Free AccessLetters to the EditorThe world war against the COVID-19 outbreak: don’t forget to sleep! Marcos Mônico-Neto, PhD, Ronaldo Vagner Thomatieli dos Santos, PhD, Hanna Karen Moreira Antunes, PhD Marcos Mônico-Neto, PhD Search for more papers by this author , Ronaldo Vagner Thomatieli dos Santos, PhD Search for more papers by this author , Hanna Karen Moreira Antunes, PhD Search for more papers by this author Published Online:July 15, 2020https://doi.org/10.5664/jcsm.8502Cited by:11SectionsAbstractPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutABSTRACTCitation:Mônico-Neto M, dos Santos, RVT, Moreira Antunes HK. The world war against the COVID-19 outbreak: don't forget to sleep! J Clin SleepMed. 2020;16(7):1215.INTRODUCTIONThe World Health Organization declared the new coronavirus disease, COVID-19, an international public health emergency concern. Governments in various countries have taken several protective measures to limit exposure to the virus, such as closing borders and schools, cancelling travel, and issuing travel warnings, and providing guidance about working from home and social distancing.1The first line of care for those who are possibly infected is conducted by health professionals who extend an incredible effort to attend to the population. In a related effort, scientists and public health leaders have been working almost uninterruptedly to find the best form of treatment for those infected and create a strategy to prevent the virus’ spread. As a result, fatigue, stress, and sleep deprivation are common.Sleep is linked to the body’s defense system and promotes inflammatory homeostasis. Conversely, sleep debt impairs immune responses by disrupting circadian rhythms, provokes a negative impact on endocrine profile and on some cytokines (specifically IL-1, IL-6 and TNF-a), and is associated with diseases and immunosuppression.2–4 Although there are no studies that associate increased diagnosis of COVID-19 with sleep debt, immunosuppression induced by sleep deficits can increase the risk of developing opportunistic diseases and worsen the clinical condition caused by COVID-19.Another relevant point to be highlighted is the reduced response during the log phase of antibody production after influenza vaccination.5 In the current environment influenza vaccination is of great importance in the process of excluding other possibilities during the investigation of suspected COVID-19 cases.So far there is no vaccine available. Based on impairments caused by sleep debt, we suggest that sleep hygiene be included in the World Health Organization COVID-19 technical guidance to the general public and to health care workers. It is important to keep a consistent sleep schedule, get at least 7 hours of sleep, not go to bed unless sleepy, establish a relaxing bedtime routine, keep the bedroom quiet and at a comfortable cool temperature, turn off electronic devices at least 30 minutes before bedtime, not eat a large meal before bedtime, exercise regularly (moderate intensity), avoid consuming caffeine in the late afternoon or evening, avoid consuming alcohol before bedtime, ensure adequate exposure to natural light, and nap no longer than 30 minutes.6DISCLOSURE STATEMENTAll authors have seen and approved the manuscript. The authors declare no conflicts of interest. Dr. Mônico-Neto is supported by grant: FAPESP #2018/15921-8.REFERENCES1. World Health Organization. Country & technical guidance - Coronavirus disease (COVID-19). https://www.who.int/emergencies/diseases/novel-coronavirus-2019. Accessed March 16, 2020 Google Scholar2. Besedovsky L, Lange T, Haack M. The sleep-immune crosstalk in health and disease. Physiol Rev. 2019;99(3):1325–1380. https://doi.org/10.1152/physrev.00010.2018 CrossrefGoogle Scholar3. Irwin MR. Why sleep is important for health: a psychoneuroimmunology perspective. Annu Rev Psychol. 2015;66(1):143–172. https://doi.org/10.1146/annurev-psych-010213-115205 CrossrefGoogle Scholar4. Santos RV, Tufik S, De Mello MT. Exercise, sleep and cytokines: is there a relation? Sleep Med Rev. 2007;11(3):231–239. https://doi.org/10.1016/j.smrv.2007.03.003 CrossrefGoogle Scholar5. Spiegel K, Sheridan JF, Van Cauter E. Effect of sleep deprivation on response to immunization. JAMA. 2002;288(12):1471–1472. https://doi.org/10.1001/jama.288.12.1469 CrossrefGoogle Scholar6. National Sleep Foundation. Sleep Hygiene. https://www.sleepfoundation.org/articles/sleep-hygiene. Accessed March 16, 2020 Google Scholar Previous article Next article FiguresReferencesRelatedDetailsCited by Alimentación y estilos de vida durante el confinamiento por pandemia en estudiantes universitarios de Chiapas, MéxicoNájera Ortiz J and Cartas Fuentevilla G RESPYN Revista Salud Pública y Nutrición, 10.29105/respyn22.1-709, Vol. 22, No. 1, (29-37) Persistent Sleep Quality Deterioration among Post-COVID-19 Patients: Results from a 6-Month Follow-Up StudyKalamara E, Pataka A, Boutou A, Panagiotidou E, Georgopoulou A, Ballas E, Chloros D, Metallidis S, Kioumis I and Pitsiou G Journal of Personalized Medicine, 10.3390/jpm12111909, Vol. 12, No. 11, (1909) Association between SARS-CoV-2 Infection and Neuropsychiatric ManifestationsVidrio A, Nicolini H, Zarate C, Castro T, Rojop I, Magaña J, López N and Mendoza A COVID, 10.3390/covid2090094, Vol. 2, No. 9, (1270-1286) Health behaviours the month prior to COVID-19 infection and the development of self-reported long COVID and specific long COVID symptoms: a longitudinal analysis of 1581 UK adultsPaul E and Fancourt D BMC Public Health, 10.1186/s12889-022-14123-7, Vol. 22, No. 1 Factors Associated with the Level of Physical Activity in Middle-Aged Colombian People during Lockdown in Response to COVID-19: A Cross-Sectional StudyGarcía-Garro P, Aibar-Almazán A, Rivas-Campo Y, Vega-Ávila G, Afanador-Restrepo D, Martínez-Amat A, Afanador-Rodríguez M and Hita-Contreras F Healthcare, 10.3390/healthcare10061050, Vol. 10, No. 6, (1050) Circadian rhythm in the pattern of online usage of Facebook messenger during the COVID-19-triggered lockdown: a sequel to the pre-pandemic studyKumar Swain R, Minz S, Parganiha A, Diwan A and Pati A Biological Rhythm Research, 10.1080/09291016.2020.1812284, Vol. 53, No. 5, (801-811), Online publication date: 4-May-2022. 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A case-series examinationVitale J, Perazzo P, Silingardi M, Biffi M, Banfi G and Negrini F Chronobiology International, 10.1080/07420528.2020.1775241, (1-5) Volume 16 • Issue 7 • July 15, 2020ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationApril 13, 2020Submitted in final revised formApril 15, 2020Accepted for publicationApril 15, 2020Published onlineJuly 15, 2020 Information© 2020 American Academy of Sleep MedicinePDF download