Nearly all patients who recovered from COVID-19 report lingering fatigue, while half experience sleep disturbances, according to a recent analysis from Cleveland Clinic. Researchers found that race, obesity, and mood disorders are contributors.
Investigators analyzed data from 962 patients from the Cleveland Clinic ReCOVer Clinic between February 2021 and April 2022. The patients were recovered from COVID-19 and completed the sleep disturbance and fatigue questionnaires of the Patient-Reported Outcomes Measurement Information System. More than two-thirds of patients (67.2%) reported at least moderate fatigue, while 21.8% reported severe fatigue. Eight percent of patients reported severe sleep disturbances, and 41.3% reported at least moderate sleep disturbances.
“Sleep difficulties are highly prevalent and debilitating symptoms reported in patients with post-acute sequealae of COVID-19,” says Cinthya Pena Orbea, MD, a sleep specialist at Cleveland Clinic, in a release. “Our study suggests that the prevalence of moderate to severe sleep disturbances is high and that Black race confers increased odds to suffer from moderate to severe sleep disturbances highlighting the importance to further understand race-specific determinants of sleep disturbances in order to develop race-specific interventions.”
Patients with moderate-to-severe compared with normal-to-mild sleep disturbances had higher body mass indices, were more likely to be Black, and had worse general anxiety disorder.
After adjusting for demographics, Black patients were three times more likely to experience moderate-to-severe sleep disturbances.
The research abstract was published recently in an online supplement of the journal Sleep and will be presented June 6 and 7 during SLEEP 2022.
PharmacyTimes: Using a transcranial magnetic stimulation method, researchers have found that reduced sleep alters central nervous inhibition from GABAergic and dopaminergic mechanisms differently in individuals with migraines versus those without.
Migraine is a primary headache disorder with a well-established association with insufficient sleep. According to the study, migraine affects approximately 15% of adults aged 15 to 64 globally and is the leading cause for years lived with disability below 50 years of age. Many patients with migraine report problems with sleep, headaches upon awakening, and using sleep as a way to avoid a headache. Researchers have also found worse sleep quality compared to individuals without migraines, as well as an increased likelihood for insomnia-like sleep patterns among individuals with migraines.
Sleep restriction with about 50% sleep for 2 nights is a human experimental model of insufficient sleep, according to researchers. In healthy subjects, sleep deprivation may alter cortical inhibitory and facilitatory systems, and seems to increase pain sensitivity. Increased sensitivity to pain has previously been discovered in patients with migraine and may be associated with both increased homeostatic sleep pressure caused by increased need for sleep as well as reduced intracortical inhibition.
Despite these findings, both the underlying pathophysiology of the disease and its relationship with sleep are unexplained. In order to investigate this association further, researchers applied transcranial magnetic stimulation to analyze possible mechanisms of insufficient sleep in patients with migraine.
According to the analysis, sleep restriction had an opposite effect on cortical silent period duration in interictal migraines and controls. The cortical silent period refers to an interruption of voluntary muscle contraction by stimulating the contralateral motor cortex. With sleep restriction, this period was reduced from 147.9 minutes to 139.6 minutes. This impact was still significant when replacing sleep condition with measured sleep time in minutes.
By Leigh WeingusSeptember 18, 2021 at 9:00 a.m. EDT
I’ve struggled with sleep since I was a teenager, and have spent almost as long trying to fix it. I’ve absorbed countless books and articles on getting better sleep that instructed me to go blue-light free at least two hours before bedtime, take nightly baths to lower my body temperature, keep my phone far from my bedroom and avoid caffeine after 12 p.m.
In between all my diligent sleep hygiene work, I couldn’t help but feel like there was a larger force at play. My sleep seemed to change throughout my menstrual cycle, for example, getting worse in the days before my period and significantly better afterward. When I was pregnant, I experienced the best sleep of my life, and when I stopped breastfeeding, I didn’t sleep for days.
I finally started to ask myself: When we talk about getting better sleep, why aren’t we talking more about hormones?
According to the National Sleep Foundation, the lifetime risk of insomnia is 40 percent higher for women than it is for men. Blaming this discrepancy entirely on hormones oversimplifies it — women also tend to take on the bulk of household worrying and emotional labor, and they tend to experience higher levels of anxiety.
But according to Mary Jane Minkin, an obstetrician-gynecologist and clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the Yale School of Medicine, anecdotal evidence and studies suggest that hormones likely play a role.
“Many people will tell me that a day or two before their period, their sleep is terrible,” Minkin says.
When a woman enters perimenopause, she starts to experience more fluctuations and produces less estrogen and progesterone throughout the month, which may wreak havoc on her sleep. The true correlation between these hormone dips and fluctuations and insomnia needs to be studied more extensively, Minkin and other experts say, and understanding this connection is confused by how a lack of estrogen is associated with hot flashes, which can disrupt sleep.
