Mental Health

The Tragic Loss of Coronavirus Patients’ Final Words

It takes a special kind of inattention to human suffering to not notice how unfortunate it is that people have been left to face death alone

By Zeynep Tufekci

Of all the wrongdoings of this pandemic, the one that haunts me most is how people are left to die alone. Health-care workers have been heroic throughout all this, but they do not replace the loved ones whom the dying need to be with, and speak with, even if only one last time.

A hallmark of COVID-19 has been the speed with which some patients have crashed, going from feeling only a little sick to being unable to breathe, sometimes in the space of a few hours. Such a crash often necessitates intubation, a process that then renders one incapable of speaking. Many people on ventilators are also heavily sedated and unconscious, to keep them from pulling out the invasive tubes going down their throat. Thus, sometimes with little warning, all communication is lost, and more often than not, a patient is without family or loved ones when this happens.

Early in the pandemic, patients were left alone precisely because the crisis was so dire. Many hospitals outright banned visitors — often even to non-COVID-19 patients. They did not have enough protective gear for the health-care workers, let alone anyone else. Many COVID-19 patients were transported solo in ambulances, and family and friends were unable to join them at the hospital once they had arrived. Others were dropped off by loved ones who were then turned away. Patients sat in their rooms, waiting. If they experienced dyspnea, the acute shortness of breath known as “air hunger,” they crashed alone and terrified.

Sometimes, a nurse or doctor managed to connect the patient with their loved ones before the tube went in. But dyspnea is a medical emergency, after all, so in many cases there was simply no time for that last call, or anyone available to arrange it. As the disease progressed, families were left clustering around a phone as a hospital worker held up the device for a final goodbye on FaceTime. Often, the family could talk to their loved one, but not vice versa. That’s not enough. What the dying have to say must be heard.


The paramount importance of dying words has long been recognized across cultures. “When a bird is about to die, his song is sad,” Master Tseng, a Confucian leader, says in the more than two-millennia-old Analects of Confucius. “When a man is about to die, his words are true.” In Plato’s Phaedo, Socrates notes how swans sing most beautifully just as they are about to die. That concept of the swan song — one’s last, most beautiful expression — also comes up in Aesop’s fables and in Aeschylus’s Agamemnon, and was already a proverb by the third century b.c. In Shakespeare’s Richard II, a dying John of Gaunt, hoping the king will come to hear his last words, says:

O, but they say the tongues of dying men

Enforce attention like deep harmony.

Where words are scarce they are seldom spent in vain,

For they breathe truth that breathe their words in pain

Last words, or “dying declarations” as they are sometimes called, have long been recognized in jurisprudence as out of the ordinary, with known cases going back as early as 1202. That’s why statements uttered by people aware of their impending death can potentially be accepted in court without being subject to “hearsay” restrictions, which ordinarily exclude from evidence assertions made by those not in court to testify in person. In the Middle Ages, it was presumed that people alert to their immediate death would not dare lie, knowing they were about to meet their maker. Death was also seen as removing motives to lie: In a 1789 court case in England, which forms the basis of the modern hearsay exception, the court admitted a woman’s dying words — that her husband was her murderer — as evidence, noting that “when every hope of this world is gone: when every motive to falsehood is silenced,” then “the mind is induced by the most powerful considerations to speak the truth.”

The clarity that can come from those facing death is also integral to many modern traditions and philosophies, including the existentialist and psychotherapy schools of thought, which emphasize that death, meaning, loneliness, and freedom are core axes of our lives, and that making all these existential considerations explicit can be key to a good life. The Holocaust survivor Viktor Frankl talks about how these “primordial facts” of existence, including our mortality, help us realize and appreciate what truly brings meaning to our lives. The existential psychotherapist Irvin Yalom, who specializes in treating people with terminal illnesses, says that terminal cancer, as terrible as it is, gives patients clarity that they did not always have before: “What a pity I had to wait till now, till my body was riddled with cancer, to learn how to live,” a patient lamented to him. Yalom advocates listening to the dying and their wisdom even before we ourselves face our final stretch.

