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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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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