Studies of women on hormone replacement therapy (HRT) and sleep strongly suggest a connection between female hormones and insomnia, Minkin and other experts say.
HRT is often prescribed to women going through menopause (and the years after it) to help them deal with unpleasant side effects of that transition, which include sleep problems, Minkin says. Some types of HRT include only estrogen, while others have a combination of estrogen and progesterone. High levels of estrogen and progesterone occur naturally during pregnancy, which may explain why some pregnant women like me often experience blissful sleep, Minkin says.
“During pregnancy, guess what? Your levels of estrogen and progesterone are very high,” Minkin says.
Although postmenopausal women have very low levels of estrogen and progesterone, once the process of menopause is complete, they often begin to sleep better. “We think hormone fluctuations can be more bothersome to some women than their actual hormone levels,” Minkin says.
She adds that if a postmenopausal woman does struggle with insomnia, low hormone levels could be the culprit, so it’s a good idea to talk with a medical professional about HRT options. A 2008 randomized, controlled study of some 2,000 postmenopausal women in the United Kingdom found “small but significant” improvements in sleep after a year of HRT vs. those taking a placebo.
Hadine Joffe, a psychiatry professor who is executive director of the Mary Horrigan Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital at Harvard, says hormonal fluctuations may be a cause of insomnia for some women. But for others, she says, sleep disruptions might be anxiety-related, or caused by noisy neighbors or a snoring bed partner.
She says that while some women experience amazing sleep during pregnancy, many others report terrible insomnia during that time of life. Her advice? If you want to figure out whether any connection exists for you, track it.
“Try a [sleep] app or even a conventional sleep diary,” Joffe says. “If you track your sleep for several months, you may start to notice a pattern emerge, like more waking in the middle of the night right before your period.”
If you do notice a pattern, she says, that information may be helpful going forward.
“If you know there are two or three days in every month when you don’t sleep well, make sure that’s a time when you practice the best possible sleep hygiene, avoid alcohol, and if you have a partner you share family responsibilities with, you can ask them to get up with the baby or toddler,” Joffe says.
Sometimes targeted treatment for those days can help, too, she adds. For example, supplementing with a few milligrams of melatonin before bedtime — the hormone our brains naturally produce in response to darkness — can help signal to the brain that it’s time to sleep. Or if you have a prescription for a sleep aid, this could be the time to use it, she says.
While it’s not always possible due to work or family responsibilities, Kin Yuen, a sleep medicine specialist at Stanford Medicine, suggests trying your best to honor your natural daily hormone fluctuations to help keep your sleep on track. To do this, you’ll have to try to figure out when your body naturally releases cortisol (the hormone we produce in the morning that helps us wake up) and melatonin (the hormone we produce at night to help us fall asleep).
By figuring out when you have the most energy — are you an “early bird” who wakes up full of energy, or a “night owl” who still feels sluggish at 9 a.m.? — you can better pinpoint when your body naturally releases these hormones. If you adjust your schedule to honor these rhythms, you may experience fewer sleep disruptions even in the face of constantly fluctuating female hormones, Yuen says.
Finally, while HRT is not prescribed for women who have not yet gone through menopause, both Minkin and Joffe say that if someone is sure that their insomnia is hormone-related — preferably by having kept a diary for a while and after having tried other techniques without success — it’s worth talking to their doctor about taking a birth control pill.
“Hormonal birth control can smooth out the ups and downs that just aren’t good for some people’s brains,” Joffe says. “It has to be the right treatment for the right person, but it can help.”
Of course, there are side effects to birth control. Some women report nausea, headaches and lower libido. Although rare, more serious side effects have been reported, too, such as blood clots.
But for many women suffering from what seems to be hormonally related insomnia, the benefits may outweigh the risks.
Minkin says that even for patients going through menopause, if they are otherwise healthy, she’ll often prescribe birth control pills. Birth control pills have higher levels of hormones than traditional HRT, and if a woman has used them in the past and hasn’t experienced negative side effects, this can be a good indication that they will work well for her.
“The only drawback is that we have no way of knowing when a woman is done with menopause, because the pill will artificially give her a period,” Minkin says. “So in order to find out if she’s done with menopause, she has to stop the pill.”
At this point, Minkin and other experts say more research needs to be done to truly understand how the ebbs and flows of female hormones impact sleep.
Sleep diaries, trackers and apps can be powerful tools to help a woman understand whether a connection exists for her, and they can help her act accordingly, the experts say.
This is an understudied but important area, as many people are increasingly turning to cannabis products as sleep aids,” said sleep specialist Wendy Troxel, a senior behavioral scientist at RAND Corporation, who was not involved in the study.
