Credit: Photo by Keira Burton from Pexels
Survey Examines Pandemic-Induced Insomnia Disorder
GPB's Ellen Eldridge speaks to chiropractor Zoe Pogrelis about her insomnia disorder, which began during the July 2020 spike in COVID-19 cases.
Zoe Pogrelis works in health care as a chiropractor. So she isn't the kind of practitioner who treats COVID-19 patients directly, but she experienced insomnia for the first time in her life during the coronavirus pandemic.
A recent study from Augusta University Medical Center found the pandemic triggered a more than 40% increase in insomnia disorder among their health care workers, and about 10% of the 678 faculty physicians, nurses, nurse practitioners, physician assistants, and residents and fellows reported that their insomnia actually got better in the early months of the pandemic.
"We had the opportunity to look at a quasi-uniform stressor — the pandemic — as it was applied almost universally across the entire population, and ask questions like, 'How frequently does insomnia disorder occur under these conditions and who's at risk?'" said Dr. Vaughn McCall, the chair of the Department of Psychiatry and Health Behavior at the Medical College of Georgia at Augusta University.
Respondents were 72% female, a mean age of 43, and included a lot of faculty physicians and staff nurses, McCall said. About 25% of the respondents were shift workers, but rates of sleep problems were similar regardless of whether they worked day or night shifts. Most were providing at least 30 hours of direct patient care weekly before and during the pandemic.
Roughly 43% of those surveyed did not have significant trouble sleeping before the pandemic, but developed insomnia disorder by May, when the survey was given, McCall said.
Insomnia disorder for the purpose of this study required sleeping problems at night, adequate opportunity to sleep, and daytime symptoms or consequences of insomnia.
Those effects included high rates of fatigue and mood disorders.
"I would have guessed 10 or 20% new cases," McCall said. "But to have 40% of people or more, who didn't have insomnia before, develop it was a little bit surprising and alarming."
Researchers attribute the rise to the ongoing stress of caring for patients and family members at the same time, effectively doubling their workload.
Pogrelis was not one of the health care workers surveyed last May, but she did develop insomnia disorder.
The 42-year-old chiropractor normally went to bed about 10 p.m. and woke at 5 a.m. having slept through the night. But around July 2020, cases of COVID-19 started spiking.
That's when Pogrelis started falling asleep while watching television, but wouldn't stay asleep more than 45 minutes.
Instead, she would awake before midnight, try to read a book and then sleep another two hours or so before waking again around 2 a.m.
"I'd be up until 4 a.m.," she said. "Then I'd finally fall asleep about 4:30 a.m. and then it was time for my alarm to go off. And that made a dramatic change in my performance. And just my total mindset was awful."
Part of the problem for Pogrelis was realizing she worked in an area where mask usage was not widespread, and as patients began catching coronavirus, she thought more about her high-risk family member.
The thoughts about how best to protect her family literally kept her up at night.
When she returned home from work during those summer months, Pogrelis would change her clothes in the garage and head straight for the shower before preparing food.
"My whole routine was completely different," she said. "And yes, you just lay in bed and you think, 'Jeez, I hope my family member is OK.' And then you lay in bed and you think about the first patient that you had that has passed away from COVID-19. And it's awful."
Even patients who survived the virus returned with long-hauler symptoms, including people who suffered multiple strokes.
Before the SARS-CoV-2 pandemic, Pogrelis didn't take supplements to her her sleep.
Last summer, she started taking 3mg of melatonin, an over-the-counter sleep hormone meant for short-term insomnia symptoms.
Now, she's up to 20mg every night and still has trouble sleeping through the night.
The clear impact of insomnia on health care workers overall implies that health care leaders need to be aware of the association, both in staff on the frontline and those working from home, the investigators report.
“If you work from home, there is a risk that your sleep is going to fall apart because you don’t have your schedule anymore,” McCall said. “Most people don’t self-regulate well.”
Insomnia is associated with the risk of developing mental health problems such as depression, as well as increased risk of suicidal thoughts and behavior and overall poor quality of life.
The combination of insomnia and anxiety over COVID-19 represents a potent risk for suicidal ideation, the researchers wrote, and the medium number of insomnia symptoms indicates that severity was “of clinical significance” to the workers.
McCall said a follow-up survey on the same group of health care workers will be made when the pandemic subsides.