COVID-19 pandemic decreased sleep quality of medical students.

Objective: Medical students are especially vulnerable to situations of poor sleep quality due to academic demands. The COVID-19 pandemic brought significant changes and high psychological stress, causing a great impact on this population. Here we aim to analyze the influence of the pandemic on the sleep quality of medical students. Methods: Cross-sectional, observational, and descriptive study with a quantitative approach carried out with students from medical universities in Rio Grande do Norte state (Brazil) through the online application of two questionnaires: Pittsburgh sleep quality index (PSQI-BR) and sociodemographic questionnaire (SQ). Results: A total of 142 medical students participated in this study: 103 women and 39 men. We observed a prevalence of low sleep quality in 78.16% of the sample and that the pandemic significantly affected the sleep quality among medical students (p<0.05). We also found an alteration in the sleep pattern in 83% of the participants, mainly due to anxiety symptoms (38%). Finally, we observed no statistically significant difference in sleep quality or sleep patterns between genders or college period (p>0.05). Discussion: This rate of poor sleep quality is higher than the prevalence of periods before the pandemic (58%). Concerns about COVID-19's negative impact on medical education, delayed training, and impact on the generation of medical jobs can directly aggravate the sleep quality. Conclusion: The COVID-19 pandemic negatively influenced the sleep quality of medical students, increasing the prevalence of poor sleep quality and promoting changes in the sleep pattern.

Evening-types show highest increase of sleep and mental health problems during the COVID-19 pandemic-multinational study on 19 267 adults.

STUDY OBJECTIVES: Individual circadian type is a ubiquitous trait defining sleep, with eveningness often associated with poorer sleep and mental health than morningness. However, it is unknown whether COVID-19 pandemic has differentially affected sleep and mental health depending on the circadian type. Here, the differences in sleep and mental health between circadian types are examined globally before and during the COVID-19 pandemic. METHODS: The sample collected between May and August 2020 across 12 countries/regions consisted of 19 267 adults with information on their circadian type. Statistical analyses were performed by using Complex Sample procedures, stratified by country and weighted by the number of inhabitants in the country/area of interest and by the relative number of responders in that country/area. RESULTS: Evening-types had poorer mental health, well-being, and quality of life or health than other circadian types during the pandemic. Sleep-wake schedules were delayed especially on working days, and evening-types reported an increase in sleep duration. Sleep problems increased in all circadian types, but especially among evening-types, moderated by financial suffering and confinement. Intermediate-types were less vulnerable to sleep changes, although morningness protected from most sleep problems. These findings were confirmed after adjusting for age, sex, duration of the confinement, or socio-economic status during the pandemic. CONCLUSIONS: These findings indicate an alarming increase in sleep and mental health problems, especially among evening-types as compared to other circadian types during the pandemic.

Social Jetlag Changes During the COVID-19 Pandemic as a Predictor of Insomnia - A Multi-National Survey Study.

PURPOSE: Lifestyle and work habits have been drastically altered by restrictions due to the COVID-19 pandemic. Whether the associated changes in sleep timing modulate the risk of suffering from symptoms of insomnia, the most prevalent sleep disorder, is however incompletely understood. Here, we evaluate the association between the early pandemic-associated change in 1) the magnitude of social jetlag (SJL) - ie, the difference between sleep timing on working vs free days - and 2) symptoms of insomnia. PATIENTS AND METHODS: A total of 14,968 anonymous participants (mean age: 40 years; 64% females) responded to a standardized internet-based survey distributed across 14 countries. Using logistic multivariate regression, we examined the association between the degree of social jetlag and symptoms of insomnia, controlling for important confounders like social restriction extension, country specific COVID-19 severity and psychological distress, for example. RESULTS: In response to the pandemic, participants reported later sleep timing, especially during workdays. Most participants (46%) exhibited a reduction in their SJL, whereas 20% increased it; and 34% reported no change in SJL. Notably, we found that both increased and decreased SJL, as a result of the COVID-19 pandemic, were associated with later sleep midpoint (indicating a later chronotype) as well as more recurrent and moderate-to-severe symptoms of insomnia (about 23-54% higher odds ratio than subjects with unchanged SJL). Primarily those with reduced SJL shifted their bedtimes to a later timepoint, compared with those without changes in SJL. CONCLUSION: Our findings offer important insights into how self-reported changes to the stability of sleep/wake timing, as reflected by changes in SJL, can be a critical marker of the risk of experiencing insomnia-related symptoms - even when individuals manage to reduce their social jetlag. These findings emphasize the clinical importance of analyzing sleep-wake regularity.

Changes in Cortisol but Not in Brain-Derived Neurotrophic Factor Modulate the Association Between Sleep Disturbances and Major Depression.

Sleep disturbance is a symptom consistently found in major depression and is associated with a longer course of illness, reduced response to treatment, increased risk of relapse and recurrence. Chronic insomnia has been associated with changes in cortisol and serum brain-derived neurotrophic factor (BDNF) levels, which in turn are also changed in major depression. Here, we evaluated the relationship between sleep quality, salivary cortisol awakening response (CAR), and serum BDNF levels in patients with sleep disturbance and treatment-resistant major depression (n = 18), and in a control group of healthy subjects with good (n = 21) and poor (n = 18) sleep quality. We observed that the patients had the lowest CAR and sleep duration of all three groups and a higher latency to sleep than the healthy volunteers with a good sleep profile. Besides, low CAR was correlated with more severe depressive symptoms and worse sleep quality. There was no difference in serum BDNF levels between groups with distinct sleep quality. Taken together, our results showed a relationship between changes in CAR and in sleep quality in patients with treatment-resistant depression, which were correlated with the severity of disease, suggesting that cortisol could be a physiological link between sleep disturbance and major depression.

