Overview of sleep management during COVID-19

Highlights

• Global prevalence reports of 20–45% for insomnia symptoms during the COVID-19 pandemic.

• Insomnia complaints persist in previously infected patients and in the public after epidemics.

• Strategies to improve sleep have been recommended but efficacy awaits further study.

• Online digital cognitive behavioral therapy holds promise but acceptance and outcomes need refinement.

• As randomized, controlled therapeutic trials are limited for sleep disturbance during COVID-19 and the pandemic, clinicians will need to use their best judgment in application of established treatment guidelines until future clinical research provides direction.

• Brief discussion of treatment of obstructive sleep apnea, ICU delirium, and repurposing of medications in COVID-19.

• Therapeutic strategies from suicide risk and opioid abuse prevention might offer models to address the global problem for improved sleep.

Abstract

The sleep of millions has suffered during the global COVID-19 pandemic. Prevalence rates of 20–45% are reported globally for insomnia symptoms during the pandemic. Affected populations include the public and health care workers. A sleep deprived society faces the increased burden of COVID-related economic disruption, psychosocial problems, substance abuse, and suicide. Disordered sleep is not expected to disappear with control of infection, making interventions acutely necessary. The question becomes how to manage the sleep dysfunction during and after the pandemic. Depression and anxiety are prominent complaints during pandemic restrictions. Insomnia symptoms and fatigue continue even as mood improves in those who are in recovery from COVID-19 infection. Management of disturbed sleep and mental health is particularly needed in frontline health care workers. This overview describes 53 publications, as of February 2021, on disturbed sleep during the pandemic, treatment studies on COVID-related sleep disturbance, and need to rely on current treatment guidelines for common sleep disorders. The available research during the first year of COVID-19 has generally described symptoms of poor sleep rather than addressing treatment strategies. It covers digital cognitive behavioral therapy for insomnia (CBT-i) for the public and frontline workers, recognizing the need of greater acceptance and efficacy of controlled trials of CBT for affected groups. Recommendations based on a tiered public health model are discussed.