Members of the European Academy for Cognitive Behavioral Therapy for Insomnia (CBT-I) task force have released a list of practical recommendations for coping with sleep problems during self-isolation in light of the coronavirus disease 2019 (COVID-19) pandemic. The recommendations, published in the Journal of Sleep Research, focus on the applications of CBT-I in the context of an unprecedented global lockdown.
As people around the world face prolonged periods of confinement to their homes during the COVID-19 pandemic, stress levels may disrupt sleep patterns and worsen overall mental health. Certain populations may experience greater levels of stress, including people struggling with financial uncertainty, individuals who live alone, senior citizens, women, and children.
Considered the most effective treatment for chronic insomnia, CBT-I may be useful in treating acute episodes related to immediate stress. Through stimulus control, CBT-I seeks to reorient negative associations between bedroom settings and sleep trouble. This treatment also involves sleep hygiene, which includes control of caffeine and alcohol intake, exposure to bright light, and exercise habits, and relaxation interventions, such as meditation. Cognitive reappraisal of dysfunctional ideas about sleep, paradoxical intention, and sleep restriction are other core features of CBT-I.
The authors of this report noted that pharmacotherapy such as benzodiazepines or antidepressants, may be useful for acute insomnia, whereas medications may be ill-suited for chronic insomnia. However, they warned that sleeping pills may have questionable effectiveness and can cause unwanted long-term side effects.
Notably, the authors mentioned a few potential positive consequences of this period of self-isolation. In particular, they noted that increased social support may diminish stress levels, and the collective nature of the pandemic will allow individuals to commiserate with each other. Some workers may gain time with family by no longer commuting to work and having limited working hours.
The authors offered an extensive list of recommendations for coping with sleep trouble during home confinement. They suggested that people maintain a regular sleep-wake schedule according to their natural circadian preferences, participate in regular exercise during daylight and relaxing activities before bed, limit exposure to news about COVID-19, and engage in brief but regular reflection on the current situation.
For women and children, the authors offered a specific list of recommendations. They endorsed limiting screen time after dinner, maintaining a routine including calming activities in the 30 minutes before bedtime, ensuring regular sleep times, and reassuring children about the importance of physical activity, routines, and any anxieties. They warned against women becoming overloaded with family and working activities at home, as women tend to work more given an unequal burden of childcare.
Lastly, the authors offered suggestions for healthcare workers and others facing an elevated level of work demands. Individuals are recommended to allocate time to express feelings of stress and other emotions with trusted colleagues and family, while also engaging in distracting tasks during their free time. They noted that even a short nap can reduce fatigue, poor concentration, and irritability resulting from lack of sleep. They also added that workers should avoid driving home after long shifts if possible.
Altena E, Baglioni C, Espie CA, et al. Dealing with sleep problems during home confinement due to the COVID-19 outbreak: practical recommendations from a task force of the European CBT-I Academy [published online April 4, 2020]. J Sleep Res.. doi:10.1111/jsr.13052