The pandemic is keeping more than a few people up at night, and the problem is so persistent that sleep specialists have coined a term for it: COVID-somnia or coronasomnia. It's a phenomenon 28-year-old Andrew Cunningham knows well. He's been struggling to fall asleep and stay asleep since March. While his migraine attacks have been fewer and less severe during the pandemic, his anxiety and insomnia are worse. “I'm lucky if I can sleep for two hours before waking up with thoughts of when and where I'm going to contract COVID-19—it's literally a waking nightmare,” says Cunningham, a business owner in Chicago. He also attributes his sleep problems to an inability to turn off negative thoughts; stress and isolation; and not being able to exercise regularly.

Jeneye Abele, 48, who has transverse myelitis—a disorder involving inflammation of the spinal cord, resulting in pain and muscle spasms in her arms and legs—has always had trouble sleeping. But the arrival of the coronavirus has exacerbated it. “Sometimes I wake up in the middle of the night with my heart and mind racing, breathing heavily,” says Abele, who lives in Boulder, CO, and is chief executive officer and president of the Argosy Foundation, a charitable organization. “And I often wake up early, when it's still dark outside, and I have trouble getting back to sleep.”

Abele and Cunningham have plenty of company. In an online survey commissioned by the American Academy of Sleep Medicine, 30 percent of the 2,007 respondents reported changes in their ability to fall asleep, 22 percent reported worse sleep quality, and 19 percent said they got less sleep because of the pandemic.

This isn't just ordinary insomnia. Lifestyle alterations during the pandemic can disrupt circadian rhythms—internally driven 24-hour cycles that regulate the sleep-wake pattern as well as essential bodily functions. “Because people are quarantining or working from home, they're not on fixed schedules, they're not exercising or moving around as much, and they're not getting exposed to sunlight consistently,” says Rachel Marie E. Salas, MD, FAAN, a sleep neurologist at the Johns Hopkins Center for Sleep and Wellness in Baltimore.

Without their usual routines, people may feel isolated or lonely, which can increase stress, says Dr. Salas. They may also be susceptible to sleep disruption if they have a history of anxiety or depression or experience emotional trauma such as a divorce, a death in the family, or the loss of a job. Certain behaviors can disrupt sleep too, like lying in bed awake for more than 15 or 20 minutes and trying to force sleep; taking long naps during the day, especially after 3 p.m.; and watching TV or using a computer before bedtime.

Nip It in the Bud

Insomnia is defined as chronic when you have trouble falling or staying asleep more than three nights a week, for three months or longer. “The goal is to prevent acute insomnia from becoming chronic,” says Alon Y. Avidan, MD, MPH, FAAN, professor of neurology at UCLA's David Geffen School of Medicine and director of the UCLA Sleep Disorders Center. “The way to do that is by addressing perpetuating factors.”

Otherwise, insomnia can take on a life of its own. “Worry about current events can make the mind overactive and lead to trouble falling or staying asleep and problems with daytime functioning,” says A. J. Barot, MD, FAAN, associate professor of neurology at Eastern Virginia Medical School and president of Virginia Neurology and Sleep Centers in Chesapeake.

For people with a neurologic condition such as multiple sclerosis (MS) or migraine, insomnia often occurs with fragmented sleep. Sleep problems also can be caused by depression or pain related to a neurologic condition. As Kim Dolce, 63, an MS patient advocate in Tecumseh, MI, explains: “I can fall asleep, but then neuropathic pain wakes me, and I can't fall back to sleep.” She recently began taking gabapentin (Neurontin) to ease the pain.

Lack of sleep can worsen neurologic symptoms, says Dr. Salas. “Sleep deprivation lowers the threshold for a seizure or migraine if you have one of those disorders,” she says. Chronic insufficient sleep can alter sensitization and consequently increase vulnerability to chronic pain, according to research in a 2018 issue of the journal Pain. Interrupted sleep sets up a vicious cycle, says Dr. Barot: Poor-quality sleep can lower pain thresholds “because of imbalances in chemicals such as norepinephrine, epinephrine, and dopamine, which are involved in sleep, pain, and emotion,” he adds.

