Dr Samhita Panda explores the impact that COVID-19 infection may have upon sleep…
The dreams were coming in fast, repetitive, flowing from one event to another, people and places from the recent and the past. How they were trying to knit a web of stories, … all this while I lay in bed sleeping while beads of sweat gathered around my neck. Briefly aroused, I again drowned myself into the oncoming onslaught of the motion picture-like dreams. Only to get repeatedly aroused from the lightness of sleep by the drop of a pen, the locking of a door, the patter of someone walking upstairs, the distant sound of a truck….. In between, the dreams kept up their tempo. I thought if I am awake enough and probably not sleeping I might as well check out some pending work on my computer…..Then again lapsing into the dreams, dragging me into an abyss, I could not make an effort to get myself off the bed. What the dickens was happening to me? A couple of times I did manage to get out of bed, I was nowhere near alert. I was feeling horribly sleepy and yawning to glory, my eyes hardly open, just enough to catch the time on my mobile- 2.15 AM. Whew! I had gone to sleep at 10 PM. What was going on? I panicked thinking how I would manage my work days ahead once I joined back at the hospital after the home isolation period ended a few days later….It was 9 AM when I finally woke up next morning, groggy. This had been the third day in succession and I now dreaded to sleep!
In the first week of 2022, after testing positive to COVID, my child had high grade fever and sore throat. In the midst of the massive COVID surge triggered by Omicron in India and the world over, the virus rapidly engulfed the remaining members of the family (India logged 1,41,986 new cases that day, 7th January 2022).1 I started getting sore throat, a dry cough, low grade fever, and troublesome feeling of cold extremities a couple of days later. Hypo-osmia and dysgeusia also did kick 4 days on much like last time. Expecting my vaccination and previous COVID infection a year before to hold me in good stead, I was looking forward to a short non-specific symptom set with quick resolution. The print and screen media was already claiming that Omicron is mild, self-remitting except in the aged and those with co-morbidities.2 Well so be it…
…Untill these dreams came crashing in. As a neurologist and sleep specialist, and a person who loves an 8 hours sleep regime, this was a rude awakening. An ominous feeling was creeping in as the virus attacked the sleep… Even though I had a cough and sore throat which was getting better, there was no breathlessness, lack of oxygen saturation which I checked ( in the middle of night), no apnea, no stress, was not on any drugs or cough sedatives. It never seemed like I had gone to sleep (I mean deep sleep- Stage 3 nonREM). I thought I was having sleep onset REM periods and accompanying sleep paralysis. It is scary. I will have to wait to see how this experience pans out, does it abate as the rest of Omicron symptoms OR will it evolve further as it attacks the nervous system. Already I feel like a zombie and I have to go back to the patients…
A thought flashing back to the previous COVID waves, Delta variant and all, and the sleep disturbances observed through them that revealed a high prevalence of sleep problems of 40% amongst general and health care populations during the pandemic with even higher prevalence rates in active COVID cases. In a systematic review of forty-four papers, involving 54,231 participants from 13 countries examining the pandemic’s impact on sleep problems, the global pooled prevalence rate among all populations- general population, health care workers, and patients with COVID-19, was 35.7% while in those with COVID-19 was 74.8%.3 In another subsequent review ending in February 2021 having 345,270 participants from 39 countries, the corrected pooled estimated prevalence of sleep problems were 31% among healthcare professionals, 18% among general population and 57% among COVID-19 patients.4 The sleep onset and sleep maintenance disorders were directly or indirectly related to COVID, psychological distress, mental health issues like anxiety and depression, and long-haul COVID.4,5 Additional features which contributed to sleep disruption in COVID, could include deprivation of natural light, our greatest zeitgeber, during the home isolation and hospitalization upsetting our biological clock, interruption of natural sleep in hospital settings, influence of COVID symptoms like cough, breathlessness or its various medications on sleep leading to sleep cycle perturbation.3-5
To deal with this surge of what some sleep specialists termed “COVID-somnia”, ranging from insomnia to hypersomnia, nightmares and sleep terrors to worsening of sleep apnea, Cognitive Behavioural Therapy for Insomnia (CBT-I) and Trauma Focused Cognitive Therapy (tf-CBT) have been proposed to streamline sleep issues. Melatonin was also found to aid sleep normalization and overall outcomes even in moderate-severe hospitalized COVID patients courtesy its circadian function as well as health-promoting properties.6
During the present surge, while the world is still waiting for new symptoms to emerge, a new data search showed sleep paralysis as one of the sleep manifestations related to the Omicron variant. While causation is not yet understood, attributing it to the stress of the illness, sleep deprivation or pre-existing REM disorder maybe be some links. Well none of that existed in my case. Whether it has a direct link with the variant, needs to be further explored.
So as the panelists on a popular news channel argued that Omicron is a ‘mild misnomer’, I could agree no less to the predicament awaiting me as only time will unfold the final message.
- Callaway E. Heavily mutated Omicron variant puts scientists on alert. Nature. 2021;600(7887):21.doi: 10.1038/d41586-021-03552-w.
- Meo SA, Meo AS, Al-Jassir FF, et al. Omicron SARS-CoV-2 new variant: global prevalence and biological and clinical characteristics.Eur Rev Med Pharmacol Sci. 2021;25(24):8012-8018. doi: 10.26355/eurrev_202112_27652.PMID:34982465
- Jahrami H, BaHammam AS, Bragazzi NL, et al. Sleep problems during the COVID-19 pandemic by population: a systematic review and meta-analysis. J Clin Sleep Med. 2021;17(2):299-313. doi: 10.5664/jcsm.8930.
- Alimoradi Z, Brostrom A, Tsang HWH et al. Sleep problems during COVID-19 pandemic and its’ association to psychological distress: A systematic review and meta-analysis. EClinicalMedicine. 2021; 36: 100916. doi: 10.1016/j.eclinm.2021.100916.
- Deng J, Zhou F, Hou W, et al. The prevalence of depression, anxiety, and sleep disturbances in COVID-19 patients: a meta-analysis.Ann N Y Acad Sci. 2021;1486(1):90-111. doi: 10.1111/nyas.14506.
- Sanchez-Gonzalez MA, Mahıllo-Fernandez I, Villar-Alvarez F, et al. What if melatonin could help patients with severe COVID-19? J Clin Sleep Med. 2022;18(1):335-6. doi.org/10.5664/jcsm.9554.
Dr. Samhita Panda is an Additional Professor and Head of the Department of Neurology, All India Institute of Medical Sciences, Jodhpur.