January 27, 2021

Is the coronavirus keeping us up at night? Here's what the research says.

Daily Briefing

    The novel coronavirus pandemic has affected the world in a host of different ways, but perhaps one of the pandemic's most widespread side effects has been a loss of sleep, according to multiple studies—an effect that could have long-lasting physical, mental, and emotional consequences, Neil Osterweil reports for Medscape.

    How Covid-19 will impact behavioral health services

    How the coronavirus pandemic is affecting our sleep

    Research has found that, since the start of the pandemic, many people are reporting worse sleep. According to Uri Mandelkorn from the Natural Sleep Clinic in Jerusalem, a cross-sectional international survey of more than 3,000 people from 49 countries conducted between March 26 and April 26 of last year found 58% of respondents reported being dissatisfied with their sleep and 40% said their sleep quality had decreased during the pandemic. Mandelkorn was a lead researcher on the study.

    Similarly, a cross-sectional survey of 843 people in the United Kingdom that was conducted between May 12 and June 2 of last year found that just 45% of respondents said they had refreshing sleep, while 46% reported feeling sleepier during the pandemic than they did before the pandemic began. In addition, nearly 70% of respondents said they had experienced a change in their sleep patterns since the pandemic began.

    Having the Covid-19 infection can affect sleep patterns too, the U.K. study found. According to the study, respondents with suspected cases of Covid-19 reported experiencing more nightmares and irregular sleep rhythms.

    Likewise, a study recently published in The Lancet that involved Covid-19 patients who were discharged from Jin Yin-tan Hospital in Wuhan, China, found that, among 1,655 patients, 26% reported experiencing difficulties sleeping six months after they were discharged.

    Looking for ways to cope

    Researchers in the U.K. study wrote that they found "[a]n impact on mental was strongly associated with sleep-related alterations." According to the survey, about 66% of respondents said the pandemic had affected their mental health, and about 26% said they had increased their alcohol consumption during pandemic-related lockdowns.

    David Gozal, a pediatric pulmonologist and sleep medicine specialist at the University of Missouri, said it's possible that some people may have experienced better sleep at the start of the pandemic, but they saw their sleep quality decline as time went on.

    "At the beginning, with the initial phases of lockdown for [the pandemic], for most of the people whose jobs were not affected and who did not lose their jobs, [for whom] there was not the anxiety of being jobless and financially strapped, but who now were staying at home, there was actually a benefit," Gozal said. "People started reporting getting more sleep and, more importantly, more vivid dreams and things of that nature."

    However, Gozal continued, "as the lockdown progressed, we saw progressively and increasingly more people having difficulty falling asleep and staying asleep, using more medicine such as hypnotics to induce sleep, and we saw a 20% increase in overall consumption of sleeping pills."

    For example, one survey of 5,525 Canadians that was conducted between April 3 and June 24 of last year found that a large proportion of respondents reported using pharmacologic sleep aids, according to Tetyana Kendzerska, an assistant professor of medicine in the respirology division at the University of Ottawa.

    "At the time of the survey completion, 27% of participants reported taking sleeping aids (prescribed or [over] the counter); across the entire sample, 8% of respondents reported an increase in the frequency of sleeping medication use during the [pandemic] compared to before the [pandemic]," she said.

    Experts raise concerns

    Kannan Ramar—a critical care, pulmonary, and sleep medicine specialist at the Mayo Clinic and president of the American Academy of Sleep Medicine—expressed concern about the number of people who are taking over-the-counter sleep medications to cope with pandemic-related sleep issues.

    "When people are self-medicating for what they think is difficulty sleeping, the concern is that even if a diagnosis of insomnia has been established, there could be another, ongoing sleep disorder that may be undiagnosed, which might be causing the problem with insomnia," such as obstructive sleep apnea, Ramar said.

    In addition, Ramar noted that all medications come with side effects, "and if one is taking a medication that has stimulants in place, such as pseudoephedrine in antihistamine combinations, that can potentially contribute to or exacerbate any underlying sleep disorders."

    Sleep also plays a role on how well people's immune systems work, Ramar said. "When people have adequate sleep, their immune system is boosted. We know that there [is] good data from hepatitis A and hepatitis B vaccinations, and recently on flu vaccination, that if people get sufficient duration of sleep before and after they receive the shot, their likelihood of building an immune response to that particular vaccination tends to go up."

    Kendzerska said data from her study showed that "having a chronic illness was associated with new sleep difficulties during the pandemic," and she noted that previous studies have shown "persistent sleep problems can make people more susceptible to infection or impair recovery."

    What can people, providers do to help?

    Overall, experts say it's important that people try to maintain good sleep—and sleep habits—throughout the pandemic, Osterweil reports. That includes keeping a consistent bed and wake time, limiting exposure to stressful news, decreasing consumption of alcohol and stimulants like coffee, not using electronic devices in bed or around bedtime, and maintaining a healthy lifestyle, Osterweil writes.

    Further, Mandelkorn and colleagues in their study wrote that there is a "need to screen for worsening sleep patterns and use of sleeping aids in … more susceptible populations … namely, women and people with insecure livelihoods or those subjected to strict quarantine." They continued, "Health care providers should pay special attention to physical and psychological problems that this surge in sleep disturbances may cause" (Osterweil, Medscape, 1/25; Pérez-Carbonell et al., Journal of Thoracic Disease, October 2020).

    Learn more: The 4 highest-priority behavioral health moves amid the Covid-19 crisis

    behavioral

    The psychological impact of the Covid-19 pandemic is unprecedented—fear, isolation, distrust. This is rapidly increasing the need for behavioral health services. But there are significant gaps and barriers that stand in the way of people getting the help they need.

    Here are four areas to prioritize immediately to support staff and manage behavioral health demand already in the system.

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