Insomnia

  • Insomnia, Disrupted Sleep Linked to Severe COVID-19

    Original Article Posted by Sleep Review Staff | Mar 23, 2021 | InsomniaSleep & the Body

    coronavirus

    Insomnia, disrupted sleep, and daily burnout are linked to a heightened risk of not only becoming infected with coronavirus, but also having more severe disease and a longer recovery period, suggests an international study of healthcare workers, published in the online journal BMJ Nutrition Prevention & Health.

    Every 1-hour increase in the amount of time spent asleep at night was associated with 12% lower odds of becoming infected with COVID-19, the findings indicate.

    Disrupted/insufficient sleep and work burnout have been linked to a heightened risk of viral and bacterial infections, but it’s not clear if these are also risk factors for COVID-19, say the researchers.

    To explore this further, they drew on the responses to an online survey for healthcare workers repeatedly exposed to patients with COVID-19 infection, such as those working in emergency or intensive care, and so at heightened risk of becoming infected themselves.

    The survey ran from 17 July to 25 September 2020, and was open to healthcare workers in France, Germany, Italy, Spain, the UK, and the USA.

    Respondents provided personal details on lifestyle, health, and use of prescription meds and dietary supplements plus information on the amount of sleep they got at night and in daytime naps over the preceding year; any sleep problems; burnout from work; and workplace exposure to COVID-19 infection.

    Some 2884 healthcare workers responded, 568 of whom had COVID-19, ascertained either by self-reported diagnostic symptoms and/or a positive swab test result.

    Infection severity was defined as: very mild – no or hardly any symptoms; mild – fever with or without cough, requiring no treatment; moderate – fever, respiratory symptoms and/or pneumonia; severe – breathing difficulties and low oxygen saturation; and critical – respiratory failure requiring mechanical assistance and intensive care.

    The amount of reported nightly sleep averaged under 7 hours, but more than 6. After accounting for potentially influential factors, every extra hour of sleep at night was associated with 12% lower odds of COVID-19 infection.

    But an extra hour acquired in daytime napping was associated with 6% higher odds, although this association varied by country.

    Around 1 in 4 (137;24%) of those with COVID-19 reported difficulties sleeping at night compared with around 1 in 5 (21%;495) of those without the infection.

    And 1 in 20 (5%;28) of those with COVID-19 said they had 3 or more sleep problems, including difficulties falling asleep, staying asleep, or needing to use sleeping pills on 3 or more nights of the week, compared with 65 (3%) of those without the infection.

    Compared with those who had no sleep problems, those with three had 88% greater odds of COVID-19 infection.

    Proportionally more of those with COVID-19 reported daily burnout than did those without the infection: 31 (5.5%) compared with 71 (3%).

    Compared with those who didn’t report any burnout, those for whom this was a daily occurrence were more than twice as likely to have COVID-19. Similarly, these respondents were also around 3 times as likely to say that their infection was severe and that they needed a longer recovery period.

    These findings held true, irrespective of the frequency of COVID-19 workplace exposure.

    This is an observational study, and as such, can’t establish cause. And the researchers acknowledge several limitations to their study.

    These include subjective assessment of exposure levels, sleep issues, and infection severity, all of which may have been incorrectly remembered. And the sample included only cases of very mild to moderately severe COVID-19.

    By way of an explanation for their findings, the researchers note: “The mechanism underlying these associations remains unclear, but it has been hypothesized that lack of sleep and sleep disorders may adversely influence the immune system by increasing proinflammatory cytokines and histamines.”

    And they point to studies linking burnout to a heightened risk of colds and flu as well as long term conditions, such as diabetes, cardiovascular disease, musculoskeletal disease and death from all causes.

    “These studies have suggested that burnout may directly or indirectly predict illnesses by occupational stress impairing the immune system and changing cortisol levels,” they write.

    And they conclude:”We found that lack of sleep at night, severe sleep problems and high level of burnout may be risk factors for COVID-19 in frontline [healthcare workers]. Our results highlight the importance of healthcare professionals’ well-being during the pandemic.”

  • “Insomnia-Like” Sleep Patterns Can Predict Future Stress

    As part of our outreach efforts to our clients, we will often share informative articles related to sleep and sleep apnea. The following is an insightful piece written for Sleep Review by Sree Roy.


    Inverse: New research suggests fragmented sleep patterns contain a critical message.

    Dipesh Chaudhury is the study’s lead author and an assistant professor of biology at New York University Abu Dhabi. He tells Inverse that this study deepens our understanding of how stress and sleep are related. Typically, we assume that stress leads to poor sleep. But things could also work the other way around, with poor sleep dampening resilience to stress at the same time.

