COVID-Somnia: How the Pandemic Affects Sleep/Wake Regulation and How to Deal with it?

Trajectories of sleep disturbance and self-management of chronic conditions during COVID-19 among middle-aged and older adults

The COVID-19 pandemic has had a widespread impact on sleep quality, yet little is known about the prevalence of sleep disturbance and its impact on self-management of chronic conditions during the ongoing pandemic. To evaluate trajectories of sleep disturbance and their associations with one's capacity to self-manage chronic conditions. A longitudinal cohort study linked to 3 active clinical trials and 2 cohort studies with 5 time points of sleep data collection (July 15, 2020-May 23, 2022). Adults living with chronic conditions who completed sleep questionnaires for two or more time points. Trajectories of self-reported sleep disturbance across 5 time points. Three self-reported measures of self-management capacity, including subjective cognitive decline, medication adherence, and self-efficacy for managing chronic disease. Five hundred and forty-nine adults aged 23 to 91 years were included in the analysis. Two-thirds had 3 or more chronic conditions; 42.4% of participants followed a trajectory of moderate or high likelihood of persistent sleep disturbance across the study period. Moderate or high likelihood of sleep disturbance was associated with age < 60 (RR 1.57, 95% CI 1.09, 2.26, P = 0.016), persistent stress (RR 1.54, 95% CI 1.16, 2.06, P = 0.003), poorer physical function (RR 1.57, 95% CI 1.17, 2.13, P = 0.003), greater anxiety (RR 1.40, 95% CI 1.04, 1.87, P = 0.03) and depression (RR 1.63, 95% CI 1.20, 2.22, P = 0.002). Moderate or high likelihood of sleep disturbance was also independently associated with subjective cognitive decline, poorer medication adherence, and worse self-efficacy for managing chronic diseases (all P < 0.001). Persistent sleep disturbance during the pandemic may be an important risk factor for inadequate chronic disease self-management and potentially poor health outcomes in adults living with chronic conditions. Public health and health system strategies might consider monitoring sleep quality in adults with chronic conditions to optimize health outcomes.

Comparison of sleep quality, diet quality, and weight change between COVID-19-recovered patients and healthy controls: A matched case-control study

Background and Aim

Literature suggests that individuals who have recovered from COVID-19 may experience post-COVID conditions, including sleep problems and alterations in smell or taste. Thus, this study aims to compare the sleep quality, diet quality, and weight change between COVID-19-recovered patients and healthy controls.

Methods

A matched case-control study involving young adults aged 18-30 years was conducted in the Klang Valley of Malaysia. The young adults were matched in a 1:1 ratio based on their sociodemographic characteristics, including gender, age, marital status, ethnicity, educational attainment, employment status, and monthly earned income. The Pittsburgh Sleep Quality Index was utilized to evaluate sleep quality, and the Diet Quality for Malaysia was used to determine the diet quality of all young adults. The young adults retrospectively recalled their prepandemic body weight in February 2020, while their current body weight in February 2023 was measured using a TANITA HD-314 digital weighing scale.

Results

Emerging findings suggest that sleep quality and weight change were comparable between COVID-19-recovered patients and healthy controls. However, healthy controls were reported to have a more diversified diet than COVID-19-recovered patients. Nevertheless, no significant main effects or interaction effects of sleep and diet quality on weight change were observed in COVID-19-recovered patients or healthy controls. In this study, young adults also reported suffering from sleep deprivation and deficiency due to the pandemic.

Conclusion

Intervention programs that emphasize avoiding stimulants before bedtime for healthy controls, promoting the importance of having a diversified and balanced diet among the COVID-19-recovered patients, and achieving an ideal body weight for all young adults should be conducted after the COVID-19 pandemic.

