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Is coronasomnia wrecking your sleep?

Columbia Icefields (Dr. Noorali Bharwani)
Columbia Icefields (Dr. Noorali Bharwani)

Some sleep experts have coined a word “coronasomnia” to describe sleep problems related to stress caused by the COVID-19 pandemic. Coronasomnia is real and widespread. More people than ever are fighting a serious loss of sleep. It is affecting all age groups.

Sleep researchers are normally focused on primary sleep disorders such as sleep apnea, narcolepsy, or periodic limb movement disorder. But stresses of daily life can affect even healthy sleep.

Over the years scientists have known that psychological stress can have strong effect on normal sleep pattern. But it is not easy to define stress.

Stress can encompass all kinds of stimuli of varying amounts and duration. It can be physical stress or psychological stress or social stress. It can be acute or chronic, and high intensity versus low intensity stress. It is possible that different types of stressors may bring with them different impacts on sleep.

Sleep problems and ADHD (attention deficit hyperactivity disorder) are tightly interwoven. Plus, comorbid psychiatric disorders like anxiety and depression can cause or aggravate sleep problems. ADHD medications can cause insomnia. ADHD symptoms and the first-line interventions to treat those symptoms both elevate an individual’s risk for poor sleep.

Ask yourself what has produced unprecedented changes in your life to keep you awake at night. For many people, COVID-19 has generated significant stress, anxiety, depression and worries about health, social isolation, employment, finances as well as the challenge of combining work and family obligations and uncertainty about the future.

Are you putting on weight? Poor sleep can lead to weight gain, which causes problems like reflux that keep you awake. Lack of sleep can lead to depression, high blood pressure to higher risks for heart attack or stroke. Stress can make us more vulnerable to COVID-19, and knowing that creates more worries and more insomnia and more binge eating.

Whatever may be the cause of your sleep problem there are things you can do to help you get a good night’s sleep. Here are some examples.

  1. Try cognitive behavioral therapy for insomnia. A sleep therapist can help you replace thoughts and behaviors that hurt your sleep with new behaviors and thinking that will help you sleep well.
  2. Have an exercise schedule during the day that will help you relax. Include yoga and meditation in your schedule. Have a physical trainer show you the right technique and encourage you to keep you going.
  3. Do not watch TV in the bedroom. Do not bring your laptop to bed. Life will go on without these distractions.
  4. Find time to spend outdoors in the sun. It helps to keep our circadian rhythms in pattern so we produce melatonin at night, not during the day.
  5. Don’t go to bed hungry. Don’t eat late in the night. You want your body to shut down all metabolic activity and digest your food before going to bed. Avoid nicotine, caffeine and alcohol in the evenings.
  6. Daytime naps can be good if they are limited to 30-minutes or less. Longer naps will keep you awake at night.
  7. If your partner is a snorer then he or she has to get some expert advice. This can be investigated and managed.
  8. Taking sleeping pills can be useful for short term use but it has risks involved for long term use. Different types of sleep medications affect the brain and the body in different ways. All sleep medications have side effects – most commonly causing people to feel drowsy, dizzy, mentally less sharp, or unsteady the next day. More rarely, people taking sleep medications have reported sleepwalking, hallucinations, memory lapses, and odd behavior, such as eating or driving while asleep. With most medications, long-term use can be habit-forming and stopping the drugs can lead to a rebound effect, where insomnia actually gets worse. Do not take sleeping pills without medical advice. Researchers have estimated people taking sleeping pills were as likely to be in a car crash as those driving with a blood alcohol level over the legal limit.

There is nothing new in this advice. It is not rocket science. What we need is discipline and perseverance. The end result can be a satisfactory night with good sleep. So, I wish you a good night’s sleep tonight and every night. Take care and be safe.

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Mystery Surrounding Havana Syndrome

Ernesto "Che" Guevara mural in Havana, Cuba. He was a physician revolutionary. (Dr. Noorali Bharwani)
Ernesto "Che" Guevara mural in Havana, Cuba. He was a physician revolutionary. (Dr. Noorali Bharwani)

I hope you had a wonderful, safe holiday season, Christmas and new year. Omicron is spreading like wild fire. It is in the news 24-hours a day. So, I thought I will write about something which has been in my mind for a while. This illness is as mysterious as COVID-19. Luckily, it has not affected millions of people. It is called Havana Syndrome.

Havana Syndrome is a set of unexplained medical symptoms experienced by U.S. and Canadian government officials and military and intelligence personnel. This was first reported by the U.S. and Canadian embassy staff in Havana, Cuba in 2016. Since then, it has been reported from many other countries, affecting diplomats and non-diplomats including children.

