The body of TFA rightly points out that we don’t actually have evidence that COVID directly causes problems with sleep.
What we know is that since COVID and lockdowns, the number of people reporting sleep issues and seeking treatment for insomnia is increased. This is obviously entirely unsurprising.
I think the more important point, somewhat ironically made on HN, is the critical effects of sleeplessness and promoting healthy sleep as a national public health priority. It seems to me this is just another pernicious example of how lockdowns and disrupting a population’s routines directly and indirectly damages public health.
>how lockdowns and disrupting a population’s routines directly and indirectly damages public health.
For me the disruption was that I finally slept enough. You save so much time commuting, there's nothing to do at night, so you get a much more stable circadian rhythm, and more hours of sleep on average.
My sleep was a mess over the summer and into mid autumn. I’ve only just reliably started sleeping through the night again. It’s always taken me a long time to get to sleep but from early May it was taking me a long time AND I was waking up two or three time’s a night which I’ve never had. Was horrible and I assumed a result of lock down and furlough.
> is the critical effects of sleeplessness and promoting healthy sleep as a national public health priority.
> It seems to me this is just another pernicious example of how lockdowns and disrupting a population’s routines directly and indirectly damages public health
And people literally dying from a virus isn't a public health priority?
You mean like this article from the UN World Food Programme[0] that states due to overzealous lockdowns, that up to 80 children "elsewhere" are at very high risk of starvation for every over-70 US citizen it perhaps saves?
Yes...mentioning things like this sure gets in the way of all the virtue-signalling that's going on these days.
I wrote a long response to your claim. However, for my mental health and your time, I will simply state that your assessment that the mental health impact of lockdown means it is not worth lockdown is superficial, misaligned to understanding the nation-cratering impact of a health system collapse, and should be reconsidered.
Please do not suggest that the public health effects of lockdowns are limited to mental health and economic effects.
There are remarkably fewer people diagnosed with early stages of cancer, for example. The question is then, if suddently the incidence went down or will people die unnecessarily from worse screening programs and non emergency care?
Things like kids missing out on school is a clear factor in lower life expectancy, one of the few things which hold true independent of country and age group studied.
Correct, with a dramatic increase in magnitude for COVID-19 compared to an average flu season (where I also acknowledge bad flu seasons exist and have massive impact).
People literally dying from a virus shouldn't be the only public health priority. There has to be a balanced focus on total public health accounting for all causes of morbidity and mortality.
Anecdotally, my WFH lifestyle didn't change much at all during lockdown, but I experienced long haul symptoms, which for a few months included not being able to sleep much and waking up very early. That part seems to have improved, fortunately.
While there are plenty of confounding variables caused by changes to the population's lifestyle, that doesn't mean that covid can't also affect these things. It is possible for there to be overlap.
Don't think like one of those doctors in the 60's that told patients their Epstein-Barr was all in their head or gave them anti-depressants.
I believe the article rightly addresses that there are multiple causes for sleep issues and that many are likely the result of stress from the pandemic. But they've noticed accute issues specifically in patients known to have tested positive fir COVID. From TFA:
> In recent months, however, Salas has watched a more curious pattern emerge. Many people’s sleep continues to be disrupted by predictable pandemic anxieties. But more perplexing symptoms have been arising specifically among people who have recovered from COVID-19. “We’re seeing referrals from doctors because the disease itself affects the nervous system,” she says. After recovering, people report changes in attention, debilitating headaches, brain fog, muscular weakness, and, perhaps most commonly, insomnia.
There is a contingent of HN posters who are primed to blame a lot of bad effects on "the lockdown." Frankly, I was one of them 8 months ago when there was actually a lockdown, but at least in most places in the USA there really hasn't been anything I could reasonably describe as a "lockdown" since early Summer. Mask mandates, and limits on how specific businesses can operate, sure, but nothing like the draconian shelter-in-place orders we saw in the spring.
I can say from firsthand experience that my families mental health is severely compromised at this point, but unfortunately none of it could be solved by less restrictive laws. It's all related to the pandemic and the choices we've had to make to reduce our chances of getting infected and passing that virus on to other people who have higher risks of dying.
> I can say from firsthand experience that my families mental health is severely compromised at this point, but unfortunately none of it could be solved by less restrictive laws. It's all related to the pandemic and the choices we've had to make to reduce our chances of getting infected and passing that virus on to other people who have higher risks of dying [..]
