‘COVID-Somnia’—Increased Sleep Disturbances Linked to the Pandemic
Sleep neurologists are reporting increased sleep disturbances and the misuse of sleep medications in people recovering from COVID-19 and people whose lives have been beset by fear and social isolation.
Neurologists who specialize in sleep disorders are seeing an increase in sleep disorders associated with COVID-19, a surge they're terming “COVID-somnia.”
From insomnia to hypersomnia, night terrors to the misuse of sleep medications, the phenomenon is being reported and treated not only in people recovering from COVID-19, but in the far larger number of people whose lives have been turned upside down by fear and social isolation. This includes persons living with dementia and their caregivers.
People are suffering from shifts in their sleep patterns due to their fears about getting the virus, concerns about loved ones, not being able to go to work, not having social contact with others, according to Rachel Marie E. Salas, MD, FAAN, associate professor of neurology at the Johns Hopkins Center for Sleep.
Some individuals now meet the diagnostic criteria for chronic insomnia: not being able to fall asleep within 30 minutes more than three times a week for more than three months. They get into bed, but the brain kicks in and they start worrying if they're going to lose their job, if their family member is going to survive, and they literally cannot fall asleep.
Conscious fears of the virus and its economic impacts are but one cause of the condition. Dissolution of daily schedules, reduced exposure to sunlight (particularly in the morning), excessive daytime napping and excessive use of electronic media (particularly near bedtime) all contribute to disrupted sleep patterns.
This is now being reflected in the increase in the number of prescriptions for sleep medications since the beginning of the pandemic.
Sleep-promoting medicines, however, are generally reserved for only fleeting cases of insomnia, and ideally should be prescribed for no more than two weeks. Sleep disorders specialists say there are far more effective approaches to treating COVID-somnia.
Loss of sleep affects not only mood and attention, but the body's immune functioning and its ability to fight infections. Those sleeping less than five hours per night may be 4.5 times more likely to develop a cold following rhinovirus exposure compared to those sleeping seven hours per night, according to a study conducted in 2015. Those sleeping between five to six hours per night were likewise at significantly increased risk of developing cold symptoms.
Not everyone is experiencing sleep loss, of course. There is a subset of the population who are actually sleeping better, because they don't have to get up as early for work and may experience less stress from not having to commute.
Even for those whose sleep is adversely affected, insomnia is not the only way in which they are affected.
Abnormal dreams and disruptive nightmares are another type of sleep disturbance that can be triggered by events such as this pandemic, which has had a profound impact on the psychological and mental well-being of individuals across society.
Non-medical strategies should be first tried, and include the following
- Setting a regular daily schedule promotes sleep. We need to go to bed at the same time and wake up at the same time.
- Even those who are working remotely, need to wake up at the same time as before, get dressed for work, have breakfast and start working at the same time as they did before the pandemic
- Getting out and enjoying the sunshine, helps to re-establish the Circadian rhythm.
- Have dinner at the same time
- Avoid watching anxiety-provoking news programs before bedtime
- Ideally avoid television at night and all electronic gadgets 1-2 hours before bedtime.
The lack of circadian cues from the sun during the morning and abnormal exposure to blue light from electronics at night severely disrupts their circadian rhythms. The best thing is to maintain normal daily routines, maximize activities that promote alertness during the daytime and avoid behaviors that promote arousal at bedtime
For complaints of insomnia, writing a prescription for zolpidem or one of the benzodiazepines may be the quickest way for a physician to respond, but those who specialize in sleep medicine say their use should generally be limited to no more than a couple weeks, and are inappropriate for patients whose condition has become chronic.
Sleep medications can significantly reduce slow-wave sleep, the deepest phase of non-rapid-eye-movement sleep and one critical to memory consolidation.
Melatonin can be very helpful for anchoring the circadian rhythm, and is a safer alternative. As always, discuss with your doctor if you continue to have sleep concerns despite trying all the non-medical strategies, before taking any medication.
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