PolicyLab

Editor’s note: This is part of our Mental Health Awareness Month blog post series, which focuses on how COVID-19 impacts child and family behavioral health. We invite you to check back for new posts or to follow along for updates on Twitter at @PolicyLabCHOP.

From infancy through adulthood, sleep is critical for overall health and well-being, including mental health. Sleep is especially important during this challenging time when many families are facing increased psychological stress, fear and illness due to COVID-19. Along with the impacts of this pandemic on other important factors, such as employment, income, work and school schedules, and child care and elder care demands, these stressors have likely resulted in poorer quality or disrupted sleep and sleep routines for many families and health care providers.

Why does sleep matter so much, especially now?

Keeping a consistent sleep schedule that allows for enough sleep may help bring some regularity during this increasingly difficult and abnormal time. In addition, research shows that getting too little sleep or having an irregular sleep schedule can increase your risk for poor immune functioning. Although healthy sleep cannot directly prevent you or your family from getting COVID-19, prioritizing sleep during this time can support your overall health.

Most importantly, optimal sleep may promote better psychological functioning and mental health. A number of studies have found that insufficient or poor quality sleep is associated with increased psychological stress, anxiety and mood concerns. Poor sleep is also linked to emotional and behavioral difficulties and attention problems. Even in early childhood, poor sleep is associated with later impairments in social-emotional and behavioral functioning.

Although more research is needed on the complex linkages between sleep and mental health, some research suggests that sleep and mental health symptoms are bi-directionally linked, or mutually influential, over time. This means that while a night of poor sleep could cause increased stress and mood concerns the next day, feeling stressed or experiencing other mental health symptoms could make it difficult to sleep at night. Sleep problems are also more common in individuals with diagnosed mental health concerns, making it even more crucial to foster healthy sleep habits.

Overall, research on sleep and mental health suggests that our sleep habits during times of increased stress—such as during a pandemic—are more important than ever. As a pediatric psychologist with expertise in sleep, I am talking to many of my patients and their families about how to prioritize sleep and mental health while also allowing for changes to routines in the midst of this pandemic.

How can we build healthy sleep habits with our children during this time?

For young children (0-5 years old), following a consistent bedtime routine can benefit sleep as well as broad child development. A bedtime routine should include two to four activities, such as washing up and changing, and something you and your child enjoy (reading, singing, praying, telling stories). If naptime looks different with changes to child care and family work schedules, pick a time that works best for your new schedule and stick to it. If you are helping your child learn to fall asleep independently, consider taking a break if it becomes too stressful for your family right now. The Pediatric Sleep Council has more information about COVID-19 and sleep in little ones.

For school-aged youth (6-12 years old), sticking to predictable family routines can help children adjust to new situations. Because your child may be using electronics more often due to online learning and connecting with friends, be sure to limit exposure at bedtime and in the bedroom. Keep in mind that children this age often develop worries or fears about real-world events that impact sleep. Avoid talking about concerns before bedtime and reduce your child’s exposure to COVID-19 discussions at home. You can also try relaxation strategies at bedtime such as belly breathing or muscle relaxation.

Teenagers and young adults (13-25 years old), typically do not get enough sleep on school nights and they may be benefitting from more sleep during this time due to altered school experiences and summer break. It is still important to keep the same schedule on weekdays and weekends to keep the internal body clock (circadian rhythm) “on time.” Parents also play an important role in promoting teen sleep. Earlier parental set bedtimes can buffer against mood concerns and suicidal ideation. Many teens and young adults may feel socially isolated or stressed about the impact of COVID-19. Taking a break from social media and trying mindfulness and meditation through popular apps can help reduce stress at bedtime.

The path to better understanding sleep

Sleep and mood are interconnected. During this time of increased stress, prioritizing sleep could benefit children’s daily mood and overall mental health. As my colleagues and I have suggested, sleep should be a vital sign that is routinely assessed in child health care and other community settings. Given that sleep disturbances can forecast emerging or worsening mental health symptoms, a focus on sleep is also relevant for researchers seeking to understand or mitigate the impacts of COVID-19 on psychosocial stress and well-being.

Access to behavioral sleep providers is limited, but increased telemedicine services and related insurance coverage could help to close this gap. Importantly, more research is needed on methods to feasibly and effectively disseminate evidence-based sleep health promotion and to integrate these approaches into existing mental health treatment programs.

Additional Resources

For children of any age and adults, pay attention to sleep and mental health. Reach out to family and friends for social support. On-call crisis services are available through the National Suicide Prevention Lifeline (1-800-273-8255) or by texting 741741. If you cannot access a behavioral health provider due to COVID-19 restrictions, consider trying mental health apps and web-based counseling resources which connect individuals with a licensed mental health provider. There are also some evidence-based apps for promoting sleep in young children and in adults.

Sleep well!