The importance of sleep

COVID-19 brings challenges to getting a good night’s rest

By Andrew J. Concatelli

While stress of any kind can interfere with a good night’s sleep, the COVID-19 pandemic introduced new stressors that make restorative sleep even more elusive.

“COVID brought on physical and psychological stress, including the stress of being isolated from each other,” says Jeff Durmer, M.D., ’87, a Denver-based sleep performance physician and neurologist who has worked with the Atlanta Falcons NFL team, the U.S. Olympic team, and the Federal Aviation Administration.

Durmer has spent much of the last several years speaking with health care organizations and other companies about the importance of sleep health and the challenges posed to it by the pandemic, which for many people has made falling asleep and staying asleep more difficult.

By definition, he says, sleep health is utilizing proper sleep techniques and identifying impediments to sleep to maintain good health. Sleep health care, by contrast, involves the diagnosis and treatment of sleep disorders, such as insomnia and sleep apnea.

Most people underestimate the importance of sleep, and about a third of American adults are not getting enough sleep on a daily basis, Durmer says. “We need to reframe how we think about sleep and sleep health,” he says. “Sleep is a fundamental building block of life, a basic physiologic need. It keeps you healthy and reduces the chances of disease.”

Experts say that with basic knowledge about sleep and careful attention to their own behaviors and environments, all people have the power to improve their sleep health, even during a pandemic.

At Trinity, Durmer studied psychology and psychobiology—a precursor to the college’s neuroscience major—and was a member of the men’s varsity heavyweight rowing team. He earned an M.D. and Ph.D. from the University of Pennsylvania and has spent decades teaching at medical schools and serving as chief medical officer for health care companies, which recognize the ways in which sleep helps fight and even prevent disease.

“Sleep affects four basic categories of health: immune, mental, cardiovascular, and metabolic or inflammatory health,” Durmer says. “The greatest benefits are realized with the proper duration, timing, and quality of sleep.” The average American adult sleeps 6.2 hours a night during the week, but that should be in the 7- to 9-hour range, he notes, adding that as the country’s average sleep times have decreased over the past 60 years, associated increases in obesity, diabetes, hypertension, stroke, and some cancers have emerged.

Trinity Assistant Professor of Psychology Brian Chin, whose areas of research and teaching include sleep and circadian rhythms, also notes that sleep is crucial to both physical and psychological health. “Repeated disruption to our circadian rhythms—an internal ‘clock’ in our brains that entrains our bodies to a 24-hour cycle of rest and activity—can compromise our immune systems,” says Chin, who joined the Trinity faculty in 2022. “Poor sleep can also be dangerous; people who don’t get enough sleep are more likely to get into accidents on the road and in the workplace.” 

Durmer notes that the immune system and sleep are intimately integrated. “Typically, if you get sick, your brain activates sleep, which helps to modulate your inflammatory response to support your defenses against viruses or other infections. If you’re not getting enough sleep, you’re not protecting yourself from agents you come in contact with on a daily basis.”

People who are sleep deprived may therefore be predisposed to COVID infection, Durmer says. COVID also has been noted to cause sleeplessness, which further weakens the immune response, making it harder for your body to fight the infection, he says. “Partially, we think that long COVID may reflect a lingering impact of sleep disruption and deprivation.”

Chin adds that there was a dramatic rise in the number of people who reported difficulty sleeping after the start of the COVID-19 pandemic. “Some people were calling this ‘COVID-somnia.’ The pandemic has increased stress levels, decreased our access to social contact and social support, and led us all to feel like things are overwhelming and unpredictable,” Chin says. “All these things are antithetical to restful sleep.

“Stress makes it harder for people to fall asleep, harder for them to reach the deeper and more restorative stages of sleep, and harder for them to stay asleep the entire night,” he continues. “On the other hand, well-functioning social relationships provide us with the security and sense of belonging that we need to get a good night of sleep. We know that people who perceive their social networks to be more supportive find it easier to fall and stay asleep.”

