Sleep disorders and factors affecting sleep

Sleep and Covid-19

  • Sleep is vital for recovery from Covid-19
  • Sleep is a restorative process that is important for the proper functioning of the immune system
  • Viral infections are known to impact sleep
  • Other factors occurring as a result of Covid-19 which can impact sleep include:
  • Being in hospital or a strange environment
  • Lack of natural daylight
  • A change in routine or sleep cycle
  • Nightmares/flashbacks
  • Side effects of medications
  • Low mood/stress

Further research is also needed to understand whether alterations in cytokines (cells produced when the immune system is activated) contribute to disordered sleep.

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Long Covid: Common issues

  • Insomnia is one of the most common symptoms of Long Covid (“Coronasomnia”)
  • Too little sleep 
  • Too much sleep 
  • Difficulty falling asleep 
  • Difficulty staying asleep 
  • Disturbed sleep (Pain/Positioning/Toilet)
  • Disturbed cycle
  • Waking up earlier than normal
  • Too scared to sleep (PTSD)
  • Anxiety/Over-thinking
  • Difficulty ‘switching off’
  • Waking up feeling unrefreshed
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Sleep Disorders

Insomnia – short term (less than 3 months) or long term (more than 3 months)

  • Difficulty falling asleep
  • Difficulty staying asleep
  • Waking early in the morning
  • Increases with age
  • Affects more women (40%) than men (30%)

Hypersomnia

  • Excessive sleepiness
  • Excessive time spent sleeping
  • Lack of alertness during the waking episodes of the day
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Sleep Apnoea

  • A disorder of interrupted breathing during sleep.
  • The windpipe collapses during breathing when the muscles relax causing snoring
  • When air flow is blocked  O2 levels drop and person wakes up
  • Signs include snoring; gasping for air; waking frequently; morning headache; dry mouth; unrefreshing sleep; fatigue; excessive daytime sleepiness
  • Associated with Obesity/neck circumference

Narcolepsy

  • Frequent sleep attacks which happen even after a normal amount of sleep
  • Research suggests it is linked to genetics – defective hypocretin receptor 2 (based on studies on canines at present)
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Conditions which affect sleep

  • Depression/Anxiety/Stress/PTSD
  • Fatigue
  • Chronic Pain Syndrome
  • Restless Leg Syndrome
  • Menopause (6% suffer with insomnia)
  • Alzheimer’s/Stroke/Head Injury
  • Cancer
  • Sensory Loss
  • Seasonal Affective Disorder

Restless Leg Syndrome – Unpleasant crawling, tickling, tingling, prickling sensation in legs and feet and urge to move them for relief.

Common in elderly; linked to pregnancy, diabetes and anaemia and dopamine abnormalities

Brain – Changes in the brain can affect the neurotransmitters that control sleep

 

Napping

Avoid naps as far as possible

Do not nap after 3pm 

  • Naps taken late day/cycle will consist of more deep sleep

Longer naps can cause:

  • Sleep inertia – feelings of grogginess and disorientation;
  • Reduced cognitive performance;
  • Disruptions to the circadian rhythm/body clock; 
  • Insomnia
  • Decreased sleep quality and duration overnight
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But, if you do nap...

Keep naps brief and short (15-20 minutes)

  • This ensures ensure you stay in the lighter stages of sleep and do not enter into slow wave/deep sleep
  • The best time for a nap is early-mid afternoon

Alternatives to Napping

  • Exposure to bright light can provide the same energy boost as a nap
  • A moderate amount of caffeine can alleviate feelings of drowsiness (small cup of coffee)
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The total amount of sleep over a 24 hour period should be no more than 8-9 hours.

Other factors affecting sleep

Alcohol

  • Reduced REM/Deep Sleep
  • Remain in lighter stages and wake more easily

Nicotine

  • Less REM sleep/stay in light sleep
  • Wake up after 3-4 hours due to nicotine withdrawal
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Medications

  • Anti-depressants suppress REM sleep
  • Side effects of certain medications = insomnia, drowsiness
  • Decongestants can contain caffeine

Caffeine

  • Stimulates the parts of the brain that cause insomnia

Dreams and Nightmares

Dreams

  • A succession of images, ideas, emotions and sensations that usually occur involuntarily in the mind during REM 
  • You become physically paralysed during REM so that you do not act out your dreams
  • Most dreams last 5 to 20 minutes and you can have 4-7 dreams in one night
  • During a typical lifespan a person spends about six years dreaming but 90% of these are forgotten
  • You are more likely to remember a dream if you wake during the REM phase

Nightmares or Bad Dreams (Parasomnia)

  • A nightmare is a disturbing vivid dream associated with negative feelings, threats to safety and feelings of anxiety of fear
  • Usually occurs during REM
  • They are more common in children but can happen at any age and are common after experiencing trauma (Post Covid PTSD)
  • Other triggers include scary books and movies; substance misuse; medications; sleep deprivation and stress or anxiety
  • Nightmares can cause distress, disrupt sleep and create a fear of going to sleep
  • Nightmares can cause excessive sweating and a pounding heartbeat
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Dream Completion Technique

Remember there is nothing to fear in your dreams. Think about the nightmare when you wake up.

Imagine what you would want to happen next – something that feels good!

Give a new direction for the dream to take.

Write down a solution.

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