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The change in the rhythm of daily activities forced by the restrictions related to the COVID-19 pandemic causes many mental health symptoms – especially the deterioration of the quality of our sleep. Meanwhile, a good rest is one of the main elements of building immunity. See how you can deal with sleep disorders during the coronavirus pandemic and how melatonin can affect not only our sleep, but also COVID-19
In the era of the ongoing pandemic caused by the SARS-CoV-2 virus, which covers the entire world, the attention of the medical community has focused on fighting the virus in all its possible aspects. The focus was on limiting the spread of the virus, trying to create a vaccine, and measures supporting treatment, thereby alleviating the symptoms of the disease.
The importance of sleep and the factors that regulate it
Sleep is extremely necessary for homeostasis. During sleep, the whole body regenerates and gains strength to take on new challenges. It depends on the number of hours slept as well as the quality of sleep (whether we sleep deeply and peacefully) whether we wake up well rested and refreshed. Research shows that after one bad night’s sleep, the body’s natural defenses are so lowered that the risk of infection, e.g. from a viral infection, increases fourfold.
In people who do not have enough sleep, the reaction time and the ability to concentrate decrease, and the motivation to work decreases. Only their appetite increases, which is caused by an increase in the level of ghrelin, which is responsible for the feeling of hunger, and a decrease in the level of the satiety hormone. Chronic sleep deprivation increases the risk of an increase in diabetes, cancer, Alzheimer’s disease and heart disease.
The circadian rhythm and homeostatic sleep requirements are two factors that regulate our sleep. The circadian rhythm of sleep is shaped by exposure to natural light and is disturbed by exposure to blue light emitted by monitors – it is especially negative in the evening. In turn, the homeostatic need for sleep depends on how active we are during the day and whether we allow ourselves to rest.
Therefore, especially now, when we spend a lot of time at home, it is worth making sure that these mechanisms work as closely as possible. Try to go to sleep regularly and, if possible, take care of physical activity during the day.
Sen w pandemic SARS-CoV2
The prevailing coronavirus pandemic has a negative impact on the psyche. We are concerned about our health and the health of our loved ones. We are afraid of the economic consequences of the ongoing pandemic. In addition, the introduced restrictions, a ban on gatherings, often working from home, and in some cases quarantine also disrupts our daily rhythm. We sleep longer in the morning, because we do not have to hurry as before, we spend more time in front of computer monitors and TV sets that emit blue light, which negatively affects the quality of sleep, and then we go to bed.
Our physical activity has significantly decreased. We do not go to the gym or swimming pool and even going to the store has been limited to a minimum. All of these factors negatively affect sleep. The published data show that about 76-79 percent. people in medical quarantine experience sleep problems at least once a week.
Recommendations for maintaining good quality sleep
Experts from the European Society for Sleep Research recommend that during quarantine periods, three areas that positively affect our sleep should be addressed. First, clearly define a bedroom as a sleeping area. We should not work in the bedroom and always go to it for a while before going to bed. In this way, the brain associates a specific place with sleep and it is easier for us to fall asleep. We should not take blue light devices in the bedroom.
Second, we should increase the need for sleep, which is to try to maintain the same amount of sleep each day, exercise, not drink large amounts of coffee in the afternoon, and avoid afternoon naps. Thirdly, let’s take care of maintaining the rhythm of sleep, i.e. go to bed at regular times, during the day try to stay in the daylight and not use electronic devices before going to bed.
Treatment of sleep rhythm disturbances
Behavioral techniques (cognitive-behavioral therapy) are the basis for the treatment of sleep rhythm disturbances. These are techniques to strengthen the mechanisms that regulate sleep: sleep time limitation technique (time spent in bed at night), stimulus control technique, relaxation techniques.
However, not always following the recommendations on enhancing the need for sleep and regulating our circadian rhythm is not always sufficient. The doctor may recommend sleeping pills to be used for short-term treatment (i.e. for 2-4 weeks) or as an ad hoc medication (i.e. not more often than 3-4 times a week). In the case of the necessity of longer and daily administration of drugs, antidepressants are also often used, especially when depressive symptoms are present.
Patients can also help themselves pharmacologically, e.g. taking melatonin (the effect of restoring the proper circadian rhythm and sleeping pills) or silencing preparations containing valerian or lemon balm.
Action of melatonin
Melatonin is an organic compound synthesized mainly in the pineal gland, but also in the retina and in the digestive tract. Pineal melatonin is produced in a circadian rhythm with levels high at night (in the dark) and low during the day, hence the name “hormone of darkness”.
In humans, under standard lighting conditions, the onset of melatonin secretion usually occurs around 21.00-22.00, the highest plasma concentration (in adults 60-70 pg / ml) is between 2.00 and 4.00, and the secretion is inhibited around 7.00–9.00. 55 a.m. The circadian rhythm of melatonin synthesis gradually flattens with age, especially after the age of XNUMX.
The main task of melatonin is to regulate the circadian rhythm, including the time to fall asleep, and the quality of sleep, so if you suffer from sleep disorders during a pandemic, melatonin can help you overcome them.
In the treatment of falling asleep disorders and poor sleep quality, melatonin is usually used one hour before bedtime for 3-6 weeks at a dose of 3-5 mg (immediate-release melatonin).
Melatonin is also indicated as the treatment of consciousness disorders in people suffering from COVID-19. In this indication, melatonin is usually used in high doses of 5-10 mg. The argument in favor of treating insomnia with melatonin in people at risk of respiratory failure is the high safety of such treatment – melatonin shows no inhibition of the respiratory center, which may be slightly present in the case of using hypnotics. (2)
Another argument for the use of melatonin in seriously ill people with COVID-19 is the additional effects of the drug, the effect of reducing the strength of the anti-inflammatory response. It is hypothesized that melatonin may be protective in COVID-19-related interstitial pneumonia by inhibiting the excessive activation of pro-inflammatory cytokines.
This is the main mechanism by which the COVID-19 coronavirus damages the lungs, causes severe respiratory failure and is fatal, especially in the elderly and those with other medical conditions. Melatonin would inhibit this excessive immune activation, termed the “cytokine storm”. In addition, in mechanically ventilated patients, melatonin is expected to reduce oxidative stress-induced lung damage.
Another hypothesis, based on theoretical considerations rather than experimental research, indicates that the mild course of COVID-19 in children is due to the high level of melatonin secretion at this age. The severe course of COVID-19 in the elderly would be caused by a physiological significant decrease in melatonin secretion clearly observed from the age of 55.
These data mean that, despite the lack of evidence from randomized clinical trials, the treatment of melatonin in combination with mercaptopurine (a drug that is a purine analogue, disrupts the synthesis of nucleic acids and is used in the treatment of leukemia and inflammatory bowel diseases) is indicated as one of the treatments for severe forms of COVID-19 .