My daughter (5) talks almost daily about the stuff she wants to do "when C19 is over".
I'm not worried about getting infected, I'm not worried about her or her elder siblings getting infected (they're at higher risk of getting hit by lightning). I'm not even worried about us infecting older relatives. I am worried about elder relatives not seeing their grandchildren for over a year (and so are the elder relatives, just for that extra data point)
She's talking about the stuff she's not allowed to do "because" of C19.
This would be a more persuasive comment if you could be specific about what "she's not allowed to do", rather than just sort of implying that all the stuff your daughter wants to do is un-doable.
I don't really understand the logic behind not being worried about your daughter being infected, because the odds of that are not in fact all that low. Do you mean the odds of her ending up with serious symptoms? Part of the point of articles like this is that we don't really yet know the prevalence of serious symptoms that don't involve acute respiratory failure.\
In a similar vein: I sort of understand the logic behind letting grandparents see their grandkids, because time is limited for them either way. But it's probably not a win if your kid visits your mom and she dies as a result, even if it was the last opportunity your mom would ever have to see your kid; it would be a scarring, debilitating thing to live with for your kid.
> if you could be specific about what "she's not allowed to do", rather than just sort of implying that all the stuff your daughter wants to do is un-doable
Do I really need to itemize all the things that kindergarten kids could do a year ago and can't do now? (Anyone with a 5 year-old, or indeed any child, can no doubt rattle off a list of this stuff pretty effortlessly...)
> it's probably not a win
Sorry, but who are you to judge that?
I offered to take my daughter to see one set of grandparents a few weeks ago, involving international travel and - how can I put this? - a somewhat liberal interpretation of the rules. The grandparents bit my arm off. Their choice. Yes, they had a fantastic time with their granddaughter for about 24h.
People die all the time, for all kinds of awful reasons. Looking at the raw stats, this year just isn't that outstanding. Sorry.
I used the word "probably" to capture the fact that you might find the psychological cost of having your kid's visit to their grandparents kill that grandparent acceptable.
Why don't you go ahead and rattle some of the things you're referring to off for us, so we're all talking about the same things.
> I don't really understand the logic behind not being worried about your daughter being infected, because the odds of that are not in fact all that low.
1) Citation needed?
2) Definition of 'all that low' needed?
EDIT: the boss at my daughter's kindergarten had C19 earlier this year, the mandatory quarantine was more of a big deal for her than the C19 itself. She's not talking about "Long Covid", she's not complaining about how bad it was, instead she's back at work looking after our kids.
As a parent of three kids, I've made multiple trips to a local hospital to a) watch the kids be born, and b) get out-of-hours urgent treatment when no local doctor's practice was open.
With multiple kids, it's not a surprise that we're on good terms with the staff at our local doctor's practice. [Un]surprisingly they're [also] pretty skeptical about the whole C19 story. They're even more skeptical about getting tested for C19, something our local government seems to be pushing.
You've lost me here. This is an article about a new potential chronic symptom associated with C19. My point is that we don't know all the chronic symptoms that will ultimately be shown to result from C19. I don't understand how the fact that the boss at your daughter's kindergarten hasn't complained addresses that concern.
> I don't understand how the fact that the boss at your daughter's kindergarten hasn't complained addresses that concern
The data[0] appears to show that if you are under 60 and otherwise healthy, the risk from C19 is somewhere between "very low" and "zero".
The younger you are, the lower the risk. If you're a child, the risk from the virus itself is so small as to be basically meaningless; the impact from society's response to C19 is likely to be severe[1]
I think what you're describing are the behavioral aspects resulting from covid. I've done some analysis on the changes in sleep behaviors on about 100,000 people using a sleep tracking app, if you're interested: https://jeffhuang.com/covid_sleep/
And all in all, about half of people have changed their sleep behavior; about 2/3 of those sleep more hours, and 1/3 of them sleep fewer hours. The usual caveat of a self-selecting population sample applies here.
>It seems to me this is just another pernicious example of how lockdowns and disrupting a population’s routines directly and indirectly damages public health.
The pandemic is disrupting people's routines, not the lockdowns. The idea that society would be functioning as normal without lockdowns is silly.
> The idea that society would be functioning as normal without lockdowns is silly.
Given the large number of people disobeying restrictions, even in California, it seems that society would be quite a bit more "normal" if people were allowed to behave as they wished. See also how people flocked back to bars and restaurants when they reopened, how people have been crowding shops and malls, etc.
