The return to the future: reflections on sleep adapted to the new reality on World Sleep Day
It was yesterday that time stopped. That fatal March, when, in Portugal and in Europe, the avenues became stripped off the usual passers-by on the sidewalks, and the streets seemed to cry, missing to be stepped on. The terrifying silence was, without any exaggeration, one of the reasons for dismay. The sun, voices and honks were gone. The air seemed better now, but we couldn't breathe without guilt. And the air at home seemed to turn against us, souring the ambiance with a bad mood and a headache. On many sofas, marks of seated bodies remained, lying down or, without the right position, falling on the living room carpet. The kitchens worked. And the bodies at rest seemed to fight scabs and increased in size.
The evenings were often confused with the days, which wine helped to forget. And many days, even though spring tried to counter it, were gloomy. The women wept and angered the men. Many angry men, unable to understand the women, wept too. And the children, given over to computers and different technologies, became autonomous in their space and dictated rules. Sleeping was perhaps the best that happened, not least because many alarm clocks stopped being used to wake people up in the morning. And whereas grandparents always take naps, they were now allowed to everyone, even if at different times. And the beginning of the evening was joyful for those who shared the tight space. Everyone at the table and everyone around the television. Then, only a few stayed awake. Several times, only the sunrise made people sleep.
Perhaps the plot does indicate that I write the previous lines with sarcasm and irony. I spent a good part of March doing the same. And when I turned off the television, to disconnect myself from the graphs that showed the development of the pandemic numbers, I looked at some works that I was writing with international colleagues, who might also manifest themselves without giving voice to the letters. Two of these works referred to exactly how the time we lived in could affect us and how. Together with colleagues David Gozal, from Missouri, US and Masaaki, from Osaka, Japan, I wrote the first document that brought evidence of the possible interaction between the virus, the endogenous temporal system and sleep. In this article, which was published in one of the leading European respiratory medicine journals, we hypothesized that the mechanisms related to the circadian clock and sleep can interact with the proteins of the virus and host cells, changing the risk of infection and the immune response associated with it.
I, who have long believed in the influence that clock failure can have on our lives, won David's friendship, with whom I have been working in some other “experiments” on the impact of circadian misalignment on cardiovascular and metabolic functions. This, moreover, can also be a key process in the complications of infection by this coronavirus. With the successive extension of the first lockdown, it was possible to appreciate the “Big Brother” effect on people's routines and habits.
I then signed, with American and Israeli colleagues, an article with great impact, in which, with a universe of 4084 individuals divided into 2 groups (one with 49 countries, and another American), we concluded that 58% of the respondents were dissatisfied with their sleep and that 40% had decreased sleep quality after the COVID crisis. The consumption of sleeping pills had increased by 20%. Also in a sample of 3 hundred teenagers, this time in Brazil, we found that the quality of sleep decreased during lockdown, and at least in part, this was due to changes in biological clocks. It did seem that the world was changing... for the worse. It was, under these conditions, urgent to ensure that, in the attempt to return to what we assumed to be the new normality, we would not throw down the gains obtained as hostages of this enemy as microscopic as terrifying. Accordingly, we drew up some proposals for clinical recommendations, taking into account what we were learning every day. The months went by and the hope that the virus would tire of the summer was dispelled by the number of infections and deaths that kept the alarm sounding.
At Christmas, with the cold, due more to the social aspect than to the temperature, the restrictions were, it seems, a tough measure with good contours. Contrary to what is usual at that time of the year, between Christmas and New Year's Eve there were fewer accidents on the road, and, consequently, fewer deaths.
There were also changes inside the homes, as, due to the inevitability of loneliness, excesses also decreased and hours were kept close to the routine of normal days. I had the opportunity to write, and to explain why, in a philosophical-scientific context of a paper recently accepted in Sleep Science, that this may indeed have been a boost for a more promising start of the year... with more positive attitudes. And now that half the world is locked down again, it is up to us to reflect, and evoke sleep to support reflection. The world has taken a detour. Lives have changed. The jobs are now less variable in space, but the time seems to be heavier. It shows in the tiredness of those who work more hours.
Those who peek at the window these days leading up to a new season, are able to see that the sun remains here and that it gives way to the moon, every day, even when we can't see it. Light and dark alternate and meet at certain times at some point in the cycle, and sleep, however much we try to avoid it, will always come, in due time and in the time allowed to it.
We know that if we do that, we will probably live better. We will be able to celebrate a new World Sleep Day next year, with a different, less wry smile. And more than anything, a return to the future from which we should not have left, but which, ironically in life and words, would leave us without dreams. It would be sad, wouldn't it?
Miguel Meira e Cruz
Director of the Sleep Unit of the Cardiovascular Centre of the University of Lisbon, Faculty of Medicine
