Dr. Chandra Jackson on COVID-19 and Sleep
Excerpts from a conversation between Dr. Marishka Brown at NIH and Dr. Chandra Jackson, an NIH expert on sleep.
Brown: From a sleep perspective, how is the COVID-19 pandemic affecting people?
Jackson: Before the pandemic, at least a third of Americans were not getting the recommended amount of at least seven hours of sleep per day. And before the coronavirus, millions of people suffered from sleep disorders like insomnia.
It’s likely that the stress many of us had before the pandemic has now increased. For instance, if people already felt isolated and depressed, it could be more difficult now to cope. Some may also feel greater financial strain, or job and housing insecurity.
Many new challenges have also emerged. One is being or knowing an essential worker on the front lines, whether a medical doctor, nurse, or a cashier at a grocery store. This can induce anxiety, which we know negatively affects sleep.
Also, our routines have been disrupted. Keeping track of time can be difficult. Other major challenges relate to not being able to cut off work at the end of the workday because you’re at home. Or trying to manage the house with children who are used to being at school and may be getting too much screen time.
All of these factors many of us have been dealing with can cause stress and strain. Those have been shown to negatively affect sleep. Additionally, simply staying in the house versus going outside can greatly lower your exposure to natural light. And lack of natural light can reduce biological signals that are important for sleep at night.
Brown: How does sleep impact the immune system?
Jackson: Good sleep helps support the immune system. Disrupted sleep can reduce circulating cytokines, which are a type of protein that helps protect against infection. This clearly has implications for being able to ward off infectious agents like coronavirus.
And if you’re actually sick for whatever reason, resting your body seems to help you recover faster. Lastly, chronic sleep deprivation has also been shown to make vaccines less effective, by reducing the body’s ability to respond.
Brown: Can you speak to the role of disparities and sleep, and its interplay with COVID-19?
Jackson: Unfavorable sleep is common in the general population to begin with. But individuals who are Black or African American, Hispanic or Latinx, Native American, and even sexual and gender minorities have been shown to be disproportionately burdened by poor sleep. Social stress is generally believed to be the connection across these different but intersecting social identity groups.
In terms of sleep disorders, the most common are obstructive sleep apnea and insomnia. Black or African American, Hispanic or Latinx, and Asian populations suffer disproportionately from obstructive sleep apnea. A lot of these disparities appear to start early in life. For instance, Black compared to white children have been shown to have a four to six times higher prevalence of sleep-disordered breathing. This is attributed not to genetics, but to living in economically deprived communities with relevant environmental hazards.
So sleep disparities are clearly relevant to the pandemic. They likely contribute to disparities in conditions like diabetes and heart disease. And these are conditions that we know increase susceptibility to poor outcomes related to COVID-19.
Additionally, the mental stress from COVID that we’re all feeling is likely exacerbating existing sleep disparities, because disadvantaged groups are disproportionately affected by the virus for largely social reasons. For instance, racial/ethnic minority groups are more likely to have service-oriented, essential, frontline, and often risky, low wage jobs without worker protections like paid sick leave.
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