    “Our findings also indicate that those mice that exhibit abnormal sleep prior to stress are more sensitive to future stress exposure. In other words, sleep abnormalities can also be a cause of stress-related disorders,” Chaudhury says.

    A BAD NIGHT’S SLEEP COMES WITH A HOST OF CONSEQUENCES, some of which aren’t obvious right away. This is especially true when stressful situations — like a year defined by a pandemic — hit. Research suggests specific abnormal sleep patterns may decrease one skill that’s crucial to weathering the storm.

    In a mouse study published Tuesday in Frontiers in Neuroscience, scientists found fragmented sleep patterns – a pattern of sleep marked by more awakenings and shorter bouts of non-rapid eye movement sleep –could predict how mice responded to future stress. Mice with regular sleep patterns were resilient to bullying, while those with fragmented sleep patterns weren’t equipped to deal with the abuse.

    WHAT DOES A “DISRUPTED SLEEP PATTERN LOOK LIKE?

    “Our findings also indicate that those mice that exhibit abnormal sleep prior to stress are more sensitive to future stress exposure. In other words, sleep abnormalities can also be a cause of stress-related disorders,” Chaudhury says.

    Chaudhury’s study was based on the sleep and stress patterns of 22 mice who had electrodes implanted into their brains. Those electrodes could measure the amount of time each mouse spent in each stage of sleep.

    Like humans, mice move through sleep stages including rapid eye movement sleep (REM) — when most dreaming happens in humans — and lighter, non-REM stages.

    Every mouse was exposed to chronic social defeat — 15 consecutive days of being attacked by aggressive mice identified at the outset of the study. The researchers found that they could break the mice up into two groups: mice who were resilient, bouncing back from bullying ready to socialize, and ones that succumbed, and retreated from others.

    WHAT WAS DISCOVERED

    The scientists found there were significant differences in the sleep patterns of each group of mice beforethey were exposed to the bullying.

    The mice in the non-resilient group showed signs of fragmented non-REM sleep. They woke up more during sleep periods (mice sleep during the day) and had were shorter NREM bouts, on average, than those seen in the resilient mice.

    “In essence, the susceptible mice exhibit insomnia-like traits even before exposure to stress,” Chaudry says.

    Ultimately, these patterns could predict which group the mice ended up in with about 80 percent accuracy, suggesting that it could have been one reason they were less resilient when stress took hold.

    WHAT DOES THIS MEAN FOR HUMANS?

    This study taps into a robust area of research on human mood disorders. Depression and sleep are intertwined in a way that makes it hard to distinguish cause and effect. Disturbed sleep is often seen in depressive patients, but those who experience insomnia are also more likely to develop depression in the first place.

    Though this study focuses on stress, it suggests that sleep may pose an even more central role in mood disorders – or in this case, resilience to stress. Before the stressful situation occurs, sleep patterns may contain early warning signs.

    These results are early-stage, Chaudhury cautions. A mouse brain (and a mouse’s stress) is quite different from a human’s. But he is optimistic that the idea that sleep signatures could be a prediction of stress — specifically the way the brain transitions in and out of non-REM sleep — will hold true in humans.

    He imagines monitoring the sleep patterns of people who have particularly high-stress jobs, like first responders or frontline workers. Even if signs of stress have yet to show themselves, a disrupted sleep pattern could be the sign of a vicious cycle (stress leading to worse sleep, leading to less resilience to stress) about to go awry.

    “By having simple non-invasive markers of stress susceptibility, such as EEG sleep patterns, it may be possible to develop strategies to protect the more vulnerable people,” Chaudhury says.

    Abstract: There is a tight association between mood and sleep as disrupted sleep is a core feature of many mood disorders. The paucity in available animal models for investigating the role of sleep in the etiopathogenesis of depression-like behaviors led us to investigate whether prior sleep disturbances can predict susceptibility to future stress. Hence, we assessed sleep before and after chronic social defeat (CSD) stress. The social behavior of the mice post stress was classified in two main phenotypes: mice susceptible to stress that displayed social avoidance and mice resilient to stress. Pre-CSD, mice susceptible to stress displayed increased fragmentation of Non-Rapid Eye Movement (NREM) sleep, due to increased switching between NREM and wake and shorter average duration of NREM bouts, relative to mice resilient to stress. Logistic regression analysis showed that the pre-CSD sleep features from both phenotypes were separable enough to allow prediction of susceptibility to stress with >80% accuracy. Post-CSD, susceptible mice maintained high NREM fragmentation while resilient mice exhibited high NREM fragmentation, only in the dark. Our findings emphasize the putative role of fragmented NREM sleep in signaling vulnerability to stress.