Lack of sleep may linger long after the on-going coronavirus (COVID-19) pandemic is over. But so, may a new commitment to sleep. Some years ago, I co-authored an article in Sleep Medicine, focused on the cultural aspects of sleep. At any given moment, over 1 billion people will engage in sleep during a 24-hr cycle. Sleep is universally powerful and has a profound impact on a person. Sleep influences not only our health and well-being but also our quality of life. The power of sleep has been illustrated by several main-stream works of literature, from William Dement’s pioneering work on “The Promise of Sleep”, to Neuroscientist and sleep expert Matthew Walker’s take on “Why We Sleep,” and Arianna Huffington’s “The Sleep Revolution”.
Our article illustrated that sleep varied from one culture to another and among young and old people alike. Morning exchanges between family and friends such as “Did you sleep well?”; “tu as bien dormi? (asks the French); or “u mwiere?” (asks the Edos of Nigeria),” are profound and symbolic expressions of general well-being. We also found that healthful sleep remains the single most critical factor in predicting longevity. It is more influential than diet, exercise or heredity. Lack of sleep may lead to serious life-threatening ailments such as cardiovascular diseases, diabetes, depression, and chronic respiratory diseases. Lack of sleep may also weaken the body’s defence system and makes people more vulnerable to contracting any virus, including the novel COVID-19.
But even before the COVID-19 outbreak, sleep disorders defined as persisting (> 4 weeks) disturbances of the sleep pattern, were an emerging global epidemic, and an unrecognized public health issue, strongly associated with morbidity and mortality. According to neuroscientist, Matthew Walker, two-third of adults fail to obtain the recommended eight hours of nightly sleep. Walker noted, that “sleep has an abundant constellation of nighttime benefits that service both our brains and our bodies.” All, our bodily organs are enhanced by sleep. So, is our ability to learn, memorize, and make logical decisions and choices. Whether we want “to control our body weight or lower our blood pressure, adequate sleep is of vital importance,” stated Walker. Without sleep, our cognitive and emotional abilities may become disrupted. Without sleep, we may suffer from sleep disorders such sleep deprivation, sleep-disordered breathing, insomnia, and restless leg syndrome. Ultimately, sleep cannot be ignored or dismissed at will. It is a powerful biological drive, essential to maintaining life, alongside food, water, and air. The key to fighting infections, and warding off all manner of sickness, including COVID-19, is sleep.
Still, the pandemic is taking a toll on the world, causing (at the time of this writing), close to 2.8 million cases, 196,000 deaths, and enormous despair of unknown duration. The unprecedented nature of the outbreak, coupled with necessary quarantine measures have interrupted daily routines. I find myself, probably like many of you, spending way too much time getting global, national, and local updates on the COVID-19 pandemic. Stressors such as the prolonged duration of the pandemic, fears of infection, inadequate information, and frustration with a global response may not only increase stress or anxiety levels but also disrupt sleep.
Frontline health care workers are not only short on personal protective supplies, but also sleep. Lockdown, homeschooling, and social distancing measures may potentially induce or exacerbate sleep problems. Yet, in spite of the pandemic, getting good sleep is more important now than ever.
It is also true that for most cases of sleep disorders such as poor-quality sleep or disturbed sleep, simple behavioural approaches, sometimes called sleep hygiene, can be very effective. These include maintaining regular bedtimes and wake times, limiting caffeine, alcohol, and other substances, creating a cool, dark, and quiet bedroom, restricting digital media in the hour before bedtime while allowing adequate opportunity for sleep.
For other persistent cases such as insomnia, or delayed sleep onset caused by an overactive mind or constantly thinking or worrying about the pandemic, these recommendations may not be very effective. Instead, practising mind-calming activities such as writing a gratitude journal, for example, performing muscle relaxation techniques or yoga, or simply reading religious or spiritual materials, 30-60 minutes before going to bed, may calm the mind and pave the way to a more healthful solid night’s sleep.
While the ultimate scope, effect and duration of this outbreak is impossible to predict, the consequences of sleep-related disorders in the era of COVID-19 cannot be underestimated. Our ability to focus or think into the future may diminish, but the pandemic underscores why adequate sleep should be prioritized. Our article revealed that all cultures have something positive about sleep that must be recognized and promoted while identifying the negative consequences of sleep-related disorders. We also found that everyone, whether young or old, should sleep, as our future will be shaped by it. Sleep is a positive adaptation to stress and setbacks from the outbreak. Sleep is also an unblinking witness to our overall physical and mental well-being. The stress and anxiety of COVID-19 will linger for a long time, and may profoundly change how we interact with each other. But sleep can help us take control of our future so that we are prepared both physically and mentally, for when this pandemic becomes a thing of the past.
Juliet Iwelunmor, PhD is Associate Professor of Global Health at Saint Louis University. She is also a core faculty in the Department of Behavioral Science and Health Education. As a global health implementation scientist, Dr Iwelunmor’s work focuses on implementing and sustaining evidence-based health interventions in low, middle-income countries. She is the lead principal investigator (PI) on a multi-PI, National Institutes of Health (NIH) project titled Innovative Tools to Expand Youth-Friendly HIV Self-Testing in Nigeria. In addition, she co-leads NIH R-01 implementation science research study that integrates evidence-based task-shifting strategies for hypertension control within HIV clinics in Nigeria.