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Strategies to promote better sleep in these uncertain times

These are unprecedented times. Given the real and tangible threat of the coronavirus pandemic on personal, community, and societal levels, it is normal to experience anxiety and sleep problems. Sleep is a reversible state marked by a loss of consciousness to our surroundings, and as members of the animal kingdom, our brains have evolved to respond to dangers by increasing vigilance and attention — in other words, our brains are protecting us, and by doing so it’s harder for us to ignore our surroundings.

Despite the threat of the coronavirus and its rapid and pervasive disruption to our daily lives, many of us are an in a position to control our behaviors and dampen the impact of the emerging pandemic on our sleep. Cultivating healthy sleep is important; better sleep enables us to navigate stressful times better in the short term, lowers our chance of developing persistent sleep problems in the longer term, and gives our immune system a boost.

Daytime tips to help with sleep

  • Keep a consistent routine. Get up at the same time every day of the week. A regular wake time helps to set your body’s natural clock (circadian rhythm, one of the main ways our bodies regulate sleep). In addition to sleep, stick to a regular schedule for meals, exercise, and other activities. This may be a different schedule than you are used to, and that is okay. Pay attention to your body’s cues and find a rhythm that works for you and that you can maintain during this “new normal.”  Make this a priority for all members of your household.
  • Get morning light. Get up, get out of bed, and get some light. Light is the main controller of the natural body clock, and regular exposure to light in the morning helps to set the body’s clock each day. Natural sunlight is best, as even cloudy days provide over double the light intensity of indoor lighting. If you are living in an area with shelter-in-place, try to expose yourself to natural light by stepping outside, at a distance from others, for at least 20 minutes.
  • Exercise during the day helps improve your sleep quality at night, reduces stress, and improves mood. Fit in exercise as best as you can. If you need to go outside for exercise, maintain proper social distancing at least six feet away from others. Avoid any group exercise activities, especially contact sports. Many gyms and yoga studios are now “at home” and offering virtual programs at low or no cost.
  • Don’t use your bed as an escape. While the gravity of the pandemic certainly makes us all tired, try not to spend too much time in bed during the day, especially if you are having trouble sleeping at night. If you must take a nap, try to keep it short — less than 30 minutes.
  • Avoid caffeine late in the day.
  • Helping others may help with feelings of uncertainty or unease. Even if you do not work in an “essential” industry, your role in maintaining physical distance is critical in our fight against coronavirus. If you would like to be more actively involved in helping people, seek out ways to contribute your skills, donate money, or leverage your social capacity locally, such as providing virtual social connection to your loved ones by checking in on elderly family members or a friend, or providing in-kind donations. Doing altruistic acts may provide a sense of purpose, reduce helplessness, and alleviate some of the uncertainty contributing to sleep problems.

Nighttime tips to help with sleep

  • Prepare for bedtime by having a news and electronic device blackout. Avoid the news and ALL electronics at least one hour before bedtime. Avoid the news and ALL electronics at least one hour before bedtime. (Yes, it’s so important, I am saying this twice!) The nonstop news cycle seldom provides new information in the evening hours that you can’t wait until morning to hear, and will likely stimulate your mind or incite fear, making it harder to fall and stay asleep. Remind yourself by setting a timer or putting your television on the sleep setting. Make a pact with your family members to respect these parameters.
  • Cell phones, tablets, and all electronic devices make it harder for your brain to turn off, and the light (even dim light) from devices may delay the release of the hormone melatonin, interfering with your body clock. If you need something to watch to help you unwind, watching something that you find relaxing on TV from far away and outside the bedroom is likely okay for a limited time. You can also curl up with a book or listen to music.
  • Minimize alcohol intake. While alcohol can help people fall asleep, it leads to more sleep problems at night.
  • Set a regular bedtime. There are certain times at night that your body will be able to sleep better than others. If you feel sleepy but your brain is busy thinking, it can’t shut off and go to sleep. It may be helpful to sit down with a pen and paper in the evening and write down the things that worry you; you can review this list in the morning and attend to any important concerns. If you have a bed partner, enlist their support to helping you stick to your schedule.
  • Reduce stress. The evening and bedtime hours are also a good time to perform some relaxation techniques, such as slow breathing or yoga. There are many free resources available for bedtime meditation.
  • Create a comfortable sleep environment, a place that is cool, dark, and quiet.
  • Don’t spend too much time in bed during the night (or the daytime). Minimize spending time in bed in which you are not sleeping. If you are having trouble going to sleep or staying asleep, don’t stay in bed for more than 20 minutes. Get out of bed and do a quiet activity — read a book, journal, or fold some laundry.

What if I am doing all these things and I still can’t sleep?