Unveiling Coronasomnia: Pandemic Stress and Sleep Problems During the COVID-19 Outbreak

The COVID-19 pandemic posed an unprecedented challenge to public well-being, necessitating an examination of its health impact. This review discusses the relationship between pandemic-induced stressors and individual sleep patterns and quality. The pandemic stressors include lockdown or physical distancing measures, direct virus exposure, and the dissemination of misinformation and disinformation. The pandemic led to delayed sleep-wake cycles, except for healthcare professionals, and worsened sleep quality. The prevalence of insomnia was higher for women due to pre-existing conditions and susceptibility stressors such as lockdown stress and family responsibilities. Healthcare professionals, who experienced worsened work conditions during the pandemic, reported higher rates of insomnia and sleep difficulties due to infection anxiety and post-traumatic stress from direct virus exposure. For the general population, stress stemmed from social isolation under lockdown and overwhelming false information available online, resulting in sleep problems. Taken together, the findings highlight the importance of promoting social interactions, providing psychological support services, and caution in navigating health information. In summary, this review underscores the need for individual- and group-centered approaches in ongoing research and interventions to address pandemic-related stress and sleep issues during COVID-19.

Sleep Education: A Narrative Review on Barriers and Opportunities to Grow a Diverse Sleep Team

The increased recognition of sleep-wake disorders and their effects, along with the anticipated shortage of sleep medicine specialists, heralds a concomitant need to have more health care providers with dedicated training in the evaluation and management of sleep disorders across the life span. A narrative review of published literature on sleep education was conducted and identified factors related to diversity within the sleep team, barriers to implementation of sleep education, and strides in sleep education. Implementation of novel sleep education strategies will require creative navigation of barriers such as allocation of curricular time, availability of teaching faculty, and funding to train more members of the sleep team. Deliberate coordination within and across health professions programs, with efforts to share resources and leverage technology, will be instrumental to guide the next phase of growth in sleep education.

Long COVID: neurological manifestations - an updated narrative review

Infection with the SARS-CoV-2 virus can lead to neurological symptoms in the acute phase and in the Long COVID phase. These symptoms usually involve cognition, sleep, smell disorders, psychiatric manifestations, headache and others. This condition is more commonly described in young adults and women. This symptomatology can follow severe or mild cases of the disease. The importance of this issue resides in the high prevalence of neurological symptoms in the Long COVID phase, which entails significant morbidity in this population. In addition, such a condition is associated with high health care costs, with some estimates hovering around 3.7 trillion US dollars. In this review, we will sequentially describe the current knowledge about the most prevalent neurological symptoms in Long COVID, as well as their pathophysiology and possible biomarkers.

Evaluation and treatment approaches for neurological post-acute sequelae of COVID-19: A consensus statement and scoping review from the global COVID-19 neuro research coalition

Post-acute neurological sequelae of COVID-19 affect millions of people worldwide, yet little data is available to guide treatment strategies for the most common symptoms. We conducted a scoping review of PubMed/Medline from 1/1/2020-4/1/2023 to identify studies addressing diagnosis and treatment of the most common post-acute neurological sequelae of COVID-19 including: cognitive impairment, sleep disorders, headache, dizziness/lightheadedness, fatigue, weakness, numbness/pain, anxiety, depression and post-traumatic stress disorder. Utilizing the available literature and international disease-specific society guidelines, we constructed symptom-based differential diagnoses, evaluation and management paradigms. This pragmatic, evidence-based consensus document may serve as a guide for a holistic approach to post-COVID neurological care and will complement future clinical trials by outlining best practices in the evaluation and treatment of post-acute neurological signs/symptoms.

An observatory on changes in dreaming during a pandemic: a living systematic review (part 1)

A 'new' way of dreaming has emerged during the pandemic, enhancing the interest of psychological literature. Indeed, during the years of the spread of coronavirus disease 2019 (COVID-19), many studies have investigated dream-related phenomena and dreaming functions. Considering the constant and rapid emergence of new results on this topic, the main aim of this study was to create an 'observatory' on the short- and long-term consequences of the COVID-19 pandemic on dreaming, by means of a living systematic review. The baseline results are presented, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines, to identify and discuss existing studies about dreams and dreaming during the COVID-19 pandemic published until February 2022. Web of Science, Embase, EBSCO, and PubMed were used for the search strategy, yielding 71 eligible papers included in the review. Our results show: (a) a more intense oneiric activity during lockdown; (b) changes in dreaming components (especially dream-recall and nightmare frequency); (c) a particular dreaming scenario ('pandemic dreams'); (d) an alteration of the dreaming-waking-life continuum and a specific function of dreaming as emotional regulator. Findings suggest that monitoring changes in dreaming provides important information about psychological health and could also contribute to the debate on the difficulties of dreaming, as well as sleeping, in particular during and after a period of 'collective trauma'.

