Do you struggle to sleep or frequently wake up in the middle of the night and lie awake for hours, you might be suffering from insomnia? Insomnia is a common sleeping condition where people find it difficult to fall asleep or they stay awake for long period of time restless in their bed or wake up frequently in between their sleep and find it difficult to go back to sleep. Insomnia can either be short term or long-term primary or secondary insomnia. Chronic sleep loss over a period can be dangerous for your health as the body needs a minimum of 8 hours sleep during which it heals itself and rests to prepare for the next day. Not getting enough sleep can increase your risk of cardio-vascular disease, stroke, diabetes and high blood pressure. However, most cases of acute insomnia are linked to poor health habits and by correcting those, it is possible to get the required amount of sleep.

Get in tune with your circadian rhythm
Your body follows an internal body clock – if you keep a specific time to sleep and wake up in the morning, your body slowly adapts to that pattern and will do the same thing without any external motivation. Set aside a specific time every day when you retire to bed. This will help you sleep better. Ensure your sleep environment supports you to fall asleep for eg, avoid using loud colours or harsh lights in your bedroom. Try to live in a noise-free area.

Schedule your meals properly
Before you go to sleep, it is important that your body is not in an active state. Very often we tend to eat heavy meals an hour before we go to bed, which may hamper our sleep. The process of digestion may interrupt your ability to fall asleep and laying down could also lead to indigestion. Preferably have your meals a minimum of 2 hours before you go to sleep. Try to eat light, and protein rich food, which takes longer to digest. This way you will not have difficult falling asleep because of hunger cravings either!

Manage stress
Stress affects all of us daily and it is important to develop coping strategies because it can have far-reaching negative effects on our lives. When you take your stress to bed with you it can impact your sleep and worsen your mood, making your stress worse the next day and leaving you in a vicious cycle. Journaling, taking therapy sessions, channelling stressful emotions into creative work or meditation will help you manage excess stress. Severe anxiety and depression can also affect your quality of sleep, seek professional help to manage this.

Exercise is key
Exercise is not only great for your overall health, but it also helps you sleep better. When you exercise on a regular basis, it helps improve your cardiac health, your immunity, reduces stress levels and tires you out so that you fall asleep easily. It is important to set aside a convenient time for you to exercise every-day and follow a routine even if it is for 15-30 minutes. Your body needs to burn a certain number of calories per day to maintain good health, without sufficient physical activity, it can lead to chronic ailments which may consequently impact your sleep.

Avoid stimulants like alcohol, caffeine, nicotine
Alcohol and nicotine can interrupt with the normal breathing patterns, making you have a disturbed sleep. Coffee in small amounts will not do much harm, but excessive amounts of caffeine will over-stimulate your system and make it difficult for you to fall asleep. It is best to avoid all the above four hours before you go to bed. More serious breathing disorders such as sleep apnoea can have a serious affect on the quality of sleep which will require medical intervention.

If you follow the above tips in your daily routine, your chances of achieving restful sleep will improve. If your sleep difficulties do not improve through this, it is adviced to consult your physician or a sleep specialist.

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For an increasing number of Covid-positive patients undergoing treatment in city hospitals, the disease has brought the added baggage of anxiety and insomnia. Prolonged treatment, loneliness and the social stigma attached to the disease are giving them sleepless nights. The anxiety has aggravated their existing illnesses and mental health conditions, if any, prompting experts to call for an urgent need to include mental health management in the Covid-19 treatment protocol. The city has already seen three suicides among Covid positive patients.
A doctor at Seven Hills Hospital said blood pressure and blood sugar levels in many comorbid patients have shot up. “Many are complaining of sleep deprivation. Patients seek attention by asking doctors to check their symptoms at regular intervals. There is also fear among the healthcare workers, who are being extra cautious in handling patients. This, too, is adding to the patients’ angst,” said the doctor.

Though patients with existing mental health conditions are being attended to via phone calls, a regular mental health check-up would help all patients. “Patients have access to information. They read about Covid-19 deaths going up every day. Many fear death, which is natural. Since many are in isolation wards, they feel lonely,” said another doctor.

Consulting chest physician VA Sajit Babu said symptomatic patients get worked up waiting for test results. “Testing positive itself comes as a shock to patients and their families. Thereafter, getting a bed in a hospital adds to their trauma. Unlike other illnesses where relatives and friends boost a patient’s morale, covid patients have to stay in isolation wards. Many fear being socially boycotted once they are discharged,” he said.

