COVID times

“We’re all shift workers’ ‘ – Dr Satchitananda Panda. 

Our sleep is periodically disrupted when we pull an all nighter for studies or when we travel different time zones or when we nurse a sick relative or when nursing a newborn child or when a working mother wakes up early morning to prepare meals for her family and sets off to work. 

But during COVID times our sleep was regularly disrupted for days on end.   This set up a prolonged jet lag which led to sleep deficit. Not to mention other aspects that added to this like digital jet lag (jet lag due to devices). 

 

Problem amplification 

I remember regularly seeing patients who would come for problems related to sleep and disturbed routine. 

One student I remember would stay up late to chat with friends and get up late just before his online classes. This resulted in nausea during the morning which would lead to him eating very little during daytime. But during early evenings he would get very hungry and would binge eat, specially sweets. This resulted in his obesity and tiredness and lethargy during daytime. He found it difficult to concentrate on his lectures.

 

Our biological clock

During lockdown routine has been disrupted. This has given rise to clocks going out of sync. I mean our biological clocks or in other words our Circadian Rhythm. Other examples of clocks going out of sync are during jet lag when the person travels towards a different time zones and during shift work. 

 

How the rhythm is regulated

We have a suprachiasmatic nucleus in our brain which responds to light. At 12am when there’s completely dark, melatonin is secreted which tells us it’s time to sleep. This melatonin secretion stops by 7am. If we don’t sleep during that time, sleep debt occurs which leads to sleep deprivation. 

 

When we wake up in the morning cortisol secretion starts and peaks at 8am. This cortisol arouses us and wakes us out of sleep. This cortisol also increases glucose levels in our blood. Thus glucose levels are highest early in the morning. This is the right time to do workout so that we can convert excess glucose into energy and we can reap the maximum benefits of exercise. 

 

Disrupted rhythms

But, although circadian rhythm is a part of our nature, which develops at the age of 3 to 6 months in infants, it is not a constant thing. We can reset our clocks. Bright light exposure in the evening makes our brain feel it’s still daytime and we can be active till late hours. Conversely, dull lights in our cabins during work hours make our brains feel it’s night and we yawn. But these frequent disruptions in circadian rhythms can cause many health problems. Problems range from insomnia and sleep deprivation to obesity, diabetes, hypertension etc. Even our longevity gets affected. Thus, it’s good to stay in bright lights during daytime and keep pitch dark at night without taking our phone to bed so that the melatonin secretion continues.

 

Zeitgeber or time giver

Our circadian rhythms are turned on by specific cues which regulate body rhythms. Newly married couple initially takes time to adjust to each other’s sleep rhythms but eventually they’re set for the long term. That is why those who lose their spouses or those who get separated have disrupted rhythms and the grieving person has difficulty sleeping and can go into depression. Thus traumatic life events can give rise to mood disorders due to this mechanism. 

 

Mental health

Disturbance in circadian rhythms give rise to mental health problems too. Those who have depression, have irregular sleep wake cycles and abnormal cortisol levels. The treatment of mild depression can be done by light therapy or sleep deprivation (by reducing REM sleep). Thus, during  episodes of mild depression, just by entraining the circadian rhythm, depression can be cured. 

 

Also disrupted circadian rhythm can be a trigger for Bipolar disorder, especially the manic phase of bipolar disorder in which there is decreased need for sleep. Thus one of the treatments for bipolar disorder is Interpersonal and Social Rhythm Therapy (IPSRT) which is meant to regulate individual’s social rhythms such as meal times, personal relationships, exercise and social demands.

 

Conclusion 

Thus, we have to set our internal clocks in order and synchronise it to a day night 24 hour cycle, which can help us in living a healthy and fulfilling life. It will not only help in overcoming lifestyle diseases like hypertension, diabetes etc but can help in psychological disorders like depression, bipolar disorder etc as well as increase longevity and would go a long way to prevent major medical illnesses.