It seems so. However, as with insomnia in the pre-COVID era, unravelling what might have caused it in the first place is an important, complex and personalised priority.
In this article, we’ll be looking at what the most recent studies say about how the prevalence of insomnia has changed during and post-pandemic, chronic insomnia in general and some solutions that you may or may not have considered.
Insomnia affected many people before the pandemic hit.
It’s important to state that even before the pandemic hit, insomnia affected up to one-third of the general population in the US.[1]
Hong Kong had a unique civil unrest situation before the pandemic hit, with estimates from a survey of 1004 people suggesting an increase in insomnia by twenty per cent even before the onset of COVID-19 in the region.[2]
When the pandemic hit in 2019, a group of people studied in Europe showed up to a sixty per cent increase in reported insomnia.[3] This increase was, of course, heavily connected with worries about the virus and the uncertainty around it.
Let’s be honest if there was ever a reasonable thing to lose sleep over, it’s an alien illness trying to integrate itself worldwide.
It’s important to note that worries and stress are only considered risk factors for insomnia and not necessarily causative.[4]
So, where does that leave those experiencing insomnia for the first time?
Or those who have developed insomnia post-infection?
Is it the worry we just referred to or the effect of COVID-19 on the brain?
These questions express the complexity of insomnia post-COVID because, according to researchers, it’s worry, infection and more.
“Coronasomnia,” a phenomenon described in many research articles, is believed to be caused by a combination of effects. These effects include the implications of COVID- infection on the brain, reduced daylight exposure due to either working from home or lockdowns and the somewhat continuous media coverage around the economic and social recession brought on by the pandemic.[5]
One of the first studies to bring these contrasting components together was a web-based survey done in China with just over seven thousand adults. People’s knowledge about COVID-19, anxiety, depressive symptoms, and sleep quality.
Anxiety was increased in the group by thirty-five per cent, depressive symptoms up by twenty per cent and sleep quality down by almost twenty per cent.[6] Anxiety levels increased based on the time spent consuming media around the pandemic, and both the anxiety and depressive symptoms were at higher levels in younger people.[7]
All three of these symptoms, anxiety, depression and insomnia, have long been interlinked.[8]
However, post-traumatic stress syndrome (PTSD) is now also a consideration, especially for those in harder-hit regions, healthcare units and survivors of COVID.[9]
A higher prevalence of PTSD has been noted in all those categories and broader populations,[10] potentially compounding sleep problems and making the origin and the solution harder to pinpoint.
This process is even more challenging because PTSD, for some, might not be the right way to describe people’s experiences. Another condition called adjustment disorder could be more appropriate.[11]
Whilst the prevalence of adjustment disorder compared to PTSD is being investigated in different regions, the symptoms of adjustment disorder seem to be close and relevant. The central theme is an inability to adapt to unpredictable situations and a preoccupation with the stressor (remember, we discussed the connection between insomnia and media consumption).[12]
This need to accurately define people’s experiences is one of the most important things I’ve learnt from working with psychiatrists and other mental health practitioners.
This specificity is important for both practitioners and patients alike. The closer you can be to properly articulate what’s going on, the better chance you have of successfully intervening.
For example, let’s use a common situation in the clinic. I have a patient seeing me for insomnia, and I naturally inquire as to the origin of it. My patient mentions they feel anxious a lot which leads to this next question:
What other words would you use to describe your anxiety?
This question is up there in my top five questions, without a doubt. Why? Because sometimes, other descriptions for anxiety could be restless, agitation, unsafe, or wired. All of which have entirely different stigmas and alternative interventions in some cases.
This line of questioning also provides a platform to clear the mystery behind where sleep disturbances originate. Something that can be incredibly reassuring if you are living with either acute or chronic insomnia.
Even with just a tiny level of analysis, it’s easy to see just how convoluted treating insomnia can be at the best of times.
Pandemic aside, this has always been the case. One of the primary reasons for this is that the origins, similar to the gut-brain axis we discuss in many articles on this website, can be bidirectional.
Let’s use PTSD and sleep disturbances as an example. Even pre-pandemic, a growing body of evidence investigating these two conditions found that they affected each other.[13] Not too dissimilar from the way stress can influence irritable bowel syndrome.
Then throw a brand new virus into the mix, and it gets that little bit harder.
Or at least that’s how it seems. COVID-19 infection affects the brain in a few alarming ways to explain insomnia symptoms. However, a selection of these origins could already be associated with pre-pandemic insomnia.
For example, one of the critical drivers of mental health conditions is inflammation in the brain, aptly called neuroinflammation. Some studies suggest that sleep disturbances caused by COVID-19 infections can drive this neuroinflammation, in turn, rebounding and worsening insomnia.[14]
Yep, the inflammatory chemicals from COVID-19 can cause the gateway to your brain, called the blood-brain barrier, to become a little more open than it usually would. This “leakiness” allows the viral proteins to get into the brain, causing more neuroinflammation.
Not only that, COVID-19 has a preference for the regions of the brain that regulate your sleep. The prefrontal cortex, basal ganglia and hypothalamus.[15]
Whether or not this is the primary cause of increased sleep problems in 2022 remains to be seen.
