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

The year 2020 will be remembered for a cataclysmic event— i.e. the coronavirus disease (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2). COVID-19 has personal, societal, and global health consequences. The world has stalled during this pandemic as it has compelled people to reduce their direct contact with each other and confined them in their homes, only to contact others maintaining a careful distance or through telecommunication facilities (distant socializing). This was a gross and unprecedented behavioral change. This also has changed the sleep schedule of a sizable population as evident by various surveys that report worsening of sleep quality during lockdown. It has been suggested that racial/ethnic minorities and other disadvantaged populations were disproportionately affected due to variety of reasons, such as poor living condition, poorer access to healthcare to name a few [1]. The lockdown has changed the routine of the people including the physical activity, eating habits, electronic usage and sleep habits [2]. Apparently, these factors have led to change in sleep habits and sleep quality. Increased sleep disturbances (both in terms of quality and quantity) and characteristic sleep changes were observed among global communities. Sleep disturbances during pandemic have been referred as COVID-somnia, a term used as a preferred euphemism to facilitate communication. Delay in bedtime and wake-time along with a reduction in total time spent in sleep during night was reported in the general population survey in India [3]. Daytime napping also increased, perhaps to overcome the deprivation of nighttime sleep (excessive daytime sleepiness) [3]. Delayed bedtime and wake-time during lockdown has been ascribed to a paucity of social zeitgebers (time cues) [2]. Other factors namely the chronotype (or circadian typology, which is the propensity of an individual to sleep at a particular time during a 24 h period) and age were found to influence change in sleep pattern during lockdown. However, alteration in sleep-schedule and sleep-habits was not uniform across population and certain factors appeared to increase risk for the same. For example, shifting to later bed-time and wake time was greatest in the evening chronotypes and minimal in morning chronotypes; it was greater among younger compared to adults; and finally, larger among women [4]. Besides change in sleep schedule, the literature suggested worsening of sleep quality during lockdown [2, 3]. Since these studies were cross-sectional, cause and effect relationship could not be ascertained. It is easy to speculate that lockdown leads to emotional and psychological distress, uncertainties, and unemployment [5, 6]. Concepts like sleep reactivity suggest that different people respond differently to stressful situations. Those with high sleep-reactivity develop sleep distirbances. A study from Morocco reported high prevalence of anxiety, depression, and sleep disturbances during lockdown, but in the background of dysfunctional beliefs about sleep in a large proportion of the population [7]. It must be noted that like stress, sleep reactivity and dysfunctional beliefs are also not causative factors but merely a risk factor for the development of insomnia [8, 9]. Thus, prevailing circumstances had only limited role in the development of sleep disturbances in population. This is further evident by the fact that there was discondance between proportion of exposure to evnet and proportion of persons developing sleep disturbances. It is possible that people with underlying biological vulnerability might have experienced the sleep-disturbance and change in sleep schedule during the COVID-19 pandemic. COVID-19 infection causes systemic inflammation leading to a surge in inflammatory mediators in the body that are known to influence sleep and vice-versa [10]. Systemic * Ravi Gupta sleepdoc.ravi@gmail.com