Adequate Sleep
“A single night of sleep deprivation can produce significant mood disturbances and lower immune defenses…”
“ ... any sleep disturbances subsequent to COVID-19-pandemic-induced stress, may increase susceptibility to infection, or compromise recovery in the case of infection.”
“Health care professionals and clinicians should monitor and warn against the presence of sleep disturbances in the general and patient populations, and devote attention to the importance of encouraging and implementing sleep hygiene as a protective factor contributing to prevent and manage infectious disease and other immune-mediated diseases”
In the peer-reviewed scientific literature, researchers have been making a well-reasoned, strong case for the critical importance of sleep for overall health and in assisting individuals to fight off SARS-CoV-2 (1 - 11).
There are very compelling reasons to make such a case. Incontrovertible evidence indicates that sleep is critical for optimal immune function (7, 8). Not getting enough hours of sleep can suppress immune function and increase inflammation (8, 9). Having the body in an state of increased inflammation (pro-inflammatory state) may be concerning because hyper-inflammation (ie cytokine storm) is the main pathophysiological feature of mortal COVID-19 (9).
Sleep timing matters too. Humans are designed to sleep during the night and be active during the day. This sleep-wake cycle influences almost all aspects of human physiology and is referred to as the circadian rhythm. However, many people are in the habit of sleeping late. This habit goes counter to the human circadian rhythm (12). This will in turn have negative consequences on immune function because the human immune system operates best when in-sync with the circadian rhythm (12 - 14). Thus, the night shift work, and the disrupted sleep patterns we are seeing during this pandemic may place people at greater risk for worse COVID-19 outcomes (3, 15). Sleep is extremely critical for optimal immune function.
Given the above information, it is very unfortunate that during this pandemic, many are experiencing issues with sleep (4, 16-20). A recent meta-analysis suggests 40% to over 50% of people report sleep problems in both the general population and healthcare workers during the pandemic (21). Some are sleeping later, waking up too early, and some are finding that it takes longer to fall asleep (19). Extreme quarantine measures may be an influencing factor and there appears to be collateral effects such as increased anxiety, psychological distress and post-traumatic stress disorder symptomatology (22). Those who previously considered themselves to be good sleepers seem to be negatively effected more so than those who already had poor sleep before the pandemic (26). The sleep quality and patterns of some children seem to have worsened as well. (24, 25).
Understandably, healthcare workers are being negatively effected. Studies show that there is an increased prevalence of waking up too early, sleep walking, sleep terrors and nightmares on up to 4 days of the week (23). 57% report new insomnia or worsening of insomnia (23). This does to bode well for healthcare workers who require their immune systems to be working optimally.
The Canadian Society for Exercise Physiology (CSEP) is the premier scientific body of exercise and movement scientists in Canada. Their 24-movement guidelines includes evidence-based recommendations for sleep (27). Though the optimal duration of sleep varies for different people, the generally accepted recommendations are:
Infants (0-3 months): 14 - 17 hours, including naps
Infants (4 - 11 months): 12-16 hours, including naps
Toddlers (1-2 years): 11 - 14 hours, including naps, with consistent bedtimes and wake-up times
Preschoolers (3 -4 years): 10 - 13 hours, including a nap with consistent bedtimes and wake-up times
Children (5-13 years): 9 - 11 hours of sleep per night
Youth (14 - 17 years): 8 - 10 hours per night with consistent bedtimes and wake-up times
Adults: (18+): 7 - 9 hours of sleep per night
The individual immune system is the most critical component in the fight against infectious diseases like COVID-19. The immune system is influenced negatively or positively by sleep patterns. Thus, everyone should be encouraged to re-orient their schedules as much as possible in order to optimize sleep habits such that the amount of sleep and the timing of sleep is aligned with the circadian rhythm.
