The impact of SARS-CoV-2 on sleep

Abstract

Free AccessLetters to the EditorThe impact of SARS-CoV-2 on sleep Sogol Javaheri, MD, MPH, Shahrokh Javaheri, MD Sogol Javaheri, MD, MPH Division of Sleep Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts Search for more papers by this author , Shahrokh Javaheri, MD Division of Pulmonary and Sleep Medicine, Bethesda North Hospital, Cincinnati, Ohio Search for more papers by this author Published Online:August 15, 2020https://doi.org/10.5664/jcsm.8598Cited by:1SectionsAbstractPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutABSTRACTCitation:Javaheri S, Javaheri S. The impact of SARS-CoV-2 on sleep. J Clin Sleep Med. 2020;16(8):1413.INTRODUCTIONThe COVID-19 pandemic not only has devastating impacts on health care and the economy, it has adversely affected the most basic aspects of life, including sleep. Over the last 2 months, we have observed concerning trends in the sleep health of our patients and suspect these trends are universal in parts of the country with similar sheltering mandates.Significant stressors including school closures, economic insecurity, fear of death, and the psychological and physical effects of social distancing have important implications, including sleep disturbances. Difficulty falling and staying asleep has increased among our patients with and without prior history of insomnia for a variety of reasons including increased anxiety levels, caffeine use, alcohol consumption, and blue light exposure secondary to increased screen time.In addition to insomnia, sheltering at home appears to have resulted in alterations in sleep circadian pattern, predominantly with sleep phase delays. Many patients are delaying sleep time from 10 pm to midnight and rise time from 6–7 to 8–9 am, a disorder called delayed sleep phase syndrome. Additionally, frequency of daytime napping has increased. Once daily obligations resume, the expected impacts include difficulty falling asleep and waking up earlier, increased fatigue, and excessive daytime sleepiness.Alcohol consumption has increased considerably based on patient reporting and spikes in alcohol sales, particularly online. Many restaurants are also offering sale of alcohol with carryout food for the first time, and bars are offering virtual happy hours.1 Alcohol inhibits the immune response and has a proinflammatory effect,2 which may increase susceptibility to COVID-19 infection and disease severity. Furthermore, alcohol worsens obstructive sleep apnea by relaxing upper airway musculature, causes sleep maintenance insomnia during the latter half of the night, and reduces rapid eye movement sleep3 with deleterious consequences.Moreover, opioid use and overdoses have increased during sheltering. In Toronto, opioid overdose deaths, which had been declining, are at their highest since March 20194 (US statistics pending) and opioid-induced sleep apnea could be a contributing factor. Moreover, patient-reported use and demand for marijuana has also increased,5 and according to the National Institute of Drug Abuse, marijuana and opioid use may increase vulnerability with COVID-19 infection, particularly if inhaled.6Therefore, we recommend that our patients maintain consistent sleep/wake patterns, according to their usual work hours, minimize substance use including alcohol, and maintain physical activity and natural light exposure. For patients with obstructive sleep apnea, fixed continuous positive airway pressure may not be adequate to control obstruction, which is worsened by depressants like alcohol and opiates. Additionally, given the potential to aerosolize COVID-19 through the exhalation port of the device, we recommend patients with mild, uncomplicated obstructive sleep apnea living with others refrain from use, and those with moderate or severe disease sleep in a separate bedroom from bed partners while using continuous positive airway pressure.DISCLOSURE STATEMENTAll authors have seen and approved the manuscript. The authors report no conflicts of interest.REFERENCES1. Associated Press. US online alcohol sales jump 243% during coronavirus pandemic, Market Watch, 2 April. https://www.marketwatch.com/story/us-alcohol-sales-spike-during-coronavirus-outbreak-2020-04-01. Accessed May 2, 2020. Google Scholar2. Szabo G, Saha B. Alcohol’s effect on host defense. Alcohol Res. 2015;37(2):159–170. Google Scholar3. Ebrahim IO, Shapiro CM, Williams AJ, Fenwick PB. Alcohol and sleep I: effects on normal sleep. Alcohol Clin Exp Res. 2013;37(4):539–549. https://doi.org/10.1111/acer.12006 CrossrefGoogle Scholar4. Jeffords S. Coronavirus: Ontario opioid crisis worsens during pandemic as services for drug users scale back. The Canadian Press, 30 April. https://globalnews.ca/news/6890040/coronavirus-opioid-crisis-worsens-ontario/. Accessed May 2, 2020. Google Scholar5. Schaneman B. Wholesale cannabis flower prices in Massachusetts climb on mounting demand, sluggish supply. Marijuana Business Daily, 16 March. https://mjbizdaily.com/wholesale-cannabis-flower-prices-massachusetts-climb-on-mounting-demand/. Accessed May 2, 2020. Google Scholar6. Volkow N. COVID-19: Potential Implications for Individuals with Substance Use Disorders. National Institute on Drug Abuse, 11 June 2020. Retrieved from https://www.drugabuse.gov/about-nida/noras-blog/2020/04/covid-19-potential-implications-individuals-substance-use-disorders. Accessed May 5, 2020. Google Scholar Previous article Next article FiguresReferencesRelatedDetailsCited by The COVID-19 pandemic, an environmental neurology perspectiveReis J, Buguet A, Román G and Spencer P Revue Neurologique, 10.1016/j.neurol.2022.02.455, Vol. 178, No. 6, (499-511), Online publication date: 1-Jun-2022. Volume 16 • Issue 8 • August 15, 2020ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationMay 7, 2020Submitted in final revised formMay 18, 2020Accepted for publicationMay 19, 2020Published onlineAugust 15, 2020 Information© 2020 American Academy of Sleep MedicinePDF download