It’s also not just that the dying deserve to be heard or that their wisdom is valuable, but that the living need to have the chance to hear them — to let go on their own, mutual terms. That was something I learned the hard way, when my mother died unexpectedly in her 50s. There is no good way to lose a mother, but my loss was compounded by how complicated our relationship had been as she spiraled into alcoholism later in life. Her drunk version was mean, terrifying, and vicious, although when she was sober, she remained the loving, funny, if quirky, parent I knew as a child. When I moved to the United States, most of our conversations took place over the phone, and I became a human Breathalyzer via voice — a sad talent, I suspect, that I share with other children of alcoholics. Before she even finished saying “Hello,” I knew exactly how drunk she was, and if it was Jekyll-time, I just hung up without fanfare. It never went well if I didn’t.

Then my phone rang early one morning. I jumped out of bed to learn that she had died, without apparent reason — just dropped dead. My mind raced with only one thought: What was our last conversation? Had I hung up on her?

Losing an alcoholic parent can be marked by the same grief anyone feels after losing a parent, especially under tragic circumstances. But it’s also full of regret and guilt in its own ways. The regret is obvious: There is no longer a chance for a final, redemptive chapter. The guilt is layered: Was there anything else one could have done? One more intervention, despite the futility of all the others? And what to do with the feeling of relief from avoiding other, even more feared futures that tangles up with the loss?

In this knot of confusing feelings, though, it was that last conversation that my mind kept circling around for the next many months. The last time my mother called me, she was not only sober; she was in a reflective mood — something that did not happen a lot. She apologized, sort of, for all her drinking and said she was very proud of me. We had a pleasant, lengthy conversation, a rarity that year. She wanted to talk about the latest books she was thinking of translating. She rambled about all the good times, and came back to how happy she was that I was her daughter. It was as close to closure as one could hope for. Intellectually, I knew that it didn’t matter much and that even if I had hung up on her the last time — as I had so many times before — I could have tried to focus on some other good conversation or experience we had shared. I knew it was a stroke of luck that this just happened to be our final conversation. It’s not logical, but that’s how grief works; in the thick of it, the last conversation feels like the truest word.


It’s been six months since the world began battling COVID-19. Coronavirus cases are now surging across the Sun Belt, and hospitals are filling up again. Immediately, some reacted by restricting visitorsMany places had never lifted their restrictions in the first place. Those facing the worst moment of their life still aren’t being treated as a priority.

That dying alone has been normalized, as if it were a small matter, is frightening and inhuman. The panic of the early days of the crisis could be seen as a temporary, terrible compromise. Since then, though, airlines have been bailed out to the tune of many billions of dollars, while there has been no rush to build more negative-pressure rooms, designed to circulate air out, at hospitals, which would allow for much safer visits. We still haven’t developed the infection-control protocols for visitors and built up supplies of personal protective equipment in ways that would avoid the need to completely isolate patients in the days and months ahead.

Even without all the wisdom of the ages, it takes a special kind of inattention to human suffering to not notice how unfortunate this is, that people have been left to face death alone. Some have come to fear dying alone more than the coronavirus itself.

In the years after my mother’s death, I managed to move my focus away from the last conversation and take stock of the good and the bad. I regained perspective, and now I would be at peace with whatever had transpired the last time we spoke, even if I had indeed hung up on her. After a bit of time, I am able to broaden out and consider everything, not just that one last conversation. But that certainly wasn’t always the case. The adage is true: Time has its own healing powers. But that’s not what the people who have lost loved ones to this pandemic should be left with, that time will help with the injustice of having been separated from them at the very end. If society seems to have lost perspective about both compassion and death, all that may be left for us is to reclaim what perspective we can, as best we can.

Covid-19 Delirium (Distorted Reality): Its Roots and Aftermaths

Ignoring it bears life-long consequences of brain health.

Contents:
1. Covid-19 Includes Delirium
2. Covid-19 Delirium Was Overlooked
3. How Covid-19 Causes Delirium
4. Prevention vs Treatment
5. Short- and Long-term Consequences of Covid-19 Delirium
6. Could We Do Better From Here On?

