During this prolonged siege of COVID-19, every facet of our lifestyle and daily activity has been called into question or challenged in some way.
Sleep has been a casualty of these extraordinary times. It is obvious that insufficient sleep, night after night, will cripple our daytime focus, energy levels and mental clarity. We are all familiar with the feelings of surgency and buoyancy that derive from a solid night’s slumber. We are better prepared for the rigors of the day. Our stress tolerance is greater, and we are less likely to be irked by trifling matters. For those in practice, you can lean into your work with patients and feel more engaged and productive.
However, the accumulated stress load during a day of assisting those with mental health needs influences receptivity to and willingness to protect the sleep process. COVID-19 has spawned much grief and trauma in ourselves, not to mention those seeking help. As the siege persists, all of us are recycling through Selye’s stages of alarm, resistance and exhaustion as the virus waxes and wanes and public health measures respond in kind. A constant bombardment of narratives and stories around loss of loved ones, loss of physical health or employment, financial hardship, and psychological pain creates a ripe environment for secondary or vicarious traumatization.
Clinicians experiencing secondary traumatization, or even direct trauma from their work, are at risk for losing hope that things can change. How do helpers bounce back from the cumulative physiological and neuro-chemical cascades elicited or unknowingly mirrored through patient predicaments?
A key to restoring equilibrium begins with the intention to self-care. This means suspending critical self-judgments and directing messages of kindness and compassion toward oneself. A good night’s sleep is a prime example of self-nourishment. Conscientious mental health therapists rehash their clinical day and may second guess their judgments come evening, asking “Is that adolescent patient at risk for suicide and needing to be in the inpatient setting to be safe? How will the adult struggling with a serious chemical addiction problem be moved to seek treatment? How will I manage to pay a higher rent when my revenue is down?” Innumerable questions, but not always ready answers.
We need to be our own best psychotherapists and cognitively re-structure expectations about practice and outcomes. A priority needs to be reducing our baseline hyperarousal and autonomic mobilization and neutralizing limbic-amygdala fueled fear and anxiety. A myth of being invincible is a dangerous position to take during this COVID-19 maelstrom. We have much faith in our therapeutic skill set. Is that faith and expertise harnessed in our own efforts to self-manage stress?
A common complaint among health care professionals is that they do not have enough time for bona fide selfcare. But choosing and protecting the private time and space between patient appointments or right after work hours is a step in that direction. One way to quell sympathetic nervous system tone and stimulate the vagus nerve is to practice mindful breathing or engage in gentle movement with a focus on the slow exhale. A vintage Spanish proverb referred to habits being first like cobwebs, then in time becoming cables. Self-care options are available till we choose to let go and seek slumber. Empty the brain of noise and alerting messages, zeroing in on the circadian signal that Melatonin is circulating in earnest and preparing us to transition from waking to sleeping. Utilize self-acceptance and dwell on what you have been grateful for in the preceding 12-14 hours of your waking day.
A common misstep is to unknowingly override the circadian and homeostatic propensity for sleep in the hours preceding bedtime, soldiering on and pushing through a problem, or indulging in a captivating book, social conversation or movie right up the point of preparing for bed. Gentle transitions from the work mind to the leisure and bedtime mind sets are key. We want to avoid elevations in cortisol levels later in the day.
Having been saturated with telehealth screen interactions all day, secondary stimulus generalization can occur, associating one’s laptop, tablet or smart phone with work images, beeps and the press to respond. Thus, there is further reinforcement of baseline recruiting responses. Individuals with refractory insomnia are often clueless to the actual level of body-mind arousal. These folks paradoxically complain of diurnal fatigue. By evening, when the body clock pivots toward the sleep cycle, rebound restlessness occurs.
Ensure the physical environment at home and in the bedroom is conducive to the winding down process. View sleep as a sacred process and opportunity for true rest and respite from the daily grind and chorus of professional responsibilities. One strategy is to write down recurring, bothersome thoughts on a card or piece of paper, tucking them in a small container, and removing them from your sleeping space. Promise yourself you will seek solutions in the new day. Avoid leaving a laptop or other e-device in your bedroom, other than a phone. Keep the phone away from your pillow or nightstand, but within audible distance.
Nowadays, travel is either restricted or overshadowed by the spectre of viral infection, so that is not necessarily a low risk or comfortable escape right now. Seeking connection with family, community, colleagues and spiritual reserves can be a source of solace and be re-energizing. Indulging in playful interactions is part of the flourishing self. Nature is nearby. Walks or jogging benefit many, kindling natural endorphins. Merely sitting on a park bench encourages self-reflection, being in the moment or maybe even pleasant daydreaming. The greens, blues and sounds of the outdoors beckon, now that Spring and daylight savings are near.
Be creative at home, increase general reflectivity in décor, re-arrange furniture, recycle or dispose of useless objects gathering dust in one’s living space. Even minor changes in the appearance and functionality of one’s living quarters can be uplifting. Cultivate indoor plants, for aesthetics, air quality and as a source of herbs for healthy eating. Establish firm spatial boundaries between work activities and those devoted to sleeping, eating and leisure pursuits. Optimally, the sleep-wake schedule, respectful of one’s body clock rhythm (owl, lark or in-between) remains consistent 7 days per week, with 7-8 hours of nightly slumber as a target.
So, a new modus vivendi has emerged, dealing with the ongoing demands of work-life balance when work and home life are fused together. More changes and trials lie ahead but self-care-intentional, focused, and tailored to individual healer’s needs, becomes a permanent part of deepening resilience.
Useful sleep hygiene information is found at:
Sleepfoundation.org (National Sleep Foundation)
www.aasm.net (American Academy of Sleep Medicine)