How to Protect Sleep Health Amid Political, Economic, and Social Upheaval

Catherine Darley, ND

Periods of major government and societal change often trigger widespread uncertainty, leading to a rise in sleep complaints. Many clinicians are seeing this firsthand among their patients. These societal shifts are akin to “the straw that broke the camel’s back,” tipping people into difficulty sleeping. Times of change challenge sleep, particularly for those with individual risk factors. Understanding these risks, along with the solutions, can help preserve our patients’ sleep. Fortunately, these strategies can strengthen the sleep and circadian systems during times of societal shift. 

Societal Shifts Impact Sleep

Historical events provide important context for what we can expect now. During the COVID-19 pandemic, 41% of people experienced sleep disruption. The rate was highest among parents during infection, children, and teens during lockdown.¹ Other recent historical events have also been associated with increased sleep complaints. The ‘Great Recession’ of 2008-2009 impacted adults’ long-term financial security. The cohort of those in their 50s in 2010 and 2016 had increased sleep disruption compared to those in their 50s in 2004. This increase was strongly associated with economic burdens and gender, with women being the most impacted.² Sociopolitical events, such as elections, can also impact individuals’ sleep and the overall public well-being. Acute effects of the 2020 US Election Day included increased stress, negative affect, and alcohol consumption, along with reduced sleep duration and sleep efficiency (ie, the percent of time in bed that was spent in sleep). These effects were felt by US residents and, to some degree, by people globally. ³

Individual Factors Increase Risk

Individual risk factors also increase susceptibility to sleep disruption. Marginalized groups, such as LGBTQ+ people, are known to have worse sleep than heterosexual groups. Newer models in sexual minority men have found poor sleep largely correlated with increased minority stress related to microaggressions, harassment, and internalized homophobia.⁴ Therefore, any new government policies that roll back the human rights of sexual minority groups could be anticipated to worsen sleep health in those individuals and communities. 

Even political beliefs can shape our sleep experience. During the contentious 2020 US election, people who considered themselves more liberal had an increased risk for worsened sleep, negative dream content, more nightmares, and more political dreams compared to those who defined themselves as more conservative.⁵ Other research done in the swing state of Arizona found that Democrats and Independents report worse sleep than Republicans.⁶

Social capital is also associated with better sleep among people of all ages. One way to assess social capital is “If there was an emergency, is there anyone you can call for help?” Short sleepers (those getting 5-6 hours per night) are more likely to believe that neighbors rarely or never help each other, and to have a decreased sense of belonging. Long sleepers (>9 hrs) had lower group membership participation. People with moderate to severe insomnia reported less trust and were less likely to participate in neighborhood improvement projects.⁷ Many other studies show an association between loneliness and self-reported sleep disruption.⁸ Could this have societal implications, if perhaps due to government change, there’s an increase in insomnia, which in turn causes people to withdraw from efforts to support the social good?

There are many other individual risk factors, including poverty, job loss, neighborhood air pollution, being in a marginalized racial or gender group, personal or family history of insomnia, and more. Some health conditions, such as anxiety or chronic pain, will also increase the risk of sleep disruption. Identifying patients with individual risk factors enables us to do early assessment and prevention of sleep disruption due to societal upheaval. 

Maladaptive Behaviors Increase Sleep Disruption

Individually, the response to these societal changes and increased stress may include maladaptive behaviors that promote sleep disruption. Primary among these is an increase in ruminating and worry. In the still of the night, thoughts can take hold when first getting into bed or later. People can even use this uninterrupted time to problem-solve and plan. The challenge is that these cognitive strategies interfere with getting the hours of sleep necessary for emotional regulation. 

At the beginning of the pandemic, there was a sharp increase in alcohol consumption. It’s too early for data to show an increase since January, when these government changes began. However, I’m hearing from individuals about an increase in alcohol use and other substances. Alcohol will disrupt normal sleep architecture, truncate sleep duration, and even trigger sleep-maintenance insomnia.⁹ 

Another maladaptive behavior is excessive reading of the news or social media on the smartphone or, in other words, “doomscrolling.” Often, people can get into this habit in the hours before bed, and possibly more so in dynamic times when people feel the need to stay informed. ‘Digital addiction’ has been identified by the World Health Organization as a contributor to disordered sleep patterns and insomnia.¹⁰ Not only does the content potentially feed into hypervigilance, but the blue light given by electronic devices signals to our body that it is morning, ie, time to be active, by suppressing melatonin.¹¹ Suppressing melatonin in this way shifts the circadian rhythm later, contributing to sleep onset insomnia symptoms and potentially truncating the opportunity to get sufficient sleep before the required wake time. 

Sleep Impacts Coping and Problem-Solving

When people aren’t sleeping well, they are less able to cope with challenges. This can build into a negative feedback loop, where upsetting events disturb sleep, poor sleep leads to poor coping, and the consequences build further distress. Inadequate sleep increases emotional volatility¹², impairs cognitive function, and problem-solving.  Research on problem-solving recently found that sleep after learning a challenge enabled 62% of participants to solve the problem, compared to only 24% of those awake after learning the challenge. Participants with more slow wave sleep were especially effective at problem solving.¹³

Preserve Your Client’s Ability to Sleep

What can we as clinicians do to preserve healthy sleep when people are suffering from rapid societal change? Let’s first make sure to ask about sleep at each patient encounter. In my experience, when people see a reason for acute insomnia, they are less likely to treat it, thinking that as the situation improves, their sleep will recover on its own. Unfortunately, that is not always true. 

