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.
Picture the pinnacle of social exhaustion: Perhaps, you’ve just spent four hours at a work holiday party, meeting the humans behind a bunch of Zoom squares IRL for the first time. Or, maybe you had a day of reconnecting with family members you haven’t seen in two, time-blurred pandemic years. It would seem that hitting the hay would be the most obvious solution—but once you get into bed, your body seems to say, Not so fast. For introverts, in particular, the draining nature of being social can leave you, paradoxically, chasing sleep.
Trying to get to sleep in that state can require a whole lot more than simply getting into bed; after all, the process of falling asleep is nothing like an on-off switch, biologically, says Dr. Harris. For an introvert, especially, easing your mind into sleep mode is best done with a calming pre-bed ritual. Below, the experts share tips for socially exhausted introverts who want nothing more than to get a good night’s sleep.
It’s especially hard for introverts to sleep after a highly social experience, but these 5 tips can help
1. Create a container for your thoughts.
“Introverts are internal processors,” says psychologist Laurie Helgoe, PhD, author of Introvert Power: Why Your Inner Life Is Your Hidden Strength. “They often take inputs from conversations and process them later, which can mean mulling over what someone said, replaying or continuing a conversation, coming up with a better comeback, and the like.”https://556d592cd02b0abe412f5bc25f63d090.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html
Journaling can help put a pause to that spiral by providing a space for you to essentially unload all of your thoughts, and, if you’d like, feel free to return to them later—ideally at a time when you’re not trying desperately to get catch precious zzz’s.
2. Talk back to negative self-talk.
In re-assessing a social event (as introverts are wont to do), you may find that certain percolating thoughts devolve into negative or anxious ones. For example, it’s easy to start over-evaluating and hyper-personalizing, says Dr. Dow. “Maybe you start thinking, ‘Was Cindy looking at me weird? I must have done something wrong.’ And as the night goes on, the thoughts can turn more catastrophic in nature, leading to something like, ‘If I don’t get a good night’s sleep, I’m going to botch this presentation tomorrow, and if that happens, I could get fired,’ and so on,” he says.https://556d592cd02b0abe412f5bc25f63d090.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html
In that case, he suggests employing one of the classic strategies of cognitive behavioral therapy, which is to reconsider thoughts and feelings not as facts but merely as information, which you can choose to disregard. “Access the best parts of yourself to talk back to those inner voices,” he says.
“Because introverts are natural problem-solvers, they can get stuck in focusing on what’s not working,” says Dr. Helgoe. “But a gratitude list can help you balance that problem orientation by reminding you of what is working.” And that, in and of itself, can be incredibly soothing.
4. Practice some non-screen-based relaxation.
While it’s tempting to scroll through Instagram or scan emails in bed to occupy a restless mind, that level of mental stimulation, combined with the melatonin-suppressing blue light, is a recipe for wakefulness. Instead, do anything non-screen-related that feels calming and relaxing, whether that’s reading, knitting, listening to music, or even coloring or doing a simple crossword or jigsaw puzzle, says Dr. Harris. (You can also practice mindfulness meditation, but because this can be challenging to really sink into with an overactive mind, Dr. Harris says it’ll be most beneficial for someone who already has a daytime meditation practice.
If you’re really at a loss for where to start, try connecting with each of the five senses, says Dr. Dow: “Soothe your sense of touch with a bath, your sense of smell with a lavender candle, your sense of sight with dimmed lighting, your sense of hearing with calming music or a meditation track, and your sense of taste with a nighttime tea.”
5. And if you’re tossing and turning, get out of bed.
Trying to make sleep happen often keeps it from, well, happening. So, instead of remaining in bed and trying to will yourself asleep, get up, walk into another room, and return to whatever wind-down exercise you were doing beforehand in dim lighting, says Dr. Harris: “Simply changing what you’re doing and where you’re doing it can often help stop an overactive mind in its tracks.”
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Whether it’s from jetting across time zones, pulling all-nighters at school or working the overnight shift, chronically disrupting our circadian rhythm—or internal biological clocks—can take a measurable toll on everything from sleep, mood and metabolism to risk of certain diseases, mounting research shows.
But a new University of Colorado Boulder study funded by the U.S. Navy suggests simple dietary compounds known as prebiotics, which serve as food for beneficial gut bacteria, could play an important role in helping us bounce back faster.
“This work suggests that by promoting and stabilizing the good bacteria in the gut and the metabolites they release, we may be able to make our bodies more resilient to circadian disruption,” senior author Monika Fleshner, a professor of integrative physiology, said in a statement.