Insomnia can impair mood, memory, motivation, energy, ability to concentrate and think clearly, and productivity. One result may be “operative inefficiency—where you get things done, but it takes twice as long,” says Dr. Avidan. Insomnia also can increase the risk of errors or accidents, including while driving.

The brain and nervous system require good-quality sleep in order to function effectively, says Daniel A. Barone, MD, associate medical director of the Weill Cornell Center for Sleep Medicine in New York City and author of Let's Talk About Sleep: A Guide to Understanding and Improving Your Slumber (Rowman & Littlefield, 2018). “The brain needs to be in a relaxed state to benefit from sleep; it becomes more excitable if you're not getting enough sleep.”

Trash Removal

During sleep, the central nervous system is cleared of waste proteins and metabolic products by a network of vessels known as the glymphatic system. The neurotoxic waste products that are removed could include beta-amyloid, a plaque associated with Alzheimer's disease. “Over time,” Dr. Barone says, “poor sleep has been shown to be associated with increased risk of cognitive impairment.” A study in a 2016 issue of the American Journal of Geriatric Psychiatry found that the odds of developing mild cognitive impairment increased nearly 150 percent for older women if they had poorer sleep efficiency (percentage of time sleeping while they're in bed) and sleep latency (how long it takes to fall asleep).

Anyone experiencing insomnia should make it a priority to take back the night. “Sleep is not like a machine where you tell the body to fall asleep and it does,” Dr. Barot says. You need to prime the body and mind for sleep. First, establish a schedule with consistent times for going to bed and waking up that allows for at least seven hours of sleep a night. Do what you can during the day to maintain your circadian rhythms. “Expose yourself to sunlight, especially in the morning,” Dr. Avidan suggests.

Be Proactive

In the evening, dim the lights and set a curfew for the use of electronic devices. “Don't watch the news or engage with social media before bedtime,” Dr. Salas advises. Exposure after 9 p.m. to the so-called blue light from computers, smartphones, or television blocks the release of melatonin and delays the onset of sleep, says Dr. Avidan, who recommends avoiding blue light for at least two hours before bedtime.

Instead, listen to calming music or a podcast, or read a book that's not overly stimulating. Better yet, create a relaxing presleep ritual. This might include taking a bath or shower, then doing deep-breathing exercises or mindfulness meditation. Do this night after night and you'll essentially condition your brain for better sleep, Dr. Avidan says.

Take stock of your environment: Eliminate stressors such as piles of bills on the nightstand, clutter, or unwanted light or sound, and make it a relaxing place, says Dr. Salas. The bedroom should be dark, quiet, comfortable, and cool. A temperature of between 60 and 67 degrees “is more conducive to slow-wave or delta sleep, which is more restorative,” says Dr. Avidan. “It helps people fall asleep more easily and stay asleep longer.”

Because of her MS, Kim Dolce often gets overheated during the night. To counter that, she switched to lighter sheets and blankets, lowered the temperature in her apartment, and placed a fan near her face—measures that help minimize her nighttime awakenings. “I've also adjusted my expectations of sleep,” Dolce says. “My goal is no longer to sleep straight through the night—that has removed a lot of my anxiety about waking up.”

If you do awaken during the night and can't get back to sleep within 20 minutes, get out of bed, go to another room, and engage in a relaxing activity until you feel sleepy, then go back to bed and try again, Dr. Barone suggests. “Use your bed for sleep and intimacy—your brain has to know the bed is your place for sleep and that's it.”

Jeneye Abele has adopted a new routine where she reads or listens to a podcast before turning in. “I used to watch more TV before I went to bed. Reducing my screen time has helped, and I try to limit my intake of news later in the day,” she says. If she wakes up in the middle of the night or before the sun rises, she avoids looking at the clock and does deep breathing “to focus my mind away from the anxiety.”

Andrew Cunningham, who has been prescribed a sedative by his neurologist, also started taking melatonin and doing breathing exercises to calm down before bed. But just as his shut-eye started to improve, another sleep challenge entered his life: In November 2020, Cunningham became a new father.