A leaky brain causes other issues too.
And this is where things get complex when it comes to the origin of why some people can’t solve their insomnia. A leaky brain is often associated with a leaky gut and can worsen your anxiety and depression symptoms. As we saw before, this worsening can make your sleep worse.[16]
Don’t despair, though, as pinning down the origin of your insomnia can be complex, but the solutions we’ve used in the past can still help.
And let’s get into those now. When dealing with a situation where there are multiple potential causes, it’s still important to choose the intervention that has the best chance of getting you some sleep!
Whether or not anything has helped beforehand will influence this initial choice. Most commonly, the first thing most patients have been attempting is melatonin. For me, I must say that melatonin has been hit or miss. I think I speak for a lot of people as well. There is substantial research to suggest that it can help.
Does melatonin help with insomnia?
Yes, there are good cases to say that it does. A meta-analysis (a type of review that pools similar studies together to draw better conclusions) combined the results of twenty-three randomised controlled trials.
Interestingly, the conclusion found that melatonin had positive effects on sleep quality for people with respiratory, metabolic and primary sleep disorders but not for people living with mental and neurogenerative conditions.[17]
This contrast may go some way to explaining the mixed results seen when using melatonin.
If you’re new to melatonin, it’s a hormone naturally produced by the brain’s pineal gland when the light changes at the end of the day. Not many people know that the same amino acid (part of a protein) that creates serotonin – tryptophan, produces melatonin.[18]
All hormones have broad effects, spanning different body systems. In the case of melatonin, these effects are in the immune system, cardiovascular system and respiratory system, and the hormone and central nervous system.[19]
It’s for this reason then that melatonin may have these differing effects. Not even so much that “it doesn’t work”; just more that its benefits may present for more specific origins of insomnia.
Are you one of the people for which melatonin doesn’t work?
Then for most, the next step is to check if it’s your blood sugar. I’ve written an entire article on this here. I have lost count of how many times I see cases of insomnia turn around after treating people’s blood sugar. The good news is that it’s pretty easy to spot if your blood sugar might be the problem. It’s how you respond to missing meals in the day.
A common question I ask patients is how they adjust to missing meals or whether or not they feel as if they have to eat regularly to avoid low blood sugar symptoms. These symptoms include fatigue, dizziness, tremors, palpitations and anxiety, and hunger![20]
If you experience these symptoms after three to four hours of not eating during the day, this might explain why you wake after a similar time in the night. The body has built-in mechanisms to prevent your blood sugar from going too low for the brain’s sake, and if this happens, it will use a spurt of adrenaline to correct this. Whilst this works for your blood sugar, this can wake you with a start, making it difficult to go back to sleep.
What if it’s not your blood sugar? Is there anything else that might help?
I think one herb most often trumps the rest when it comes to sleep disturbances, and that herb is Piper Methysticum, more commonly known as Kava. I’ve chosen this herb specifically for the function I believe it can have in insomnia and COVID conversations.
Remember we discussed how neuroinflammation is a large part of COVID-oriented insomnia or coronasomnia? Kava has exhibited some excellent effects in calming that brain inflammation down[21] , along with excellent studies around its use for generalised anxiety disorder. An action confirmed by the prestigious Cochrane review.[22]
Building on the anxiety effects, Kava has been shown to improve deep sleep periods and sleep induction.[23]Another action relevant to sleep is the positive effect Kava can have on recognition and memory tasks with benefits for visual attention and working memory.[24]
Whilst more recent studies into Kava have had conflicting results[25] for generalised anxiety; the future is bright for its role in sleep and inflammation.
So do the same solutions still apply post-COVID-19 when it comes to insomnia?
I would say that the answer is yes. We’ve seen in this article that the uncertainty of lockdowns, COVID anxiety and the infection itself have all added a new dimension to insomnia. The fact that the term coronasomnia even exists is a testament to that.
However, this doesn’t mean that we don’t have the necessary solutions to continue to solve either waking issues or problems getting to sleep. The same solutions can still apply. It might take some work to get there, but rest assured that you can rely on evidence-based ways to get back to sleeping well.
Hope this helps x
References
[1] Kaur H, Spurling BC, Bollu PC. Chronic Insomnia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 17, 2021.
