We are all spending most of our time indoors since the lockdown began and now with things moving slowly towards opening, we still need to review sleep. Although these trying times have brought about a significant change in our lives, we are still spending one third of that time doing exactly what we have always done -sleeping.

In our clinical practice over the last two months, we have come across more and more patients who we initially thought had a sleep disorder and now with an increase in their sleep duration we have realized that their symptoms were sleep deprivation related.

Roughly 1/3 of the general population in the United States and Canada suffers from sleep deprivation. This may not necessarily reflect the proportion of sleep deprived people in India but I would assume that we would not be far from this number either. Our lives are getting busier with time, some if it due to increased work or school load, increase stress,  lifestyle changes e.g. with the reliance on electronics and technology.

We often see adults sleeping late after their children have gone to sleep stating they need "me time" and they will sacrifice sleep time to get this. Children and young people in school and university are staying up longer in the evening, compromising on their sleep duration and then waking up earlier to reach school on time.

An average adult requires between 7 to 9 hours of sleep time through 24 hours and for children it is longer. Infants can need upto 16 to 18 hours or sleep, older children 10 to 12 hours and adolescents 8 to 10 hours. The individual needs vary from person and the above is an average.

Sleep deprivation and over sleeping are both associated with increased risk of physical and mental health problems. Individuals who sleep less or more than their requirement are likely to live shorter and unhealthier lives.

During the lockdown, more and more people are catching up on their sleep. This can be seen as an advantage that may have come out of the closures. Utilizing this time to not only catch up on sleep deprivation but also to recognize how much sleep we actually need during a 24 hour period is a useful health improvement task that one can take on. When one is sleep deprived for months or years, it can take several weeks of sleeping regular and sufficient hours to pay off the "sleep loan" or "sleep debt" that we have piled up with interest over the years. Now that we are in to the 8th week of the lockdown, many of us are closing in on paying off our sleep debt. For those who have not yet done this, it is perhaps time to start paying of this debt.

The aim here is not to sleep 12 to 14 hours a day or just lay in bed trying to sleep. The aim is to sleep the required amount that makes us feel refreshed on waking up and not lazy or drowsy on waking up. The latter can happen if we sleep more or less than what we need. An extra 30 to 60 min of sleep every day on top of our average requirement is likely to pay off the 'sleep loan' in 4 to 6 weeks. After that we should not over pay it by continuing to sleep extra hours  ut rather sleep the hours our body requires.

Look back at your sleep duration over the last 8 weeks and average it out to come to a rough calculation of how much sleep you need per day and going forward try and provide this sleep opportunity to yourself regularly everyday once life gets back to normal.

AASM Sleep Diary

Use a sleep diary to track your sleep. Examples of these can be acquired online by searching 'sleep diary'. A commonly used one is the "AASM sleep diary" which is a pdf sheet that covers two weeks. Keeping this diary for 2 weeks and calculating the total hours slept divided by 14 will give you a mean sleep time. The sleep diary should be kept everyday covering the last 24 hours and can be completed in a few minutes allocated to this task during the day.  Do it with your family members so that each person has their own diary and is tracking their own sleep. Again it is only meaningful if you have been catching up on your sleep. This takes me to another important suggestion.

While we are confined in our homes, we may find that we are delaying our sleep onset at night and slowly shifting from say 11 pm usual bedtime to a much later 1am or 2 am and as a result waking up later in the morning. This should be actively avoided. We are at greater risk of this happening as the social cues (or entrainers of our body clock) are missing from our lives. Light is the strongest natural entrainer of our body clock (examples of our body clock include the 24 hours sleep-wake pattern that runs in sync with rotation of the earth at 24 hours). We nay be getting less light exposure as we are spending more time indoors. Other cues include meal times, school and work times, etc which have become slightly obsolete due to the lockdown. Hence reduced exposure to light, absence of other entertainers such as fixed work times will lead to is getting off track from our own body clocks and we have to actively keep things on track. This can be done by keeping your sleep diary and trying regular sleep wake times, keeping meal times in order, keeping a structure through the day that mimics structure on a typical work day but allows you to catch up on your sleep as well. Aim towards keeping it the same through the weekdays and weekends unlike we would on a typical work week where we would sleep much longer on weekends and less on weekdays.

Sleep related illness

This is also the time to assess whether one has a sleep related illness. If you are getting enough sleep and yet feel untested on waking up could he a simple sign that your sleep is disturbed for some other reason. Sleep disorders can include sleep apnea (breathing difficulties in sleep often presenting as heavy snoring), restless leg syndrome (discomfort in your calves in evenings which then affects your sleep), parasomnia (abnormal behaviours in sleep such as talking or walking in sleep) amongst many. 

On the other hand, one may find that they are struggling to fall asleep, staytl asleep or wake up earlier than usual despite trying hard to sleep. This is often a symptom of insomnia disorder, a very common condition. These problems are also likely to occur as there is greater stress in life due to loss of incomes, closure of business, breakdown in social interaction, confinement in homes, familial stressors getting more intense due to everybody being spending more time with each other etc. 

If one finds that they are experiencing the above difficulties, they should reach out to their healthcare provider such as their doctor if usual home remedies are not helping. 

Relaxation, prayer, eating  a healthy diet, regular exercise (preferably in the morning), yoga and meditation, listening to relaxing music are all stressful management strategies that can be very helpful and conducive for good sleep. 

During this lockdown; aim towards paying of your sleep loan if not your house or car loan, regularize your sleep wake schedule, and stay in tune with your body clock, take time to study your own sleep quality and identify if you need help or whether you are sleeping well, introduce good lifestyle habits including taking out time for yourself, eating healthy and working out.

Lets make the most of what is left of this lockdown rather than letting it take over our sanity! With good sleep.