Covid-19 Includes Delirium

Delirium means disturbed consciousness in the DSM-IV. The DSM-5 now defines delirium as a disorder of attention, awareness, and cognition, and may share symptoms with psychosis such as hallucinations, paranoia, irrational thoughts, and grotesque dreams. The Atlantic reports that a few delirious Covid-19 patients became psychotic. They “may believe their organs are being harvested, or that nurses are torturing them. A spike in fever might feel like being set on fire. An MRI exam might feel like being fed into an oven.”

About 20–30% of Covid-19 patients experience delirium; in severe cases, the number rises to 60–70% regardless of age. This prevalence is consistent with the literature where delirium occurs to 60–70% in patients admitted to the intensive care unit (ICU).


Covid-19 Delirium Was Overlooked

The first report of Covid-19 delirium dated back to a China study published on April 10, 2020. It is not just Covid-19; about 75% of delirium cases in critically ill patients, in general, were not diagnosed. Why? A reason is that ICU patients undergoing intubation cannot speak, so verbal tests are challenging. Second, delirium is no single disease, but three with a subsyndromal form:

  • Hyperactive delirium: restlessness, agitation, hallucinations, and delusions.
  • Hypoactive delirium: fatigue, sedation, and slow responses or reactions. This subtype is often misdiagnosed as dementia or depression or just ignored.
  • Mixed delirium: having symptoms of both hyper- and hypoactive delirium. This subtype is the most prevalent, followed by hypoactive and then hyperactive delirium.
  • Subsyndromal delirium: a borderline phase that may or may not progress into full-blown delirium.

As a result of late reporting, there may have been four to five months of missed diagnoses, wherein delirium is the chief symptom of Covid-19. Also, the prognosis of Covid-19 with delirium might have been undervalued, leading to inadequate supervision and increased mortality. Because delirium might be a sign of impending and sudden respiratory failure from the shut down of the brain’s cardiorespiratory centre.

There are guidelines for diagnosing delirium. They are relatively quick as well. But delirium is not apparent, unlike fever or cough. Health professionals either missed it or actively looked for it.


How Covid-19 Causes Delirium

No single brain pathology reflects delirium. Attempts to pinpoint a specific brain region or neurotransmitter responsible for it have failed. A disconnected brain best describes delirium where neurons can no longer comprehend reality properly, said a 2017 review titled “Delirium pathophysiology: An updated hypothesis of the etiology of acute brain failure.”

A brain disconnected from reality best describes delirium.

One risk factor for delirium is the lack of social contact. It makes one more vulnerable to lose in touch with reality. Particularly so in the context of highly contagious infectious disease, where quarantine measures are mandatory. Deprived social bonding increases the risk of depression, anxiety, anger, apathy, fear, and disorientation — all of which are predictors of delirium.

“In the age of Covid-19, in an attempt to “flatten the curve” and slow the spread of the virus, many hospitals have instituted no-visitation or very limited visitation policy, which may propagate a sense of isolation, ultimately contributing to disorientation and lack of awareness in the patient,” researchers in the U.S. and Poland wrote in a review in Critical Care.

A second risk factor is the prolonged use of sedatives required for mechanical ventilation. A patient is unconscious with anaesthesia but falls somewhere between sleepiness and relaxed consciousness with sedation. Regardless, both are independent risk factors for delirium as the brain tries to fill the gap in consciousness.

The third risk factor for delirium is biological brain insults, be it trauma, pathogens, chemicals, hypoxia, or multi-organ damage. Covid-19 delirium, scientists believe, is partly caused by:

  • Coronavirus brain invasion via olfactory neurons or blood-brain-barrier. Neuro-Covid is a disease terminology recently coined for this. The lower prevalence of smell loss in severe vs mild-moderate cases supports the olfactory invasion of SARS-CoV-2, given that destruction of renewable olfactory neurons might be a protective mechanism to halt virus spread into the brain. The cytokine hurricane that causes multi-organ damage increases the risk of virus penetrating the compromised blood-brain-barrier.
  • Hypoxia and blood clots. Covid-19 is primarily a disease of the lungs, followed by blood vessels. Lung damage endangers gas exchange and, thus, less oxygen would enter the circulation. Blood vessels damage leading to blood clots might restrict blood flow to the brain. The brain could then be deprived of oxygen or blood and malfunctions.