COVID-Somnia: A Multicentric Study on Sleep Disturbances During the COVID-19 Pandemic With Spatial Mapping of Hotspots

Objective The purpose of this study was to document sleep quality and assess its sociodemographic, behavioral (i.e., tobacco use, alcohol use, and screen time), and mental-health-related indicators (i.e., anxiety and depression) in adults aged 30-59 years across three states of India, and to geo-locate state and district-level findings of sleep quality during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Methods From October 2020 to April 2021, residents (aged 30-59 years) of Kerala, Madhya Pradesh, and Delhi completed a web-based survey that included sociodemographic and behavioral factors, clinical history of COVID-19, and mental health screening instruments for anxiety and depression, namely the Generalized Anxiety Disorder 2-item (GAD-2) and Patient Health Questionnaire-2 (PHQ-2). The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the quality of sleep. Average PSQI scores were geo-mapped. Results Of the 694 participants who responded, 647 completed the PSQI. The mean (SD) global PSQI score was 5.99 (3.2), with approximately 54% of participants reporting poor sleep quality (PSQI Score>5). Eight hotspot districts with severe sleep disturbances (mean score PSQI>6.5) were identified. Multivariable logistic regression analysis showed that compared to Madhya Pradesh, participants from Kerala and Delhi had 62% and 33% lower chances of having poor sleep quality, respectively. Those who screened positive for anxiety had higher odds of having poor sleep quality (adjusted odds ratio {aOR}=2.4, P=0.006*). Conclusion Overall, sleep quality was poor during the early stages of the COVID-19 pandemic (October 2020-April 2021), especially among those who reported high levels of anxiety. Among the three included states, there were differences in sleep quality.

Sleep Disorders in Post-COVID Syndrome: A Psychiatric or Neurological Problem?

The coronavirus pandemic that began in 2019 continues. COVID-19 adversely affects human health not only in the acute, but also in the long-term period of the disease: in a large percentage of cases, health is not fully restored after long periods, requires medical intervention, and is often difficult to correct. Researchers noted during the first wave of the pandemic in 2020 that about 10–20% of patients did not fully recover by three weeks from disease onset and the possible duration of the recovery period remains insufficiently clear, as do the reasons for differences in course during this period. Prolonged recovery after viral infection is not a feature exclusive to COVID-19, which does not facilitate the management of patients with post-COVID syndrome (PCS). The mental health impact of COVID-19 is significant, with at least 30% of recovered patients likely to have symptoms of anxiety and/or depression after the acute phase has passed. Since the onset of COVID-19, there has been an increase in sleep disorders by 42%, with every third COVID-19 survivor reporting sleep complaints. In PCS, this condition is referred to as coronasomnia. The success of therapy for this condition depends on identifying and correcting patients’ mental disorders, as anxiety and depression are often accompanied by sleep disorders this results in a bidirectional interaction between mental disorders and sleep quality. This article presents data on the anti-anxiety drugs Noofen and Adaptol, which help to correct the manifestations of PCS with sleep disorders.

Trajectories of Sleep Disturbance and Self-Management of Chronic Conditions during COVID-19 among Middle-aged and Older Adults

Background

The COVID-19 pandemic has had a widespread impact on sleep quality, yet little is known about the prevalence of sleep disturbance and its impact on self-management of chronic conditions during the ongoing pandemic.

Objective

To evaluate trajectories of sleep disturbance, and their associations with one's capacity to self-manage chronic conditions.

Design

A longitudinal cohort study linked to 3 active clinical trials and 2 cohort studies with 5 time points of sleep data collection (July 15, 2020 - May 23, 2022).

Participants

Adults living with chronic conditions who completed sleep questionnaires for two or more time points.

Exposure

Trajectories of self-reported sleep disturbance across 5 time points.

Main Outcomes

3 self-reported measures of self-management capacity, including subjective cognitive decline, medication adherence, and self-efficacy for managing chronic disease.

