Sleep Disorders | Sleep Review
The COVID pandemic appears to have sparked an approximately 44% increase in insomnia disorders among healthcare workers in a medical school-affiliated health system, with the highest rates surprisingly seen in those who spent less time in direct patient care, they say Investigator.
Another surprise was that around 10% of the group of 678 faculty doctors, nurses, advanced practice providers such as nurses and nurses, and residents and colleagues in a 17-question survey said their insomnia actually improved over the early months of the pandemic says Vaughn McCall, MD, chairman of the Department of Psychiatry and Health Behavior at Augusta University’s Medical College of Georgia.
Another surprise was the group’s high insomnia rate – 44.5% – before the pandemic, McCall and colleagues report in the Journal of Clinical Sleep Medicine.
“There are many studies looking at insomnia problems in response to natural disasters like an earthquake in Peru or a typhoon in Taiwan, but this is a universal stress,” says correspondent author McCall of the year-old COVID pandemic in pandemic one Publication.
While McCall, an expert on the Trifecta insomnia, depression, and suicide, expected the pandemic to affect workers’ sleep and increase the rate of acute insomnia disorder, the rate of the increase was still surprising: from 44.5% to 64% .
The May 15, 2020 survey, the scope of which investigators limited so as not to increase the burden on already overworked health workers, looked at basics such as demographics, work habits, symptoms of mood and anxiety, and indicators of acute insomnia disorders – not just episodic sleep problems, the commonly referred to as insomnia. Respondents were 72% female, an average of 43 years old, and included many faculty doctors and nurses, McCall says. About 25% of respondents were shift workers, but sleep problem rates were similar regardless of whether they worked day or night shifts. Most offered at least 30 hours of direct patient care per week before and during the pandemic.
Survey participants were asked to reflect on work assignments for the two weeks prior to the start of the rise in SARS-CoV-2 infections and impact on the functioning of health facilities and society, as well as the two weeks prior to the survey. As of the May 2020 survey date, the healthcare system had an average daily count of 21 COVID-19 patients, four of whom were in the intensive care unit. In mid-March, heads of state and government asked that healthcare workers take on non-patient care responsibilities at home.
The clear effects of insomnia on health care workers as a whole imply that health care executives need to be aware of the association, both with frontline workers and when working from home, investigators report.
The combination of insomnia and fear of COVID-19 put a high risk of suicidal ideation, they write, and the median number of symptoms of insomnia suggests that the severity was “of clinical concern” to workers.
Previous studies have looked at the effects of COVID on more common sleep problems among health workers, but the new study looked at more accurate and potentially more problematic acute insomnia disorders.
“Insomnia disorder is a patient complaint about poor sleep, either quantitatively or qualitatively – it can be either – with the consequences of their poor daytime sleep,” says McCall. “You suffer during the day because of the night.”
In this case the reported consequences were fatigue, malaise, decreased initiative, even gastrointestinal problems. More than half of the respondents reported at least one core symptom of depression, while almost 65% reported at least one anxiety symptom.
“We see a lot of people who work too much on one job or have two jobs and just don’t have enough time to sleep,” says McCall. “You don’t have insomnia, rather the opposite, namely sleep deprivation. Insomnia requires that you at least have the opportunity to sleep. “
Insomnia disorder affects approximately 10% of the general population, and acute insomnia disorder reported by health care professionals is generally defined as a problem that lasts for weeks while chronic insomnia disorder lasts for months or years. Acute insomnia can develop into a chronic condition.
There are no good numbers on insomnia disorder rates among healthcare workers prior to COVID, McCall notes. Deliberately limiting the duration of the survey also meant that respondents did not provide information about how long they had problems with insomnia before the COVID-19 illness or why, but there are logical factors such as continued stress and responsibility for caring for the sick and injured.
Investigators also logically assumed that more time spent in direct care of patients would mean increased risk / concern about COVID exposure, more worries and more insomnia, they write.
Because of this, one of the most interesting and surprising findings was that around 10% of respondents said their insomnia improved after the COVID outbreak, possibly because working from home suited them, but again, it was not looked after Shapes asked those details, says McCall.
Most of us complain about isolation, the inability to easily visit and dine out to our friends and family, says McCall of the social impact of the ongoing pandemic, and he is one of it. “Isolation has been bad for most people, but there are people who love it.”
Because those who were not involved in direct patient care had to work from home, the researchers hypothesized that some of these people might not be able to work from home. Trying to work while juggling the daily online educational needs of school-age children and the ongoing needs of all of their children has been a significant, potentially insomnia-provoking stress.
He notes that the majority of respondents who spent 30 hours or more per week in direct patient care tended to be younger than those who worked less, and age increases the overall risk of insomnia. Fatigue from those directly involved in the hands-on care could also be a factor in promoting better sleep for those who stayed on the front lines and helping to explain the startling inequality.
The lack of a typical structured day with generally set times for work, home, and sleep could also be a factor. McCall notes that the pandemic has also brought more college students to his practice who had to move home and struggled to stay up late and wake up late.
“If you work from home, you run the risk of losing sleep because you no longer have your schedule,” he says. “Most people are not good at self-regulating.”
He plans to interview the group again when the pandemic has subsided. Meanwhile, the MCG Department of Psychiatry and Health Behavior, under the direction of Dr. Lara Stepleman, head of psychology and director of the MCG office for faculty success, phone, video, or face-to-face consultations; confidential weekly online group meetings where they can discuss the topic with their colleagues; and short term telemedicine or personal psychotherapy and medication management to their colleagues.
McCall notes that, in general, insomnia is more common among women, as was the case in the survey.
Insomnia is linked to the risk of developing mental health problems like depression, as well as an increased risk of suicidal thoughts and behaviors and an overall poor quality of life, investigators say.
Both good and bad personal life events, such as an upcoming wedding or divorce, can trigger acute insomnia.
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