The fourth reason includes factors unrelated to Covid-19 disease or treatment procedures. These are existing neurological disease like dementia or stroke, multiple medical comorbidities, nutritional deficiency, HIV infection, surgery, sleep deprivation, and being older than 65 years or a male.

All these risk factors compound, making delirium difficult to decipher. No single cause means no single solution.

“In the patients with Covid-19, delirium can be a manifestation of direct CNS invasion, induction of CNS inflammatory mediators, secondary effects of other organ system failure, and untoward medical and environmental factors including heavy use of sedatives for prone positioning of the patient and quarantining and social isolation during care,” the review summarized. CNS means central nervous system — that is, the brain and spinal cord


Prevention vs Treatment

Practising higher-quality health care could prevent 30–40% of delirium cases. Pharmacological treatments for delirium prevention have not worked so far. One effective program is the Hospital Elder Life Program (HELP) that aims to maintain the following:

  • Orientation to surroundings (awareness of time, place, and person).
  • Nutrition and hydration.
  • Sleep and circadian rhythm.
  • Mobility that is feasible within limits of physical condition.
  • Visual and hearing function, especially in those with sensory deficits.

Another effective preventive guideline recommended for Covid-19 is the ABCDEF bundle: A: Assess, prevent, and manage pain; B: Both spontaneous awakening trials and spontaneous breathing trials; C: Choice of analgesia and sedation; D: Delirium assessment, prevention, and management; E: Early mobility and exercise; F: Family engagement and empowerment.

If prevention failed or unattempted, treatment options for delirium entail re-orientation to surroundings, making frequent eye-contact, lowering the dose of sedatives or neuromuscular blockers, increasing physical mobility, avoiding changes in surroundings including staffs, mitigating noises, and taking anti-psychotics drugs. But these interventions do not guarantee success as they have to be tailored to factors causing delirium and delirium subtypes.


Short- and Long-term Consequences of Covid-19 Delirium

Another reason why prevention is better lies in the aftermath or collateral damage of delirium. Delirium is an end to a critical disease that have involved and involves the brain. Delirium itself is an independent risk factor for one-week longer hospitalization and two-fold increased risk of hospital death.

Delirium has a heavy financial toll as well. “Total cost estimates attributable to delirium ranged from $16,303 to $64,421 per patient, implying that the national burden of delirium on the health care system ranges from $38 billion to $152 billion each year” in the United States alone.

In addition to these short-term effects, most delirious patients will not have the same brain as before.

Despite the recovery, delirium further poses a two-fold increased rate of cognitive deterioration in a 5-year follow-up, leading to a higher risk of dementia. “At 3-and 12-month follow-up, 79% and 71% of survivors [of delirium] had cognitive impairment, respectively (with 62% and 36% being severely impaired),” a 2010 study found. People who had delirium also had a more imperfect recall of factual events two years later. All these statistics are in comparison to non-delirious patients. Hence, most people experiencing delirium will not have the same brain function as before.

And the same applies to coronaviruses.

Published in The Lancet Psychiatry, a meta-analysis of 65 peer-reviewed and seven pre-print studies analysed the short- and long-term psychiatric features of coronavirus infections. “Our main findings are that signs suggestive of delirium are common in the acute stage of SARS, MERS, and COVID-19,” they wrote. “There is evidence of depression, anxiety, fatigue, and post-traumatic stress disorder in the post-illness stage of previous coronavirus epidemics, but there are few data yet on COVID-19.”

“SARS-CoV-2 might cause delirium in a significant proportion of patients in the acute stage,” they made a concluding statement. And “clinicians should be aware of the possibility of depression, anxiety, fatigue, post-traumatic stress disorder, and rarer neuropsychiatric syndromes in the longer term.”


Could We Do Better From Here On?

“To prevent is better than to treat,” researchers can’t emphasize this enough about delirium in a 2013 review. “Many risk factors are modifiable by relatively easy and inexpensive interventions, such as…,” as discussed above. And these mitigative strategies “are not widely used in ICUs around the world.” To reiterate, about 75% of delirium cases missed diagnosis.

Sharon K. Inouye, a professor of medicine at Harvard Medical School and director of the Aging Brain Center in the Marcus Institute for Aging Research, played a pivotal role in communicating the prevalence and dire consequences of Covid-19 delirium in early April. “If there is a silver lining to this pandemic, it’s that people are seeing how important delirium is,” she said in an interview. “There may never have been this much delirium all at one time.”