Getting a good night’s sleep is simply essential for a person’s well-being, Chin says. “We can’t thrive without good sleep. It’s connected to our mood and our emotions; we feel better and happier after a great night of restorative sleep than we do after a lousy night of interrupted sleep.”

While this may be easier said than done, Chin and Durmer say there are ways to improve the duration, timing, and quality of sleep. Maintaining what they call “good sleep hygiene” sets a person up for a restful night and a better day to follow.

“Sleep is not the end of your day; it’s the beginning of your next day,” says Durmer. “What you do to prepare for and improve your sleep today will have a dramatic impact on your tomorrow.”

Illustrations: Mirjam/Stock.Adobe.Com

Students and shut-eye

Even before the pandemic, one segment of the population stood out as particularly sleep-deprived: “Of students in middle school and high school, 66 percent are not getting the sleep they need,” says sleep expert Jeffrey Durmer, M.D., ’87.

Assistant Professor of Psychology Brian Chin notes that poor sleep greatly impacts student performance because sleep is associated with cognition. “When we are sleeping poorly, we can’t think as clearly, as quickly, or as creatively. We are also worse at paying attention and staying focused on tasks,” he says. “Athletes who aren’t getting enough sleep are going to recover more slowly from training and perform worse on the field.”

With these reasons and more in mind, Charles A. Dana Professor of Psychology and Neuroscience Sarah A. Raskin has been a longtime advocate of later school start times. She says that adolescents experience a sleep phase delay after puberty, meaning they can’t fall asleep early, often not before 11:00 p.m. or midnight. The problem with early school start times, she notes, is that students this age need 9 to 10 hours of sleep, but they can’t get an adequate night’s sleep if they need to be in class at 7:30 a.m. “We set them up to be cognitively less than their best, and then we tell them to go learn algebra or do a close reading of a novel,” she says. “It’s counterproductive.”

A Trinity faculty member since 1994, Raskin teaches a unit on sleep in her “Brain and Behavior” course. “Recent studies of college students show that, everything else being equal, grades go up in line with the hour in the day they take a class; the later in the day, the higher the GPA,” she says. “The State of Connecticut has a task force looking at making a change to later, healthier start times. Advocates say that high school and middle schools should not start before 8:30 a.m.”

School start times also are an equity issue, Raskin says. “We know that early start times impact students from disadvantaged backgrounds more, so it makes the achievement gap worse. Kids whose parents have means can drive them to school, which may give them an extra hour of sleep, while others may have to wait at a bus stop,” she says.

It’s critical to recognize the effects of sleep deprivation on mental health, Raskin adds. “Students who are sleep-deprived have much higher rates of depression, anxiety, substance abuse, and thoughts of suicide,” she says. “One of the tools we have to help improve their mental health is to encourage them to get enough sleep.”

Beyond counting sheep

Tips to help you sleep

From Jeffrey Durmer, M.D., ’87, sleep performance physician and neurologist, and Brian Chin, assistant professor of psychology at Trinity

Avoid artificial light and caffeine before bed.
Durmer: Think about light as medicine that wakes you up. Better sleep is associated with outdoor daylight and reducing screen time in the evening.
Chin: Avoid caffeine close to bedtime. It’s a powerful signal to our bodies to stay awake and alert. Drinking coffee, caffeinated tea, or caffeinated soft drinks within six hours of your bedtime can be harmful to your sleep that night.

Have a bedtime routine.
Durmer: Think about what we do with our kids, things like a calming bath, reading quietly, reducing stimuli.
Chin: Even though it’s hard, try not to sleep in too late on your weekends. Your circadian rhythm could be thrown off, as if you had jet lag from changing time zones.

Make your bedroom a sanctuary for sleep.
Durmer: Try to do things other than sleep—like studying, working out, and eating—outside of your sleep space.
Chin: You will get the best night of sleep possible in a quiet, dark room with no interruptions.