Sound Sleep

Before bad sleep habits become entrenched, take steps to mitigate or manage insomnia, says Rachel Marie E. Salas, MD, FAAN, a sleep neurologist at the Johns Hopkins Center for Sleep and Wellness in Baltimore.

Talk to your neurologist about treatment options and possible adjustments to medications that could be interfering with your slumber. “Treatment for insomnia should be individualized,” says Dr. Salas, who also suggests these steps.

Exercise. Regular physical activity can alleviate insomnia by decreasing physiological arousal, anxiety, and depressive symptoms, according to the National Sleep Foundation. A small study in a 2020 issue of the International Journal of Environmental Research and Public Health reported that people with multiple sclerosis who engaged in higher levels of moderate physical activity experienced better-quality sleep, including more deep sleep. Yoga has also been found to help, according to a 2020 meta-analysis about women and sleep in BMC Psychiatry.

Deep breathing. If you wake up during the night and can't get back to sleep, use breathing or visualization exercises to help let go of your thoughts, Dr. Salas advises. An article published in Frontiers in Psychology in 2019 suggests that besides quieting your mind, deep breathing can calm hyperarousal in the autonomic nervous system and alter brain waves in ways that boost sleep.

Relaxation techniques. Mindfulness meditation—in which you focus on the present moment and let your thoughts pass without latching on to or judging them—can improve sleep quality, according to research in a 2019 issue of the Annals of the New York Academy of Sciences. A pilot study in a 2019 issue of the Journal of Behavioral Medicine found that practicing relaxation methods with biofeedback (which helps you learn to control some of your body's functions, such as heart rate) at bedtime reduces physiological arousal in women with insomnia.

CBT-i. Cognitive behavioral therapy for insomnia (CBT-i) is a short-term, skills-based treatment that helps people learn better sleep patterns and change their relationship with sleep. It encourages people to address stressors such as work or finances only during the day, to quiet the mind at night, and to establish a transition time to wind down each evening. To reduce physiological arousal that can interfere with sleep, CBT-i incorporates elements of mindfulness meditation and relaxation practices. A meta-analysis in a 2019 issue of Sleep Medicine Reviews found that CBT-i produces significant effects that last up to a year after therapy.

Medication. Various drugs, including benzodiazepines such as lorazepam (Ativan), alprazolam (Xanax), and clonazepam (Klonopin) and sedative-hypnotics such as zolpidem (Ambien) and eszopiclone (Lunesta), are prescribed for insomnia. But many neurologists say these should be used on a short-term basis only. Benzodiazepines can be addictive, while sedative-hypnotics may cause amnestic events—“where people get up during the night and do things they don't remember,” Dr. Salas says—and leave them feeling sleepy during the day. Even over-the-counter sleep aids, many of which contain antihistamines such as diphenhydramine (Benadryl), can cause side effects such as dry mouth, forgetfulness, nightmares, and grogginess, Dr. Salas says. “Hypnotic medications can be helpful on a short-term basis as a bridge to CBT-I,” but they are not a long-term solution, says Alon Y. Avidan, MD, MPH, FAAN, director of the UCLA Sleep Disorders Center.

Supplements. Many people believe melatonin supplements improve sleep. “When you take melatonin in pill form, it's like a vitamin because you're [adding to] what's already there,” says Daniel A. Barone, MD, associate medical director of the Weill Cornell Center for Sleep Medicine in New York City. His advice: If you have trouble falling asleep, take one to three milligrams of melatonin before bedtime; if you can't stay asleep, take a time-release version at bedtime. Some evidence supports valerian and chamomile for insomnia, but more research is needed.

Gratitude. A 2019 study in Behavioral Sleep Medicine indicates that people who have higher levels of gratitude have better sleep quality and higher daytime energy; this may be because people who score higher in gratitude have fewer symptoms of depression, which may lead to fewer presleep worries and better sleep quality. Think about the things you're grateful for in your life such as family, home, and career—or small pleasures like cooking a meal or taking a walk in nature.