Sleep Patterns Of Covid Patients: All-Day Slumber?

The COVID-19 pandemic has had a profound impact on our daily lives, from the way we work to our sleeping patterns. While some of its effects are more apparent than others, the virus has disrupted the sleep of many people worldwide. This phenomenon, known as COVIDsomnia or coronasomnia, refers to sleep problems caused by the virus, even though insomnia is not a direct symptom of COVID-19.

COVID-19, like other viral illnesses, can affect the quality of sleep due to blocked nasal passages, difficulty breathing, fever spikes, and chills, which interfere with the deeper stages of sleep. Additionally, the stress and anxiety associated with the pandemic can lead to insomnia, even in those without COVID-19. The incidence of depression and anxiety has increased significantly during the pandemic, correlating with rising insomnia levels globally.

The disruption to our daily routines, work schedules, and increased time spent indoors can also throw off our circadian rhythm, the body's internal clock that regulates sleep and wakefulness. As a result, the body's production of melatonin, the hormone that cues sleep, can be affected, leading to further sleep disturbances.

Insomnia can have a negative impact on both physical and mental health. In the short term, it can affect mood and cognitive function, while long-term consequences include an increased risk for heart, brain, and endocrine system diseases, as well as mental health disorders such as anxiety and depression.

Treating insomnia typically involves addressing the underlying issues, such as stress, through cognitive-behavioural therapy or medication. However, medication should be used with caution, as it can have side effects and lead to dependence. Instead, establishing a healthy sleep routine, regular exercise, and relaxation techniques can help improve sleep quality.

COVID-19 can cause insomnia, but it is not a direct symptom

While insomnia is not a direct symptom of COVID-19, the virus can cause sleep disturbances in patients. Insomnia is defined as any or all of the following: trouble falling asleep, staying asleep, waking up too early, or feeling tired during the day. Acute insomnia is short-term and can last a few days or weeks, while chronic insomnia involves sleep trouble for three or more nights a week over three months or longer.

COVID-19 can cause insomnia, with symptoms such as blocked nasal passages, breathing difficulties, fever spikes, and chills interfering with the body's ability to enter deeper stages of sleep. These issues are usually short-lived, but they can develop into chronic insomnia. The pandemic has also caused stress and anxiety, which can further disrupt sleep. Spending more time indoors and having irregular work routines can also disrupt the body's internal clock, leading to the production of melatonin at odd times.

Insomnia can have a negative impact on health, affecting mood and the ability to function in the short term, and increasing the risk of heart, brain, and endocrine system diseases in the long term. It also weakens the immune system, making individuals more susceptible to infections like COVID-19.

To treat insomnia, doctors may prescribe medication, but this often comes with side effects and a high risk of dependency. Cognitive Behavioral Therapy for insomnia (CBT-I) is a recommended treatment option, as it addresses underlying issues such as stress. CBT-I can help patients change unhelpful beliefs and habits that perpetuate insomnia.

There are also self-care practices that can help with insomnia. These include unwinding and doing restful activities before bed, creating a daily structure, and avoiding naps and excessive screen time during the day.

COVID-related insomnia is referred to as 'COVIDsomnia' or 'coronasomnia'

The terms "COVIDsomnia" and "coronasomnia" refer to sleep disorders caused by stress, anxiety, and depression linked to the COVID-19 pandemic. The pandemic disrupted daily routines and work cultures, leading to increased insomnia worldwide. A study in the *American Academy of Sleep Medicine* found that there were 2.77 million Google searches for "insomnia" during the first five months of 2020, a 58% increase over the previous period.

The shift to working from home created stress and anxiety for many, with minimal opportunities for in-person interaction and unprepared home spaces. The pandemic also affected women disproportionately, as they had to juggle additional responsibilities like caring for patients, disinfecting, and managing children's education.

Coronasomnia is not an official medical condition, but it raises concerns about its long-term impact on physical and mental health. Lack of sleep can disrupt the body's natural circadian rhythms, leading to adverse events like the development of psychiatric disorders and high blood pressure.

To combat coronasomnia, it is important to establish a sleep routine, be active during the day, limit electronic device usage before bed, and consult a mental health professional if needed. Cognitive-behavioral therapy is an evidence-supported approach to help manage anxiety, stress, and insomnia.