I'm not sure we've actually seen percentages, have we? Like, is 5 % of people disobeying restrictions? Or 50 %?
I'm sure some people flocked, but for example in my friends circle, nobody did - of course, that's an anecdote which is why the numbers would be needed.
Porque no los dos? Lockdowns are disruptive (surely nobody could disagree with that); pandemics are disruptive (again, presumably nobody disagrees). The important question is to what extent the population is disrupted in the "lockdown" and "non-lockdown" scenarios, and what costs the society pays in human death, a collapsed economy, long-term health effects etc in the two cases.
A reasonable discussion has to start by accepting that every course of action is shitty here! The task is to weigh up the amount of shit and the different qualities of the shit down each pathway; it'll help nobody to claim that one pathway is shining and clean.
> I think the more important point, somewhat ironically made on HN, is the critical effects of sleeplessness and promoting healthy sleep as a national public health priority. It seems to me this is just another pernicious example of how lockdowns and disrupting a population’s routines directly and indirectly damages public health.
Does this really blame it all on lockdowns? All I see is "lockdowns are damaging", which is certainly true whatever your political beliefs.
Your claim has been mostly disproven. Society is functioning largely as normal in Florida and other states which have decided not to impose state level lockdown rules. (Whether that's a good idea or not is a separate issue.)
I don't know how exactly you quantify "disrupting a population’s routines", but Florida's unemployment is roughly double what it was a year ago. It doesn't seem like everything is normal there.
Everything you wrote is your opinion, whereas it’s been extensively documented that lockdowns are leading to a huge surge in depression and suicidal ideation. Just one example:
I can't believe that 11 months in and 1.7 million confirmed people dead, 350K of those your countrymen and I don't know how many people gravely ill and or affected for life that you are still on the 'let's downplay COVID-19' bandwagon.
Didn't you learn anything at all in the last 11 months? I recall you categorically dismissing it and claiming that it was going to all be over in a couple of months. Here we are, almost a year later, the worst is yet to come - in spite of a vaccine, the roll-out is obviously not going to be instantaneous - and still you're harping away in every COVID-19 related thread minimizing whatever is written. It really is astounding.
> Didn't you learn anything at all in the last 11 months?
What I've learned over the past 11 months, from watching the numbers wax and wane with the seasons totally unrelated to the severity of lockdowns, the ages of those most affected (and for that matter asymptomatic estimates and the corrected IFR estimates), and the knock-on effects of the lockdowns? While it was good to be cautious initially, turns out for this particular virus we've blown it way out of proportion and ought to be letting up a lot more than we have been.
I was sick in February. At the time covid tests weren't as readily available to be tested but I had many of the symptoms of covid including debilitating headaches like I've never had before. Eventually I recover and test positive for antibodies.
To this day I have issues sleeping and I'm not solely sure if it's anxiety due to pandemic or because of my presumptive case of covid.
It's gotten slightly better in recent weeks but for months now I'd wake up about 30 minutes after falling asleep with a pounding heart and and feeling of extreme anxiety. Not as bad as a panic attack but still not pleasant.
This sounds a lot like sleep apnea symptoms. A sleep study would be well worth it. It may sound like a headache to go sleep in a lab, but if it is sleep apnea the positive life changes of treating it are beyond worth it.
I used to wake with near panic attack just like that.... turns out I wasn’t breathing well. And you don’t have to be overweight to have sleep apnea. Since treating it, I sleep like a baby.
Maybe covid induces some type of central sleep apnea?
Barely related PSA: Just want to underline the “You don’t have to be overweight to have sleep apnea” thing. I, for example, have teeny tiny airway (via overbite) that gives me Obstructive Sleep Apnea. Took me, oh, 20 years to figure this out
(Snoring is normalized/funny in our society but should be viewed as cause for potential concern)
Totally agree how snoring is normalized and probably shouldn’t be. I think there’s a lot of belief that sleep apnea is something that only happens to old or unhealthy individuals. Frankly for most people it’s due to airway size and back of throat muscle issues. Age and obesity simply bring it to the point where people are so sick they can’t ignore it, hence those who get treated.
I tell people it’s more like needing glasses. Most people just are born with the issue that develops over time. We don’t have hang ups with treating vision problems (at least not anymore)... sleep apnea should be the same.