Results

549 adults aged 23 to 91 years were included in the analysis. Two thirds had 3 or more chronic conditions; 42.4% of participants followed a trajectory of moderate or high likelihood of persistent sleep disturbance across the study period. Moderate or high likelihood of sleep disturbance was associated with older age (RR 1.57, 95% CI 1.09, 2.26, P<.05), persistent stress (RR 1.54, 95% CI 1.16, 2.06, P=.003), poorer physical function (RR 1.57, 95% CI 1.17, 2.13, P=.003), greater anxiety (RR 1.40, 95% CI 1.04, 1.87, P=.03) and depression (RR 1.63, 95% CI 1.20, 2.22, P=.002). Moderate or high likelihood of sleep disturbance was also independently associated with subjective cognitive decline, poorer medication adherence, and worse self-efficacy for managing chronic diseases (all P<.001).

Conclusions

Persistent sleep disturbance during the pandemic may be an important risk factor for inadequate chronic disease self-management and potentially poor health outcomes in adults living with chronic conditions. Public health and health system strategies might consider monitoring sleep quality in adults with chronic conditions to optimize health outcomes.

Prevalence of Insomnia in the Early Post-COVID-19 Recovery Period

BACKGROUND

Sleep is a complex, reversible process that is responsible for the modulation of various physiological mechanisms. COVID-19-related sleep disorders are affecting different populations with a heterogenous prevalence, yet high rates among infected patients are frequently reported. The aim of the study is to assess the prevalence of insomnia in the early post-COVID-19 recovery period and explore the differences in the results acquired by the Athens Insomnia Scale (AIS) by gender and selected infection severity parameters.

METHODS

The data presented in the paper come from a prospective, observational study on COVID-19 complications (SILCOV-19) consisting of 200 COVID-19 patients. The AIS was used for the quantitative measurement of insomnia symptoms based on ICD-10 criteria.

RESULTS

32% (n = 64) of all patients in the study group obtained results indicating sleep disturbances (>5 points on the scale), while 21.5% (n = 43) obtained results indicating insomnia (>10 points on the scale). The analysis of the results obtained by all patients in the AIS showed a significant correlation with the duration of symptoms (Spearman's rank-order: R = 0.18; p < 0.05), but not with the number of days spent in the hospital or age. Women achieved a higher score in overall AIS, as well as in questions assessing total sleep time, well-being the next day, physical and mental fitness the next day, and sleepiness during the day (p < 0.05).

CONCLUSIONS

the prevalence of insomnia in the early post-COVID-19 recovery period is high.

An automated heart rate-based algorithm for sleep stage classification: Validation using conventional polysomnography and an innovative wearable electrocardiogram device

Background

The rapid advancement in wearable solutions to monitor and score sleep staging has enabled monitoring outside of the conventional clinical settings. However, most of the devices and algorithms lack extensive and independent validation, a fundamental step to ensure robustness, stability, and replicability of the results beyond the training and testing phases. These systems are thought not to be feasible and reliable alternatives to the gold standard, polysomnography (PSG).

Materials and methods

This validation study highlights the accuracy and precision of the proposed heart rate (HR)-based deep-learning algorithm for sleep staging. The illustrated solution can perform classification at 2-levels (Wake; Sleep), 3-levels (Wake; NREM; REM) or 4- levels (Wake; Light; Deep; REM) in 30-s epochs. The algorithm was validated using an open-source dataset of PSG recordings (Physionet CinC dataset, n = 994 participants, 994 recordings) and a proprietary dataset of ECG recordings (Z3Pulse, n = 52 participants, 112 recordings) collected with a chest-worn, wireless sensor and simultaneous PSG collection using SOMNOtouch.

Results

We evaluated the performance of the models in both datasets in terms of Accuracy (A), Cohen's kappa (K), Sensitivity (SE), Specificity (SP), Positive Predictive Value (PPV), and Negative Predicted Value (NPV). In the CinC dataset, the highest value of accuracy was achieved by the 2-levels model (0.8797), while the 3-levels model obtained the best value of K (0.6025). The 4-levels model obtained the lowest SE (0.3812) and the highest SP (0.9744) for the classification of Deep sleep segments. AHI and biological sex did not affect scoring, while a significant decrease of performance by age was reported across the models. In the Z3Pulse dataset, the highest value of accuracy was achieved by the 2-levels model (0.8812), whereas the 3-levels model obtained the best value of K (0.611). For classification of the sleep states, the lowest SE (0.6163) and the highest SP (0.9606) were obtained for the classification of Deep sleep segment.

Conclusion

The results of the validation procedure demonstrated the feasibility of accurate HR-based sleep staging. The combination of the proposed sleep staging algorithm with an inexpensive HR device, provides a cost-effective and non-invasive solution deployable in the home environment and robust across age, sex, and AHI scores.