The animal study, published in the journal Brain, Behavior and Immunity, is the latest to suggest that prebiotics—not to be confused with probiotics found in fermented foods like yogurt and sauerkraut—can influence not only the gut, but also the brain and behavior.
Naturally abundant in many fibrous foods—including leeks, artichokes and onions—and in breast milk, these indigestible carbohydrates pass through the small intestine and linger in the gut, serving as nourishment for the trillions of bacteria residing there.
The authors’ previous studies showed that rats raised on prebiotic-infused chow slept better and were more resilient to some of the physical effects of acute stress.
For the new study, part of a multi-university project funded by the Office of Naval Research, the researchers sought to learn if prebiotics could also promote resilience to body-clock disruptions from things like jet lag, irregular work schedules or lack of natural daytime light—a reality many military personnel live with.
“They are traveling all over the world and frequently changing time zones. For submariners, who can be underwater for months, circadian disruption can be a real challenge,” said lead author Robert Thompson, a postdoctoral researcher in the Fleshner lab. “The goal of this project is to find ways to mitigate those effects.”
How a healthy gut may prevent jet lag
The researchers raised rats either on regular food or chow enriched with two prebiotics: galactooligosaccharides and polydextrose.
They then manipulated the rats’ light-dark cycle weekly for eight weeks—the equivalent of traveling to a time zone 12 hours ahead every week for two months.
Rats that ate prebiotics more quickly realigned their sleep-wake cycles and core body temperature (which can also be thrown off when internal clocks are off) and resisted the alterations in gut flora that often come with stress.
“This is one of the first studies to connect consuming prebiotics to specific bacterial changes that not only affect sleep but also the body’s response to circadian rhythm disruption,” said Thompson.
The study also takes a critical step forward in answering the question: How can simply ingesting a starch impact how we sleep and feel?
The researchers found that those on the prebiotic diet hosted an abundance of several health-promoting microbes, including Ruminiclostridium 5 (shown in other studies to reduce fragmented sleep) and Parabacteroides distasonis.
They also had a substantially different “metabolome,” the collection of metabolic byproducts churned out by bacteria in the gut.
Put simply: The animals that ingested the prebiotics hosted more good bacteria, which in turn produced metabolites that protected them from something akin to jet lag.
Are supplements worthwhile?
Clinical trials are now underway at CU Boulder to determine if prebiotics could have similar effects on humans.
The research could lead to customized prebiotic mixtures designed for individuals whose careers or lifestyles expose them to frequent circadian disruption.
In the meantime, could simply loading up on legumes and other foods naturally rich in the compounds help keep your body clock running on time? It’s not impossible but unlikely, they say—noting that the rats were fed what, in human terms, would be excessive amounts of prebiotics.
Why not just ingest the beneficial bacteria directly, via probiotic-rich foods like yogurt?
That could also help, but prebiotics may have an advantage over probiotics in that they support the friendly bacteria one already has, rather than introducing a new species that may or may not take hold.
What about prebiotic dietary supplements?
“If you are happy and healthy and in balance, you do not need to go ingest a bunch of stuff with a prebiotic in it,” said Fleshner. “But if you know you are going to come into a challenge, you could take a look at some of the prebiotics that are available. Just realize that they are not customized yet, so it might work for you but it won’t work for your neighbor.”
We’ve all had those nights where we inexplicably wake up in the middle of the night with a grumbling belly. Maybe it was that HIIT workout you braved for the first time, your marathon of meetings-slash-evening-errands that left you with little time to eat an adequate dinner, or maybe you were just dreaming about delicious pasta (the best type of reverie).
While you could certainly go forth and eat gobs of Nutella straight from the jar—convenience and tastiness are both extremely key, after all—you don’t need to be an registered dietitian to conclude that the sugar content isn’t exactly a recipe for sound sleep the rest of the night. “High fat and high sugar foods like ice cream and cookies are a double whammy of not helping you sleep well, because fat takes a long time to digest,” says Dawn Blatner, RDN, author of The Superfood Swap. “Giving your gut foods that are difficult to digest distracts your body from sleep, and then sugar causes spikes and crashes of blood sugar and those will interrupt sleep, too.”
Blatner also suggests avoiding alcohol since, even though your nightcap can make you feel sleepy, it will disrupt your sleep cycle later in the night and lead to lower quality sleep. Caffeinated teas or too much of anything liquid should also be consumed in moderation, she adds, as having to use the bathroom can keep you awake.
