Paulina Ochoa never had a problem sleeping until the COVID-19 pandemic began in March and life dealt her a series of serious setbacks. She lost both her jobs, her car was stolen and her aunt died — and that’s when the nightmares started. The dreams got so bad they sometimes left her paralyzed in bed.
Ochoa isn’t alone. A sleep study conducted by University of Arizona researchers monitored the role of insomnia during the pandemic, and more than 50% of 1,000 participants reported experiencing insomnia.
Ochoa, a sustainability student at Arizona State University, tried to wear herself out by staying up until 7 a.m. so she’d be forced to finally fall asleep.
The insomnia eventually made her imagine hearing voices or see unsettling shadows.
Michael Grandner, who runs the Sleep and Health Research Program in the UA’s department of psychiatry, said he has seen a great number of people with sleep problems this year.
“With everything going on during the day, they have a real hard time disconnecting,” he said.
Grandner, who also sees patients at the Behavioral Sleep Medicine Clinic at Banner Health, said insomnia occurs on a spectrum.
“So there’s insomnia, I would say with a lowercase ‘i’, which is just sort of the experience of being unable to sleep sometimes,” he said, adding that many people deal with insomnia at some point in their life.
“Then there’s the line into what we call insomnia disorder, which is actually a diagnosable medical condition that usually does not go away on its own once you meet criteria for it.”
Grandner said if it takes more than 30 minutes to fall asleep for at least three nights a week, and if the pattern has been ongoing for months, you may have insomnia.
Stress is a common cause of insomnia, said Lauri Leadley, president of Valley Sleep Center, a company with several locations in metro Phoenix.
“Insomnia is literally the inability to escape your thoughts. And during stressful times, our bodies create cortisol … our ‘awake’ hormone,” Leadley said.
Unable to escape her stressful and frightening thoughts, Ochoa tried to force herself to exhaustion. But even when she finally fell asleep, she said, nightmares would jolt her awake.
Nightmares can do double damage, said Denise Rodriguez, a clinical psychologist who specializes in behavioral sleep medicine to treat insomnia at Banner Health.
“Typically, for a lot of folks who do struggle with nightmare disorders, it’s not just that they’re having a nightmare, but that the nightmare prevents them from going back to sleep,” Rodriguez said.
After Ochoa lost two jobs and switched to online learning at ASU, her daily routine became less active. Rodriguez said that could cause an increase in dreaming.
“Some of the theories behind why we’re dreaming more is that we’re under stimulated during our day … and so our brain is trying to give us that extra stimulation at night,” Rodriguez said.
Grandner said inactivity during the day is a common denominator in people with insomnia.
“Sleep difficulties are probably the most reliable predictor of poor mental health,” he said, “and especially in terms of depression and anxiety.”
Poor sleep and suicide rates are directly correlated, Grandner said.
“There have been over 50 studies now that when you pool them together, people who have significant sleep problems, whether it’s nightmares or insomnia, are about three times as likely to be thinking about suicide,” he said.
Ochoa said she was already experiencing stress and anxiety in daily life, which insomnia only made worse. Then, in June, Ochoa tested positive for COVID-19.
“So I was still having trouble sleeping and now I had the added factor of like, (I) can’t breathe right,” she said.
Insomnia can significantly increase the chances of getting sick, Grandner said.
“If you want to have a robust immune system,” he said, “it’s important to sleep. There’s data that shows that people who aren’t getting enough sleep, they’re more likely to get sick, especially for viral infections.”
To get better sleep, Grander suggests reducing screen time, getting sunlight exposure shortly after waking up and exercising during the day rather than at night.
Sleep is programmable, he said, and it’s important to train the brain that the bed is meant for sleep, not for rehashing the day or planning the next.
Before getting in bed, he said, “Check your schedule, process all the stuff that you need to process so that by the time you get into bed, you’ve already done all that work.”
Ochoa took a different approach.
“I actually kind of got it solved. I actually had to go ahead and resolve to getting a blessing from this church,” she said. Her visit to the church was just over two months ago.
The blessing consisted of two missionaries applying oil to her forehead, placing their hands on her head and praying.
“All of a sudden, I could sleep,” she said. “And I think maybe it was just like a mental thing. You know, maybe it was just my fears and anxiety.”