Prevalence and risk factors of sleep disturbance in adults with underlying health conditions during the ongoing COVID-19 pandemic

To determine the prevalence of sleep disturbance during the coronavirus disease 2019 (COVID-19) pandemic among US adults who are more vulnerable to complications because of age and co-morbid conditions, and to identify associated sociodemographic and psychosocial factors. Cross-sectional survey linked to 3 active clinical trials and 2 cohort studies, conducted between 11/30/2020 and 3/3/2021. Five academic internal medicine practices and 2 federally qualified health centers. A total of 715 adults ages 23 to 91 years living with one or more chronic conditions. A fifth (20%) of participants reported poor sleep. Black adults were twice as likely to report poor sleep compared to Whites. Self-reported poor physical function (51%), stress (42%), depression (28%), and anxiety (36%) were also common and all significantly associated with poor sleep. Age ≥70 years and having been vaccinated for COVID-19 were protective against poor sleep. Sex, education, income, alcohol use, and employment status were not significantly associated with sleep quality. In this diverse sample of adults with chronic conditions, by race, ethnicity, and socioeconomic status, disparities in sleep health amid the ongoing pandemic were apparent. Worse physical function and mental health were associated with poor sleep and should be considered targets for health system interventions to prevent the many subsequent consequences of disturbed sleep on health outcomes. Measurements: self-reported sleep quality, physical function, stress, depression, and anxiety.

Sleep alterations following COVID-19 are associated with both neuroinflammation and psychological disorders, although at different times

Introduction

By the end of 2019, severe acute respiratory syndrome coronavirus 2 rapidly spread all over the world impacting mental health and sleep habits. Insomnia, impaired sleep quality, and circadian rhythm alterations were all observed during the pandemic, especially among healthcare workers and in patients with acute and post-acute COVID-19. Sleep disruption may induce a pro-inflammatory state associated with an impairment of immune system function.

Objective

We investigated the relationship between sleep alterations, psychological disorders, and inflammatory blood biomarkers in patients with post-acute COVID-19.

Methods

We enrolled 47 subjects diagnosed with COVID-19 pneumonia at Santa Maria della Misericordia University Hospital (Udine, Italy) between March and May 2020. Selected patients were evaluated at 2 months (T1) and 10 months (T2) after discharge. Each time, we collected clinical interviews, neurological examinations, and self-administered questionnaires to assess sleep and life quality, anxiety, depression, and post-traumatic stress disorder. Blood biomarkers of endothelial activation, neuroinflammation, and inflammatory cytokines were also measured at each follow-up. Collected variables were analyzed using comparisons between groups and linear regression models.

Results

Prevalence of insomnia increased from 10.6% up to 27.3% after COVID-19. Poor sleep quality was found in 41.5% of patients at both study visits. At T1 follow-up, poor sleepers showed higher levels of neurofilament light chain, vascular cell adhesion molecule 1, and interleukin 10; no significant associations were found between sleep quality and psychological disorders. At T2 follow-up, lower sleep quality was associated with higher levels of vascular cell adhesion molecule 1 and interleukin 8, but also with higher scores for anxiety, depression, and post-traumatic stress disorder.

Conclusion

Our results suggest an association of poor sleep quality with both psychological disorders and neuroinflammation, although at different times, in previously hospitalized patients with moderate-to-critical COVID-19.

COVID-19 and Central Nervous System Hypersomnias

Purpose of review

Central nervous system (CNS) hypersomnias can be triggered by external factors, such as infection or as a response to vaccination. The 2019 coronavirus disease (COVID-19) pandemic, which was caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), led to a worldwide effort to quickly develop a vaccine to contain the pandemic and reduce morbidity and mortality. This narrative review is focused on the literature published in the past 2 years and provides an update on current knowledge in respect of the triggering of CNS hypersomnias by infection per se, vaccination, and circadian rhythm alterations caused by social isolation, lockdown, and quarantine.

Recent findings

At present, there is no consensus on the association between hypersomnias and COVID-19 vaccination or infection per se; however, the data suggest that there has been an increase in excessive daytime sleepiness due to vaccination, but only for a short duration. Kleine Levin syndrome, hypersomnia, excessive daytime sleepiness, and narcolepsy were aggravated and exacerbated in some case reports in the literature. Both increased and decreased sleep duration and improved and worsened sleep quality were described. In all age groups, delayed sleep time was frequent in studies of patients with hypersomnolence.