7 healthy midnight snacks that will help lull you back to sleep
1. Tart Cherries
“Tart cherries are a natural source of melatonin, a hormone that regulates the body’s internal clock and sleep-wake cycle,” says Blatner. If you can’t find tart cherries at the supermarket, she suggests opting for tart cherry concentrate, which is the super-charged version of tart cherry juice with two tablespoons packing in the equivalent of a whopping 60-plus cherries. Instead of guzzling it (remember that sugar and excessive amounts of liquid can keep you awake), create yourself a little ‘natural’ jello shot before bed. “All you do is mix two tablespoons of tart cherry concentrate with a tablespoon of chia seeds and chill it in the fridge. Try topping it with greek yogurt to combat the tartness,” Blatner says.RELATED STORIES‘I’m a Registered Dietitian, and This Is the One Food I Always…Why Snacking on Hemp Seeds Can Help You Sleep More Soundly
2. Pumpkin Seeds
“Pumpkin seeds are an excellent source of magnesium, and studies have found that magnesium improves insomnia and sleep efficiency,” says Blatner. Almonds, cashews, and peanuts are other good sources of magnesium that all make for ideal healthy midnight snacks.
3. Cottage Cheese
Cottage cheese contains the amino acid L-tryptophan. “Tryptophan plays a role in the production of serotonin, a neurotransmitter that’s associated with healthy sleep,” says Blatner. “Research has found people who ate cottage cheese about 30 minutes to an hour before going to bed experienced better metabolic health, muscle quality, and overall health than people who didn’t.”https://79dbc014217aa09ddae4500b65493fc3.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html
We know it’s no cheesy mozzarella pizza or ricotta cheesecake, but you can optimize your enjoyment of cottage cheese with a sprinkle of cinnamon (which has its own sleep benefits). “You can also try topping it with tahini or sunflower seed butter, which both contain tryptophan as well,” says Blatner.
“Research suggests that the antioxidants and natural serotonin in kiwis can improve both sleep quality and quantity,” says Blatner. Kiwis are naturally sweet and delicious as-is, but you can jazz them up by lightly dipping them in dark chocolate. “Dark chocolate has magnesium, a helpful sleep mineral, but it also has a little caffeine, so go easy on it.”
6. Banana with Peanut Butter
“Foods that contain unsaturated fats, like peanut butter, can help improve serotonin levels and boost satiety to keep you feeling satisfied and full during sleep,” says Carissa Galloway, RDN, a nutrition consultant at Premier Protein. “Eating bananas with peanut butter can also be helpful before bed, as bananas contain magnesium which, as mentioned, help support good sleep.” The combination of bananas plus peanut butter makes for one of the most delicious healthy midnight snacks out there.
7. Chamomile Tea
“There are numerous studies that support the benefits of chamomile tea in promoting a healthy nighttime routine,” says Galloway. Chamomile tea contains flavonoids, which are compounds found in certain foods, including one called apigenin. “Apigenin connects with receptors in our brains to help reduce insomnia and promote a state of steady sleep.”
So when you find yourself wide awake in the wee hours, sip a cup of chamomile tea with a splash of steamed almond milk, or have a batch of Blatner’s chamomile cookies on hand.
All that said, bear in mind that more important than what you eat before bed, is the amount. “Having a large amount of any food will take too much effort for your body to digest instead of resting,” says Blatner. A light nosh of one of the foods recommended here, on the other hand, will send you right into the sweetest of dreams.
Research on the exact cause of insomnia during menopause does not point to one clear cause. Several things may contribute to it, including:
Some evidence suggests that low hormone levels can increase the likelihood of insomnia during menopause.
According to the SWANTrusted Source, previous longitudinal studies have found a correlation between lower levels of estradiol and poorer sleep. This is especially true if the decline in hormones happens quickly, as it does after a person undergoes surgery to remove the ovaries.
Sometimes, insomnia happens during menopause because of hot flashes or night sweats. These symptoms can disrupt sleep, causing frequent waking.
Hot flashes cause a sudden sense of heat around the face and neck and often occur with sweating and a fast heartbeat.
Reduction in melatonin
Melatonin is a hormone that plays a key role in the sleep-wake cycle, helping keep people asleep. It is especially important at the start of sleep.
However, melatonin levels appear to decrease with age, which may cause sleep disturbances.
It is not clear whether there is a link between menopause and a decline in melatonin. Some evidenceTrusted Source suggests that there is and that individuals during postmenopause have less melatonin than those during premenopause.
For many people, menopause signals a major change. It is also a sign that a person is getting older. This, along with the symptoms of menopause, can have an impact on an individual’s mental health.
How long insomnia lasts during and after menopause depends on many factors. Every person who goes through menopause has a different experience. Some will find that the symptoms last longer than they do for others.
A person’s hormone levels can start to change 7–10 yearsTrusted Source before a person’s last period. After this point, people can continue to have symptoms such as hot flashes for several years.