Psychiatrist Dr Harish Shetty said, “Besides the fear of the disease, people are worried if their housing societies will accept them or if they will end up infecting their loved ones. The biggest fear is that of death,” he said. He rued the lack of a mental health expert in the state task force. “The battle is not just between life and death. It’s also about giving confidence to those on the frontline,” he said, adding Covid warriors such as doctors and nurses must be debriefed.

Interestingly, Sion Hospital doctors believe the psychiatric morbidity of Covid-19 is not as high as they expected it to be. “Patients who came in the initial stages of the outbreak were more anxious. We have had patients becoming violent at the very mention of Kasturba Hospital. But that’s not the situation anymore,” said Dr Nilesh Shah, adding he saw mental health issues in less than 1% patients. “Patients who are not as aware about the disease are calmer compared to those who have read a lot,” he said.

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Strange dreams, insomnia, overall restlessness. While sleep problems like these have long been an issue in the United States, the impact of the coronavirus pandemic may be exacerbating pre-existing sleep disorders – especially among women, who are more likely than men to suffer from insomnia and other sleep-related issues.

How can women maintain a quality sleeping pattern? Dr. Kanta Velamuri, a sleep medicine expert at Baylor College of Medicine, discusses the importance of sleep, and shares tips for healthy sleep.

Q: What is the relationship between sleep and overall health?
A: Sleep is an integral part of health and well-being. It is a basic biological requirement along with food, water and air. As English dramatis Thomas Dekker elegantly stated: “Sleep is that golden chain that ties health and our bodies together.”

Inadequate quantity and quality of sleep due to sleep restriction or disorders lead to numerous adverse impacts, including cardiovascular, metabolic, neurologic, mental, immunologic health, as well as on human performance and mortality.

Q: What are the risk factors for sleep disorders like insomnia? Why are women disproportionately impacted?
A: Many factors account for this, including hormonal and non-hormonal factors such as presence of anxiety and depression, and social factors such as childcare responsibilities. 

Many women who suffer from pre-menstrual syndrome or pre-menstrual dysmorphic disorder report trouble sleeping with complaints of difficulty falling asleep, frequent awakenings, and non-restorative sleep. Thirty percent of pregnant women and 42% of postpartum women also report insomnia and restless sleep.

Q: How is the COVID-19 pandemic impacting our sleep patterns?
A: The pandemic has led to changes in the normal day-to-day routine for many people. There is an increased burden of balancing work and home-schooling of children. Sleep patterns have shifted with more people tending to stay awake later and waking up later.

Stress levels are increased due to uncertainty, as well as due to illness and loss. Stress is a major factor in sleep problems. For people who already had insomnia prior to COVID-19, a major stressor like the pandemic can lead to post-traumatic stress disorder (PTSD), which can then lead to worsening sleep quality.

A study of Wuhan residents showed that up to 7% of the population reported symptoms of PTSD, and women were disproportionately impacted by these symptoms. The risk was higher in those following COVID-19 news updates for more than three hours a day.

Isolation can also lead to detrimental effects. Previous studies that looked at sleep during quarantine showed younger women were more at risk for negative psychological impacts. However, these studies were of a shorter duration and the effect of this pandemic on sleep is still being studied.

Q: Are quality and quantity of sleep equally important?
A: Both the quantity and quality of sleep are important. The recommended quantity of sleep during a 24 hour period for an adult is 7-8 hours. Both inadequate sleep and excessive sleep are detrimental to health.

Good quality sleep results in sleep satisfaction, which is a subjective evaluation of how satisfied a person is with their sleep. Usually, people feel refreshed upon awakening if they have slept an adequate number of hours and have had a good quality sleep (e.g. how long it took to fall asleep, number of awakenings in the night, condition of sleep).

Q: For women who are balancing priorities, such as work and childcare, what are some things they can do to get healthier sleep?
A: The increased burden of work, childcare, and housework, which is mainly falling on women, can cause women to neglect their own sleep. Here’s some advice to keep in mind:

• It is important to have regular bedtimes and wake times, ensuring adequate quantity of sleep.
• Avoid naps during the day.
• Turn off electronics and bright lights at night. Do not work, watch TV or use devices or tablets while in bed.
• Bedtime rituals such as reading and bath time help initiate sleep.
• Exercising helps promote good sleep – but do not exercise just before bedtime.
• Avoid caffeine late in the day.