Delirium has always been overlooked, and it is still is.

The WHO only mention altered mental status, and not delirium, as a possible sign of Covid-19. The CDC and Public Health England listed neither altered mental status nor delirium as a Covid-19 symptom, Professor Inouye said in a review published on May titled, “Delirium: a missing piece in the COVID-19 pandemic puzzle.” Delirium has always been overlooked, and it is still is.

Misplaced Anger: Why You Have It, What to Do About It

The phenomenon of ‘displaced aggression’ helps explain why your accumulated anger during the pandemic can spill out into real-world interactions

Anger is an animal without a cage. Once provoked, it can lash out at anyone within reach of its claws. This was true before Covid-19. The man pissed about his job picks a fight with his spouse, or the woman annoyed by a friend loses her temper with her kids.

But if science had an instrument capable of measuring anger, the pandemic and its many challenges would be pushing its needle into the red. All this accumulated rage is certainly spilling out into real-world interactions. The evidence for this is all over the news. Outlets across the country have reported cases of “retail rage” during which store employees who try to enforce rules regarding masks or social distancing have been spit on or otherwise assaulted.

And it’s a certainty that the current moment’s frustrations are causing a surge in angry exchanges among friends, couples, and families.

This roaming, unfocused aspect of anger is sometimes referred to as “displaced aggression,” which psychologists define as “retaliatory aggression that is misdirected from an initial source of provocation and turned instead upon an innocent other.” At a moment when tempers are running hot, it’s helpful to recognize the threat of displaced aggression — in society, and in ourselves.

“There are basically two reasons why people displace aggression onto others,” says Brad Bushman, PhD, a professor of communication at Ohio State University who studies anger and aggression. “One is that the target of their anger is not available — like if a person is pissed off at a politician.” There’s no way to calculate just how many spousal spats or unfortunate parent-child interactions today’s politics have caused, but the number is surely staggering. “The other reason,” he says, “is that the target is available, but the angry person fears reprisal or retaliation.” For example, yelling at a boss is likely to have negative professional repercussions. Yelling at a partner is safer.

Bushman points out that aggression comes naturally to most people. “You don’t have to teach children to be aggressive, that comes very easily,” he says. “You need to teach them self-control, and not to shout, scream, yell, kick, or hit when they’re frustrated.”

“If you think of anger like a fire, there’s a lot of fuel for that right now. Social media and the news provide a lot of that fuel.”

Anger’s strange appeal

Considering anger’s promiscuity when choosing targets, one would think that people would try to avoid angering themselves for fear of misdirecting their fury or causing their relationships some avoidable strife. But anger is oddly intoxicating. “There’s an adage in the world of the internet and Google and Big Data — enragement is engagement,” says Piers Steel, PhD, a psychologist, behavioral scientist, and professor at the University of Calgary. “Creating outrage is a great way to keep people watching or clicking.”

Steel says that this formula is deployed again and again in cable and online news content, and also in the algorithms that govern many popular social media platforms. “You see everyone being fed back their own viewpoints in a more extreme fashion — your beliefs are confirmed, and you’re told that other people are so stupid because they can’t understand it — and so there’s basically this firehose of anger being sprayed over society,” he explains. “And 100%, this anger will bleed out into our lives.”

Another challenging element of anger is its propensity to group people together in ways that may justify acts of displaced aggression. “We tend to blame all members of a group if one member does something bad,” says Eduardo Vasquez, PhD, a senior lecturer and displaced-aggression researcher at the University of Kent in the U.K.

While people often view members of their own group — for example, the members of their own political party — as a diverse mix, members of the competing group are often viewed as more or less “interchangeable,” he says. “So if you encounter somebody who is a member of an out-group or somehow related to it, then at some level your system generalizes the anger to include that individual.”

This may help explain why retail workers are bearing the brunt of some people’s Covid-19 fury. For the person who disagrees with social-distancing protocols, those charged with enforcing them may seem of a piece with the public officials who put those protocols in place.