My Dream, My Rules: Can Lucid Dreaming Treat Nightmares?

Nightmares are defined as repeated occurrences of extremely dysphoric and well-remembered dreams that usually involve subjective threats to survival, security, or physical integrity. Generally, they occur during rapid eye movement sleep (REMS) and lead to awakenings with distress and insufficient overnight sleep. Nightmares may occur spontaneously (idiopathic) or as recurrent nightmares. Recurrent nightmares cause significant distress and impairment in occupational and social functioning, as have been commonly observed in post-traumatic stress disorder, depression and anxiety. By contrast, during lucid dreaming (LD), subjects get insight they are dreaming and may even control the content of their dreams. These features may open a way to help those who suffer from nightmare disorder through re-significations of the dream scene, i.e., knowing that they are dreaming and having control over their dream content. Thus, lucid dreamers might be able to render nightmares normal dreams, thereby assuring a restoring sleep. The aim of the present study is to review the existing literature of the use of LD as an auxiliary tool for treatment of nightmares. We conducted a careful literature search for eligible studies on the use of LD treatment for nightmares. We observed that whereas LD may be a feasible aid in the treatment of patients with nightmares through minimizing their frequency, intensity and psychological distress, the available literature is still scarce and does not provide consistent results. We conclude therefore that more research is clearly warranted for a better estimation of the effective conductance and therapeutic outcome of LD treatment in clinical practice.

Experiências fora do corpo: aspectos históricos e neurocientíficos / Out-of-body experiences: historical and neuroscientifical aspects

A experiência fora do corpo (EFC) é definida como uma sensação subjetiva de ter saído dos limites físicos do corpo, tendo uma longa história registrada em diversas culturas. Conhecida também como “desdobramento do espírito” ou “projeção astral” nos círculos esotéricos, a EFC é estreitamente ligada à autoscopia, que é a experiência do sujeito enxergar o próprio corpo físico como se o mesmo estivesse distante. Na presente revisão bibliográfica, faremos inicialmente um breve apanhado histórico das EFC, principalmente na sua relação com as tradições Egípcia, Budista, Teosófica e Espírita. Posteriormente, nos deteremos aosachados neurocientíficos recentes sobre o tema, enfatizando os mecanismos centrados nas regiões do giro angular e junção têmporo-parietal. Estas regiões são responsáveis pela integração das informações visuais, auditivas, vestibulares e somestésicas, participando assim da formação da imagem corporal e, consequentemente, da noção de eu. Por último, discutiremos aspectos clínicos relacionados com a EFC, que passa a ser considerada doença se acontecer de forma frequente ou intensa, causando algum prejuízo físico, mental e/ou social a quem a experimenta(AU)

The out-of-body experience (OBE) is defined as a subjective feeling of leaving the body’s physical limits, which was reported in various cultures. Also called as “unfolding of the spirit” or “astral projecti on” in esoteric language, the OBE is closely linked to autoscopy, which is the experience of the subject to see his/her own physical body as if it is far away. In this review article, we will initi ally describe a brief history of OBE, especially in its relati onship with the Egyptian, Buddhist, Theosophical and Spiritualist traditi ons. Subsequently, we will focus on recent neuroscienti fi c fi ndings on this theme, emphasizing the mechanisms centered on the angular gyrus and the temporo-parietal junction. These regions are responsible for the integration of visual, auditory, vestibular and somesthesic information, thereby participating in the formation of body image, and consequently, the notion of “self”. Finally, we will discuss clinical aspects that are related to the OBE, which is considered a disease when happens too frequently or intensely, causing any physical, mental and/or social harm to those who experience it(AU)

Experiências fora do corpo: aspectos históricos e neurocientíficos / Out-of-body experiences: historical and neuroscientifical aspects

A experiência fora do corpo (EFC) é definida como uma sensação subjetiva de ter saído dos limites físicos do corpo, tendo uma longa história registrada em diversas culturas. Conhecida também como "desdobramento do espírito" ou "projeção astral" nos círculos esotéricos, a EFC é estreitamente ligada à autoscopia, que é a experiência do sujeito enxergar o próprio corpo físico como se o mesmo estivesse distante. Na presente revisão bibliográfica, faremos inicialmente um breve apanhado histórico das EFC, principalmente na sua relação com as tradições Egípcia, Budista, Teosófica e Espírita. Posteriormente, nos deteremos aos achados neurocientíficos recentes sobre o tema, enfatizando os mecanismos centrados nas regiões do giro angular e junção têmporo-parietal. Estas regiões são responsáveis pela integração das informações visuais, auditivas, vestibulares e somestésicas, participando assim da formação da imagem corporal e, consequentemente, da noção de eu. Por último, discutiremos aspectos clínicos relacionados com a EFC, que passa a ser considerada doença se acontecer de forma frequente ou intensa, causando algum prejuízo físico, mental e/ou social a quem a experimenta

The out-of-body experience (OBE) is defined as a subjective feeling of leaving the body's physical limits, which was reported in various cultures. Also called as "unfolding of the spirit" or "astral projecti on" in esoteric language, the OBE is closely linked to autoscopy, which is the experience of the subject to see his/her own physical body as if it is far away. In this review article, we will initi ally describe a brief history of OBE, especially in its relati onship with the Egyptian, Buddhist, Theosophical and Spiritualist traditi ons. Subsequently, we will focus on recent neuroscienti fi c fi ndings on this theme, emphasizing the mechanisms centered on the angular gyrus and the temporo-parietal junction. These regions are responsible for the integration of visual, auditory, vestibular and somesthesic information, thereby participating in the formation of body image, and consequently, the notion of "self". Finally, we will discuss clinical aspects that are related to the OBE, which is considered a disease when happens too frequently or intensely, causing any physical, mental and/or social harm to those who experience it