Narendra Sadanand, 32, an independent art director for ad films, has been grappling with anxiety issues since the past 4 years and had just about managed to reach a level of stability when the lockdown was announced. While he continued with his therapy sessions, little did he know that a new monster would raise its head—hypersomnia. “I had little to no work. I had to fine-tune skills I had barely used, such as animation, in order to keep some work coming in,” Sadanand recalls. “With hardly anything to do through the day, I felt sleepy all the time. I kept napping for stretches of 3 to 4 hours and kept feeling groggy even after, which led to more naps.”
With the covid-19 pandemic having claimed almost a year of our lives already, it is not to be wondered at that it has affected every part of our daily existence, not least our sleep patterns. Those who had pre-existing conditions such as depression, anxiety and sleep disorders faced even greater risk of what is being called the Lockdown Sleep Syndrome, a disorder which has got institutional acknowledgement by being mentioned in the Consensus guidelines of Indian Sleep Disorders Association and the Journal of the International Society of eHealth and Telemedicine.
While insomnia is the most commonly occurring symptom of this syndrome, other sleep issues like hypersomnia have been noted in those who never had problems with their sleep earlier, while those who have had chronic sleep problems have seen their symptoms worsening. Additionally, sleep specialists have noticed that those who get infected with the virus have persistent insomnia for several weeks. And there are also a few patients who have presented with excessive sleepiness and narcolepsy after recovering from a covid-19 infection.
Loss of sleep affects mood and attention. Sleep is a restorative process, and it marks the repairing phase of our system. Adequate sleep provides an adequate framework for good emotional and mental health. Thus, sleep deprivation can produce impairment in attention span, reaction time, concentration in addition to causing irritability, mood changes and feeling anxious. “Untreated insomnia results in GAD (Generalized Anxiety Disorder). Patients with GAD will experience fatigue, irritability, restlessness, lack of concentration, unwanted thoughts, anxiety and fear attacks, emotional distress, excessive worrying, headaches, palpitations etc,” says award-winning clinical psychologist Dr Prerna Kohli. Those with comorbidities like diabetes and hypertension are also at increased risk of having aggravated sleep problems, say doctors.
Life without sleep
Prerna Pawar, 30, quit her job in February 2020, two weeks before the nationwide lockdown started. Not only has she been unable to find another job yet but she has been unable to sleep all these months. “The anxiety is just way too overwhelming. I keep surfing the internet in search of a job and also end up reading Covid-19 news. I know it may be affecting my mental health, in turn affecting my sleep, but I don’t know what to do.” Prerna has tried it all — meditation, reading, switching off her phone, but to no avail. “I am unable to switch off the trail of negative thoughts. I just can’t stop thinking and put myself to sleep peacefully,” she says. She has gained nearly 10 kilos of weight, has frequent crying spells and breakdowns and has now fallen into a routine where she stays up the whole night, sleeps for 4 to 5 hours a day, and then is awake for the next 10-20 hours again, feeling exhausted and tired all the time.
Prof. Dr. Gauthamadas, senior consultant in Neuro Behavioral Medicine, Chennai, explains why that may be the case, saying, “Sunlight is our biggest zeitgeber or ‘time giver'. If people aren't leaving their homes because of fear of Covid-19, if they're not going to work as they once did, then they aren't getting that daily exposure to sunlight in the morning. That can disrupt their internal clock.”
Sleep is important in helping to maintain overall occupational performance and wellbeing. “The major reasons for disturbed sleep during the pandemic/lockdown have been reduced physical activity and altered lifestyle, reduced sunlight exposure as most have remained at home, fear of getting infected with covid-19 and generalized fear and anxiety about the future,” says Dr. N. Ramakrishnan, Senior Consultant in Sleep Medicine at Apollo Hospitals and Nithra Institute of Sleep Sciences.
Because of working from home, people are going to bed later, sleeping longer, and their body clocks are disrupted. “Abnormal dreams and disruptive nightmares are another type of sleep disturbance that can be triggered by events such as this pandemic, which has had a profound impact on the psychological and mental wellbeing of individuals across society,” cites Prof Dr Gauthamdas. “There is a new daily schedule or even lack of schedule. People are unable to keep track of time with no typical ‘anchors’ such as arriving at the office, dropping and fetching kids from school. Being stuck at home with low levels of natural light may reduce light-based cues for sleep and wakefulness.”
The link between sleep and immunity
There is a bidirectional link between sleep and the immune system. Sleep is altered by immune system activation; and the innate and adaptive immune systems are affected by sleep. Depending on the magnitude and time of an inflammatory response stimulated by the immune system, sleep can be increased in duration and intensity but also disrupted. “It has also been shown that prolonged sleep loss weakens the body’s immune system and renders it prone to colds or other infections, including covid-19. Inflammation present in a wakeful state due to sleep disturbance causes malaise, fatigue, immobility, pain and several other physical symptoms. Prolonged periods of sleep loss can lead to negative changes in health and immune function,” says Prof Dr Gauthamdas.
All was well with Suyash Shah even after the lockdown took place. Work was going fine, he was able to manage the change in work schedule and he believed he was getting enough sleep until 4 months into the lockdown. It was then that the company announced paycuts, something he did not foresee. Married with a wife who was pregnant, Shah started grappling with anxiety and started looking for more work, spending more time on screens, scanning LinkedIn and other job websites. He then started suffering constant headaches, loss of appetite and weakness.
Dr Kohli warns about cases such as Shah’s, saying, “If you suffer from insomnia or fretful sleep for more than 14 consecutive days, it helps to talk to a professional psychologist, who will help you reach the root cause for the lack of sleep.”