Sleep is a necessity, not a luxury. It allows our bodies and brains to rest and keeps us functioning during the day. It also can reduce anxiety and increase energy, which are important benefits during this stressful and uncertain time. Adults between the ages of 16 and 65 need seven to nine hours a night. People over age 65 need seven to eight.

Not getting enough sleep or sleeping poorly is associated with headaches and irritability, depression, and other mood disorders. For people with neurologic conditions, poor sleep can make symptoms feel more pronounced or less manageable. Various factors can interfere with sleep, including medical conditions such as asthma, which can be worse at night; pain; psychiatric problems like depression and anxiety; certain medications such as stimulants and antidepressants; and poor sleep habits.

The factor you can control is your sleep habits, which specialists call sleep hygiene. To improve these habits, which will make managing your neurologic condition—and the COVID outbreak—easier, follow these recommendations.

Establish a regular bedtime. Your brain likes routine, especially if you have a neurologic condition. Pick a reasonable time to go to bed at night and wake up in the morning and stick to it. This will help train your brain to associate these times with sleeping and waking.

Strengthen your brain’s sleep signal. We all have a biological signal—called a homeostatic sleep drive—that tells us when to sleep and when to wake up. In healthy sleepers (those who get adequate and high-quality sleep), this signal is weakest in the morning and gradually strengthens throughout the day so that we can fall asleep at night. Anything that interferes with this signal can affect your wake/sleep cycles, For example, taking a nap during the day or drinking caffeine weakens the signal as does the blue light from computer, tablet, and smartphone screens. That’s why sleep specialists recommend avoiding daytime naps, not drinking caffeine at least six hours before bedtime, and turning off all screens within an hour of going to bed.

Reserve the bedroom for sleep. To strengthen the association between your bedroom and sleep, use it for sleeping only. That means no watching television, looking at screens, reading books, or even ruminating. Do those activities in other parts of the house. If you wake up in the middle of the night and can’t get back to sleep, instead of tossing and turning, go to a different room and engage in a relaxing activity such as deep breathing, meditation, or reading. If thoughts are keeping you up at night, try writing them in a journal. Don’t return to your bed until you feel sleepy. That will continue to strengthen the association between bed and sleep.

Rethink drinking. Many people say alcohol helps them fall asleep, which can be true, but when the effect wears off it can interfere with sleep quality during the second half of the night, resulting in less deep sleep. Alcohol also can make sleep apnea—a condition in which breathing is briefly and repeatedly interrupted during sleep—worse because it relaxes the muscles around the airways, making them more likely to collapse at night. If you do drink, limit yourself to two alcoholic beverages a week and avoid drinking at least four hours before bedtime.

Eat early. As with drinking, eating too late disrupts sleep. It interferes with your circadian rhythms, which tell us when to sleep and when to wake up. And if your body is actively digesting food it can’t settle into sleep mode.

Quit smoking. The nicotine in tobacco is activating, and smoking has been associated with an increased risk of sleep apnea. For these reasons, smokers should talk to the doctor about cessation programs. Even reducing the number cigarettes you smoke a week may make a difference.

Reduce stress. Stress raises cortisol levels and pumps adrenaline through your system. If you’re chronically stressed, your body and brain are activated and it’s harder to induce a relaxation response. Deep breathing, meditation, journaling, prayer, and exercise (as long as it’s not too close to bedtime) can all relieve stress. In the age of COVID, many are feeling overly anxious. If news reports increase your anxiety, limit what you watch or listen to. Step away from the computer or television and take a walk or call a friend to talk about something other than the coronavirus.

Review your medications. Talk to your doctor about your drug regimen. If your medications interfere with sleep at night or cause daytime sleepiness, you may need to adjust the dose or timing or try a different drug. For example, donepezil (Aricept), a drug prescribed for Alzheimer’s disease, can be stimulating so it’s best taken in the morning.

Address insomnia. If sleep eludes you consistently, discuss it with your doctor. Effective treatments for insomnia include cognitive behavioral therapy (a type of talk therapy that involves changing unhealthy or unhelpful thinking patterns), stress reduction, and talk therapy. Sleeping pills are consider a last resort as they can worsen cognition over time and cause people to sleepwalk or sleep talk. They should be used for short periods of time, typically no more than three to six months.

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COVID-19 (Coronavirus) and Neurologic Disease Resource Center