Summary

The hypothesis that there is a pathophysiological mechanism by which the virus, vaccination, and the effects of quarantine aggravate hypersomnias is discussed in this review.

'COVID-Somnia' in healthcare workers during the pandemic

OBJECTIVES

Sleep disorders associated with COVID-19 pandemic are termed as 'COVID-somnia.' In this study, we sought to assess the prevalence of COVID-somnia in healthcare workers, establish the factors that trigger this condition, and to investigate its relationship with anxiety and depression symptoms.

METHODS

This cross-sectional study was conducted between April 2021 and June 2021, and it included healthcare workers who served during the pandemic. Participants' demographic data, Beck Depression and Anxiety Inventories, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Insomnia Severity Index (ISI) were used, and the results were statistically analyzed. Multiple analyses of factors affecting ESS and ISI scores were evaluated using binary logistic regression model and PSQI score were analyzed using a multiple linear regression model.

RESULTS

A total of 1,111 healthcare workers who served during the pandemic voluntarily enrolled to the study. The mean age was 37.3 ± 8.48 years, and 63.5% were females. Our study showed that the healthcare workers, evaluated with the PSQI, experienced a deterioration of sleep quality. Primary factors affecting this are working on the front line, the presence of chronic diseases, depression, and anxiety. Regression analyses identified depression and anxiety as the common factors affecting ESS, ISI, and PSQI scores.

CONCLUSION

Raising awareness regarding COVID-somnia among healthcare workers, who play a leading role in curbing the pandemic, would reduce sleep disturbances, depression, and anxiety. It would also contribute to the planning and implementation of preventive and therapeutic mental health programs with a multidisciplinary approach.

COVID-19 Pandemic and Its Impact on Sleep Health: A Rapid Review

This rapid review aims to elucidate the impact of coronavirus 2 (SARS-CoV-2) (COVID) disease-both in the acute phase and the "long-hauler" syndrome-on sleep health. Literature regarding the direct physiologic impact of COVID disease on sleep is sparse but has illuminated a toxic synergy between the immune response to COVID disease and the pro-inflammatory state brought on by obstructive sleep apnea (OSA). Primary care physicians and sleep medicine specialists should aggressively screen for OSA in COVID patients.

Morbidities Worsening Index to Sleep in the Older Adults During COVID-19: Potential Moderators

Older adults were considered a vulnerable group for the COVID-19 infection and its consequences, including problems with sleep.

Changes in sleep pattern and dream activity across and after the COVID-19 lockdown in Italy: A longitudinal observational study

A large body of evidence has documented the impact of the global COVID-19 outbreak - and especially the lockdown period - on sleep quality and quantity. Here, we present the first Italian longitudinal study on sleep and COVID-19 considering four different time points collected during lockdown (from 29 March 2020 to 3 May 2020) and a subsequent follow-up period (October 2020). We used an online survey to collect socio-demographic and COVID-19 related information. Subjects were also asked to complete a sleep diary at each time point of the study. Our longitudinal sample included 147 participants. Statistical comparison across time intervals showed remarkable changes in sleep patterns during and after the lockdown. In particular, during lockdown we observed longer sleep latency, less ease of falling asleep, a higher total bedtime, and a lower dream frequency. The week-by-week evaluation described relatively stable patterns in the observed measures during the lockdown period, except for dream frequency, affected by a rapid increase in the early phase of lockdown. Our findings are in line with the current literature. Furthermore, the prospective longitudinal investigation comprising several time points offered the possibility of (a) observing the temporal dynamics and the different entities of such changes over time, and (b) reducing the typical memory bias for these studies.

Management of Chronic Insomnia Using Cognitive Behavior Therapy for Insomnia (CBT-I) During COVID-19 Pandemic: Does One Shoe Fit All?

Purpose

Insomnia is a highly prevalent disorder that is seen across all age groups causing significant morbidity to the patients. Its prevalence has further risen during COVID-19 pandemic. It is widely acknowledged that untreated insomnia can lead to significant health risks and socio-occupational dysfunction.

Methods

A narrative review was conducted following focused search of databases.