Individuals started falling ill, many after hearing strange sounds and experiencing bizarre physical sensations, loss of balance with cognitive changes along with symptoms of mild traumatic brain injury.

A group of Canadian diplomats is accusing Canada’s government of withholding information about what the diplomats say are three new cases of brain injury resulting from Havana Syndrome that have been identified in the past two years.

They say that since March 2020, a total of 25 Canadian diplomats have been evaluated for potential brain injury by experts at Dalhousie University.

Media report says so far roughly 200 U.S. diplomats, intelligence officers, military officers and other government personnel, mostly based abroad, have experienced a strange and often debilitating set of symptoms.

Canada, like the U.S., has said it hasn’t determined a cause or culprit for what the U.S. initially deemed targeted attacks. A study commissioned by Canada’s government pointed the finger at likely overexposure to pesticides in Cuba, while a report by the U.S. National Academies of Science said the mysterious neurological symptoms are consistent with directed microwave energy and raised the possibility of a microwave weapon.

Cuba has denied any responsibility for the symptoms suffered by diplomats or having weapons that could produce such symptoms.

It has been more than five years since Havana Syndrome has been in the news. Do we know where did the illness start from? What is the cause – viral, bacterial, or psychological? Is Cuban, Chinese or Russian government involved? Is there a cure for the illness?

Symptomatic presentation varies. The symptoms range in severity from pain and ringing in the ears to cognitive difficulties. Other symptoms include dizziness, headache, fatigue, nausea, anxiety, and memory loss of varying severity. In some cases, diplomats and intelligence officers have left active service due to complications from the condition.

What are the leading theories as to what causes the syndrome?

This could be due to mass hysteria caused by anxiety and fear of the unknown. Second theory is this could be due to brain damage caused by microwave energy. Third theory is brain damage caused by ultrasound energy.

Ultrasound energy can cause permanent loss of hearing, problems with orientation and balance, tinnitus, and injury to the ear. This does not sound so different from the symptoms of the Havana Syndrome.

Several U.S. and Canadian intelligence and scientific experts are investigating this mysterious illness and try and determine the mechanism used in the attack. Diagnosis has been difficult because there have been so many different symptoms and some of them are subjective and difficult to measure. The diversity of symptoms also suggests a psychological rather than physical cause.

Recently, President Biden signed the Helping American Victims Afflicted by Neurological Attacks (HAVANA) Act, which authorizes additional medical and financial support for intelligence officers and diplomats affected by the syndrome.

CIA Director William Burns was quoted in the media saying, “I’m certainly persuaded that what our officers and some family members, as well as other U.S. government employees, have experienced is real, and it’s serious.”

Canadian diplomats, their spouses and children, who were based in Havana and were affected by this illness are suing the federal government for $28 million. We will see what happens.

Be safe and have a wonderful year.

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Year three of the pandemic – what to expect in 2022.

Hawaii Ocean (Dr. Noorali Bharwani)
Hawaii Ocean (Dr. Noorali Bharwani)

In 2022, it will be year three of the COVID-19 pandemic. As we continue to fight Delta variant, we are now facing Omicron virus. None of the experts expected the pandemic to last this long. Many countries are enduring multiple major waves of infections. This is unusual.

COVID-19 is not going to end soon because it is so transmissible, and it continues to vary. Now we have to deal with the Omicron variant of the coronavirus. It is spreading rapidly. The Omicron variant is now in 70 countries.

By the time you read this it may have spread in other countries. Is it dangerous? Early indications suggested it may be less dangerous than Delta, which continues to drive the pandemic. But this information will change as we gather more information. Recently, Britain recorded world’s first publicly confirmed death due to Omicron.

President Joe Biden’s chief medical adviser, Dr. Anthony Fauci, told CNN’s State of the Union that scientists need more information before drawing conclusions about Omicron’s severity.

Reports from South Africa, where the Omicron virus emerged and is becoming the dominant strain in that country, suggest that hospitalization rates have not increased alarmingly.

So far Delta remains the dominant variant, making up more than 99 per cent of cases and driving a surge of hospitalizations. This may not be true anymore. In London, England the Omicron variant now accounts for 40 per cent of infections.

“So, I think the idea that this is somehow a milder version of the virus – I think that’s something we need to set on one side – and just recognize the sheer pace at which it accelerates through the population,” says Boris Johnson, British Prime Minister. Johnson said people should rush to get booster vaccines to protect “our freedoms and our way of life.”