Q: Any advice for healthcare workers?
A: Many frontline healthcare workers are facing an increased amount of stress and anxiety. Additionally, many are having to work shifts that impair their usual sleep schedule. Frontline workers should:

• Use the available mental health resources to deal with anxiety and stress.
• Practice self-help activities such as meditation, yoga, and relaxation exercises. This can help improve stress levels after a shift.
• Schedule brief times during the day to de-stress and reflect. Talk to trusted colleagues about your concerns with work situations.
• Limit the time you are exposed to COVID-19 news that is not directly related to your institution.
• For those who are working unusual shifts, it is important to protect sleep during the daytime. Using ear-plugs, turning off the phone or placing it on do-not-disturb, and room-darkening shades are all strategies to ensure good daytime sleep.
• If possible, try to avoid using sleep medications to help you sleep.

Q: How can partners and loved ones help support healthier sleeping habits?
A: Take the time to help your partner de-stress by having quiet times to talk. You can also help support healthy sleeping habits by sharing in the workload of childcare, including bedtime, home-schooling, feeding and general care. Healthy sleeping patterns for the whole family are important in ensuring that women obtain healthy sleep as well.

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Perhaps memorizing these short Latin phrases will help combat your sleeplessness.

St. Francis de Sales admonished Christians who couldn’t abandon themselves to sleep … even though he himself was subject to the torments of insomnia. Yet, calling it a “blessing,” the good doctor of Annecy offered in his “rule of life” a proactive mystical program to render it up to God. Here’s his authoritative prescription to avoid sleeping pills.

Do you suffer from broken sleep?

If you wake up in the middle of the night, remember this advice: “I awaken my troubled heart with these words: Media nocte clamor — at the stroke of midnight, a voice cries out, ‘Behold, the bridegroom comes, go out to meet him.’”

And if insomnia continues?

You can’t manage to get back to sleep? Follow this advice: “I try again to rouse myself with these words of the Prophet: In noctibus extolite manus vestras in sancta: Raise and stretch out your hands toward heaven, and bless the Lord.”

What if a sudden fright wakes you?

What if a sudden fright wakes you? Is your sleep disturbed by nightmares? Follow his example: “I deliver myself up to thoughts of my guardian angel, saying: Dominus a dextris est mihi ne commovear: My Lord is by my right hand; I fear nothing.”

And if that still doesn’t work?

You still can’t sleep? Here’s the right attitude to take: “I remind myself of this verse: Scuto circumdabit te: The shield of faith and firm trust will protect me; that is why I fear nothing.”

Following this treatment, you should at last get to sleep. And that’s when the alarm goes off and you’re off on another daily round of activities. Here are some words of St. Francis de Sales to meditate on to ensure a good day: “Let us think only of spending the present day well. Then when tomorrow shall have come, it will be today, and then we will think about it.”

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Turn your bedroom into a “sleep sanctuary,” consider buying a white noise machine, and stop checking your phone before bed.

On a recent FaceTime call, my friend Jon told me that he hadn’t had a satisfyingly restful night of sleep since March, before the stay-at-home orders and the wave of coronavirus cases hit the US. He’s taken sleeping aids, exercised before bed, and listened to ASMR videos but to no avail; he couldn’t manage to turn his brain off until 2 or 3 am on most nights.

Jon isn’t alone in his sleeplessness. While many people have anecdotally reported having startlingly vivid dreams in quarantine, some are struggling with what feels like incurable insomnia, whether that manifests as difficulty falling asleep, trouble staying asleep through the night, or waking up too early.

A survey of nearly 1,000 people by SleepHelp.org found that 22 percent of responders have had poorer quality sleep due to the pandemic, and a third said their sleep troubles stemmed from the news coverage they consumed. In China, health care workers were reportedly prone to sleeplessness and experienced feelings of depression, anxiousness, and stress-based trauma. The coronavirus, it seems, has conjured up “a perfect storm of sleep problems,” according to one Stanford sleep researcher.

In pre-pandemic times, about 30 to 35 percent of adults suffer from insomnia, and most are short-term conditions that can be resolved without professional help. (Medical professionals and sleep experts generally recommend about seven to nine hours of sleep each night.) The inability to fall asleep can be frustrating, especially in the midst of a pandemic with no end in sight. If you’re an insomniac, you’ve probably spent at least one night Googling something along the lines of “How to fall asleep” instead of actually falling asleep.