Results

Available guidelines mention two different approaches for the management of insomnia-pharmacological and non-pharmacological. Non-pharmacological therapies like multicomponent cognitive behavior therapy for insomnia (CBT-I) have been advocated for the management of acute as well as chronic insomnia in the literature as it has been found efficacious and useful. Multiple variants of CBT-I, e.g., digitally delivered CBT-I, brief CBT-I have been tested during pandemic owing to closure of clinics. However, there are certain issues to be considered while choosing CBT-I as therapy. For example, like other forms of psychotherapies, is there a need for assessing the candidature of patient before administering CBT-I; is CBT-I free of adverse effects as commonly thought; is CBT-I more efficacious than hypnotics; and at last, how to manage cases that are not candidate for CBT-I.

Conclusion

This narrative review addresses the scientific robustness of evidence for issues related to adherence, efficacy and adverse effects of non-pharmacological therapies. Available literature suggests that data related to adherence and efficacy of CBT-I suffer from methodological shortcomings and careful selection of patient is important for the successful therapy. At the same time, attempts have been made to shed light to the areas where CBT-I can be helpful in the management of insomnia.

Sleep disorders and COVID-19

This chapter summarizes the known associations between COVID-19 and sleep dysfunction, including insomnia, excessive daytime sleepiness, restless legs syndrome and nightmares, and touches upon pandemic-related considerations for obstructive sleep apnea and continuous positive airway pressure treatment. Treatment strategies and management approaches are also briefly discussed.

Mental Health and Time Management Behavior among Students During COVID-19 Pandemic: Towards Persuasive Technology Design

The study explored the impact of the COVID-19 pandemic on students’ mental health in higher education while capturing their perceptions and attitudes towards time management. The aim was to examine relationships between stress, anxiety, and specific time management-related factors. Considering possible differences between genders and degree levels, we developed five structural equation models (SEMs) to delineate these relationships. Results of a large-scale study of 502 participants show that students suffered from stress and two types of COVID-19-related anxiety: disease and consequences. Students’ preference for organization was the only factor that significantly promoted their perceived control over time, which contributes to reducing stress, hence anxiety. However, female students reported higher stress and anxiety levels than male students. Graduate students reported higher anxiety levels related to the consequences of the pandemic compared to undergrads. To promote students’ preference for organization, we map the three categories of organization to corresponding persuasive strategies which could be used in the design of persuasive interventions. This creates an opportunity for developing technological interventions to improve students’ perceived control over time, thus reduce stress and anxiety.

Sleeping through a pandemic: impact of COVID-19-related restrictions on narcolepsy and idiopathic hypersomnia

STUDY OBJECTIVES

To assess the impact of coronavirus disease 2019 (COVID-19)-related restrictions on narcolepsy type 1 (NT2), narcolepsy type 2 (NT2), and idiopathic hypersomnia (IH).

METHODS

Participants with NT1, NT2, and IH followed in a university hospital completed an online 78-question survey assessing demographic, clinical, and occupational features of the population during the first COVID-19-related lockdown.

RESULTS

A total of 219 of 851 (25.7%) respondents of the survey reported a mean increase of 1.2 ± 1.9 hours (P < .001) in night sleep time and a mean decrease of 1.0 ± 3.4 points (P < .001) on the Epworth Sleepiness Scale during lockdown. Bedtime was delayed by 46.1% of participants and wakeup time was delayed by 59.6%, driven primarily by participants with IH. Teleworkers (but not in-person workers) reported a mean increase of 0.9 ± 1.2 hours in night sleep (P < .001) and a mean decrease in sleepiness score of 1.6 ± 3.1 (P < .001). Cataplexy improved in 54.1% of participants with NT1. Sleepiness correlated with psychological wellness (r = .3, P < .001). As many as 42.5% enjoyed the lockdown, thanks to reallocation of time usually spent commuting toward longer sleep time, hobbies, and family time, and appreciated a freer napping schedule. Conversely, 13.2% disliked the lockdown, feeling isolation and psychological distress.

CONCLUSIONS

Extended sleep time, circadian delay (in patients with IH), and teleworking resulted in decreased symptoms of central hypersomnias. These findings suggest that people with IH, NT1, and NT2 may benefit from a decrease in social and professional constraints on sleep-wake habits, and support advocacy efforts aimed at facilitating workplace and schedule accommodations for this population.