What does the World Health Organization (WHO) say?

The WHO’s main message is – do not underestimate Omicron.

On December 14, 2021, UN News reported the following:

The Omicron variant is “probably” now present in most of the world’s countries and it would be a mistake to dismiss the COVID-19 strain as “mild”, said the head of the UN health agency (WHO).

Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, told reporters from WHO headquarters in Geneva that the variant was now present in 77 countries.

“Omicron is spreading at a rate we have not seen with any previous variant. We’re concerned that people are dismissing Omicron as mild”, he said. “Surely, we have learned by now that we underestimate this virus at our peril.”

“Even if Omicron does cause less severe disease, the sheer number of cases could once again overwhelm unprepared health systems. I need to be very clear: vaccines alone will not get any country out of this crisis. Countries can – and must – prevent the spread of Omicron with measures that work today.”

It is worth remembering Omicron is dangerous because it spreads and infects people very effectively than other variants. It is always better to prevent it than to have to worry about treating it.

Will pre-pandemic life ever return?

Unlikely.

We have to be extremely careful. We can transmit COVID-19 before we start showing symptoms or without ever developing symptoms. Evidence indicates that vaccines are effective at preventing serious outcomes due to COVID-19, such as severe illness, hospitalization and death.

Vaccination does not change your risk of exposure to the virus. Vaccination is the best prevention against post COVID-19 condition. So, get vaccinated, wear a mask, clean your hands and keep a safe distance.

Have a wonderful holiday season, Merry Christmas and a Happy New Year. And do not underestimate Omicron.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Influenza is a serious condition that can be prevented with a flu vaccine.

Pow wow dancers in North Battleford, Saskatchewan. (Dr. Noorali Bharwani)
Pow wow dancers in North Battleford, Saskatchewan. (Dr. Noorali Bharwani)

There is no doubt flu vaccination can keep you from getting sick with flu.

Seasonal influenza is the annual influenza that affects people in Canada during the winter, typically between November and April. While you can get influenza at any time, even in summer, it is most common in the colder months.

In Alberta, in 2020-2021, there were zero confirmed flu cases due in large part to the COVID-19 public health measures in place, but many of those measures have since been relaxed. And Alberta has had few cases of flu already.

So far this year, there have been four lab-confirmed influenza cases – three in the Edmonton Zone and one in the Calgary Zone. By the time you read this there may be more cases. As we continue to fight COVID-19, it is safe to have both vaccines (COVID-19 and flu vaccine) at the same time.

Albertans are encouraged to get a flu shot. By keeping flu counts low we can make sure our health-care system has capacity to respond to the COVID-19 pandemic and let health-care workers focus on treating people with other illnesses and injuries, says Alberta Health.

All Albertans, six months of age and older, are eligible to be immunized with flu vaccine. There is no charge. It is not difficult to get immunized. Children under five years of age must be immunized at an AHS clinic or participating doctor’s office. All other Albertans can get immunized at participating pharmacies and doctor’s offices.

Vaccine effectiveness varies from year to year but immunization is still the best protection. The effectiveness of the current vaccine is not known when the immunization program begins but is determined as the season progresses.

It is important to get the influenza vaccine every year because the virus changes each year. COVID-19 and influenza have similar symptoms, so getting a flu shot could reduce the likelihood of someone having symptoms that may cause them to have to stay home or get tested for COVID-19.

We know flu shots are not one hundred per cent effective because the virus mutates. Over the years the average effectiveness has been around 43 per cent. That means people who got the flu vaccine over those years were on average 43 per cent less likely to get sick enough with the flu to go to their doctor and get tested.

Although flu shots are not one hundred per cent effective it is still important to get a shot. The flu shot offers protection against the flu for about six months. A person should get a flu shot every year, and the best time to get one is the end of October.

Scientists have been working very hard to come up with the best effective vaccine each year. Starting in the 1930s, it took decades of research to understand the complexities of the influenza virus, and it wasn’t until 1945 that the first vaccine was approved for use in the US.

The health burden caused by seasonal influenza is substantial. It can seriously affect individuals with heart disease, lung disease and type-2 diabetes. Children and elderly are very susceptible.

COVID-19 mitigation measures such as wearing face masks, staying home, hand washing, school closures, reduced travel, increased ventilation of indoor spaces, and physical distancing, likely contributed to the decline in 2020-2021 flu incidence, hospitalizations and deaths. We should continue to follow these measures.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!