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Sleep is vital for our mental and physical wellbeing, but with the COVID-19 pandemic continuing to disrupt the way we live and most importantly, our routines, it also continues to disrupt our patients’ sleep. Our sleep expert provides a guide on how to manage sleeping problems when they arise.

 

Disruption to daily life

Following the global outbreak of COVID-19 in December 2019 and widespread national lockdowns, a unique and highly stressful situation has developed for many worldwide.

Having to work from home, tackling challenging new family dynamics and drastically reducing our social interactions, as well as the ongoing anxieties around the health risks of COVID-19 and financial uncertainty, have all had a major impact not only on our day-to-day functioning but also on our sleep at night.

As sleep plays a key role in our 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 and younger people were significantly more likely to report experiencing changes in their sleep.

“Recognising and treating sleep problems can help individuals cope better with the anxiety and stress brought about by lockdowns and may also have important impacts on physical health and immune function,” says Dr Alanna Hare, consultant physician in respiratory and sleep medicine at Royal Brompton & Harefield Hospitals Specialist Care.

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 more severe 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 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 daytime naps and spending a prolonged time in bed.

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. Physical activity, including walking, has been demonstrated to be associated with improved sleep outcomes for both healthy people and those with insomnia.

Electronic devices such as mobile phones and laptops can significantly disrupt sleep. To prevent this, use a low blue light filter or blue light glasses during the evening and try to stop using the device at least an hour before bed.

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 cognitive behavioural therapy (CBT-I) approach. This treatment is based on sleep diaries and personalised sleep restriction as well as cognitive strategies which aim to identify and address sleep related dysfunctional thinking.

Cases of acute insomnia can also respond well to CBT-I, providing sleep hygiene advice and sleep education.

Investigating and diagnosing sleep disorders during the pandemic

Since the COVID-19 outbreak, most sleep services have adapted diagnosis and treatment options available to patients to support remote consultations. 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, such as using smartphone apps to record snoring and video recording of sleep behaviours by bed partners can also help. Having the bed partner present during a remote consultation can also provide vital collateral 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) set up, with video assistance from an expert team of physiologists, enables rapid adjustment to the device and consultant-led support.

For individuals newly diagnosed with insomnia, Dr Hare is trained in CBTi and provides a personalised programme of care for each patient. She also offers remote consultations to treat patients safely from home.

To find out more about our sleep services, or to refer a patient, please contact the customer services team on +44 (0)20 3131 0535 or email privatepatients@rbht.nhs.uk.

Consultant

Dr Alanna Hare

Consultant physician in respiratory and sleep medicine

Dr Hare specialises in sleep disorders, respiratory failure and domiciliary ventilation.