Keeping anger in its cage

The big takeaway here is that anger breeds anger, and accumulated fury tends to lash out at whatever target is convenient. As the old saying goes, to a man with a hammer, everything is a nail.

How can people put down the hammer of anger — or avoid picking it up in the first place? Ohio State’s Bushman says avoiding things that tend to make you angry is the obvious remedy.

During Covid-19, that may mean limiting the time you spend reading or watching the news, or staying away from online content or platforms that tend to leave you hot and bothered. “If you think of anger like a fire, there’s a lot of fuel for that right now,” he says. “Social media and the news provide a lot of that fuel.”

The sooner you can nip anger in the bud, the better. Rumination — basically, thinking about or replaying in your mind the thing that made you angry — tends to turn anger up to 11. “Rumination is the worst thing you can do,” Bushman says.

On the other hand, spending time in nature is an effective way to reduce angry feelings and emotions, he says. Humor — whether it’s a funny video on YouTube or texting with friends who make you laugh — also tends to quickly snuff out the flames of anger.

A little empathy doesn’t hurt either. A 2017 study in the Journal of Personality and Social Psychology found that people can, with effort, put themselves in someone else’s shoes and gain a better understanding of their viewpoints. Unfortunately, many are unwilling to make this effort even when it would lead them toward more positive emotions, according to research from the American Psychological Association. Again, anger is oddly intoxicating; turning away from it requires strength.

“Anything you can do that’s incompatible with anger or aggression is helpful,” Bushman says.

Coronavirus: 10 science-backed ways to find happiness during trying times

On the surface, these are not joyful times. They are hard times. We can’t see family, we can’t meet friends, we can’t travel and we can’t get physically close to people (hugs make humans thrive!). So, it’s pretty rough out there right now.

Happiness, being subjective and relative, is hard to define. However, can roughly be explained as a combination of things that make life worth living.

But if you dig a little deeper, you can work on your happiness and find joy in the little moments.

Here are ten science-backed ways to help you become happier in your life.

1. Practise gratitude

I immediately feel very lame saying this, but it really does work wonders. All you have to do is think about the good things in your life. Be thankful that you have your health. Be thankful for the fact that you are in a safe country. You have a home and a bed. Be thankful for your friends, your parents, your kids or your spouse. It’s important to feel lucky to be alive. And once you start appreciating the simple things about your life, you immediately feel happy.

I once interviewed a recovered corona patient, who said to me, “I appreciate the fact that I can breathe without tubes in my throat. I can breathe and that is a blessing to me.”

2. Practise something challenging

Whether you are learning a new instrument or learning how to do a handstand, doing something that, you can work on and improve on every day will send endorphins (happy hormones) to your brain. So make sure to challenge yourself, while you are stuck at home.

Great homebound activities to learn are yoga, painting, an instrument or a language.

3. Force yourself to smile

Even if you don’t feel like it, plastering a smile on your face will trick your brain into thinking that you are happy and your mood will instantly get a lift. Do this especially if you live with other people. You don’t want to constantly be grumpy. If that doesn’t work, then watch a funny or cheerful YouTube video to relax your facial muscles and give you a chance to smile.

4. Connect with another person

The one thing that really makes humans happy is connecting with others. Whether it’s with a family member, a partner or a friend. If you aren’t happy, just pick up the phone or jump on Zoom and call someone to feel connected.

5. Stop procrastinating

People who don’t ‘put things off until tomorrow’ are generally happier, as they have a proactive attitude and don’t waste time, even though you think you have a lot of it. Very often completing a task will leave people feeling accomplished and proud, thus making them feel happy.

Under normal circumstances, if you procrastinate long enough, eventually you’ll run out of time and you would’ve missed the chance to get things done. But now, being at home you eventually get bored of doing nothing and procrastination feels slow and unproductive, so it forces you to get up and do things just to avoid sitting and doing nothing.

6. Be intellectually curious

Reading books about complex topics or watching documentaries that explain how the world works, is a trait that most happy people have. Happy people are curious about intellectual topics and enjoy meaningful conversations with others. Rather than talking about other people or discussing things they did during the day, the happiest peoples are ones who discuss ideas and plans.

7. Be open to new experiences

Whether you have a new dish delivered to your home from a restaurant or you buy yourself a puzzle after never having done one before, new experiences make people feel a lot happier than those who just go on with their days without doing anything new.

