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Managing sleep in Long COVID Dr David Lee of Sleep Unlimited looks at techniques to help those struggling to recover sleeping patterns Experiencing sleeping difficulties is very common after sustaining a brain injury, with at least 50 per cent of people who have had a brain injury reporting disturbed sleep as a result of the trauma they have sustained. The situation is often very complex, as described below in figure one, there can be multiple sources of sleep disturbances in this group of clients, which can originate from a range of experiences over a broad time-course. Figure One. Factors which can impact on the sleep of someone who has had a brain injury. When we are asked to treat a sleep problem for a client who has had a brain injury, then a detailed assessment is essential. One which probes for all the factors shown in Figure One above, and one that, preferably, uses objective outcome measurements such as actigraphy. Firstly, and most importantly is the quality of sleep that the client experienced before their injury. The actual location of the injury, and areas of the brain which have been specifically damaged may also have significant effects on a client’s sleep, as are current and previous medication prescription, psychosocial lifestyle factors (such as activities of daily living, alcohol, nicotine, and caffeine consumption), and the presence of pain and mood disturbances (both of which are very commonly experienced by people who have had such injuries). All of these factors have been important to consider for people living with a brain injury, but with the recent advance of the Coronavirus variants across the globe the impact of symptoms of COVID-19 in the short-term and Long COVID in the medium-term have brought additional challenges for the sleep of this group of clients. Fatigue is a very common symptom of Long COVID, and this can often lead to people sleeping for long periods, so-called “hypersomnia.” Paradoxically, common symptoms of hypersomnia are feelings of tiredness and fatigue. As a result, some of the fatigue experienced by people living with Long COVID may be driven by their oversleeping (hypersomnia) as much as be the condition itself. There is a potentially useful intervention
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which may be of significant benefit to those experiencing these negative symptoms, and so potentially promote a faster and more full recovery.
Exposure to light should be: • Natural light, i.e., daylight, outside and not through a glass window for example. • Best in the morning or early afternoon as light at this time of day is in the best And that is: exposure to natural daylight. frequency range for promoting the production There are three potential benefits of this: of melatonin. 1/ Exposure to natural daylight during the • For at least one hour, but as much as possible day promotes the production of melatonin beyond this will likely add additional benefit. in the pineal gland within our brains. Melatonin • This intervention is free of charge and aids with sleep onset and sleep maintenance. easily accessible. 2/ With an excess of melatonin, the body can This intervention only requires some simple break this down and convert it into serotonin. lifestyle changes (not sleeping for too long and Serotonergic depletion is associated with going out of doors more often) and as a result depression, so if we have excess amounts of should be easy for most people to engage and melatonin in our systems due to an additional comply with. exposure to natural daylight, we can convert Critically important in the design and this into serotonin, and this can lead to delivery of effective interventions for this client improvements in mood. group is a sensitive assessment process 3/ Being exposed to natural daylight also alongside close liaison with the promotes the production of Vitamin D in client, their family and other carers, as well our skin which has proven immune boosting as with other treating professionals within benefits, but you do need to let your skin the client’s multi-disciplinary team. see the sun and not be too covered up. Being “on the same page” and working in a client-centred way is essential to ensure compliance and so deliver effective and durable outcomes for the client and their family. Excellent results can be achieved with regard to improving sleep in this group of vulnerable clients Fa t i g u e i s a when these factors are taken into consideration. If you, your family members, colleagues or very common friends are struggling with symptoms of symptom of Long Long COVID then trying this for a few weeks C OV I D, a n d t h i s should show benefits for many. If you are still struggling with your sleep, mood can often lead to and /or levels of fatigue after trying this for a few people sleeping weeks, then it may mean that you require some more help. In which case, please do contact our for long periods, offices for an informal and confidential so-called discussion about additional options for further “ h y p e r s o m n i a ”. treatment or onward referral as may be required. Dr David Lee BSc PhD CertEd AFBPsS CPsychol CSci is clinical director at Sleep Unlimited Ltd