“But we really lack solid evidence demonstrating whether cannabis helps or hurts sleep,” Troxel added.
Use of weed may actually harm sleep, a new study has found. The research, published Monday in a BMJ journal, revealed adults who use weed 20 or more days during the last month were 64% more likely to sleep less than six hours a night and 76% more likely to sleep longer than nine hours a night.
Optimal sleep for adults is defined by the US Centers for Disease Control and Prevention as seven to eight hours a night.Moderate consumption — using weed less than 20 days during the past month — didn’t create short sleep problems, but people were 47% more likely to snooze nine or more hours a night, the study also found.
No clear evidence either way
The study analyzed use of marijuana for sleep among 21,729 adults between the ages of 20 and 59. The data was gathered by the National Health and Nutrition Examination Survey, and is considered representative of over 146 million Americans.
Young adult cannabis consumers nearly twice as likely to suffer from a heart attack, research showsIn addition to issues with short and long sleep, people in the study who used weed within the last 30 days were also more likely to say they have trouble falling asleep or staying asleep, and were more likely to say they have discussed sleep problems with a health care provider, Diep said.”The problem with our study is that we can’t really say that it’s causal, meaning we can’t know for sure whether this was simply individuals who were having difficulty sleeping, and that’s why they use the cannabis or the cannabis caused it,” he added.Prior studies have also found a connection between the two components of marijuana, CBD and THC, and poor sleep. CBD, or cannabidiol, is a key component of medical marijuana, while THC, or tetrahydrocannabinol, is the main psychoactive compound in cannabis that produces the high sensation.A 2018 randomized, double-blind, placebo-controlled study — the gold standard — found no benefit from CBD on sleep in healthy volunteers. Other studies have also found high rates of insomnia when withdrawing from nightly use of marijuana.”At this time there still isn’t any clear evidence that cannabis is helping sleep,” said Dr. Bhanu Prakash Kolla, a sleep medicine specialist in the Center for Sleep Medicine at the Mayo Clinic in Rochester, Minnesota, who was not involved in any of the studies.”We know that when people initiate use there is some benefit in the immediate short term but there is quick tolerance to this effect,” Kolla said. “There currently is no good quality evidence to suggest that cannabis will help improve sleep quality or duration.”
Confounding factors
Still, people continue to believe that weed is helping their sleep. Surveys of marijuana users show they do indeed rely on the drug for better sleep.”The issue is that there’s a disconnect between these anecdotal reports of people reporting therapeutic benefits and the evidence behind it in terms of the data,” Diep said.
Sleep training for adults prevents depression, study finds One possible reason, Kolla said, is that when people stop using cannabis after a period of regular use, the withdrawal effects from weed can cause sleep disruptions. That leads people to believe “the cannabis was in fact helping (sleep), while what they are actually experiencing are withdrawal symptoms.” Another factor to consider is the increased potency of weed today as compared to when many of the studies on cannabis and sleep were conducted, said Dr. Karim Ladha, staff anesthesiologist and clinician-scientist in the department of anesthesiology and pain medicine at the University of Toronto.” A lot of the older data related to cannabis is based on lower doses of THC than what patients are using now, and there’s very little research related to CBD,” Ladha said.” Studies tell us about what happens at a population level, but on an individual level that discussion is much more personal,” he said. “The studies just give us the possibilitiesthat(marijuana) could hurt your sleep, but it may help and so we just don’t know until you try it.”
That’s why additional studies need to be done, he added.”Patients are spending money and time and resources to obtain cannabis right now to help with sleep,” Ladha said. “I think as the medical community, we need to do everything we can to make sure that we enable our patients to make the best possible decisions for their health.”
A new MIT study looks at how the length of time a person sleeps may impact their sense of well-being.
Subjectively, getting more sleep seems to provide big benefits: Many people find it gives them increased energy, emotional control, and an improved sense of well-being. But a new study co-authored by MIT economists complicates this picture, suggesting that more sleep, by itself, isn’t necessarily sufficient to bring about those kinds of appealing improvements.
The study is based on a distinctive field experiment of low-income workers in Chennai, India, where the researchers studied residents at home during their normal everyday routines — and managed to increase participants’ sleep by about half an hour per night, a very substantial gain. And yet, sleeping more at night did not improve people’s work productivity, earnings, financial choices, sense of well-being, or even their blood pressure. The only thing it did, apparently, was to lower the number of hours they worked.
“To our surprise, these night-sleep interventions had no positive effects whatsoever on any of the outcomes we measured,” says Frank Schilbach, an MIT economist and co-author of a new paper detailing the study’s findings.
Six weeks of saffron supplementation led to improved sleep duration and quality in a recent study involving 66 volunteers, suggesting it could be a natural and safe replacement for sleeping pills.
