Managing sleep - in long Covid

Experiencing sleeping difficulties is very common after sustaining a brain injury, with at least 50% 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.

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 below, 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 clients’ 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, socalled “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 by the condition itself.

There is a potentially useful intervention which may be of significant benefit to those experiencing these negative symptoms, and so potentially promote a faster and more full recovery.

And that is: exposure to natural daylight.

THERE ARE THREE POTENTIAL BENEFITS OF THIS:

1. Exposure to natural daylight during the day promotes the production of melatonin in the pineal gland within our brains. Melatonin aids with sleep onset and sleep maintenance.

Figure One. Factors which can impact on the sleep of someone who has had a brain injury.

2. With an excess of melatonin the body can break this down and convert it into serotonin. Serotonergic depletion is associated with depression, so if we have excess amounts of melatonin in our systems due to an additional exposure to natural daylight, we can convert this into serotonin and this can lead to improvements in mood.

3. Being exposed to natural daylight also promotes the production of Vitamin D in our skin which has proven immune boosting benefits, but you do need to let your skin see the sun and not be too covered up. Please be

careful with sunburn at the same time

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 frequency range for promoting the production of melatonin. For at least one hour, but as much as possible beyond this will likely add additional benefit. This intervention is free of charge and easily accessible.

This intervention only requires some simple lifestyle changes (not sleeping for too long and going out of doors more often) and as a result should be easy for most people to engage and comply with.

Critically important in the design and delivery of effective interventions for this client group is a sensitive assessment process alongside close liaison with the client, their family and other carers, as well as with other treating professionals within the client’s multi-disciplinary team. 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 when these factors are taken into consideration.

If you, your family members, colleagues or friends are struggling with symptoms of long covid then trying this for a few weeks should show benefits for many.

If you are still struggling with your sleep, mood and / or levels of fatigue after trying this for a few weeks, then it may mean that you require some more help. In which case please do contact our offices for an informal and confidential discussion about additional options for further treatment or onward referral as may be required. ■

Read More about sleep management in Lee DR. 2017. Teaching the World to Sleep: Psychological and Behavioural Assessment and Treatment Strategies for People with Sleeping Problems and Insomnia. Routledge, London.

For further information, please visit www.sleepunlimited.co.uk

Sleep Unlimited Ltd – the largest private company of sleep experts in the UK - specialise in the assessment of people who have sustained a life changing injury – and our reports have been used by many legal practitioners in successful litigation. We also offer highly acclaimed training in CBT for insomnia to healthcare professionals, corporate training and consultation, both apnoea testing and assessments for insomnia disorders, and Bond Solon trained expert witness testimony. Please see our website for further details, or contact our friendly team - we look forward to hearing from you. info@sleepunlimited.co.uk | www.sleepunlimited.co.uk