Sleep

COVID-19, Melatonin, and the New Year

Melatonin may be of benefit in the management of COVID-19.

Posted Dec 31, 2020

By NIAID-RML
Novel Coronavirus SARS-CoV-2
Source: By NIAID-RML

As a tumultuous year ends, scientists continue to learn more about SARS-CoV-2 and the disease it causes, COVID-19. This disease affects multiple systems in the body and can have significant cognitive and psychological effects. Across the planet and in the United States, increasing numbers of people are becoming infected, requiring hospitalization, and dying with this illness.

Many people who test positive for SARS-CoV-2 do not show any symptoms or only mild ones. Others have much more severe and dangerous cases. Of concern, and while rare, it has emerged that some patients appear to develop severe new-onset psychotic symptoms two weeks to several months after having had, often relatively mild, symptoms of COVID-19, and this may be related to persistent immune system activation. Some patients have had repeated bouts of illness that have required multiple hospitalizations that further tax already strained medical resources as well as the limits of patients’ endurance. Other patients are having prolonged debilitating symptoms and are known as “long-haulers.” 

For those of us concerned about the behavioral contribution to the spread of illness, this is a very stressful time. We have already seen the impact of travel around the holidays and are now at one of the top party nights of the year. Standard New Year’s Eve parties often have all the elements needed to spread the virus very effectively: people who may not be aware of the potential suffering caused by COVID-19, indoor locations where the virus can hang in the air waiting to be inhaled, use of alcohol and other substances that could further erode judgment, close (non-social distanced) proximity to others, and so on. I hope that readers of this post will be using good judgment and safe practices to celebrate the New Year so that we all have a better chance of having another New Year after this one.

Fortunately, significant progress has been made with regard to the prevention and treatment of COVID-19. Standard behavioral public health measures, such as wearing appropriate masks and social distancing, have clearly been helpful, and multiple vaccines are now becoming available, even if the pace of delivery has been distressingly slow. Interestingly, a connection between sleep and COVID-19 has emerged and has been explored in an excellent article by James Hamblin, to which I will return shortly. 

Recognition of the importance of sleep to recovery from illness has increased over time. For example, improved quality of sleep in critically ill patients can have a positive effect on outcomes such as how long patients need to be on mechanical ventilation, whether they experience delirium, and whether or not they develop a mood disorder following recovery (Farshidpanah et al., 2017). It is now known that sleep and immune function are tightly interwoven, and chemicals that are involved in the immune response are also involved in the modulation of sleep and wakefulness (Opp & Krueger, 2017). The release of immune factors can help induce sleep and also allow the body to put full energy into the defense of the body against bacterial and viral agents.

Melatonin is a hormone with antioxidant and anti-inflammatory properties. It has been of interest regarding its possible use as a treatment for infectious diseases. It is thus understandable that during these pandemic times, researchers are exploring melatonin’s properties as they search for ways to deal with the virus. 

According to Hamblin’s article, melatonin was first noted as a possible treatment for COVID-19 by Feixiong Cheng, Ph.D., at the Cleveland Clinic. He used artificial intelligence to study the structure of the virus and its possible vulnerabilities, which led to melatonin being considered as a possible treatment and being reported in the scientific literature. Soon, other researchers were noticing potential benefits, which are mainly related to melatonin’s role in regulating the immune system and preventing it from overreacting to infection, which appears to be a significant problem for many suffering from COVID-19.

There is some evidence that taking melatonin may offer some protection against getting the virus, and for those who do become infected, decreasing the risk of dying. There are now clinical trials being conducted to evaluate whether or not these promising early findings hold up. Of course, Dr. Cheng is not recommending starting to take melatonin for COVID-19 until further research can be completed.

COVID-19 has potential neurological effects, which may contribute to the long-lasting problems noted above. We have certainly noted increased demand for treatment of insomnia this year, and this is most likely due to the stresses of 2020. But there is also increasing evidence that having had COVID-19 can lead to long-lasting negative effects on sleep with increased insomnia. Many of the long-lasting effects of this illness may be related to inflammation, including inflammation of the nervous system.

Helping patients get good sleep may be important in managing or preventing some of the long-term symptoms being reported. Hamblin suggests, and I would agree, that perhaps getting more sleep needs to be included in public health recommendations like wearing masks and hand washing. Recommendations are also being made for the use of melatonin in the treatment of COVID-19, and I have been hearing from recently hospitalized patients that they were treated with it while in the hospital. Clearly, keeping good sleep hygiene and getting the best sleep you can is beneficial in so many ways and is better than relying on supplements or medications.  

Public Domain By NASA/Apollo 17 crew; taken by either Harrison Schmitt or Ron Evans
The Blue Marble
Source: Public Domain By NASA/Apollo 17 crew; taken by either Harrison Schmitt or Ron Evans

It has been a difficult year, one that will undoubtedly go into the history books. We now have some renewed hope for the new year. Advances in the treatment of COVID-19 offer the possibility that by the fall of next year, life may be returning to something like normal. To get there will require solid leadership and active participation by citizens.

Successfully controlling the pandemic will also give us hope that we can once again take on projects like building the Panama Canal or going to the moon and make progress on long-term problems like climate change, systemic racism, and wealth inequality. Scientific advances in universities and technological innovation by businesses will help. Hopefully, the experience of the past year will strengthen our resolve to work together and move forward. And, of course, getting good sleep will be important in helping us to meet the challenges ahead. So, on this last day of 2020, I wish you all a good night’s sleep and a very happy New Year!

References

Farshidpanah, S., Pisani, M.A., Ely, W.E., & Watson, P.L. (2017). Sleep in the critically ill patient, in Kryger, M, Roth, T, & Dement, W.C. (Eds.), (2017). Principles and Practice of Sleep Medicine sixth edition, Philadelphia: Elsevier, Inc., p. 1329 - 1340.

Opp, M.R. & Krueger, J.M. (2017). Sleep and host defense, in Kryger, M, Roth, T, & Dement, W.C. (Eds.), (2017). Principles and Practice of Sleep Medicine sixth edition, Philadelphia: Elsevier, Inc., p. 193 - 201.