Insomnia During COVID-19 Pandemic: Few Points to Ponder

The article by Hasan et al. [1] is an attempt to understand the prevalence of insomnia during the second wave of COVID-19 pandemic. It concludes that despite fall in prevalence of insomnia (13%) in relation to previous studies, it is still a public health problem which is often ignored. However, there are a few considerations that need to be evaluated while carrying out such studies:

1. COVID-19 itself can cause insomnia by varied possible mechanisms including through hypoxia and systemic inflammatory mediators [2]. Hence, active cases can easily be analyzed as a sub-group in such survey-based studies and the prevalence of insomnia in such patients can be estimated and compared with others. However, the study by Hasan et al. [1] showed no relation of insomnia with personal COVID-19 infection among the study subjects. It is possible that these were post-COVID-19 recovered patients who had decreased anxiety and fear due to reassurance by recent asymptomatic infection, uneventful recovery and uncommon risk of reinfection [3]. Thus, the timing of the COVID-19 infection in this cohort of 45 patients can be studied.

2. A simple explanation for a lower prevalence of Insomnia found by Hasan et al. could be that they included only young adult participants (mean age ± standard deviation of 22.24 ± 4.39 years). Decreased mobility, Circadian rhythm changes and depression among elderly commonly lead to insomnia which has been accentuated by COVID-19 by affecting all these factors [4]. The systematic review of 78 studies quoted to have pooled prevalence of insomnia of 35.7% had a age ranging from 7.89 years to 63.9 years [5]. Thus, the study by Hasan et al. is a glimpse of the challenge of insomnia which the young socio-economically productive generation is facing amid the COVID-19 pandemic and the urgent need to recognize it, prevent it and provide early treatment for the same.

The study by Hasan et al. is an effort to make the medical community realize the unmet need of treating insomnia in COVID-19 times. Even though sleep clinic services are adversely hit in COVID-19 pandemic, telemedicine is often the route of patient care in current times. It is imperative not to ignore sleep quality evaluation and keep a high index for diagnosing insomnia as part of patient treatment policy.

Author Contributions

PI and KS were involved in Conceptualization, literature search, writing, review and editing. All authors have read and agreed to the final draft submitted.

Funding

We certify that we have received no funding for the creation of this work and have no disclosure of other sources of funding that would conflict with the published work.

Declarations

Conflict of interest

We certify that we have no primary or secondary competing interests or conflict of interest in submitting and publishing this work.

Ethical approval

The submitted work does not contain human subject research and is composed of review of the available literature and suggestions to improve clinical practice. The authors certify that there are no ethical conflicts that would preclude its publication.