I spoke to Bill Fish, a certified sleep specialist and managing editor at SleepFoundation.org, about those struggling with sleep and lifestyle changes. Here is his best advice to achieve more restful nights.

How has staying inside affected our sleep patterns?

It’s interesting to see a progression of the pandemic from a mental health and sleep perspective. Within the first three weeks, starting in early to mid-March, there wasn’t a lot of talk about sleep, but as we got into the stay-at-home orders for two to three weeks, people have really started to notice they weren’t sleeping as well and have had trouble sleeping. There are all kinds of factors at play that cause insomnia in people. For those of us who are fortunate to be working from home, we’ve lost the structure of our daily lives. We don’t have an external reality, so to speak.

What a lot of people have started doing, instead of going to bed at 10:30 and getting up at 6:30, there’s no longer a big motivator to get up at 6:30. While that can be good to some extent, at the end of the day, all adults should be getting between seven to nine hours of sleep on a nightly basis.

If you’re getting any more than that, you could wake up feeling lethargic and not really yourself. Our bodies have become trained to know and prepare for the sleep process. With more people staying up at night and sleeping later in the morning, their bodies after about two to three weeks have redialed, and that doesn’t even take into consideration the health and the financial stress the pandemic has caused.

What tips do you have for people struggling with insomnia?

My biggest thing is schedule — encouraging someone to get back to a sense of normalcy. I have two sons who just want to stay up all night and play video games because they can’t see their friends. I have to explain to them that it’s not healthy for them to stay up. If your body is used to you waking up early, consider adopting that habit again. All of us, and our bodies, are trying to figure out what this “new normal” is, and what I push for is to try and do everything you can to get back to your old bedtime. If you’ve messed up your sleep pattern, I’d recommend trying to change it in increments of 10 or 15 minutes a night until you get back to where you were before.

At one point, kids are going to go back to school and people are going to go back to work, so we can train our bodies by the repetition of going to sleep at the same time and waking up at the same time. It might not cure all insomnia, but it’ll give you a better chance of success.

That’s why I suggest not watching television or scrolling on your phone in your bed. It’s about creating that separation in your waking and sleeping environments between sleep, leisure, and work that’s now occurring in the same building. It’s hard, though. Even my wife does it; she sits with her headphones on and watches a show in bed.

Can you explain how a lack of sleep affects a person’s immunity?

Sleep is considered the third pillar of wellness along with diet and exercise. Those are the three most important factors to keep us healthy. When we get ready to sleep, our body produces melatonin, which causes us to tire. When we aren’t getting that full night of sleep, our immune system isn’t producing as much of an effective response to fight against other infections or viruses. We really want people to get those seven to nine hours of sleep to stay as healthy as they can.

What tips do you have to improve a person’s quality of sleep, not just the duration of sleep?

I’m a believer that people should turn their bedrooms into a sleep sanctuary. Create a separation of your bedroom from the rest of your life. Set up your bedroom so that it’s intended for sleep. Clean up around your sleeping area, since your mind might race if there’s clutter in the room. Consider charging your phone in another room, and don’t watch television before bed.

Give yourself at least 45 minutes away from screens before you go to bed, so maybe read a book or keep a journal — just something to allow your mind to calm down before bed. Make sure that your room is cool and that it’s as dark as possible. I’m a fan of a white noise machine; you can buy it online for $20 and plug it in beside your bed to create a steady stream of white noise, which can mask any external sound that might jolt you out of sleep. The machine can help you stay in sleep and help you feel more refreshed when you wake up in the morning.

Since more people are staying home and, as a result, are more sedentary, how does that affect our sleep?

The key is to get 30 minutes of some form of cardio movement or even just walking. The human body is not meant to sit at a desk all day. Think about it like how a dog needs to be walked every day. We have to get this energy out of our bodies so we are physically tired by the time we get to bed each night.

I do get the question a lot of when you should be exercising, and there are a bunch of studies, but none of them are really conclusive as to what point of the day you should be exercising. You should have your body temperature back to normal, and not be out of breath at least 45 minutes before bed. It doesn’t make sense to run a few miles right before your bedtime.

Are there certain foods or substances like caffeine that might affect a person’s sleep?

