Add Sleep Problems to the List of COVID-19 Challenges for Nurses
By Carol Davis
Working the front lines of the early COVID-19 pandemic led to sleepless nights, anxiety, and depression for more than half of nurses surveyed for a new study.
“Nurses are already at risk for higher rates of depression and insufficient sleep compared to other professions, thanks to the stress of patient care and the nature of shift work,” said Amy Witkoski Stimpfel, PhD, RN, assistant professor at NYU Rory Meyers College of Nursing and the study’s lead author.
“The pandemic seems to have further exacerbated these issues to the detriment of nurses’ well-being,” Witkoski Stimpfel said.
On the frontlines of the pandemic, nurses have faced staffing shortages, an early lack of personal protective equipment (PPE), intense fatigue, and being witness to unparalleled suffering, death, and grief, and these ongoing stressors have taken a toll on their mental health and well-being.
The study’s researchers, who surveyed 629 nurses and interviewed 34 nurses, found high rates of insomnia (55%), anxiety (52%), and depression (22%) among nurses. Notably, difficulty sleeping was both a contributing factor to and an outcome of poor mental health, researchers said.
Sleeping for only five hours or less before a shift increased the odds of depression, anxiety, and insomnia. Nurses also described how anxiety and thinking about stressful working conditions led to difficulty falling asleep and waking up at night, according to the study, which was published in the Journal of Occupational and Environmental Medicine.
“We found that sleep problems were interwoven with anxiety and depressive symptoms,” said Witkoski Stimpfel. “Prior research supports this bidirectional relationship between sleep and mental health. We know that getting sufficient sleep fosters mental and emotional resilience, while not getting enough sleep predisposes the brain to negative thinking and emotional vulnerability.”
What employers can do
“Healthcare employers should strive to create healthy work environments and follow evidence-based staffing and scheduling guidelines set forth by the National Academy of Medicine, the American Nurses Association, and sleep researchers,” Witkoski Stimpfel told HealthLeaders.
This includes:
- Eliminating mandatory overtime
- Monitoring staff schedules, and allowing working no more than two or three consecutives shifts
- Limiting shift length to no more than 12 hours in a 24-hour period and no more than 60 hours in a seven-day period)
- Allowing scheduling flexibility for nurses who need to take time off to be evaluated for a sleep disorder, mental health care services, or other healthcare services.
What nurses can do for themselves
“Ruminating about stressful work events, especially during COVID-19, has exacerbated sleep problems, like insomnia,” Witkoski Stimpfel said.
“In addition to routine sleep hygiene—such as sleeping in a dark, cool, and quiet environment and avoiding alcohol, nicotine, exercise, and bright light before bed—nurses could benefit from healthy coping strategies to de-stress,” she said. “That could include meditating, practicing yoga, or participating in other types of mindfulness-based stress reduction techniques.”
Exercising and being outside and in nature on days off are healthy ways to cope, she advised.
“Talking to peers, friends and family, or a therapist could benefit nurses,” she said, “and ultimately lead to more restful sleep.”
Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.