In the best of times, I’m an early-to-bed, early-to-rise person, and that much hasn’t changed. Sleep is the only respite my brain gets from worrying about COVID-19, and, even then, not always: The other night, I dreamt I had congestion and a cough, and struggled to hide it from people I passed at the supermarket. Many of us are currently experiencing nightmares, restless sleep and/or insomnia, and exhaustion that persists even after a decent night’s sleep.
Because “fatigue” is one possible coronavirus symptom and can precede more telltale signs like body aches and fever, I’ve worried that my tiredness means something, even as I know it’s very likely that it’s largely a result of stress: Along with fight and flight, fatigue is also one of the body’s evolutionarily adaptive responses to stress. (There is also freeze and flooding of emotions — all Fs!)
For everyone else who is tired all the time now, and worried about what that means, I got in touch with Andrew Varga, a neuroscientist and physician at the Mount Sinai Integrative Sleep Center, and Curtis Reisinger, clinical psychologist and corporate director at Northwell Health, to learn more.
If I’m tired all the time, does that mean I could have coronavirus?
A report from late June, published in the journal PLOS One, compiled and analyzed data from 148 separate COVID-19 studies and revealed that fatigue was the third-most common symptom reported in laboratory-confirmed cases. (Persistent cough was the first, and fever was the second.) But, as is the case with chest tightness, or a cough, it’s hard for doctors to make a definitive diagnosis based on a single symptom. And because fatigue can be a symptom of a number of things (many of them unrelated to your physical health), it’s not a reason to panic. “If you get more symptoms, so it’s not just the fatigue, but fatigue plus body aches plus a cough and a fever, that’s worrisome,” says Varga. “Chest tightness alone, fatigue alone — those are less concerning that you’re about to become really sick.”
So if I’m not sick, why am I tired every day?
Okay, yes: Many people likely have a pretty good guess as to an answer here. Many essential workers are overworked and underpaid, often with fewer resources available when they do feel sick. Parents are tired because they are often still parenting all day every day without the relief of school and/or child care. But I work from home, on my couch, and I don’t have kids, so what’s my excuse?
First, says Reisinger, it’s important to understand there are different types of fatigue. There’s physical fatigue, like you might experience after a long run or playing sports. That kind can lead to achy muscles, but it’s usually pretty good for sleep.
There’s mental fatigue, like you might get after doing your taxes or something similarly … taxing. Unless you’re an infectious-disease modeler, this probably isn’t the most likely culprit for your persistent exhaustion at the moment. “When you get mental fatigue, you may jump up in the middle of the night and think of a solution,” says Reisinger, but otherwise, your sleep stays pretty regular.
What’s most troubling, says Reisinger, is the third form of fatigue: emotional. When we’re on high emotional alert — worrying for ourselves, our families and friends, the world at large — we use up a lot of brain energy, and we tend to have a harder time recouping it. “Emotional fatigue is the one that’s going to wake you up at three in the morning or give you insomnia — either you can’t get to sleep, or you wake up in the middle of the night and you can’t get back to sleep,” he says.
Without intending to, many of us play into our emotional fatigue through a process of “rehearsal,” says Varga. “If you’re stressed about things during the day, there’s this tendency to kind of rehearse the things that are stressing you out right as you’re lying down in bed, and that kind of rehearsal can prevent you from falling asleep,” he says. Getting into bed and mentally paging through every worst-case coronavirus graph you’ve ever seen? Not such a good idea, apparently.
So how do I manage — or prevent — emotional fatigue?
Sleep is hugely important to our immune function, which makes it all the more frustrating when we can’t seem to get enough of it. There are a number of tips Varga and Reisinger suggest for those struggling with emotional fatigue, and the resulting poor sleep quality, right now.
1. Practice consistency: Get in bed at the same time every night, and get up at the same time every morning, as much as humanly possible.
2. No screens for an hour before bedtime. It’s hard, but avoiding your phone/laptop/iPad before bed benefits you in two ways: It gives you a break from the endless news cycle, and it gives your eyes a break from blue light, which Reisinger says promotes wakefulness: “Incandescent, red-spectrum lights are more like a sunset, and blue is more like a sunrise.” Reading a book by lamplight: good. Reading a book on your phone: not the best if your main goal is to sleep.
3. Instead of phone time before bed, try relaxation techniques. These can include deep-breathing exercises, progressive muscle relaxation, meditation, or taking a hot shower or bath.
4. Avoid relying too heavily on alcohol. While available evidence suggests we as a nation are not heeding this advice, Reisinger warns that using alcohol as a sleep aid (or a response to emotional fatigue) leads to a “rebound effect,” where sleep is disturbed once the alcohol is metabolized.
It’s also important, I think, to be understanding with ourselves for being tired or cranky or emotional as this crisis unfolds. These events may be painful in ways we don’t even realize, says Reisinger. “Some of the people who will be most affected by this are people with emotionally abusive histories and/or trauma in their past,” he says. “Often, these types of things tap into the same sort of emotional areas of the brain, so they just can’t sleep, and they don’t know why.”
At the moment, some stress and emotional fatigue is unavoidable, but practicing consistency and limiting our news intake, especially before bed, are perhaps the best things we can do to keep it manageable.