You shouldn’t have any caffeine at least three to four hours before bed so it’s out of your system, and really, you shouldn’t be eating anything within an hour of going to bed because your body needs to digest your food and makes it more difficult for you to fall asleep. Eating spicy foods that could possibly cause indigestion doesn’t make a lot of sense. I would stay away from caffeine, and I’ve read a lot of stories that people are drinking more during the pandemic. That’s really not good for your sleep. While alcohol might help you get to sleep a little quicker, the quality of sleep you want, as the alcohol leaves your system, a lot of people tend to wake up in the middle of the night.

As the pandemic becomes the “new normal,” how do you think it will affect our sleeping habits?

It gives us the opportunity to get the recommended amount of sleep. The vast majority of people have a commute, and they used to spend a lot of time in the car, in the subway, or on a train. Now that’s gone. While we will go back to work eventually, we don’t know how quickly that’ll be and whether it’ll be five days a week or less. It takes away the excuse of saying, “Well, I don’t have the ability to get eight hours of sleep a night.”

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Having trouble to have a good night’s sleep? If yes, then read below to find out how some food items can help regulate your sleep patterns and help you to sleep well at night.

Are you someone who plans to sleep early every night, but are awake till 2 am? Do you feel sleepy throughout the day, but when it comes to bedtime, you are wake as an owl? If yes, then we know how you feel. Not getting enough sleep not only makes your next day less productive, but it also makes you cranky, angry and you tend to feel more hungry.

Enjoying a good night’s sleep is important for overall health, and it helps maintain mental stability and lower stress levels. And if you are planning to do something about it for a while, then don’t worry we’ve got you covered with this one. Read below to find out how these food items can help you sleep well naturally. These food items help in the production of hormones like melatonin and cortisol that are responsible for defining the body’s sleep habits and patterns.

Cheese:

Good news for all you cheese lovers, since cheese can contribute to a good night’s sleep. It is so because cheese is an excellent source of calcium, which is also known to release serotonin. So if you are having trouble sleeping, include more cheese in your diet, and it will increase serotonin production for battling insomnia!

Chamomile tea:

Chamomile tea is one of the best remedies for good night sleep. It contains a compound called apigenin that has sleep-inducing properties. It also boosts the immunity levels and keeps health in check.

Almonds:

Almonds are packed with magnesium and calcium, which help relax the brain and body muscles. Consuming a handful of almonds daily can help regularise sleep patterns, as it helps provide a high dose of melatonin, correcting the sleeping and waking up timings. 

Cherries:

Cherries contain melatonin, a chemical that controls the body’s internal clock to regulate sleep. They can be consumed in the form of juice or just as a fruit. Eat a handful of them an hour before bedtime to get a good night’s sleep. 

Warm milk:

This remedy is known to all. Research suggests that milk contains the amino acid L-tryptophan, which turns to 5-HTP and releases relaxing serotonin. It’s also high in calcium and other minerals, known to have a relaxing effect.

Bananas:

Bananas are packed with potassium and magnesium, which are known as muscle relaxers. They also contain the amino acid L-tryptophan, which gets converted to 5-HTP in the brain. The 5-HTP is converted to serotonin, which is a relaxing neurotransmitter.

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Simple lifestyle choices can enhance mental health

Because of widespread unemployment and the closing of mental health clinics due to the pandemic, millions of individuals struggling with anxiety, depression, and insomnia do not have access to, or cannot afford psychotherapy or medications. These circumstances may continue for months or even years, depending on how soon effective antivirals and vaccines become available. This post is offered as a concise review of the mental health benefits of lifestyle changes for depressed mood, anxiety, and insomnia, including changes in diet, regular exercise, improved sleep, and a daily mindfulness practice.

Diet

Individuals who consume whole foods (as opposed to processed foods and fast food diets) are at reduced risk of developing depressed mood. For example, individuals who closely adhere to a Mediterranean diet, as well as traditional diets in Norway, Japan, and China, which are rich in vegetables and fish, have a 30% lower risk of developing depressed mood than those with the lowest rate of adherence to a Mediterranean diet.

Twelve essential nutrients have established mood-enhancing benefits. These are: folate, iron, long-chain omega-3 fatty acids (EPA, DHA), magnesium, potassium, selenium, thiamine, vitamin A, vitamin B6, vitamin B12, vitamin C, and zinc (LaChance and Ramsey 2018). Foods with the greatest antidepressant benefits include seafood, leafy greens, and cruciferous vegetables such as broccoli, cauliflower, cabbage, kale, and Brussels sprouts.

