Sleep Apnea and “Spatial Distance” – How to Cope With Changing Times
Social distancing guidelines have affected nearly all of our lives, but there are additional challenges for those with medical conditions such as sleep apnea. Changes to our schedules, routines, housing arrangements, financial situations, and the amount of time we spend with family can not only add stress to our lives, but can also affect our sleep and sleep health. For those with sleep apnea, proper sleep health also means proper adherence to treatment, something difficult to maintain through shifting schedules and changing environments. Healthy sleep is important for everyone, but those with sleep disorders need to pay particular attention to life changes that can affect their ability to achieve and maintain proper sleep. Daily stressors can have a substantial impact on sleep behaviors, including sleep apnea symptoms. If not treated properly, the disorder can escalate, eventually contributing to other comorbid conditions in the long term. And our best defense against stress is how we choose to manage it, regardless of what form it takes in our everyday lives. Keeping our coping strategies flexible and consistent during times of change can help us to better navigate the disruptions of social distancing and improve our stress-reduction techniques in the process, something that every sleep apnea patient can benefit from.
The Stress of Social Distance
For some, social distancing can lead to a sense of isolation. For others, not getting enough alone-time is more of a problem. In either case, the new conditions can cause a lot of stress, especially when a quarantine is involved. Trying to work at home or stay apart from loved ones can be difficult on its own, but adding schedule changes or lost income to the situation can make it extremely disruptive, and potentially harmful to health and well-being. As a result, many individuals develop higher levels of anxiety, depression, irritability, or fatigue. As the added stress of distancing oneself becomes a part of everyday life, family or marital difficulties are common as well. Each of these problems can have a substantial negative impact on sleep and sleep apnea if not dealt with in a healthful manner. And while simple stress-reduction techniques like slow breathing or stretching take little time or effort, as usual, consistency is the key.
Unfortunately, it is common for people experiencing major life changes to react in a less-than-healthy manner, and this is especially true for sleep apnea patients. For example, schedule changes can lead to more time in bed or excess screen time, both of which can have a detrimental impact on sleep and sleep apnea. In addition to problems with treatment routines, the blue light emitted from devices can stimulate the mind and suppress the production of melatonin, the primary hormone for the onset of sleep. Another problem is discouragement. People tend to shut themselves off or feel inhibited, rather than facing the new challenges and taking them head-on. In these situations, when there is a lack of discipline, adherence to treatment is one of the easiest things to fall behind on, making it even harder to cope with stress as the symptoms inevitably return (or worsen).
Many disorders originate from the body’s (and the mind’s) inability to keep up with the constant stress of daily life, especially if the stress is severe and prolonged. In a situation where you may be isolated and experiencing problems with work or family, the chances of developing a sleep disorder are high. And for those who have sleep apnea, the condition can very easily become exacerbated. Without a consistent health plan that includes both stress-reduction and regular PAP therapy, sleep health is likely to suffer.
Stress Reduction and Sleep Health
Stress and sleep are very closely related, and how we deal with the stress of our daily lives will almost always carry over into night, either disrupting or enabling a complete and quality sleep experience. What we gain from an effective stress response is a complete sense of renewal when our mornings arrive, a fresh start from which each new day of experiences can be perceived with high spirits. But getting to that point requires coping strategies. Even in the short term, proper sleep boosts our immune system which in turn enables our coping mechanisms for daily stressors. In the longer term, if consistent, healthy sleep reduces our chances of developing other comorbid conditions, including other sleep disorders.
Proper sleep health can improve nearly every aspect of health, which means it is always important, but in response to increased stress, it is crucial. Consistent nights of quality sleep will boost the immune system, improve brain function, mood, and mental health, and give us energy in the morning when we need it most. Our response to stress has a direct effect on sleep that extends into the following day, helping us cope with each new day’s stress with a calm and well-rested approach.