Oh man I got a new fear now. I have scheduled a video visit with my GP for next month I'll bring this up. I'll also have to ask my partner if they've noticed how I breathe when I'm sleeping.
The amount we still don't know about the long term effects of being infected with COVID-19 is terrifying, and I honestly don't think it's talked about enough, because we have learned more.
I recall another submission on HN yesterday, talking about how the brain puts on "brakes" to cognitive capacity in response to some viruses/injuries (the article itself was about reversing that cognitive decline) [0]. I wonder if some of the neurological effects of COVID-19 are related to that or something different entirely.
"The amount we still don't know about the long term effects of being infected with COVID-19 is terrifying"
The amount that we do know about the potential long term effects of various other illnesses, including some that most of us have already had in our lifetimes, is also terrifying.
Let's not forget that many illnesses can, in some percentage of cases, cause serious and ongoing problems. COVID-19 doesn't appear to be bizarrely unique in this respect, it's just new and receiving a uniquely massive amount of attention (obviously for good reason).
> COVID-19 doesn't appear to be bizarrely unique in this respect
I don't agree. How many highly contagious, long-incubation, temporarily debilitating, and permanently damaging (cardiovascular, neurological, etc) diseases do we deal with regularly that we aren't already vaccinated against/haven't mostly eradicated? I haven't been alive long enough to remember tuberculosis, so this is quite bizarrely unique to me.
> In 2018, there were more than 10 million cases of active TB which resulted in 1.5 million deaths.[7] This makes it the number one cause of death from an infectious disease.[13] [..] About 80% of people in many Asian and African countries test positive while 5–10% of people in the United States population test positive by the tuberculin test.[14]
Mentions of tuberculosis stick out for me because there was a scare in my middle school that resulted in lots of us getting tested for it (in 2003, in the US). Luckily it was only a scare, as far as I'm aware none of the tests came out positive (and I know mine didn't).
Influenza can cause all kinds of serious and long term health problems. So can most STDs any given bacterial infection if they are left unobserved/untreated for long enough. Most pathogens have some chance of causing serious problems, they are just usually rare, just like with COVID-19.
> The amount we still don't know about the long term effects of being infected with COVID-19 is terrifying, and I honestly don't think it's talked about enough, because we have learned more.
Maybe a dumb question, or maybe I did not understand (the part before the "and"), but how can one be terrified of what one does not know about?
Even after a brief look at his site, I can see why :) Didn't put me off, though. A guy who can read @dhh and @gnat can read Mark. Plus, I can see it is for effect.
Did you get a checkup? I had loss of sense of smell 4 years ago, some bacterial infection of paranasal sinus, treated with antibiotics. What I mean, maybe initially you lost it due to Corona, but some bacterial superinfection keeps it away.
covid based loss of smell is suspected to be a result of an infection of the sustentacular and basal cells in the olfactory epithelium. It should return once the infection is gone. You should probably have that checked out.
Some of it returned, but a bit messed up. Same with my girlfriend. Same with several friends. It's pretty common. I only regained the ability to smell natural gas somewhat in the last month. It varies day to day whether I can smell it, though. Or smell at all.
> the brain puts on "brakes" to cognitive capacity in response to some viruses/injuries
A terrifying prospect. Misuse of lead (pipes, paint, gas) was a national tragedy with demonstrable ill effect on society and, IMO, still badly affecting the mental health of the older folk who grew up in that era. We can’t afford to take on another generation of mentally diminished, emotionally fragile citizens.
> The virus could potentially be blocked by melatonin.
I was sleeping an average of 4-5 hours maximum a night. Once in a while I slept 7 hours, that was the maximum I could and I felt really great about it. Then I accidentally started intermittent fasting about 6 months back to see if helps with lowering cholesterol. But surprisingly I started sleeping more. Now, I eat my meals between 6am and 1pm. After that I fast. I sleep well and I can feel my body producing enough melatonin. For some reason, melatonin supplements never helped me when I tried before. My urge to drink alcohol has also lowered since even though I am an occasional drinker and I sleep for at least 8 hours a day. I can feel my body healing from at least 10 years of insomnia.
It's hard to describe but you can feel something similar if you take melatonin supplement and then don't sleep well. But the body produced melatonin doesn't give you a hangover like feeling.