This may be a sign that you have a clinical sleep problem, such as insomnia disorder or sleep apnea. If you are doing all the right things, and still have trouble falling or staying asleep, you should discuss your sleep problems with your doctor.

What if I have been diagnosed with a sleep disorder?

If you have a history of insomnia and take sleep medications and can’t sleep, contact your doctor for medical advice, including questions about making changes in your medication. Many doctors are doing virtual visits now and they can review your current sleep problems and changes to management. You can also consider online programs for insomnia, such as Sleepio.

If you have obstructive sleep apnea you can check out the American Academy of Sleep Medicine guidelines for COVID-19-related questions.

Remember, don’t stress out about sleep

Disrupted sleep is a normal response to stress, and it is okay to have a few nights of poor sleep as you adjust to new routines and big changes to your work and personal life. But with some simple measures you can preserve your sleep and improve your well-being during these uncertain times. We can’t control what’s happening in the world right now, but we can control our behaviors and dampen the impact of the emerging pandemic on our sleep.

The post Strategies to promote better sleep in these uncertain times appeared first on Harvard Health Blog.

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Thinning hair in women: Why it happens and what helps

Many people think of hair loss as a male problem, but it also affects at least a third of women. But unlike men, women typically experience thinning hair without going bald, and there can be a number of different underlying causes for the problem.

“Some are associated with inflammation in the body. Some are female-pattern hair loss,” says Dr. Deborah Scott, assistant professor of dermatology at Harvard Medical School and co-director of the Hair Loss Clinic at Brigham and Women’s Hospital. But the good news is that in many cases this hair loss can be stabilized with treatment, and it may be reversible. When it’s not, there are a number of new cosmetic approaches that can help.

Understanding hair loss

The first step in dealing with thinning hair is determining what’s happening inside your body that is causing those extra strands to cling to your shoulders and your brush. Some hair loss is normal. Everyone loses hair as part of the hair’s natural growth cycle, which occurs in three stages:

  • The anagen stage refers to when a hair strand is actively growing. This stage can last anywhere from two to eight years.
  • The catagen stage is a short transition phase that lasts up to three weeks. At this point the hair has stopped growing and is preparing to shed.
  • The telogen stage is the part of the hair cycle when the hair is expelled from the follicle (the structure that produces and holds the hair). After the hair sheds, the follicle then stays dormant, typically for around three months, before a new hair starts to sprout.

Normal hair loss is highly individual. Most people have a sense of how much hair is normal for them to lose. If you suddenly notice more hair than usual falling out, you’re shedding clumps of hair, or your hair seems to be visibly thinning, it may be a sign that something is amiss, says Dr. Scott.

Underlying causes for hair loss

Numerous problems can trigger female hair loss. Some are external, such as taking certain medications, frequently wearing hairstyles that pull the hair too tight, or even a stressful event such as surgery. In other cases, thinning hair is triggered by something going on inside the body — for instance, a thyroid problem, a shift in hormones, a recent pregnancy, or an inflammatory condition.

Hair loss may also be genetic. The most common genetic condition is known as female-pattern hair loss, or androgenic alopecia. Women with this condition might notice a widening of the part at the top of the head, often beginning when a woman is in her 40s or 50s. You might experience this if you inherit certain genes from one or both parents. Hormonal shifts that occur during menopause may also spur it.

Another trigger for hair loss in women is an inflammatory condition affecting the scalp. That might be eczema, psoriasis, or a condition called frontal fibrosing alopecia, which typically causes scarring and hair loss — sometimes permanent — at the front of the scalp above the forehead.

Other common causes of hair loss include overuse of damaging hair products, or tools such as dryers and other devices that heat the hair. Underlying illness, autoimmune conditions such as lupus, nutritional deficiencies, or hormonal imbalances may also cause hair to shed.

Medications to treat hair loss

Treatment depends on the underlying cause, says Dr. Scott. Sometimes simply addressing a medical condition prompting hair loss will be enough for the hair to regrow. In other instances, a woman might consider a medication like minoxidil (Rogaine), which helps with certain types of hair loss, or another treatment to replace or regrow lost hair.

A newer option being used to treat hair loss is platelet-rich plasma (PRP) injections. For this treatment, the doctor draws your blood, divides it into its separate components, recombines the blood fluid (plasma) with a high concentration of platelets (structures in the blood that help with clotting, among other functions), and introduces the resulting preparation back into the scalp.

“The science on this isn’t totally worked out. We still don’t completely understand the mechanism behind PRP, but growth factors contained in platelets can stimulate regeneration of hair follicles and other tissues as well,” says Dr. Scott.

In addition, low-level LED laser lights have been found to be helpful in regrowing hair in some cases. It’s likely that even more treatments will be developed in the near future.

