L’Express: Public Health France surveys show that since the Covid, the proportion of French who complain about their sleep kept increasing. Why has the epidemic degraded our nights so permanently?
Sylvie Royant-Parola: Many of us have changed our habits, especially during confinement. Our rhythms of life, our practice of sport, our view of work, all of this has been upset, with positive or negative effects depending on the case. A reduction in physical activity degrades sleep. Before the pandemic, some had to get up every morning at 6 a.m., and all of a sudden, during confinement in particular, they were able to sleep until 7:30 a.m. and extend their sleep time.
On the other hand, the continuation of teleworking on certain days a week may have proved to be more harmful. It’s quite counter-intuitive, because at first glance it seems positive to be able to choose, at least from time to time, a time to wake up that is more suited to your desires. But in reality variations in rhythm, and in particular irregular wake-up times, turn out to be very bad for the quality of sleep.
Why ?
Getting up at the same time every morning strengthens the chronobiological control of the body. Sleep specialists have been repeating this for 40 years, and yet most people continue to think that the essential is regular bedtime… But the circadian notion of sleep regulation is not brought into play by the time we fall asleep at night. In reality, it is the moment of getting up that counts, because it synchronizes all the rhythms. There is a kind of reset of the internal clock. Having a good training of our clocks will regulate the organization of sleep, but also the rhythms of hormone secretion, evolution of body temperature, etc. Sleep is just the tip of the iceberg. By changing your wake-up time, you are asking your body to readjust each time, it will completely disrupt your internal rhythms.
““For most adults, seven hours of sleep is usually enough””
So should we stop sleeping in on weekends?
It’s not as rigid: your body can tolerate a little offset. But if you vary when you get up from four to five o’clock — say emerging all week at 6:30 a.m. and weekends at 10:30 a.m. — then you’re going to quickly find yourself in a situation similar to a full-jet traveler. -the G.
But if we get up every day at 7 a.m. for example, and go to bed at irregular times, we will end up lacking rest…
It is important not to put yourself into sleep deprivation. But not everyone needs eight hours a night. That can be six hours for light sleepers, even though they only make up 3-4% of the population. For most adults, seven hours of sleep is usually sufficient.
When the internal clock is well set, you will wake up spontaneously at the same time on weekends. It can then be tempting to stay in bed a little longer, or even to go back to sleep if you went to bed a little late the night before. But to keep a rhythm, it is better to get up, even if it means taking a nap in the early afternoon. Thus, we maintain a correct sleep time without breaking its chronobiological regulation.
What is the best time to get up?
It really depends on your pace. If you are of a “morning” or intermediate chronotype (neither morning nor evening) you will be able to get up early quite easily. On the other hand, people who are more “evening” will find themselves permanently constrained: they will have difficulty getting up in the morning, emerging, and performing well before 10 am. If they cannot arrange their working hours, they will have to get up, at the cost of a major effort, and with an internal clock that will always tend to shift. They will be in more pain. Especially if, in addition, they have young children who are always in the morning!
Afterwards, squaring the circle means finding what time to go to bed in order to sleep seven hours while being at your own pace – one hour for getting up at 8 a.m., 11 p.m. for getting up at 6 a.m., etc. It is very individual but we are never taught these differences. Many think they can do whatever they want and sleep will follow, but sleep should be the guide. But we don’t learn to listen to ourselves when we want to sleep, or when we wake up spontaneously. Added to this are many misconceptions, such as the importance of sleeping before midnight, for example.
““There is still an insomniac personality, often a little more worried, a little more anxious, a little more perfectionist than the average””
Can changes in habits linked to the pandemic increase the proportion of the population suffering from chronic insomnia?
It’s possible. By modifying one’s schedules, the time spent in bed, the activities during the day, the exposure to light, one modifies one’s sleep. If this is not wanted, and not in accordance with his needs, then yes, there is a risk of inducing sleep disorders in the long term. But beyond these environmental factors, there is still an insomniac personality, often a little more worried, a little more anxious, a little more perfectionist than the average. In the same context, everyone will not necessarily have insomnia. Attention, I am not talking about pathological anxiety, which must be treated because it also induces sleep disorders, but rather personality traits.
What do you recommend for these patients?
Cognitive and behavioral therapies (CBT) are the most effective, although they do not work for all insomniacs. They work especially for those who have built their disorder through maladaptive behaviors. In this case, by modifying their habits and their beliefs, we manage to change the organization of their sleep in a very positive way. But an insomniac always remains an insomniac: even when he recovers, and he manages to sleep more or less well, he risks relapsing as soon as an emotionally charged event arises.
We now await the arrival of new drugs called anti-orexin, because they work by blocking the arousal protein. It will be interesting to be able to offer this new molecule to our patients, because insomnia is so complex that we need a wide therapeutic panel, which ranges from meditation to these drugs via CBT.