Stress affects people in different ways, but in times of change or new challenges, the development of coping strategies can allow us to adjust and move on in a healthy manner. For the most part, this is a lot easier than many of us would believe. Simply establishing a new routine when changes occur can keep you in balance and give you a sense of security. This includes:
- Relaxation Techniques: There are many resources available to help you with breathing and meditation techniques, but most people start by simply slowing their breathing. It’s that easy. Slow your breathing and your heart and blood pressure will follow. Meditation can begin with this simple exercise: breathe in slowly through the nose, exhale slowly from the mouth. You can do this before bed with your eyes closed, or throughout the day as you go about your work and routines. As long as you keep with it, you will begin to experience the results.
- Sticking with a Routine: Even though things have changed, you can still establish a new routine and daily schedule. This means going to bed and getting up at the same time. If we are in tune with our circadian rhythms, our internal clock, we will already know when we should rise up and wind down. Normally, natural light cues are telling us more than the clock, but consistency is the aim, so low-volume alarms are helpful. Just make sure that you maintain regular exposure to natural light to keep the body in tune with these processes. Keep the curtains or blinds open, but also spend time outside, whether or not the sun is out. The fresh air will help you as much as the light will, so keeping windows open is a good idea as well.
- Exercise and Activity: One of the most difficult routines for people to maintain are exercises. Even more than dietary restrictions, people tend to have problems with exercise as a routine activity. But oftentimes, people try to take on too much too fast. When it comes to physical activity, balance is very important. Your body will not benefit much from over-straining, and not enough activity leads to not enough benefits. The idea is to find a good balance that pushes you a little, but not to the point that it becomes yet another source of stress in your life. Start with walks, or perhaps a bike ride. As long as you make it a regular activity, scheduled for the same time each day, you will see results.
- Avoiding Bad Habits: As mentioned above, one of the biggest problems with major life changes is how we react to them. We often seek comfort in habits such as TV binging, naps, overuse of alcohol and caffeine, or constant web surfing on devices. These habits upset the balance, or equilibrium, of healthy living, making it more difficult to cope with stress in the long term. In addition, each of these habits poses problems of its own that can further impede the body’s response to stress. Alcohol intake, for example, may feel comforting, but when it is consumed in high quantities, it is actually adding further stress to the body. This is also true for blue light exposure. And each of these habits can have an effect on night sleep, which is the body’s first line of defense against stress.
- Treatment Compliance: The most important aspect of a patient’s daily routine is regular use of CPAP therapy in compliance with a physician’s recommendations. At a time of social distancing, one may feel cautious about using CPAP around others, but as long as regular safety measures are taken, treatment recommendations should always be followed. Always seek the advice of a doctor or sleep specialist before reducing or discontinuing therapy, especially at a time when increased stress levels can affect your overall sleep health. For a sleep apnea patient, this is a number-one priority.
Just because you have to maintain physical distance from others doesn’t mean you are completely cut off from the world. Using online tools, postal mail, or controlled gatherings of small groups can keep you socially active and involved with others. By helping people, making donations, or communicating regularly with loved ones, you will not only be helping others, but will also feel better about your place in life and your role in the community. The less we feel trapped, the better our chances will be for long-term healthy living.
A study published recently in the International Journal of Public Health suggests using the term “Spatial Distance” in place of “social distance” to de-emphasize the social aspects of living with physical restrictions. This rebranding of the term “social distance” could help us view the circumstances with more optimism. As the authors of the study point out, our choice of words and phrases has an effect on public opinion, especially when so much of our social lives takes place online and with written communication. As long as we’re focusing on health and uniting the world community in a single cause, we should have no problem staying connected, remaining active and engaged, and keeping in touch with those we love.
American Academy of Sleep Medicine – https://www.sleepfoundation.org/articles/why-electronics-may-stimulate-you-bed
Centers for Disease Control and Prevention – https://www.cdc.gov/
EXCLI Journal – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579396/
International Archives of Otorhinolaryngology – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4835326/
International Journal of Public Health – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7111296/
Sleepdisorders.sleepfoundation.org – https://sleepdisorders.sleepfoundation.org/chapter-1-normal-sleep/the-physiology-of-sleep-the-immune-system-sleep/