[2] Wai Sze Chan & Cecilia Cheng (2022) Elevated Prevalence of Probable Insomnia among Young Men during Social Unrest in Hong Kong: A Population-Based Study, Behavioral Sleep Medicine, 20:2, 204-211, DOI: 10.1080/15402002.2021.1902813
[3] Brown LA, Hamlett GE, Zhu Y, et al. Worry about COVID-19 as a predictor of future insomnia [published online ahead of print, 2022 Feb 14]. J Sleep Res. 2022;e13564. doi:10.1111/jsr.13564
[4] Gupta R, Pandi-Perumal SR. COVID-Somnia: How the Pandemic Affects Sleep/Wake Regulation and How to Deal with it? [published online ahead of print, 2020 Dec 3]. Sleep Vigil. 2020;1-3. doi:10.1007/s41782-020-00118-0
[5] Semyachkina-Glushkovskaya O, Mamedova A, Vinnik V, et al. Brain Mechanisms of COVID-19-Sleep Disorders. Int J Mol Sci. 2021;22(13):6917. Published 2021 Jun 28. doi:10.3390/ijms22136917
[6] Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey [published correction appears in Psychiatry Res. 2021 May;299:113803]. Psychiatry Res. 2020;288:112954. doi:10.1016/j.psychres.2020.112954
[7] Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey [published correction appears in Psychiatry Res. 2021 May;299:113803]. Psychiatry Res. 2020;288:112954. doi:10.1016/j.psychres.2020.112954
[8] Cutler AJ. The Role of Insomnia in Depression and Anxiety: Its Impact on Functioning, Treatment, and Outcomes. J Clin Psychiatry. 2016;77(8):e1010. doi:10.4088/JCP.14076tx3c
[9] Yunitri N, Chu H, Kang XL, et al. Global prevalence and associated risk factors of posttraumatic stress disorder during COVID-19 pandemic: A meta-analysis. Int J Nurs Stud. 2022;126:104136. doi:10.1016/j.ijnurstu.2021.104136
[10] Yunitri N, Chu H, Kang XL, et al. Global prevalence and associated risk factors of posttraumatic stress disorder during COVID-19 pandemic: A meta-analysis. Int J Nurs Stud. 2022;126:104136. doi:10.1016/j.ijnurstu.2021.104136
[11] Brunet A, Rivest-Beauregard M, Lonergan M, et al. PTSD is not the emblematic disorder of the COVID-19 pandemic; adjustment disorder is. BMC Psychiatry. 2022;22(1):300. Published 2022 Apr 28. doi:10.1186/s12888-022-03903-5
[12] Dragan M, Grajewski P, Shevlin M. Adjustment disorder, traumatic stress, depression and anxiety in Poland during an early phase of the COVID-19 pandemic. Eur J Psychotraumatol. 2021;12(1):1860356. Published 2021 Jan 26. doi:10.1080/20008198.2020.1860356
[13] El-Solh AA, Riaz U, Roberts J. Sleep Disorders in Patients With Posttraumatic Stress Disorder. Chest. 2018;154(2):427-439. doi:10.1016/j.chest.2018.04.007
[14] Semyachkina-Glushkovskaya O, Mamedova A, Vinnik V, et al. Brain Mechanisms of COVID-19-Sleep Disorders. Int J Mol Sci. 2021;22(13):6917. Published 2021 Jun 28. doi:10.3390/ijms22136917
[15] Banerjee D, Viswanath B. Neuropsychiatric manifestations of COVID-19 and possible pathogenic mechanisms: insights from other coronaviruses. Asian J Psychiatry. 2020;54:102350. doi: 10.1016/j.ajp.2020.102350.
[16] Clapp M, Aurora N, Herrera L, Bhatia M, Wilen E, Wakefield S. Gut microbiota’s effect on mental health: The gut-brain axis. Clin Pract. 2017;7(4):987. Published 2017 Sep 15. doi:10.4081/cp.2017.987
[17] Fatemeh G, Sajjad M, Niloufar R, Neda S, Leila S, Khadijeh M. Effect of melatonin supplementation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. J Neurol. 2022;269(1):205-216. doi:10.1007/s00415-020-10381-w
[18] Savage RA, Zafar N, Yohannan S, et al. Melatonin. [Updated 2021 Aug 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534823/
[19] Li L, Gang X, Wang J, Gong X. Role of melatonin in respiratory diseases (Review). Exp Ther Med. 2022;23(4):271. doi:10.3892/etm.2022.11197
[20] Mathew P, Thoppil D. Hypoglycemia. [Updated 2022 Jan 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534841/
[21] Park, Chung & Han, Jong-Min. (2016). Anti-inflammatory Effects of Flavokavain C from Kava (Piper methysticum) Root in the LPS-induced Macrophages. Journal of the Society of Cosmetic Scientists of Korea. 42. 311-320. 10.15230/SCSK.2016.42.4.311.
[22] Pittler MH, Ernst E. Kava extract versus placebo for treating anxiety. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD003383. DOI: 10.1002/14651858.CD003383
[23] Emser W., Bartylla K. Improvement in quality of sleep: Effect of kava extract WS 1490 on the sleep patterns in healthy people. TW Neurol. Psychiatr. 1991;5:636–642.
[24] Münte TF, Heinze HJ, Matzke M, Steitz J. Effects of oxazepam and an extract of kava roots (Piper methysticum) on event-related potentials in a word recognition task. Neuropsychobiology. 1993;27(1):46-53. doi:10.1159/000118952
[25] Sarris J, Byrne GJ, Bousman CA, et al. Kava for generalised anxiety disorder: A 16-week double-blind, randomised, placebo-controlled study. Aust N Z J Psychiatry. 2020;54(3):288-297. doi:10.1177/0004867419891246