While insomnia is not listed as a common symptom of COVID-19 by the CDC, it may be more related to pandemic-induced stress than the virus itself.

Insomnia affects 50% of COVID long-haulers

Sleep is an important means of relieving fatigue and improving physical function. However, insomnia and other sleep disturbances can adversely affect the risk of infectious and inflammatory diseases.

Insomnia is a common complaint among COVID-19 patients. Studies have shown that anywhere between half and three-quarters of COVID patients experience some kind of sleep problem during their initial infection. This is not surprising given that common symptoms like coughing and breathing difficulties can keep patients awake at night. Staying in bed all day and sleeping whenever one feels sick can also disrupt the natural sleep-wake cycle, making it harder to get uninterrupted sleep at night.

For most patients, sleep patterns return to normal within a few weeks of infection. However, for some, these issues develop into chronic insomnia with long-term consequences. Months after the initial COVID infection, almost 50% of COVID long-haulers still experience sleep disturbances, with insomnia being the most common complaint.

Insomnia is a modifiable risk factor, and studies have shown that some relaxation therapies, such as tai chi and yoga, can greatly improve symptoms of insomnia.

Direct changes to the brain, such as structural changes in the thalamus, can cause insomnia

The thalamus is an egg-shaped structure in the middle of the brain, acting as a relay station for all incoming motor and sensory information. It plays a role in sleep, wakefulness, consciousness, learning, and memory. Structural changes in the thalamus can cause insomnia, which is a sleep disorder characterised by chronic dissatisfaction with sleep quantity or quality. Insomnia is associated with daytime fatigue, mood disruption, and cognitive impairment, and can also lead to depression and anxiety disorders.

The thalamus is a critical component of the brain's biological clock, and its role in regulating sleep and wakefulness is well-established. Structural changes in the thalamus can disrupt the communication between brain regions, impairing the individual's ability to fall or stay asleep. This disruption can have far-reaching consequences, affecting not only sleep but also cognitive and emotional processes.

The thalamus is connected with structures of the limbic system, which is involved in processing and regulating emotions, memory formation and storage, sexual arousal, and learning. Damage to the thalamus can result in insomnia and other sleep disorders, as well as movement disorders, vision problems, and thalamic pain syndrome.

Insomnia can be understood as a disorder of hyperarousal, with individuals experiencing increased somatic, cognitive, and cortical activation. This hyperarousal can refer to heightened physiologic, affective, or cognitive activity, which interferes with the natural "disengagement from the environment" and decreases the likelihood of sleep.

In summary, direct changes to the brain, such as structural changes in the thalamus, can cause insomnia by disrupting the brain's ability to regulate sleep and wakefulness and by interfering with the natural disengagement from the environment that is necessary for sleep. This can have wide-ranging impacts on the individual's sleep, cognitive function, and emotional state.

Dysfunction of the autonomic nervous system (ANS) can cause insomnia

One of the symptoms of ANS dysfunction is insomnia. This may be due to the role of the ANS in regulating sleep-wake cycles and controlling the body's response to stress. When the ANS is not functioning properly, it can lead to disturbances in sleep patterns, making it difficult for individuals to fall asleep or stay asleep throughout the night.

In addition to insomnia, other symptoms of ANS dysfunction include chest pain, mood swings, fainting, fatigue, dizziness, nausea, vomiting, "brain fog," changes in heart rate, blurred vision, and urinary problems. These symptoms can vary in severity and may be mild or life-threatening.

ANS dysfunction can be primary or secondary. Primary dysautonomia occurs on its own without another cause, while secondary dysautonomia is caused by another condition. Some of the conditions that can lead to secondary ANS dysfunction include autoimmune disorders, infections, degenerative neurological diseases, traumatic brain injuries, and certain medications.

The treatment for ANS dysfunction aims to manage symptoms and improve quality of life. Lifestyle changes, such as increasing salt and water intake, wearing compression stockings, and making slow changes in posture, can help with orthostatic hypotension, a common symptom of ANS dysfunction. Medications, such as midodrine and droxidopa, may also be prescribed to increase blood pressure and improve symptoms.

It is important to note that ANS dysfunction can be challenging to diagnose and treat, and individuals may experience frustration or anxiety during the process. Seeking support from a qualified healthcare provider and making lifestyle changes can help improve symptoms and overall well-being.

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