Impact of Sleep Deprivation on Emotional Regulation and the Immune System of Healthcare Workers as a Risk Factor for COVID 19: Practical Recommendations From a Task Force of the Latin American Association of Sleep Psychology

Abstract

Healthcare workers who are on the front line of coronavirus disease 2019 (COVID-19) and are also undergoing shift schedules face long work hours with few pauses, experience desynchronization of their circadian rhythm, and an imbalance between work hours effort and reward in saving lives, resulting in an impact on work capacity, aggravated by the lack of personal protective equipment (PPE), few resources and precarious infrastructure, and fear of contracting the virus and contaminating family members. Some consequences are sleep deprivation, chronic insomnia, stress-related sleep disorders, and post-traumatic stress disorder. These sleep alterations critically affect mental health, precipitating or perpetuating anxiety, stress, and depression, resulting in the inability to regulate positive and negative emotions. Pre-existing sleep disorders are an important risk factor for the development and maintenance of PSTD when individuals are exposed to an important stressor such as a COVID-19 pandemic. At the same time, how an individual regulates the emotion associated with worries during daytime functioning impacts nighttime sleep, precipitating and perpetuating difficulties in sleeping. All of these changes in sleep and emotional regulation also alter the immune system. Sleep deprivation is commonly associated with chronic inflammatory diseases, due to the desynchronizations in circadian rhythms, causing possible psychophysiological disorders and impaired neuroimmune-endocrine homeostasis. From this perspective, we clarify in this article how sleep disorders affect the immune system and emotional regulation, explaining their phenomenological and neurobiological mechanisms, and discussing elements of cognitive and behavioral coping for health professionals to adopt and manage a healthier sleep pattern in the COVID-19 outbreak.

Keywords: cognitive behavioral therapy; emotional regulation; health professionals; immune system; sleep.

FIGURE 1

Model of vulnerability and maintenance of the disease due to sleep deprivation and stress (source authors). It can be seen how stressful events that exceed the body’s ability to respond to them generate sleep deprivation and stress; these last two factors form a relationship that occurs in a bidirectional way because one can be the cause of the other. Regarding sleep, it can be affirmed that the causal relationship of deprivation can be facilitated by voluntary and involuntary restriction of the subject or by fragmentation of the same or both factors, which cause sleep deprivation to increase. As a result of this interaction, the alteration of emotional regulation and the immune response, both acquired and adaptive, arises, which puts the subject, after the alteration of said factors, at greater vulnerability for the acquisition of mental and physical diseases, which increases the primary factors of stress and sleep deprivation, which is not linear and can create a perpetuation of these problems or the acquisition of diseases such as COVID. This demonstrates the importance of prevention measures in healthcare workers.