With the Covid19 and the economic crisis, you’re struggling to sleep these days? You feel tired, irritable, depressed, or you feel that you get sick more often than usual? 
You are not alone! 
With all the uncertainty that surrounds us, sleep can be elusive, and it may come as no surprise that sleep, mental health and immunity are linked. 

We interviewed  psychiatrist and researcher Hala Kerbage about the link between sleep and mental health, and asked her for tips and recommendations to sleep better. 

This transcription has been slightly edited for clarification purposes. 

1- Can you introduce yourself?

Hi. My name is Hala Kerbage, I am a psychiatrist and researcher and I will be talking to you about the importance of sleep to mental health and how to maintain good sleeping habits.

2-  How are sleep and mental health connected?

Sleep deprivation affects your psychological state and mental health even of the absence of any prior psychiatric disorder. And those with mental health problems are more likely to have insomnia or other sleep disorders. Sleep problems are particularly common in patients with anxiety, depression, bipolar disorder, and attention deficit hyperactivity disorder (ADHD).
Traditionally, we as clinicians treating patients with psychiatric disorders have viewed insomnia and other sleep disorders as symptoms. But studies in both adults and children suggest that sleep problems may raise risk for, or directly contribute to, the development of some psychiatric disorders or psychological problems, especially irritability, mood swings, and anxiety. The brain basis of a mutual relationship between sleep and mental health is not yet completely understood. But neuroimaging and neurochemistry studies suggest that a good night’s sleep helps foster both mental and emotional resilience, while chronic sleep deprivation sets the stage for negative thinking and emotional vulnerability.

3) How does sleep affect mental health? (Can you talk about the mental health benefits of sleep? )

Every 90 minutes, a normal sleeper cycles between two major categories of sleep. During “quiet” sleep, a person progresses through four stages of increasingly deep sleep. Body temperature drops, muscles relax, and heart rate and breathing slow. The deepest stage of quiet sleep produces physiological changes that help boost immune system functioning. The other sleep category, REM (rapid eye movement) sleep, is the period when people dream. Body temperature, blood pressure, heart rate, and breathing increase to levels measured when people are awake. Studies report that REM sleep enhances learning and memory, and contributes to emotional health — in complex ways.
Although scientists are still trying to figure out all the mechanisms, they’ve discovered that sleep disruption — which affects levels of neurotransmitters and stress hormones, among other things — impairs thinking and emotional regulation. In this way, insomnia may amplify the effects of psychiatric disorders, or even causes psychological problems.

“People learn insomnia and can unlearn it”

 4)  What is good sleep hygiene?

It is a series of tips that you can do to maintain a good quality of sleep. Many experts believe that people learn insomnia, and can learn how to sleep better and in some ways, unlearn insomnia. Those tips include maintaining a regular sleep-and-wake schedule, using the bedroom only for sleeping, and keeping the bedroom dark and free of distractions like the computer or television. Some experts also recommend sleep retraining: staying awake longer in order to ensure sleep is more restful.

5)  What can I do on a daily basis to sleep better ?

Apart from maintaining good sleep hygiene, some other changes on a daily basis can be useful, like some lifestyle changes. For example, most people know that caffeine contributes to sleeplessness, but so can alcohol and nicotine. Alcohol initially depresses the nervous system, which helps some people fall asleep, but the effects wear off in a few hours and people wake up.
Nicotine is a stimulant, which speeds heart rate and thinking.
Giving up these substances is best, but avoiding them before bedtime is another option.
Moreover, regular physical activity helps people fall asleep faster, spend more time in deep sleep, and awaken less often during the night. Decreasing screen time on the phone, laptop or television before going to sleep is also helpful.

6) What do you recommend if you are experiencing insomnia?

 If you are experiencing insomnia, first thing is to ask yourself if you are going through stressful times and are feeling anxious, which is quite normal and frequent in the context of Coronavirus pandemic and consequent lockdown. The usual daily routines have changed and it is expected that our sleep might be disrupted too.
So as a first step, accepting that we live in a stressful period, without blaming ourselves for the sleep problems or for being stressed out. It takes time to adapt to a time of crisis, so you can begin by trying to implement some of the measures I talked about earlier, but without making an obsession out of it, as you may have a sense of failure if you can’t apply them, as you cannot change overnight. The most important thing is that you gain awareness about what is stressing and worrying you, try to talk about it with your loved ones,  enhance social support even virtually, and develop some indulgence towards yourself. This in itself can have a positive effect on your sleep.
If the sleep problem becomes too severe and frequent and is affecting your daily functioning, then you can consult first with your general physician to rule out any medical problem and who can eventually refer you to a mental health specialist.
If along with the insomnia, you are experiencing severe and constant low mood, loss of interest, feelings of helplessness and hopelessness, then you can directly seek a mental health professional.

7) How to stop the stress and negative thoughts before going to bed ?

If you’re having too many thoughts before going to bed, or if you get up at night and have difficulties falling asleep again, the first thing to do is to accept your anxiety, without blaming yourself or obsessing about going to sleep right away.
If you’re used to relaxation techniques, you can resort to them, but if you’re not, other options can work like calling someone that you’re very close to, reading a bit, avoiding looking at a screen or going through social media.
However if you’re having a severe panic attack or even suicidal ideas then you should call your physician, go to the ER, or call an emotional support hotline such as Embrace 1564 or Speak Up Covid (if you’re a health professional):  79120570.

#Howtohurtless #becausewearealllockeddown