I view hunger almost like an addiction or a strong habit. If you eat 3 meals a day at 8am, 1pm, and 6pm, then you will feel hungry around those times every day. If you change your eating habits to eat only between 10am and 3pm, then you go through a period (of around a few days to a week) where you continue to feel hungry around 8am and 6pm or later, but your body adjusts to the new schedule.
At least, that's how my body adjusts when I go between phases of eating breakfast and not easting breakfast.
the best diet "hack" I have found is simply not to keep any food in your home that can be ready to eat in less than ten minutes. that little bit of delay/work between feeling hungry and eating enables a much more intentional attitude towards eating for me. it's helped me realize that hunger signals don't necessarily mean my body actually needs nutrients at that instant. random feelings of hunger will often pass if I don't act on them.
Sometimes when I eat light during the day, I feel intense hunger, happened more during early days. But even that hungry feeling wades off in about 45 minutes.
I'll be curious if those countries that minimized infections will be more competitive over the next few decades because of a population with less mental impairment.
The paper A network medicine approach to investigation and population-based validation of disease manifestations and drug repurposing for COVID-19 [1]:
> We identified that melatonin usage (odds ratio [OR] = 0.72, 95% CI 0.56–0.91) is significantly associated with a 28% reduced likelihood of a positive laboratory test result for SARS-CoV-2 confirmed by reverse transcription–polymerase chain reaction assay. Using a PS matching user active comparator design, we determined that melatonin usage was associated with a reduced likelihood of SARS-CoV-2 positive test result compared to use of angiotensin II receptor blockers (OR = 0.70, 95% CI 0.54–0.92) or angiotensin-converting enzyme inhibitors (OR = 0.69, 95% CI 0.52–0.90). Importantly, melatonin usage (OR = 0.48, 95% CI 0.31–0.75) is associated with a 52% reduced likelihood of a positive laboratory test result for SARS-CoV-2 in African Americans after adjusting for age, sex, race, smoking history, and various disease comorbidities using PS matching. In summary, this study presents an integrative network medicine platform for predicting disease manifestations associated with COVID-19 and identifying melatonin for potential prevention and treatment of COVID-19.
I'm not sure what to make of this. In my mind, melatonin usage is associated with sleep disorders just like ACE inhibitors are associated with cardiovascular disease (CVD), a known comorbidity. There are better ways to determine the impact of sleep on COVID-19 and vice versa.
Have you read the footnotes? There are several papers referenced. From an evidence based medicine standpoint this recommendation is rather weak but the benefits appear to outweigh the minimal cost and risks.
No, I did not read the footnotes in the longer 49 page pdf in your link, I only scanned the 2 page summary. In the Pre and Postexposure Prophylaxis (The I-MASK+ protocol) section, page 11:
> Melatonin (slow release): Begin with 0.3 mg and increase as tolerated to 2 mg at night. [1,7,69-75]. Melatonin has anti-inflammatory, antioxidant, immunomodulating and metabolic effects that are likely important in the mitigation of COVID-19 disease. It is intriguing to recognize that bats, the natural reservoir of coronavirus, have exceptionally high levels of melatonin, which may protect these animals from developing symptomatic disease. [76]
For the more serious stages:
> Melatonin 10 mg at night (the optimal dose is unknown) [75]
From my quick scan of the papers in the related footnotes, melatonin is a good antioxidant and may be anti-inflammatory, in addition to the well known association with sleep regulation.
It makes sense to me. I had a pretty tough time going through Covid - bear in mind I really took care of my vit D intake, sun exposure and healthy food, exercise in months before. One thing I always lack is probably sleep. And then - living with my gf (she must have had it from me, can't imagine she wouldn't catch it) who had no signs of covid, with one thing she always get plenty of - sleep.
WTF? How can you tell without explaining the mechanism?
This is not a normal year by any measure of it. It's much more likely that the stress and change of habits caused by the pandemic response is causing the sleep patterns than the virus itself.
> Conclusion Greater proportion of vitamin D-deficient individuals with SARS-CoV-2 infection turned SARS-CoV-2 RNA negative with a significant decrease in fibrinogen on high-dose cholecalciferol supplementation.
What we know is that since COVID and lockdowns, the number of people reporting sleep issues and seeking treatment for insomnia is increased. This is obviously entirely unsurprising.
I think the more important point, somewhat ironically made on HN, is the critical effects of sleeplessness and promoting healthy sleep as a national public health priority. It seems to me this is just another pernicious example of how lockdowns and disrupting a population’s routines directly and indirectly damages public health.