind our teeth more? Do we toss and turn? 

“Yeah, I think I would say all of the above. So certainly more fragmentation, more tossing and turning at night. Greater incidence of things like nightmares and other parasomnias, other things that can kind of go awry at night.”

That becomes a feedback loop, right? Because if you're not getting enough sleep, you're more anxious, you have less energy, you’re more depressed?

“Absolutely, yeah. We do know that when we're not sleeping, sometimes it can exacerbate feelings of depression or anxiety. Sometimes if we just struggle with insomnia, that can kind of predict new episodes of depression or new episodes of anxiety. So absolutely, we see this relationship between insomnia and other mental health outcomes, as well as just decreased quality of life. It can be really difficult to not be sleeping to our optimal level.” 

What is the optimal level of sleep?

“There's a lot of individual differences when it comes to sleep. So people might expect that in order to stay healthy, I need to sleep eight hours, or I should have a sleeping pattern that's the same as my bed partner. And that's not always the case. We know that there are big individual differences. 

But in general, we recommend that adults spend about seven hours in bed, and kind of aim for a sleep duration of about seven hours. 

Of course, it does take some time to fall asleep. Sleep is a little bit more like a dimmer than a light switch. It'll take some time for our bodies and minds to unwind in order to get to sleep. And likewise, we all wake up in the middle of the night, and that's a very normal part of our sleep physiology. 

So if you find that you are awakening at night, just the act of waking up in and of itself is not pathological. But if you find that you're spending long periods of time awake, that's where we start to kind of cross over into insomnia territory.”

What should people do if they are wide awake at 4:00 a.m.? 

“Try not to panic. … It can be upsetting and distressing to be awake. But sometimes the more we try to force sleep, get ourselves to go back to sleep, the more it backfires. 

So if a person is awake at 4:00 in the morning, and especially if they've been awake in bed for, let's say, more than 20 minutes, we might encourage them to get out of bed. 

You might pick up some reading or watch some light television. But just doing something that's a little bit more pleasant than staying in bed trying to sleep.”

I’ve heard a lot of people are having vivid nightmares or dreams. Why is that happening?

“I think there could be a few reasons for it, especially as people are working from home. People can be sleeping a little bit later, and especially as we sleep in a little bit longer in the morning, we tend to have more rapid eye movement sleep, the state of sleeping which dreams are most likely to occur. So that can give us this experience of just having more dreams or more vivid dreams, just because we're spending more time in REM sleep.

… Related to kind of our arousal system, sometimes especially if our dreams are a little bit more negative or more distressing, we might remember those more. And so now we're kind of queued to remember our dream content when we wake up. And so that kind of narrows the focus into our dream content at night.”

If people are having problems that they can’t solve by your recommendations, what should they do?

“We have good treatment options, so don't despair. The first is around the timing of sleep. So we really encourage one to wake up at the same time every morning, regardless of what time you actually got to bed, or whether it was a good night or bad night. Just getting up at the same time every morning. 

And ideally getting outside and getting sunlight shortly after waking too can really help anchor and stabilize rhythms. 

Not napping in the daytime because napping is a little bit like snacking before dinner. It just makes us less hungry for our main meal of sleep, so to speak. So really trying to stay awake and build up as much hunger to fall asleep and stay asleep throughout the night.”

Getting sunlight might be difficult right now as some people are advised to stay inside due to poor air quality from wildfires. 

“In situations like that, where the air quality is too poor to leave the house, one of the things we just recommend is trying to turn on a lot of the ambient household lights in the morning. So just getting a lot of indoor light in the daytime. Sitting next to or working near a window with the shades up, so that we can maximize our exposure to light. 

And then of course dimming these light sources in the evening to kind of help cue the system that nighttime is coming or is here.”

— Written by Amy Ta, produced by Brian Hardzinski



  • Kate Kaplan - a psychologist who specializes in sleep disorders, and a clinical instructor at the Stanford University School of Medicine