Managing Life at Home During the COVID-19 Outbreak
BY CARRIE MACMILLAN, KATHY KATELLA, COLLEEN MORIARTY March 19, 2020
As we adjust to working from home during the COVID-19 pandemic, it’s natural to struggle with maintaining healthy habits. People may be having trouble sleeping, managing stress, coping with loneliness, and eating right.
“Many of my patients are very anxious about what the implications are for their personal health and their safety,” says Dwain C. Fehon, PsyD, chief psychologist of Yale New Haven Hospital's psychiatric services. “I think this is on everybody's mind right now.”
There are strategies that can help. “It's important for adults to stay engaged with their work or other sources of stimulation, like reading, hobbies, listening to music, and continuing to exercise,” says Fehon. “We just need to find ways to build them into our schedule and to be flexible.”
In addition to Fehon, we asked Yale Medicine experts in different specialties to provide tips on how to handle common health issues related to social distancing and self-quarantine.
How to handle loneliness
A distinct challenge of being in quarantine or keeping social distance is a sense of loneliness. Loneliness is no small matter, even in the best of times. According to a 2018 survey by The Economist and the Kaiser Family Foundation, 22% of adults in America report always, or very often, feeling lonely, feeling a lack of companionship, or believing they are socially left out or isolated. Other studies have found the number to be closer to half of all Americans. Loneliness touches all age groups and, perhaps surprisingly, some research indicates that millennials may be lonelier than any other age group.
“It is important to differentiate social isolation—being alone or away from family and friends, which is what is occurring now—from loneliness, which is a person’s perception of the quality rather than the quantity of their social interactions,” says Yale Medicine geriatrician Mary Tinetti, MD, chief of geriatrics. “So, the physical and mental effects of the current situation may not be the same as what we know about the health effects of loneliness.”
What we do know is that, overall, people who report being lonely have shorter lives, higher rates of cardiovascular disease, dementia, depression, and anxiety. In contrast, one study has shown that people who report having “adequate” social relationships have a 50% greater likelihood of survival compared to those with “inadequate” social relationships. The negative health effects of feeling lonely, in fact, rank with smoking, obesity, and physical inactivity, researchers say.
Feeling isolated and alone takes a potential mental health toll as well. “Being isolated is a significant risk factor for depression and anxiety, and many people rely on work as a way of staying connected to people—or, for our kids and teenagers going to school, as a way to stay connected to friends,” says Fehon. “Being home for extended periods of time can certainly exacerbate that sense of isolation. I guess we're lucky, in a way, that we're living in a time where social media is such a part of our lives,” he says. “But, not everybody is into social media. So, it’s important to reach out by phone, to stay connected to friends, family, or coworkers.”
Older people, less likely to be connected via social media, may be finding social distancing especially difficult—but it’s also especially important for this age group. “Unfortunately, for people over 60, staying isolated from others appears to be one of the most effective ways to reduce deaths or need for prolonged critical hospital care,” says Dr. Tinetti. “We know it is hard, but no grandkid visits.”
How to avoid stress eating
When you are managing new stresses—like being isolated or working at home for an extended period—it may be helpful to start identifying the circumstances that tend to make you want to overeat. “Boredom and stress can be huge triggers,” says Fehon. “It's when we're not doing much, when we're idle or feeling overwhelmed, that we may eat as a way of managing stress. The boredom and restless energy that can come from being quarantined may cause some people to want to reach for snacks as a way to self-soothe.”
Times of stress and change can disrupt healthy behaviors—and that can lead to weight gain, says Albert Do, MD, MPH, a Yale Medicine weight loss expert. But it’s also possible to take charge and create habits that result in effective weight maintenance and even weight loss, he says. That may be especially true right now, when more people are eating at home and avoiding bars and restaurants.
“The more planning the better,” Dr. Do says. “It’s a key to controlling nutritional intake, and it can help eliminate impulsive eating. Planning also reduces the amount of cognitive work that is required to prepare and eat food—there is no thinking required as it had already been decided earlier.”
Another key to better eating during a time of home confinement is “purposeful eating,” as Dr. Do describes it. “It has to be a deliberate process,” he adds. “An element of mindfulness can help.” He also provided the following tips:
- Instead of planning meals around a set of ingredients, plan around the foods you have available for consumption.
- If you feel you need to stockpile food, make sure to store that food away so it is not readily available.
- Boredom is often a trigger for impulsive snacking, so try to keep busy.
- Creating routines for eating, working, exercise, and play is also important, Dr. Do says, because that can help you avoid stress, which can lead to impulsive eating and elevated cortisol, a stress hormone associated with weight gain. “Your routines can provide some comfort in uncertain times, and they also can help to eliminate unstable eating habits due to impulsive behavior,” he says.
How to practice good sleep hygiene
When you are under stress, bedtime can present a catch-22—it’s hard to sleep because you’re anxious, and you’re anxious because you can’t sleep. Stress can also make the quality of sleep elusive, making it difficult to fall asleep, stay asleep, or sleep soundly—all of which can increase the chance that you’ll be more reactive to stress the next day, according to the National Sleep Foundation.
“We need to get enough sleep to reduce stress and stay healthy,” says Christine Won, MD, MS, medical director of the Yale Centers for Sleep Medicine. Sleep is a factor in keeping the immune system strong so it can fight off exposures and infections, and it plays an important role in cellular repair functions, she says. “This means seven to nine hours of sleep every night. It is also important to keep regular sleep hours, as well as a regular schedule for eating and exercise,” she adds.
For many people, preparing for a good night’s sleep can be as simple as “having time in the evening where we can settle down into quiet activity, prepare the body and mind for rest, and keep the bedroom for sleep,” says Fehon.
Here are some tips from Yale Medicine doctors and the National Sleep Foundation:
- Get an hour of bright light in the morning and around midday to help regulate your circadian rhythm.
- Start the day with exercise, which release hormones that signal your body to stay awake.
- Stick to the same bedtime and wake-up time every day.
- Meditate. This can be as simple as sitting quietly for a couple of minutes as you focus on your breathing. Many apps are available.
- Avoid eating in the three to four hours before bedtime—it can throw off your internal clock and lead to reflux, which is disruptive to sleep.
- If you can't get seven to nine hours of sleep at night, take short naps during the day. “This will help curb some of the consequences of sleep loss,” Dr. Won says.
How to interrupt negative ‘thought loops’
Even if we do put away our smartphones and stop watching the COVID-19 updates on the news, our minds can become our worst enemies during a time like this, replaying fearful thoughts and worries. Fehon explains that the first step toward stopping these thoughts is simply to start noticing them as they happen—being mindful of them. “When you realize that you’re lost in thoughts, catch yourself, and bring yourself back to an activity that’s grounding,” he says.
Grounding means being engaged in an activity that helps provide a sense of peace. Consider what activities calm you down. These will depend on individual interests or feelings of competence, Fehon says. “It could be knitting, reading, strumming a guitar, meditating, going for a walk, or just sitting outside and watching birds,” he says. As long as the activity requires you to be focused and present, and gives a sense of relaxation, it can help keep away spirals of negative thoughts.
How to keep a positive perspective
The social distancing rules and working-from-home arrangements offer a rare opportunity, Fehon says. “It’s given us a chance to pause and reflect on what is most important in our lives. And more often than not, people say that their health and family are the most important things—and that’s what we’re focused on now,” he says.
Click here to learn more about Yale’s research efforts and response to COVID-19.