As the Covid-19 pandemic, unfettered by coherent government action, rolls across the United States, the impact of the disease on a good night’s sleep bothers both those who have to battle the contagion and those who are worried sick by it.
Steven Feinsilver, MD, director of the Center for Sleep Medicine at Lenox Hill Hospital, and professor of medicine at Hofstra Northwell School of Medicine in New York City, understands the impact of Covid-19 from both the medical and psychological viewpoints.
Staying Home May Complicate Sleeping at Home
“I was trained in pulmonary medicine, so during the height of the epidemic in New York, I was doing pulmonary service,” he told BreakingMED. “At one point, 90% of the people in the hospital were Covid-19 patients. The hospitals did a pretty good job, but it was everybody working ridiculous hours for a couple of months.”
“I think there is more insomnia definitely related to Covid-19,” Feinsilver said. “I don’t know if there is anything caused by the disease itself. The disease does leave people very fatigued for a month or two afterwards. A lot of people say that. Fatigue clearly seem to be part of this.
“The other thing is that people who are locked down really sleep badly,” he told BreakingMED. “They are not burning many calories during the day; people are bored; it is hard to separate day and night; they are not on schedule anymore. One of the times I see bad sleep is when people are tired. It is good to be on schedule. Good sleep wants habits.
“With Covid-19 also, there are a lot of people not working, not doing much, not going outside, a lot of people are gaining weight — it’s been a bad time,” he said. “But this is a very anxious time for everybody.”
The SARS-CoV-2 novel coronavirus infection has been contracted by more than 15 million people worldwide, including more than 4 million in the United States. More than 650,000 deaths worldwide have been reported to the World Health Organization and more than 145,000 deaths have occurred in the United States. Dozens of states continue to report record numbers of deaths, hospitalizations, and confirmed infections on a daily basis.
Even though scientists are still learning about the disease and its impact on sleep, Tom Roth, PhD, director of the Sleep Disorders and Research Center at Henry Ford Hospital and professor of psychiatry at Wayne State University, School of Medicine, in Detroit, said even people who haven’t been infected are affected by the pandemic.
“The whole idea that there is a life-threatening disease out there if you are a 70-year-old or 80-year-old person or you are living in an old-age home, that would scare the hell out of you and that would disturb sleep,” he says. “There are psychological effects of any chronic and life-threatening disease. And, there are physical effects, too. Covid affects respiratory systems, making breathing and sleeping hard. We snore because we aren’t breathing well. It is important to differentiate between physiological effects of this infection versus the psychological effects.”
And Now, The Brain
“This is not well set science at this point,” said Russell Rosenberg, PhD, chief science offer and chief executive officer of NeuroTrials Research of Atlanta, “but there is some emerging information that even though Covid-19 may be predominantly a respiratory illness, it is possible that it also affects the brain and then affects sleep.
“During the Covid-19 pandemic we are all experiencing heightened anxiety,” he says. “Even those people who have recovered from Covid-19 are still anxious about it. We also have patients who have had Covid-19 and say they get a good night’s sleep but yet remained fatigued long after they are no longer infected.” Jennifer Martin, PhD, a clinical psychologist, professor of medicine at the David Geffen School of Medicine at the University of California at Los Angeles, who also serves on the board of directors for the American Academy of Sleep Medicine, echoed those comments:
“We really don’t know much about what happens to sleep among people who have Covid-19 beyond what we know about viral illnesses in general,” she says. “When we have any kind of infection or viral illness, our need for sleep goes up and our ability to sleep goes down. When people are sick with anything, they should just allow themselves plenty of time to rest and recover.
“I think what we are seeing clinically in the sleep world is that people are spending more time in bed, and there has been some science out of China and Europe – Italy, in particular – showing that people are spending more time in bed but they are complaining more about problems with sleep.
“This is probably because if you are kind of sleepy for like 7 and a half hours, but you don’t have much else to do, you start going to bed early and maybe sleeping in later. At some point you are going to exhaust your need to sleep and end up lying there awake,” Martin said. “Some people have kind of extended their time in bed too far. That creates struggles with sleep.”
And then, she said, there is the anxiety surrounding the disease and the issues that surround how it is being attacked or ignored. “The other issue is anxiety,” Martin said. “People worry about getting Covid-19, about the financial stresses that go with stay-at-home orders for a lot of people, worry about whether my kids are going back to school, worry about whether my customers are coming back, worry about whether my job is still going to be there when this is over.
“Those kinds of things creep into the bedroom,” she said, “and so, what I am hearing clinically is there are a lot of people who are having a hard time falling asleep because they are laying worrying about these kinds of issues.”
Martin suggested that there are strategies that can combat Covid-19-related insomnia or sleeplessness. “Think about how much sleep you need and spend only the amount of time you need in bed to get that good solid sleep. If you are someone who needs 8 hours of sleep, you should be spending between 8 and 8 and half hours in bed. That’s Number 1.
“Number 2 is creating kind of a buffer zone between the stress and anxiety of the day and going to sleep at night. Don’t check the news. Stay off the Johns Hopkins Covid-19 website at least a half hour or so before going to sleep. Do something to help you disconnect from the mental stresses and worries before you climb into bed.
“It is very likely what you are doing or thinking of just before you try to sleep may come up also when you wake up in the middle of the night,” Martin said.
Source: Various telephone interviews
Roth disclosed that he consults for many companies who do work in insomnia, including Merck, Eisai, and Novartis. Rosenberg disclosed that he and his research organization consult for all the companies that work on insomnia issues. Martin and Feinsilver disclosed no relevant relationships with industry.