10 steps to ease your nightmares and improve sleep
1. Establish a sleep routine
Nightmares, Martin said, occur during rapid eye movement sleep, the phase during which our muscles relax and we dream. Waking up during REM sleep enables recollection of the dream and resulting distress.
"One of the most effective ways to treat nightmare problems in adults is actually to get them sleeping more soundly (so) they wake up less often," Martin said.
A healthy sleep routine begets sound sleep. Develop one by exercising, setting regular sleep and waking times, ensuring your room is dark and cool, avoiding stimulating beverages after midafternoon and engaging in relaxing activities.
2. Cut back on alcohol
Alcoholic beverages can induce restlessness and awakenings throughout the night — potentially helping you remember nightmares, Martin said.
"A lot of people use alcohol as a way to wind down and feel sleepy at the end of the day, but it's really not the right solution," she added. Instead, try herbal teas and other beverages conducive to sleep. If drinking was the only part of your relaxation routine, chat with your partner or read instead.
One drink more than three hours before bedtime is OK, Martin said. Just pay attention to whether it causes a post-dinner nap and alertness at bedtime, and eliminate that drink if it does.
3. Don't eat before bed
Snacking can boost metabolism, which causes your brain to be more active and could lead to nightmares, according to the National Sleep Foundation.
While some people sleep better after eating a light snack, you should stop eating two to three hours before bedtime. If you notice that you have nightmares afterward, try avoiding nighttime snacking or heavier meals before bed.
4. Review your medications
Some medications can prompt nightmares by interrupting REM sleep.
"If people can identify that their nightmares either started or increased when they had a change in their medication, that's definitely a reason to talk to their doctor" about their medication schedule or alternatives, Martin said.
Melatonin, while a popular sleep aid, influences our circadian rhythm that regulates REM sleep, and can lead to more or fewer nightmares. If you want to take melatonin for better sleep, work with a sleep specialist to ensure you're taking it at the right time and not compounding the problem, Martin said.
5. Practice stress-relieving activities
Progressive muscle relaxation — tensing muscle groups as you inhale and relaxing them as you exhale — has been effective for reducing nightmares.
"Nightmares activate the sympathetic nervous system, the 'fight or flight system,' the body's natural response to imminent danger," said Tal via email.
"The body also has an innate relaxation system: the parasympathetic nervous system, aka the 'rest and digest' system." Progressive muscle relaxation and other relaxation activities can help activate that system.
6. Journal your worries
Write down your worries to get them all out ahead of time, lest they rear their disquieting heads at night. Journaling can be helpful for alleviating nightmares and stress in general, Tal said.
7. Don't watch or read scary content before bed
Since our nighttime observations can appear during sleep, "spend some energy engaging with things that are more emotionally neutral or even positive" before bedtime, Martin suggested.
During the pandemic, our everyday lives are looking pretty scary, too. "Reading the news media and then hopping into bed is more likely to trigger disturbing and upsetting dreams than looking through pictures from your last vacation with your family," she added.
8. Rewrite the ending
Imagery rehearsal therapy is effective "when the chronic nightmares are showing similar themes and patterns," Tal said.
Since nightmares can be learned behavior for the brain, this practice involves writing down in detail the narrative elements of the dream. Then rewrite the dream so that it ends positively. Just before falling asleep, set the intention to re-dream by saying aloud, "If or when I have the beginnings of the same bad dream, I will be able to instead have this much better dream with a positive outcome."
"By practicing a rewrite during the daytime, you increase your chances of having them at night while you're sleeping instead of your nightmare," Tal said.
9. Use a white noise machine
Silence is key in a sleep routine, but "for people who either don't like it to be completely quiet or who are awakened by noises they can't control during the night," background noise "is a good strategy," Martin said.
Try a fan or a white noise machine or app for several consecutive nights to help your brain adapt, she added.
10. Check up on your mental health
If nothing works and you're still having nightmares, talk with a therapist or sleep specialist.
"Nightmares might be a sign of a larger issue, such as PTSD or a mood disorder," Tal said. "It is possible to treat the nightmares without treating the underlying disorder, but it may also be helpful to treat both the symptom and the disorder.
"There has been great progress on psychological treatments for nightmares, insomnia, anxiety and mood disorders," Tal added. "Do not be afraid to ask for help; psychotherapy works and it is often short term and accessible."