How to Regain Control of Your Sleep

Before the COVID-19 pandemic, Dr. Hunter Spotts, assistant professor of family medicine and community health and medical director of student health at Duke, has a stable sleep routine.

After relaxing with a little TV at the end of the day, Spotts went to bed around 9 p.m., read a book and soon fell asleep. This left him rested enough for a morning run around 5am before going to work.

But during the pandemic, Spotts’ work landscape changed as he played a key role in organizing and running contact tracing, isolation and quarantine programs for students.

“It became a seven-day-a-week job for a couple of years,” Spotts said. “There was a lot of stress, and there was a lot going on early in the morning and late at night.”

Like many others, the COVID-19 pandemic affected Spott’s ability to get enough sleep. A 2022 study using data from 49 countries concluded that four in 10 people reported having trouble sleeping during the pandemic.

“We’ve seen a lot more people struggling to sleep because of the fear of the pandemic,” said Dr. Sushrusha Arjyal, assistant professor in the Department of Psychiatry and Behavioral Sciences and Department of Neurology, which treats patients with sleep disorders. “Fear is the enemy of sleep.”

The Centers for Disease Control and Prevention (CDC) recommends that adults get at least seven hours of sleep each night. However, she acknowledges that more than a third of adults report not meeting this goal, which can put them at greater risk of developing high blood pressure, type 2 diabetes and obesity.

Meanwhile, getting the recommended amount of sleep can also improve mental function and well-being.

If you’re among the millions of Americans who struggle with sleep problems, Dr. Arjyal, three things to keep in mind.

Think about your sleep hygiene

For the past several years, Angela Rice-Warren, a Duke Cancer Institute education and training coordinator, has stuck to a bedtime routine that has helped her get more than seven hours of sleep a night.

Inspired by the Three Good Things well-being program offered by Duke Healthcare Safety and Quality, Rice-Warren set a reminder on her phone every night at 9 p.m. to pause and write down three positive developments from that day. After that, she begins her nightly routine to prepare for bed.

“It was such a good habit for me,” Rice-Warren said. “It gives me a trigger that tells me it’s time to calm down and get ready for bed.”

Bedtime routines like these are part of what sleep experts call “sleep hygiene,” or the steps we can take to create the right environment and attitude for falling asleep. For many who struggle with sleep problems, simply improving their sleep hygiene by establishing a bedtime routine and being more concerned about the conditions in their bedroom can go a long way.

dr Sushrusha Arjyal said helpful parts of sleep hygiene include sticking to a regular bedtime and waking time, avoiding naps during the day, reducing caffeine and alcohol intake in the evening, and keeping a bedroom cool and dark. She said it’s important to avoid using electronics – which includes watching TV or reading on the phone – in bed.

“The key is not spending time in your bed when you’re not sleeping,” Arjyal said. “The idea is to create an environment that is conducive to sleep.”

Don’t stress

Regardless of the sleeping environment, there will inevitably be times when we lie awake in bed and are unable to fall asleep. For those moments, said Dr. Sushrusha Arjyal, it is important to relax and realize that these situations are probably not as bad as they seem.

dr Arjyal said it’s common to go to bed and not be able to fall asleep right away. It usually takes 20-30 minutes to fall asleep. Likewise, she said, people typically wake up once in the middle of the night and sometimes can’t get back to sleep quickly. While these might seem like signs of a sleep problem, Arjyal said that in most cases they’re often fairly harmless and don’t last as long as we think. Typically, people fall asleep again within about half an hour, she said.

“If it happens,” said Arjyal. “You have to get up and walk around or go somewhere and read a book, that’s fine. You’ll probably fall asleep again. In general, people are very concerned about how long it takes to fall asleep. We have to avoid that in order to sleep well, which is kind of paradoxical.”

When to get help

Rice-Warren served as a Patient Experience Instructor for Duke Private Diagnostic Clinic for several years, a role that often required her to visit clinics far from her Roxboro home for early morning training sessions. During that time, Rice-Warren said she struggled to get enough sleep consistently.

Around the time she transitioned to her role at Duke Cancer Institute, and with the COVID-19 pandemic making her job remote, she turned to her GP for advice on how to get better sleep. Her doctor recommended spending more time outdoors to support her circadian rhythm, sticking to her bedtime routine, and occasionally taking melatonin — a dietary supplement that can help with sleep problems — when needed.

“When you haven’t slept enough, you make more mistakes, become harsh with people, and just feel bad,” said Rice-Warren, who is now getting the recommended amount of sleep. “Sleep is so crucial that this is how your body heals.”

When it comes to determining if you have a sleep problem that requires professional help, Dr. Sushrusha Arjyal that it has as much to do with what happens during the day as it has to do with what happens at night. If you’re consistently falling short of the recommended amount of sleep and you feel tired or lack focus throughout the day, it may be wise to speak to a doctor or sleep specialist who can review your behavior or medical resources that can find the cause and possible solutions to sleep problems be able.

“If you feel like you have good sleep hygiene and you’re still having trouble sleeping so badly that your daytime functioning is affected, it may be time to seek the help of a doctor or specialist,” Arjyal said.

Submit story ideas, shoutouts, and photos through our story idea form or email [email protected].