Estradiol levels continue to decline for the first 1–6 years in early postmenopause, which may result in continued symptoms.
It is of note, however, that there are treatments and therapies available that can reduce sleep difficulties. It is also important to address any other factors that may be contributing to poor sleep quality.powered by Rubicon Project
The main treatment for menopause-related insomnia is hormone therapy. This works by replacing the lost hormones, which can improve many menopause symptoms. People may find that they sleep better and experience fewer hot flashes while using this treatment.
Hormone therapy is available in topical gels, creams, and patches. People can also take it internally via tablets or an implant.
Doctors typically prescribe SSRIs for mental health conditions, but these medications can also reduce the frequency of hot flashes, which may help with sleep. However, it is of note that insomnia can also occur as a side effect of SSRIs.
For those who are experiencing mood changes, anxiety, or depression, talk therapy may help them understand and cope with these feelings. Lessening the impact of mental health conditions may also benefit sleep.
Doctors rarely prescribe sleeping pills to treat insomnia, as these can have serious side effects. Many are also addictive and are not suitable for managing a long-term sleep problem.
According to a 2019 review, no study has found that herbal or dietary supplements consistently help with menopause symptoms. However, there are many other ways people can try to make sleep easier during menopause.
Below are some evidence-based approaches:
Avoiding caffeine, nicotine, and alcohol
Smoking, consuming caffeine, and drinking alcohol can all make it more difficult to sleep. While it may seem that alcohol makes people drowsy, even a small amount reduces overall sleep quality.
A person can try to reduce or avoid any of these, especially in the afternoon and evening.
Aromatherapy may be helpful in inducing relaxation and reducing hot flashes.
In a clinical trial involving 100 women, researchers found that after 12 weeks of lavender essential oil inhalation, the participants had 50% fewer hot flashes.
Other studies have also found that aromatherapy together with massage was more effective than massage or aromatherapy by themselves.
A 2019 review notes that there is evidence that hypnosis may reduce the frequency and severity of hot flashes by up to 50%.
Moreover, for people whose insomnia results from hot flashes, hypnosis may be a helpful complementary treatment.
Some studies have found that yoga has a beneficial impact on the psychological symptoms of menopause. If a person is having difficulty sleeping due to stress or anxiety, yoga practice may help reduce these symptoms.
However, the results of other studies on yoga have been mixed. This is partly because there are many styles of yoga and numerous ways of practicing, which may lead to inconsistent results.
Addressing sleep symptoms during menopause may reduce susceptibility to weight gain, according to a small study presented virtually at ENDO 2021, the Endocrine Society’s annual meeting.
“Our findings suggest that not only estrogen withdrawal but also sleep disturbances during menopause may contribute to changes in a woman’s body that could predispose midlife women to weight gain,” says lead researcher Leilah Grant, PhD, of Brigham and Women’s Hospital in Boston, Mass, in a release. “Helping women sleep better during menopause may therefore reduce the chances a woman will gain weight, which in turn will lower her risk of diabetes and other related diseases.”
Rates of obesity increase in women around the age of menopause. Menopause-related weight gain is often thought to be caused by the withdrawal of the female hormone estrogen. Estrogen is unlikely to be the only contributing factor, however, since all women stop producing estrogen in menopause while only about half of women gain weight, Grant says. Another common symptom, also affecting around half of women during menopause, is sleep disturbance, which has independently been linked to changes in metabolism that might increase the risk of weight gain.
To better understand the role of sleep disturbances and hormonal changes in menopausal weight gain, the researchers studied 21 healthy premenopausal women.
They used an experimental model simulating the sleep disturbance experienced in menopause to examine the effects of poor sleep on the body’s use of fat.
Participants had two nights of uninterrupted sleep followed by three nights of interrupted sleep, where they were woken by an alarm every 15 minutes for 2 minutes each time. The researchers then restudied a subset of nine participants in the same sleep interruption protocol after they were given a drug called leuprolide, which temporarily suppressed estrogen to levels similar to menopause.
Compared to a normal night of sleep, after three nights of disturbed sleep there was a significant reduction in the rate at which the women’s bodies used fat. A similar reduction in fat utilization was also seen when estrogen was suppressed, even during normal sleep. The combination of low estrogen and sleep disturbance also reduced fat utilization, but the effect was not larger than either exposure on their own.
“In addition to estrogen withdrawal, sleep disturbances decrease fat utilization,” Grant says. “This may increase the likelihood of fat storage and subsequent weight gain during menopause.”
If you are struggling with any sleep issues as a result of a diagnosis of sleep apnea, please contact us today for a consultation. We can help ensure better nights for better days!