For the people who have been pushed into sleep disruption by current events, prioritize everything that makes their sleep system more robust. Choose these strategies based on individual need. Putting these basics in place may be sufficient to stabilize their sleep. 

1. The first step to improve sleep is to ensure people allow enough time in their schedule. The recommended amount of sleep for adults is 7 to 9 hours nightly.¹⁴ Think of this as a bell curve, with some people needing 7 hours, some needing 8 hours, and some needing 9 hours. Help your patient identify how much sleep they feel best on, then re-prioritize their activities to allow that much sleep nightly.
2. For some people, when they get into bed, it has become their time to process the day and think things through undisturbed. Encourage them to take 10 minutes, a couple of hours before bed, to process their thoughts in advance with journaling. This can take many forms, including a narrative diary-like entry, problem-solution brainstorming, or a ‘to-do’ list. Then close the journal to set those thoughts aside until morning. Then the patient will focus on a sleep-promoting story, visualization, meditation, or progressive muscle relaxation once they get into bed. 
3. Our sleep environment can significantly affect our ability to sleep well. Often, it has a bigger impact than people anticipate. An ideal bedroom is cooler than 65 degrees, as dark as a cave, with a comfortable bed (whatever the patients’ preference is), clean and uncluttered, and without a clock visible. Bedroom doors should be closed during sleep, not only for a sense of safety but also as an important fire-safety precaution. 
4. We are trained to be responsive and hyperaware of our smartphones. Research shows that using them in bed is associated with more wake time and longer sleep latency.¹⁵ Instruct patients to turn them entirely off and place them in another room during sleep. For people who want to be reachable in an emergency, they can program notifications only to allow those who would need to reach them to get through during sleep hours. 
5. Treat daytime anxiety and depression. Current events are likely to increase daytime anxiety if they are impacting sleep. Ensure patients have effective treatment to keep calm during the day, too. 
6. Evaluate your clients’ level of social connection vs. loneliness. If there’s a need, encourage them to build connections purposefully. It may be necessary to get into specifics with them, brainstorm aligned groups they may be interested in, determine times of day or week available for social connection, and address any barriers to success. 

For some, these foundational suggestions to improve sleep may not be enough, so they need targeted insomnia treatment. The first-line recommended treatment for insomnia is Cognitive-Behavioral Therapy for Insomnia (CBT-I). This approach is conducted over approximately six sessions by a trained Behavioral Sleep Medicine provider.¹⁶ 

Link to previous article on CBT-1

Strengthen the Circadian System

Light and dark are the primary environmental cues that entrain our circadian rhythm to a 24-hour pattern. Unfortunately, most Americans have insufficient daytime light and a darkness deficiency at night. Proper light during the day is 250 lux or more, enriched with the blue spectrum. In the evening, starting three hours before bed, the recommendation is to get less than 10 lux, devoid of blue light. Light should be less than 1 lux during sleep hours without blue light.¹⁷ Some tips to help patients achieve these light recommendations include installing a light meter app on the smartphone to check current light exposures. During the day, getting 20-30 minutes of outdoor light in the first hours of waking, and then ‘light breaks’ outside for 10 minutes every couple of hours, can increase circadian amplitude. In the evening, many people are still in an active part of their day three hours before bed, and may find it difficult to turn down the lights to 10 lux. If that is the case, installing blue light filters on electronics or using blue-blocking glasses for those hours can decrease insomnia symptoms after just one week of use.¹⁸ 

Conclusion

We don’t know how long this period of societal change will last. We do know that these periods increase the prevalence of poor sleep, and some people have identifiable risk factors. Since healthy sleep empowers our ability to cope and problem-solve, it is especially important to preserve during challenging times, which require people to respond. As clinicians, we can improve the situation by asking our patients about sleep disruption. Then, we can provide patients with the education and strategies to make their sleep and circadian systems as robust as possible. Reinforcing these systems will likely enable patients to better deal with unanticipated change. 

Catherine Darley, ND, is the leader in natural sleep medicine. She combines her knowledge of sleep disorders with her training as a naturopathic physician to bridge these fields. She founded The Institute of Naturopathic Sleep Medicine Inc in Seattle which is dedicated to patient care, public education, and consultation with high-risk populations such as first responders. Dr. Darley regularly writes and trains healthcare providers in the treatment of sleep disorders.  She created a series of online courses available at www.skilledsleeper.com, which are customized to the unique sleep needs of different groups, and offers naturopathic CE courses at www.naturalsleepmedicine.net. In her personal time, Catherine advocates for later secondary school start times and enjoys being outside in nature.

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Resource: https://ndnr.com/neurology/behavioral-treatments-for-insomnia/