Now is the time to live on the edge, (but at home).

8. Physical affection

According to Virginia Satir, a respected American therapist, people need four hugs a day for survival, eight hugs for maintenance and twelve hugs for growth. The trickle-down effect of the oxytocin release following a hug can reduce stress and elevate your mood. Obviously, we can’t exactly go around hugging people, but if you live with your family, kids or your spouse, make sure you show them physical affection when you can.

9. Compassion

Scientists have proven that those who are interested in other peoples’ lives, stories and problems are usually a lot happier than those who are only concerned with themselves. Communicating and connecting with others makes human beings thrive. Compassionate people also tend to do random acts of kindness for people they love and also for strangers. They tend to be happier and more satisfied with their life.

10. Work on strengthening your relationships

The famous 75-yearlong Harvard study of 268 undergraduate males looked at life from every aspect, ranging from lifestyle to political views in order to find out what made human beings happy.

The most important finding of the unique study was that relationships are the only thing that matter if you want to have a fulfilled and happy life. Nurture your closest relationships and let go of toxic ones. Work on them every day. Stay in touch with your family and friends. Knowing that there are people out there looking out for you and who love you, will let you go to sleep with a lighter heart.

Why are we all so tired?

Some of us have more time to sleep yet we feel fatigued, wasted and stressed out

Published:  May 16, 2020 17:07
Jenna Jonaitis, Washington Post

Since the onset of the coronavirus pandemic, I wake up most days already tired. Coffee is mandatory, and that wasn’t the case before. My husband is more sluggish too. We have increased responsibility, taking care of our toddler while still working full time from home. It’s also harder for him to fall asleep and harder for me to keep my eyes open in the afternoon.

This pandemic is exhausting, mentally and physically. Our worlds have shifted, and it takes emotional energy to cope with that. Health-care workers are spending long shifts in hospitals and care homes trying to keep patients alive. Other essential workers are pulling overtime in grocery stores, warehouses, fields, production plants and delivery trucks to ensure the country has enough food, toilet paper and face masks. At-home workers are doing their jobs and, in many cases, also caring for and educating children.

But some of us actually have more time to sleep. If we’re working from home, our commutes have been eliminated. We don’t have to get ourselves ready for work and the kids — and their lunches — ready for school. We can sleep in, or perhaps even squeeze in a nap. But with these supposed sleep luxuries at our disposal, it’s still common to feel downright drained. Why?

If you theoretically have more hours to spend sleeping but “are experiencing sleep difficulty, it’s absolutely logical,” says Rebecca Robbins, a postdoctoral fellow and sleep researcher at Harvard Medical School. Though you might be working from home or be in a low-risk category, “the worry of being impacted can loom larger than life on your sleep and mental bandwidth.” The uncertainty of the pandemic, concern for others and ourselves, and the utter lack of control is a perfect storm for insomnia and sleep difficulty, Robbins says.

A study out of Wuhan, China, involving 3,637 participants who were covid-19 free found that the prevalence of insomnia increased significantly along with worsened insomnia symptoms during the outbreak. The main causes included anxiety, depressive symptoms and fear of getting infected, but also economic-related stress, difficulty handling social distance restrictions and changes in daily life.

As we experience repetitive days under duress over a long period of time, we move from acute stress to chronic stress, which takes a toll on the brain, says Gail Saltz, associate professor of psychiatry at New York-Presbyterian Hospital and the Weill-Cornell School of Medicine, and host of the “Personology” podcast. “Chronic stress raises cortisol levels … and it can certainly cause you to have more awakenings during the night. It doesn’t matter if you have the time to sleep.”

Finally, “everything we’re doing is new and [it] takes a lot of energy to do new things,” says Lori Russell-Chapin, a professor of counsellor education and co-director of the Centre for Collaborative Brain Research at Bradley University in Illinois. The mental and emotional burden of novel experiences — from being hyper-alert while grocery shopping to grieving the loss of a loved one from afar — wears on us.

