20 April 2021 | NEWS


Interview - Dr. Haba-Rubio

According to some researchers, the Covid-19 epidemic is the biggest global health crisis since World War II. The stress and anxiety experienced since the start of the pandemic has and will continue to have many repercussions on mental health. Sleep patterns are disturbed for some by psychological stress that causes insomnia. For others, the quarantine and isolation made it possible to reconnect with their own biological clock.

The Office of Federal Statistics published figures on the Swiss state of health and physical sleep disorders in 2017. It showed that 22.9% of the population suffered from "moderate" sleep disorders while 6.3% were considered "pathological" sleep disorders. What are the consequences of the pandemic's impact on sleep when psychological stresses can be assumed to be numerous for the entire population? What is happening in sleep clinics? We met with doctor José Haba-Rubio, a neurologist and medical co-director of the Florimont sleep centre. He is a specialist in sleep disorders and a lecturer and clinical researcher at the Faculty of Biology and Medicine of Lausanne; he is also a registered physician at the CHUV sleep investigation and research centre.

Portrait José Huba-Rubio


Have your consultations increased as a result of the pandemic ?

José Haba-Rubio: It should first be noted that even before the pandemic, consultations for sleep disorders are extremely frequent. About a third of the general adult population sleeps poorly. This figure was confirmed in our last major "HypnoLaus" study on sleep, carried out in Lausanne. While we do not have to deal with a spectacular increase in the number of consultations since the quarantine, our patients do report to us in consultation that they suffer from more anxiety than before. Many are worried about the repercussions of the health crisis on their work, for example. All these uncertainties have an additional impact on sleep.

What are the repercussions of this anxiety on our sleep ?

J-HR: These concerns increase the risk of insomnia. Sleep is a very complex phenomenon. There are a lot of things going on in our brains that enable us to fall asleep. There are so many external and internal influences that can affect the quality of sleep. The quality of the mattress - of course - but also the presence of noise or light. In the midst of all of this, psychological factors play an extremely important role too. 

Is the fragile balance between the "awakening" cycle and the "sleeping" cycle strained ?

J-HR: Yes, because the flood of anxiety-inducing information causes a state of hyper-arousal. The balance between the "waking" state and the "sleeping" state is very subtle and fragile. When all is well, the switch from one to the other happens naturally. During the "wakefulness" phase, it is this system that inhibits and slows down sleep. Once asleep, it is the "sleep" system that kicks in and inhibits and slows down the arousal system. Since this arousal system is very activated when we have anxiety, stress, preoccupations, we develop what is called hyperarousal. While the balance is very delicate between wakefulness and sleep, wakefulness tends to outweigh sleep and the individual has a much harder time falling asleep. It is then really necessary to accumulate a great need for sleep so that the scale tilts to sleep. But even at this point, when sleep has started, the arousal system is still very active. All it takes is the slightest noise for you to be fully awake again and the brain activated once again with negative thoughts. This is how insomnia develops. 

According to you, the lockdown made it possible to return to our natural biological rhythm ?

J-HR: This is indeed the case: lockdown has enabled some patients suffering from sleep disorders to regain their natural biological rhythm.Flexible time schedules allowed many to better sleep. It also gave us time to reflect on society's responsibility, which has imposed identical rhythms for everyone, even when we know that, for some people, these rhythms are not suitable. The simple fact of changing to flexible working hours allowed many people to rediscover their natural rhythm.

What has the pandemic revealed anything about sleep ?

J-HR: Observing sleep patterns for a few months cannot offer enough perspective into the real long-term impact of the pandemic on sleep. So far, our observation confirms what we already know about sleep physiology, namely the mechanisms that control sleep and the stress factors capable of disrupting it.

Is it true that our immune system is more efficient when we sleep well ?

J-HR: Of course. The impact of sleep on the immune system has been known for a long time, even though we still do not know the exact process. Sleep continues to remain a great mystery even to specialists! We still don't yet know exactly why we sleep. Some research in recent years has allowed some hypotheses on the essential functions of sleep. One of them, in particular concerned the regulation and stimulation of the immune system. During a study carried out on two groups after vaccination against hepatitis A, the first group was allowed to sleep as usual while preventing the second group from sleeping the night  after the vaccine. It was observed that the second group developed significantly less antibodies than the first group, who were allowed to sleep. We still don't know exactly what happens during sleep that boosts the immune system. Another study also demonstrated this when administering tiny drops of rhinovirus to people who slept well and to people who lacked sleep. The second group developed the disease much more than the first group, who slept well. When we are sick and have a fever, we are exhausted and need to sleep because our body produces pro-inflammatory substances that make us sleepy, which is probably the best way to fight infections. There is no doubt that good sleep improves our immune response. 

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