‘The coronavirus can cause insomnia and long-term changes in our nervous systems. But sleep could also be a key to ending the pandemic….’
— James Hamblin MD via The Atlantic
Early in the pandemic, a Cleveland researcher examining the structure of the newly identified virus found it could potentially be blocked by melatonin, a physiological hormone that calibrates sleep and the immune response. Subsequent studies have shown that patients taking melatonin, which is available as an over the counter dietary supplement, have reduced rates of Covid infection and better survival. (Trump was given melatonin as well as other more experimental therapies at Walter Reed). Eight clinical trials of melatonin are currently ongoing, making it one of the most studied potential treatments. But is it melatonin per se or the improved sleep it facilitates, and In turn the effect that has on immune function, that improve Covid-19 outcome?
Initially clinicians saw rampant sleep disturbances and attributed them to pandemic anxiety. But long-term neurological sequela after infection, including sleep disturbance, are becoming apparent and appear out of proportion to patients’ level of preoccupation or worry. Post-Covid symptoms were assumed to be autoimmune reactions, similar to those known in the CNS after other viral infections. But autoimmune researchers feel the effects of Covid don’t exactly fit the bill, being more sporadic and widespread. As one put it, it is “haphazard inflammation — less a targeted attack than an indiscriminate brawl,” with symptoms resulting from a number of mechanisms, perhaps similar to myalgic encephalitis or “chronic fatigue syndrome,” which is poorly understood, widely misrepresented, poorly treatment-responsive, and stigmatized. Interestingly, many clinicians and theoreticians believe the sleep disturbance is central in myalgic encephalitis. Impairment of stages of deep (slow wave) sleep dysregulate metabolism and immune response. This reinforces the idea that melatonin treatment should be part of standard practice.
And, with some discipline, routines to regulate sleep are possible during the pandemic, unlike so many other uncontrollable factors in our current lives. Recommendations may sound prosaic but are profound, and include consistent sleep-wake times, even on weekends, scheduled walks, sunlight exposure early in the day, reduction in blue light exposure for at least the last hour before bed, and maintaining meaningful social connections with others. As Hamblin opines, “Sleep like your life depends on it.”