Some depressed individuals are deficient in certain B vitamins, omega-3 fatty acids, vitamin D, zinc, and magnesium. Foods rich in folate and B-12 such as whole grains and green leafy vegetables may be especially beneficial for depressed mood. Omega-3s and some B vitamins also have anti-inflammatory and neuroprotective effects on the body and brain, which are believed to enhance their antidepressant benefits. Diet also plays an important role in anxiety. For example, generalized anxiety is often associated with reactive hypoglycemia, resulting in acute anxiety symptoms. Individuals who have anxiety caused by hypoglycemia benefit from reducing sugar and carbohydrate intake, increasing protein intake, and reducing or eliminating caffeine. Excessive consumption of caffeine is also associated with an increased risk of anxiety. Many chronically anxious individuals report significant reductions in the severity of anxiety when they abstain from caffeine.

Finally, recent research findings show that the microbiome—i.e., the microorganisms that naturally populate the large and small intestines—causes beneficial changes in brain levels of serotonin and other neurotransmitters implicated in mood regulation. Research studies suggest that there is a link between imbalances in bowel microflora, increased inflammation of the mucosal lining of the intestines, and systemic immune dysregulation resulting in an increased risk of depressed mood. Findings of animal and human clinical trials suggest that probiotics have beneficial effects on both depressed mood and anxiety.

Exercise

Short-term and long-term beneficial effects of exercise on mood are mediated by increased brain levels of mood-elevating endorphins, dopamine, norepinephrine, and serotonin (Schuch 2016). Regular exercise may also promote increased neuroplasticity in certain brain regions, resulting in improved mood (Gourgouvelis 2017). 

Regular exercise including both aerobic exercise and non-aerobic strengthening exercise has established anti-depressant effects and less sedentary individuals have a reduced risk of both depressed mood and cardiovascular disease (Schuch 2017). Chronically depressed individuals often experience difficulties with thinking and memory, and regular aerobic exercise can significantly improve cognitive functioning in this population (Oertel-Knochel 2014). A meta-analysis of controlled studies on exercise used either as a single intervention or in combination with antidepressants found that regular exercise has beneficial effects on depressed mood (Kvam 2016). A systematic review of studies on exercise as an add-on therapy to antidepressants found that depressed individuals who exercise regularly have better response rates compared to individuals who take an antidepressant only (Mura 2014). Antidepressants and exercise probably have equivalent efficacy against moderately severe depressed mood (Blumenthal 2007).

Regular exercise improves sleep quality in depressed individuals who do not respond to antidepressants (Rethorst 2013). Improved sleep enhances resilience and day to day functioning because of the high prevalence rate of insomnia in chronically depressed individuals. In addition to its mood-enhancing and anxiety-reducing effects, regular exercise enhances self-sufficiency.

Both aerobic exercise and strength training improve anxiety when done on a regular basis (Paluska 2000). A daily workout lasting 20 to 30 minutes can significantly reduce generalized anxiety and may also reduce the intensity and frequency of panic attacks.   

Relaxation, mindfulness and mind-body practices

Relaxation techniques include sustained deep breathing, listening to calming music, and progressive muscle relaxation. Examples of mindfulness training include different styles of meditation and guided imagery. Mind-body practices include taijiquan, qigong, yoga, and other approaches that involve both the mind and the body. A regular meditation or mind-body practice such as yoga, may be as effective as antidepressants and cognitive behavioral therapy (CBT) for moderately severe depressed mood.

Relaxation techniques and mind-body practices also improve sleep quality in individuals with insomnia. Progressive muscle relaxation and sustained deep breathing are especially effective at reducing the time needed to fall asleep in individuals with chronic insomnia. Listening to relaxing music soon before bedtime can also help individuals with insomnia fall asleep quicker. Many individuals who have problems falling asleep because of chronic worrying report improved sleep with guided imagery. Individuals with chronic insomnia who use a cognitive-behavioral technique alone or in combination with a benzodiazepine or other sedative-hypnotic drug report that non-pharmacologic or combined approaches are more effective than medications alone.

Supportive relationships

Finally, I want to emphasize the importance of relationships. In addition to engaging in healthy lifestyle choices, supportive relationships with friends and family members can provide important buffers to day to day stresses and uncertainties that we will all face at this time of great uncertainty. Video calls or phone calls can be very heartening and encouraging even when shelter-in-place orders restrict us from direct contact with family, friends, and loved ones.

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