CITATION

Nigam M, Hippolyte A, Dodet P, et al. Sleeping through a pandemic: impact of COVID-19-related restrictions on narcolepsy and idiopathic hypersomnia. J Clin Sleep Med. 2022;18(1):255-263.

Sleep disorders in patients with COVID-19

Sleep disorders often accompany COVID-19 and are a part of post-COVID syndrome. Some of the sleep disorders that occur in patients hospitalized for COVID-19 can be attributed to acute forms of insomnia. This type of sleep disorders is due to special conditions associated with hospitalization, and is short-term. Other sleep disorders appear as a part of anxiety-depressive symptoms diagnosed in patients with COVID-19. These symptoms can be classified as nosogenies psychogenic disorders that are associated with diagnosis of coronavirus infection; somatogenies psychopathological conditions resulting from pathological effects on the central nervous system of somatic and neurological complications of COVID-19; iatrogenies mental disorders that occur due to the intake of medication. Currently, information on the impact of sleep quality on the severity of COVID-19 and the effectiveness of treatment for post-COVID syndrome is accumulating. This review provides up-to-date information on sleep disorders in patients with COVID-19 and the principles of their therapy.

The Impact of Quarantine on Sleep Quality and Psychological Distress During the COVID-19 Pandemic

PURPOSE

We investigated the impact of isolation on sleep quality and psychological distress during the COVID-19 pandemic in Saudi Arabia.

METHODS

An online survey was conducted on 353 (88 isolated and 265 not isolated) individuals from May to June 2020. Subjective sleep quality was determined using the Pittsburgh sleep quality index (PSQI), and psychological distress measured using the Kessler psychological distress scale (K10).

RESULTS

The mean age of the isolated group was 28.6 years versus 27.5 years for the non-isolated group, with male participants accounting for 37% in both groups. The mean PSQI score was 8.5±3.6 and 8.4±3.5 for the isolated and non-isolated groups, respectively (P= 0.92). The mean K-10 score was 27.6± 9.4 and 25.3± 9.5 for the isolated and non-isolated groups, respectively (P= 0.04). Poor sleep (PSQI ≥6) was reported in 235 (66.6%) and psychological distress (K-10 ≥20) in 244 (69.1%) participants. Isolation was not associated with poor sleep (OR: 0.73 (95% CI: 0.41-1.3), P=0.29), but was statistically significant with psychological distress (OR: 2.12 (95% CI: 1.10-4.08), P=0.03).

CONCLUSION

Poor sleep and psychological distress symptoms were highly prevalent in our study population. Isolation may influence psychological distress but not sleep quality during the COVID-19 pandemic.

Dream Activity in Narcoleptic Patients During the COVID-19 Lockdown in Italy

Some studies highlighted that patients with narcolepsy type-1 (NT1) experience high lucid dream frequency, and this phenomenon has been associated with a creative personality. Starting from the well-known "pandemic effect" on sleep and dreaming, we presented a picture of dream activity in pharmacologically treated NT1 patients during the Italian lockdown. Forty-three NT1 patients completed a web-survey during Spring 2021 and were compared with 86 matched-controls. Statistical comparisons revealed that: (a) NT1 patients showed greater sleepiness than controls; (b) controls showed higher sleep disturbances than NT1 patients, and this result disappeared when the medication effect in NT1 was controlled; (c) NT1 patients reported higher lucid dream frequency than controls. Focusing on dreaming in NT1 patients, we found that (a) nightmare frequency was correlated with female gender, longer sleep duration, higher intrasleep wakefulness; (b) dream recall, nightmare and lucid dream frequency were positively correlated with sleepiness. Comparisons between low and high NT1 lucid dreamers showed that patients more frequently experiencing lucid dreams reported a greater influence of dreaming during wakefulness, especially concerning problem-solving and creativity. Overall, our results are consistent with previous studies on pandemic dreaming carried out on healthy subjects. Moreover, we confirmed a link between lucidity and creativity in NT1 patients. Considering the small sample size and the cross-sectional design, our findings cannot provide a causal relationship between lucid dreams and the COVID-19 lockdown. Nevertheless, they represent a first contribution to address future studies on this issue, suggesting that some stable characteristics could interact with changes provoked by the pandemic.