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Sleeping is a basic human need- like breathing, eating and drinking. It is vitally important for physical health. Getting a good night’s sleep can improve our immunity and is a vital component of staying healthy.
Inadequate quantity and quality of sleep not only adversely affects work and family life due to lack of concentration and low mood, but can also damage our health. A number of clinical studies have highlighted close links between the amount and quality of sleep we get with conditions such as high blood pressure, stroke, diabetes and heart failure. So getting quality sleep is crucial to ensure good health and quality of life.
Disruption of daily life
The COVID-19 pandemic has resulted in many people being exposed to unprecedented levels of anxiety and stress. Social distancing, school closures, quarantines, working-from-home have resulted in profound changes to normal routines for people across the globe of all ages and walks of life.
The pandemic has created a host of new challenges even for people who previously had no sleeping problems. Individuals and families have experienced major changes in their routines which have resulted in reduce sleep opportunity. Many people are living with uncertainty, health anxiety, and financial and employment concerns which can impact sleep quality.
As sleep plays a key role in mental wellbeing, physical health, work performance, and emotion regulation, sleep disturbance can have direct consequences on daytime functioning. Recent surveys of the impact of COVID-19 on sleep found that 70% of respondents reported changes in their sleep patterns since the pandemic began. Younger people were significantly more likely to report experiencing changes in their sleep.
Dr Alanna Hare, consultant physician in respiratory and sleep medicine at London’s Royal Brompton Hospital, explains, “Recognising and treating sleep problems can help individuals cope better with the anxiety and stress brought about by global lockdown and may also have important impacts on physical health and immune function.”
Direct effects of COVID-19 on sleep
Beyond the impacts of lockdown on sleep and the indirect impacts of the virus, such as anxiety and stress, the virus itself may also have direct impacts on sleep. Although the respiratory manifestations of COVID-19 have been well described, emerging evidence suggests COVID-19 has neurologic consequences as well.
The most common neurologic symptoms in COVID-19 are anosmia, loss of taste and headache, but other symptoms such as stroke, impaired consciousness, and seizure have also been described.
Sleep dysfunction is common in patients admitted to an intensive care unit (ICU) under normal circumstances but seems to be seen more severely in COVID-19 ICU patients. Whether these patients will later develop persistent insomnia remains to be studied. There is also a suggestion, that there may be an increased prevalence of obstructive sleep apnoea (OSA) in COVID-19 patients.
Managing insomnia during COVID-19
Fortunately, for most people insomnia will be a temporary condition. It is important for individuals to focus on maintaining good sleep habits and a regular sleep and wake schedule, avoiding naps and prolonged time in bed.
Alcohol and caffeine should be avoided for the six hours before bed and it is particularly important to continue to get regular exercise and daylight exposure each day, especially in the early morning. Physical activity has been demonstrated to be associated with improved sleep outcomes for both healthy people and those with insomnia.
During this time, individuals are likely to be spending more time online or using electronic devices. To prevent these from interfering with sleep, they should use the low blue light filter during the evening and try to stop using the device at least an hour before bed.
Cases of acute insomnia can respond well to cognitive behavioural therapy (CBT-I), providing sleep hygiene advice and sleep education. This helps to identify and address sleep related dysfunctional thinking and can help to lower the risks to mental and physical health and wellbeing.
Chronic insomnia, defined as difficulty establishing or maintaining sleep on more than 3 nights a week for more than 3 months, with daytime consequences of the sleep disturbance, is best managed with a conventional CBT-I approach based on sleep diaries and personalised sleep restriction.
Investigating and diagnosing sleep disorders during COVID-19
Since the COVID-19 outbreak most sleep services have adapted diagnosis and treatment options available to patients. The use of pre-screening questionnaires provides an assessment of someone ahead of a telephone or video consultation.
Sleep diaries are helpful, particularly where insomnia, behaviourally insufficient sleep or sleep-wake cycle disorders are suspected. Other methods using smartphone apps to record snoring can assist in diagnosing sleep apnoea and video recording of sleep behaviours by bed partners can also help. But having the bed partner present during a remote consultation can provide vital patient history.
At the Royal Brompton Hospital, the sleep department has established safe systems to provide home testing. This includes the diagnosis of sleep apnoea and other sleep-related breathing disorders, and wearable devices to aid diagnosis of sleep-wake rhythm disorders. For individuals newly diagnosed with sleep apnoea, remote CPAP (continuous positive airway pressure) with video assistance from an expert team of physiologists enables rapid adjustment to the device and consultant-led support.
Focusing on quality and quantity
COVID-19 appears to have direct effects on sleep, but good-quality and quantity of sleep makes a big difference to how we feel, so it's important to get enough. Everyone should focus on trying to maintain a regular sleeping pattern and stick to good sleep practices.
In times of stress and uncertainty it’s even more important to engage in strategies that can help to manage stress such as regular exercise, healthy meals, relaxation and mindfulness, self-care, and personal connections within social distancing guidelines. Each of these health behaviours can enhance how well a person sleeps.
Consultant physician in respiratory and sleep medicine