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Sleep the Night Away

African American man sleeping

It’s no secret that the COVID-19 pandemic has caused stress, anxiety and depression, leading many people to experience sleep disruption. Anxiety and depression are highly associated with disturbed sleep and insomnia, and both conditions make it difficult to fall asleep. Staying asleep is another common symptom of anxiety, while depression typically causes earlier-than-desired morning awakening. The relationship between depression and anxiety with insomnia is two-way: both conditions cause insomnia, and individuals with chronic insomnia are more likely to develop anxiety and/or depression. 

Inconsistent sleep patterns present another COVID-19-related sleep disturbance factor: remote working and learning allow for later bed and wake times. Irregular sleep schedules make it challenging to transition back to a “normal” schedule on days requiring physical attendance at work and school.

Smart sleep solutions

There are simple solutions to improve sleep quality and duration. These positive sleep habits, combined with creating an environment conducive to sleep, are called “sleep hygiene.” Along with keeping a relatively consistent sleep schedule (going to sleep and waking around the same time each day) sleep hygiene includes:

  • Keeping the bedroom quiet, dark and at a comfortable temperature.
  • Avoiding light emitted from screens before bed—especially LED screens which activate the part of the brain that keeps it awake.
  • Refraining from sleep-impacting substances in the evening—caffeine, alcohol and nicotine).
  • Getting exercise during the day.

It’s important to understand that sleep doesn’t have an on/off switch in the brain—there are increases and decreases in various neurotransmitters (chemicals in the brain) that make sleep or wakefulness more likely.

This makes it difficult to recommend particular sleep medications, whether prescribed or over-the-counter. Each medication impacts specific chemical systems in the brain and differs in success, duration and side effects. Most people discover which medication works best for them through trial and error. In general, sleep medications are most effective when taken intermittently for short-term, transient insomnia. They are not recommended for treating chronic insomnia.

Sound Sleep Tips

  • Keep a consistent sleep schedule: go to bed and get up around the same times daily.
  • Make your bedroom a sleep sanctuary. Keep it quiet, dark and at a comfortable temperature.
  • Avoid screen time before bed.
  • Don’t use substances before bed that can impact sleep: caffeine, alcohol and nicotine.
  • Get exercise daily.
  • Contact your health care provider if lack of sleep is negatively impacting your functioning ability. Your provider will determine if there is an underlying medial or psychiatric issue, if you simply need sleep hygiene/behavioral recommendations or if you should see a sleep specialist.
  • Sleep medications are not recommended for chronic insomnia. Only use them intermittently, if necessary.
  • Try not to stress about sleep! It only makes it harder to fall and stay asleep.

When providers can help

Anyone experiencing sleep disruptions consistently affecting daily functioning should contact their primary health care provider. Providers can make sleep hygiene recommendations or determine if an underlying medical or psychiatric condition is causing, or contributing, to the sleep disturbance. Sometimes a sleep disorder is present (most commonly sleep apnea), so an evaluation by a sleep specialist may be appropriate.   

Treating the core problem first is crucial. However, sometimes people continue to experience insomnia after it’s addressed. This “learned” insomnia is an unintentional brain pattern of thoughts and behaviors around sleep that is best corrected with behavioral changes, not medication. Cognitive behavioral therapy for insomnia (CBT-I) is one of the safest and most effective treatments for long-term control of insomnia.

My best advice is don’t get too frustrated about not sleeping–it only makes it worse! Nearly everyone experiences trouble sleeping at some point in their lives. There is generally an underlying problem causing the sleep disturbance. Try to understand and address the cause (stress, anxiety, pain, etc.), or contact a health care provider for assistance.

Brooke JuddBrooke Judd, MD, is the section chief of Sleep Medicine at Dartmouth-Hitchcock Medical Center. She also serves as assistant professor of both Medicine and Psychiatry at the Geisel School of Medicine, Dartmouth. Her areas of focus include non-invasive mechanical ventilation, obstructive sleep apnea and sleep disorders.