Sleep disorders during the COVID-19 pandemic

Mental health issues became a global concern during the coronavirus pandemic (COVID-19), especially sleep disorders-the main mental health issue associated with increased psychosocial stressors. Sleep is a key physiological activity to ensure physical and mental well-being and quality of life. Breaking the normal sleep cycle can lead to insufficient rest and prolonged alertness, increasing the risk of insomnia, nightmares, excessive daytime sleepiness and fatigue. Recent studies have shown that insomnia affects 34% of health professionals who are traditionally associated with comorbidities such as psychiatric disorders. Serious stressful circumstances such as depression, anxiety, trauma, low socioeconomic status, hectic urban life, increased use of technology and social media entail potential risk factors for sleep disorders. Such context worsens in the current circumstances, riddled with several psychological stressors. Generally, the number of people with mental disorders tends to increase, as does that of people with sleep disorders¹.

A major literature review found that sleep disorders are significant mental health issues associated with the current pandemic period, suggesting a high load of sleep disorders in different population groups. In developed countries², the mains factors associates with sleep disorders in women, youth, and health professionals were stressors related to COVID-19.

Mental health professionals should evaluate the psychosocial component in insomnia, detecting their triggering and perpetuating factors. Diseases and family losses can be a triggering factor, but over time, insomnia can detach from the generating factor and perpetuate itself through negative thoughts and bad sleep hygiene habits³.

All patients who seek out health centers should be examined, and those diagnosed with any form of insomnia should be referred to appropriate resources and strategies. As health professionals reported a higher burden of insomnia, specific interventions designed to address problems in health units should be available. Most health professionals are overburdened. If health and well-being are not ensured, the ability to work will be further compromised, imposing a severe situation on the current fragile health system⁴.

Cognitive behavioral therapy is the treatment of choice for insomnia. If face-to-face consultation is not possible, due to social distancing measures to prevent the virus spread, similar interventions can be performed using virtual platforms. Since it can be administered over the Internet, using a computer or cell phone, cognitive behavioral therapy was considered an effective and viable alternative in the current context. At the same time, other telepsychiatry venues, such as virtual clinics, remotely administered psychotherapies, psychoeducation, 24/7 listening and guidance line, and digital monitoring can also be explored^{4), (5}.

For areas with slow Internet connection or for individuals who are not accustomed to modern intervention formats, brochures or guidance manuals can be an effective alternative, but can reduce service standardization, quality control, and optimal resource utilization⁵.

Exercises and dietary interventions are associated with improved sleep quality. Low-fat diets and more exercises showed good results, altering metabolic pathways. Future intervention research should focus on how lifestyle-based interventions can impact sleep quality and overall mental health in different populations at risk. We must assess the protective and risk factors, which can be used to develop mental health promotion programs that potentially prevent sleep disorders among vulnerable individuals. The scope of digital interventions, support groups, community-based mental health services, self-management programs, and public mental health resources should be evaluated to promote it and prevent sleep disorders in populations. Amidst this pandemic context, both infection control ⁽⁵ and mental health issues are a growing concern.

REFERÊNCIAS

• ¹
  Preti E, Di Mattei V, Perego G, Ferrari F, Mazzetti M, Taranto P, et al. The psychological impact of epidemic and pandemic outbreaks on healthcare workers: rapid review of the evidence. Curr Psychiatry Rep. 2020;22(8):43. doi: 10.1007/s11920-020-01166-z.
  » https://doi.org/10.1007/s11920-020-01166-z
• ²
  Hossain MM, Sultana A, Purihit N. Mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence. Epidemiol Health. 2020;42:e2020038. doi: 10.31234/osf.io/dz5v2.
  » https://doi.org/10.31234/osf.io/dz5v2
• ³
  Pinto MCR, Alves RC. Componente psicossocial nas insônias: fatores desencadeadores e perpetuantes. In: Pinto LR Jr. Diretrizes para o diagnóstico e tratamento da insônia. Rio de Janeiro: Elsevier; 2009.
• ⁴
  Torales J, O'Higgins M, Castaldelli-Maia JM, Ventriglio A. The outbreak of COVID- 19 coronavirus and its impact on global mental health. Int J Soc Psychiatry. 2020;66(4):317-20. doi:10.1177/0020764020915212.
  » https://doi.org/10.1177/0020764020915212
• ⁵
  Rossi R, Socci V, Talevi D, Mensi S, Niolu C, Pacitti F, et al. COVID-19 Pandemic and lockdown measures impact on mental health among the general population in Italy. Front Psychiatry. 2020;11:790. doi:10.3389/fpsyt.2020.00790.
  » https://doi.org/10.3389/fpsyt.2020.00790

Publication Dates

• Publication in this collection
  17 Sept 2021
• Date of issue
  Apr-Jun 2021