While you might have more opportunities to rest during this period, additional time in bed doesn’t necessarily improve your sleep quality. “Your bed should be the place that you crave for sleep,” says Robbins, co-author of “Sleep for Success!” If you allow yourself to lie there and toss and turn, “you can actually start to develop insomnia because the bed starts to be that stressful place … as opposed to where you fall into peaceful slumber.”

Saltz says oversleeping can lead to problems, too, such as impaired cognitive function. “Oversleeping is likely to make you feel ‘less sharp-minded’ and ‘blah’ in terms of mood,” she writes via email. Getting seven to nine hours of sleep each night on a consistent schedule is recommended, not logging 12 hours just because you can.

It’s certainly tempting to stay up late when you don’t have to be in the office early, or snooze for a couple of hours midday because you’re at home. But with those habits, “we’re messing around with our natural circadian rhythms,” Russell-Chapin says. “If you nap in the daytime, you’re not telling your body that [you’re] supposed to nap at night for eight hours.”

The tenets of good sleep hygiene — such as getting some exposure to sunlight and limiting caffeine intake — shouldn’t be overlooked. Setting and sticking to a sleep schedule should be a priority, because our circadian rhythm acts as a well-oiled machine, Robbins says. “Commit to keeping your bed and rising time as close to the same time” every day of the week, she writes via email. “If you are a true night owl and prefer late bedtimes, find a schedule that you can keep throughout the workweek and operate on your preferred rhythm.”

But keeping a consistent schedule is only part of the solution. During the pandemic, it’s common to “lie down and your mind is still going because there’s just no downtime,” says Alyza Berman, founder and clinical director of the Berman Centre, which offers mental health treatment in Atlanta. You might be thinking about how you forgot to buy hand sanitiser at the store, whether you have enough toilet paper left or how your nurse friend is coping with being on the front lines.

To improve your sleep quality, you have to calm that brain activity, something Robbins said she didn’t learn to do until she went to a meditation retreat. “What we have to do to fall asleep is quiet our mind,” she says, “and that’s exactly what you’re doing when you’re meditating.”

But you don’t need a retreat or even an app to get started. The one tool Robbins suggests? A five-minute timer. Before lying in bed, find a quiet place. Sitting comfortably with your eyes closed, try “calming the mind, breathing heavily and deeply, and moving away from stressors in your environment,” she says. As thoughts enter the mind, “acknowledge them and then come back to the breath, come back to something that’s tangible in the present.” The goal is to slip away from stress and prepare your brain and body for sleep. Robbins says that those who meditate regularly experience better quality sleep, because they fall asleep faster and into a deeper sleep.

Both Robbins and Saltz agree that meditation takes practice, so you’re not likely to see life-changing results the first time you try it. But sticking to some meditation for even five days could help you reap the rewards of better, deepersleep, Robbins says.

While it’s unlikely that we’ll return to our lives as they once were — at least for some time — some workplaces are beginning to reopen across the nation. We might see different schedules or more opportunities to work from home, but some of us will go back to a set schedule that might be a difficult jump from our current state. If you have enjoyed not having to commute or put in long hours away from home, how can you ready yourself for this shift?

Robbins suggests preparing for your transition as you would an upcoming trip. If you were heading to London, for example, “in the week leading up to that trip, you’d be starting to switch your calendar a little bit closer to your destination.” She says to take small steps each night, such as going to bed 15 minutes earlier, to move in the direction of your new schedule. These incremental adjustments give your body and mind time to adapt.

Besides our sleep schedules, there can be additional stress and exhaustion as we re-enter the world. From worrying about whether we’ll be infected to wondering whether we’ll still have a job, some fear of the unknown remains — and that, as we know, is tiresome.

Digging into the “what-ifs” usually causes anxiety, Saltz says, which expends a lot of energy. “We’re not going to be able to get uncertainty to go away.” The best approach for dealing with uncertainty, Saltz says, is to first pick a trustworthy source for information, such as the Centers for Disease Control and Prevention or the World Health Organisation, to help you make decisions such as whether to wear a mask. Then, allow the remaining uncertainty to sit with you, rather than fight with it or run away from it. “The only way you can coexist with [uncertainty] is to sort of let it float like a cloud and be there. It won’t be in your front windshield. It’ll be off to the side … so you can drive.”

— Jenna Jonaitis is a writer who covers relationships, marriage, and lifestyle.