Cosmetic options for hair loss

When medical treatments fall short, women can also consider cosmetic options to make up for lost hair, such as wearing a wig. At the other end of the spectrum is hair transplantation, a surgical procedure that moves active follicles from the back of the scalp to areas where the hair is thinning. Once transplanted, the hair grows normally.

Hair transplantation is typically performed as an outpatient surgical procedure. In appropriate patients, it can be extremely successful, but it won’t work for everyone, says Dr. Scott. One drawback is the expense: it can cost thousands of dollars and is not covered by insurance. The procedure also requires recovery time. And it may not be appropriate for women who have diffuse thinning across the whole scalp. It’s more effective in treating smaller, more defined areas of balding.

The post Thinning hair in women: Why it happens and what helps appeared first on Harvard Health Blog.

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Coping with the coronavirus pandemic for people with anxiety disorders

These days, we all have to accept the anxiety inherent in living in the time of the coronavirus pandemic and COVID-19. If there was a way to dispel all anxious feelings, I’d tell you, but there isn’t. The one exception might be someone who could summon such a degree of denial that they carry on as if everything was normal. And that, as I’m sure you can see, would prove to be very, very unwise.

Anxiety helps us prepare to respond in a more adaptive and healthy way. Some people find it possible to tolerate some degree of discomfort and can manage their anxiety in a healthy manner. Often that’s because some people have done well under this kind of challenge already, albeit in very different contexts. Life has a way of requiring this. Yet other people — particularly people who have anxiety disorders — may understandably be having a great deal of trouble coping.

How can I cope with the coronavirus outbreak if I have a pre-existing anxiety disorder?

Anxiety disorders take many forms and affect many people. So, what happens now if you’re someone who has suffered way too much already with a pre-existing anxiety disorder? For example, perhaps you have been, or could be, diagnosed with panic disorder, post-traumatic stress disorder (PTSD), or obsessive-compulsive disorder (OCD). Hopefully, you may find that the tips below will help you cope more successfully with what we are all facing together in these unprecedented times.

Seek support from a mental health professional

Talking to a mental health professional can bolster your ability to address present concerns, and help you clarify where your feelings are coming from, as explained below. When you’re feeling extra worried or overwhelmed, it could be that some of your feelings are from the present challenge and some are from challenges you have faced in the past.

Many psychotherapists and health plans are offering telehealth visits during this time. Ask your therapist or insurance plan if this is an option. More therapists than ever before are moving their practices online. If you search for therapists in your area, their websites may tell you whether they participate in telehealth. Additionally, some national telehealth apps offer therapy via video or audio chat.

Work toward separating out where your feelings are coming from

Doing this work can allow you to take a breath and divvy up the different emotional contributions that feed how you’re feeling.

  • Try saying this, for example: “Of course, I’m more concerned than (my roommate/my friend/my family), because I’m practiced at feeling anxious or helpless.”
  • The next step is to recognize that the percentage of feelings that stem from the past do not have to govern how you necessarily feel in the present. Try saying this out loud: “Well that was then, this is now.” A simple statement like this can actually open the door to some significant relief.
  • Gently remind yourself of this crucial separation, cleaving the past from the present. And kindly and reassuringly remind yourself that you have the resources — both internal and external — to manage your feelings and reactions in the now. This is crucially important.

Keep providing yourself with guidance

As often as you need to hear it, tell yourself the following: “I can manage. I can practice what I know to be helpful, and I know that in managing my feelings and reactions I can seek support from a few close friends. Further, I can seek the support of a mental health professional when needed. By combining these strategies, I will be able to settle my nerves in order to be able to make healthy choices.”

This kind of mantra bears repeating over and over. This is not “fake it till you make it.” This is believing in yourself and believing in a course of action that you can set in motion. Try to believe that, together with supportive others, this self-guidance and this plan will work for you. Know that in many instances, people who have known tremendous adversity and even trauma are able to demonstrate a strength forged from those circumstances. This is entirely consistent with human abilities.

Drawing on what you’ve learned can help you cope

We are wired for fight or flight. But as a colleague of mine noted, the present situation does not require either of these. If you’re a human who’s been challenged, or somewhat disabled, by anxiety in the past, I encourage you now to draw upon what you’ve learned in terms of how you can manage successfully.

Separating out feelings from the past, reminding yourself that you have the strength and ability in the present to prevail, seeing a path forward for yourself and setting yourself upon that path is the way forward. If along that way you should stumble and fall, picture yourself as able to pick yourself back up and carry on. Reassure yourself that the basic provisions for your safety and well-being are within your power to meet. In my book, every day that you are able to do so, counts as a very good day indeed.

The post Coping with the coronavirus pandemic for people with anxiety disorders appeared first on Harvard Health Blog.

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