References
Morin, C et al. Sleep and circadian rhythm in response to the COVID-19 pandemic. Canadian Journal of Public Health (2020) 111: 654 - 657
Martins e Silva, E et al. Sleep and Immunity in times of COVID-19. Rev Assoc Med Bras 2020; 66 (SUPPL2): 143 - 147
Flavia Rodrigues da Silva, Renato de Carvalho Guerreiro, Henrique deAraújo Andrade, Eduardo Stieler, Andressa Silva & Marco Túlio de Mello (2020) Does thecompromised sleep and circadian disruption of night and shiftworkers make them highly vulnerableto 2019 coronavirus disease (COVID-19)?, Chronobiology International, 37:5, 607-617
Leo Sher. COVID-19, anxiety, sleep disturbances and suicide. Sleep Med. 2020 Jun ; 70: 124.. doi: 10.1016/j.sleep.2020.04.019
Stanton, R et al. Depression, anxiety and stress during COVID-19: associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults. Int J Environ Res Public Health. 2020 Jun 7; 17 (11): 4065. doi:103390/ijerph17114065
Gulia, K & Kumar, VM. Importance of sleep for health and well-being amidst COVID-19 pandemic. Sleep Vigil. 2020 May 4; 1 - 2.
Garbarino, S & Scoditti, E. On the role of sleep hygiene in health management during COVID-19 pandemic. Sleep Med. 2021 Jan; 77:74
Monico-Neto, M et al. The world war against the COVID-19 outbreak: don’t forget to sleep! J Clin Sleep Med. 2020; 16 (7): 1215
Chen, Y et al. In the big picture of COVID-19 pandemic: what can sleep do. Sleep Med. 2020 Aug; 72: 109 - 110
Morin,C et al The acute effects of the COVID-19 pandemic on insomnia and psychological symptoms. Sleep medicine 77 (2021): 346 - 347
Lim, R et al. Are night shift workers at an increased risk for COVID-19? Medical Hypotheses 144 (2020) 110147
Scheiermann, C et al. Clocking in to immunity. Nat Rev Immunol. 2018 Jul;18(7):423-437
Labrecque, N & Cermakian, N. Circadian clocks in the immune system. J Biol Rhythms. 2015 Aug;30(4):277-90
Abele, S et al. Time is on the immune system’s side, Yes it is. Yale J Biol Med 92 (2019) 225 - 231
Lim, R et al. Are night shift workers at an increased risk for COVID-19? Medical Hypotheses 144 (2020) 110147
Marelli, S et al. Impact of COVID-19 lockdown on sleep quality in university students and administration staff. J Neurol. 2021 Jan; 268 (1): 8 - 15
Majumdar, P, Biswas, A & Sahu, S. COVID-19 pandemic and lockdown: cause of sleep disruption, depression, somatic pain, and increased screen exposure of office workers and students of India. Chronobiology International, 37:8, 1191 - 1200
Deng, J et al. The prevalence of depression, anxiety, and sleep disturbances in COVID-19 patients: a meta-analysis. Ann N.Y. Acad. Sci. 2021 Feb; 1486 (1): 90 - 111
Barrea, L et al. Does Sars-Cov-2 threaten our dreams? Effect of quarantine on sleep quality and body mass index. J Transl Med. 2020; 18: 318.
Javaheri, S & Javaheri, S. The impact of SARS-CoV-2 on sleep. J Clin Sleep Med. 2020 Aug 15; 16(8): 1413
Jahrami, H et al. Sleep problems during the COVID-19 pandemic by population: a systematic review and meta-analysis. J Clin Sleep Med. 2021; 19&2): 299 - 313
Casagrande, M. The enemy who sealed the world: effects quarantine due to the COVID-19 on sleep quality, anxiety, and psychological distress in the Italian population. Sleep medicine 75 (2020) 12 - 20
Herrero San Martin et al. Sleep characteristics in health workers exposed to the COVID-19 pandemic. Sleep medicine 75 (2020) 388 - 394
Lecuelle, F et al Did the COVID-19 lockdown really have no impact on young childrens’ sleep? J Clin Sleep Med. 2020; 16(12):2121
Dellagiulia, A et al. Early impact of COVID-19 lockdown on children’s sleep: a 4-week longitudinal study. J Clin Sleep Med. 2020; 16(9): 1639 - 1640
Kocevska, D et al. Sleep quality during the COVID-19 pandemic: not one size fits all. Sleep medicine 76 (2020) 86 - 88
Ref CSEP: https://csepguidelines.ca/home/practicing-healthy-movement-behaviours-in-the-covid-19-era/#:~:text=The%20Canadian%2024-Hour%20Movement%20Guidelines%20published%20by%20the,ways%2C%20particularly%20through%20interactive%20floor-based%20play%E2%80%94more%20is%20better.