|Year : 2022 | Volume
| Issue : 3 | Page : 203-206
Facing sleep and mental health problems in the COVID-19 era: What shall we do?
Shiqiu Meng1, Lin Lu2, Kai Yuan3, Doris Yang4, Icey Zhang4
1 National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
2 National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence; Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit; Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
3 Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit, Peking University, Beijing, China
4 Editorial Department, Asia-Pacific Office of Heart and Mind, Beijing, China
|Date of Submission||29-Jul-2022|
|Date of Acceptance||01-Sep-2022|
|Date of Web Publication||30-Sep-2022|
Source of Support: None, Conflict of Interest: None
In this interview, Prof. Lin Lu introduced ways to improve sleep and relieve stress, influences of sleep on the heart and mental health, essential qualities of psychiatrists, etc. His major viewpoints are: (a) sleep deprivation disrupts physiological functions, (b) prevalence of mental health problems in the general population, health-care workers, and students showed an increasing trend following COVID-19, and (c) it is a tendency for doctors to develop a comprehensive and integrated treatment plan from the physical and mental perspectives.
Keywords: Sleep, mental health, COVID-19
|How to cite this article:|
Meng S, Lu L, Yuan K, Yang D, Zhang I. Facing sleep and mental health problems in the COVID-19 era: What shall we do?. Heart Mind 2022;6:203-6
| Foreword|| |
The number of individuals with sleep and psychological disorders has surged globally, especially in the era of COVID-19. Psychological problems, such as “how to relieve pressure?” and “how can we sleep better during quarantine?” have flooded the world and become another “pandemic.” Therefore, we are very honored to interview Prof. Lin Lu, a renowned sleep and psychiatric expert. Prof. Lu is an academician of the Chinese Academy of Sciences and the director of the National Clinical Research Center for Mental Disorders.
When Prof. Lu was still a medical student, he aspired to become an excellent psychiatrist. Now, as the world-famous expert in mental health, he has a lot to share with the growing demand for psychological therapies. The interview is recorded authentically and edited as follows. We do hope that our readers will enjoy and get inspired.
| Interview Record|| |
Prof. Lu, you are a pioneer and an expert in sleep and mental health disorders, and many people are curious about your sleep habits and methods of relieving stress. How is your sleeping in daily life? How do you relieve stress?
Prof. Lu: Thank you for your question. Humans spend one-third of their lives sleeping, and sleep deprivation can lead to problems such as difficulty in concentration, mood changes, and memory loss. Staying up late for a long time can damage the intestinal flora and destroy the physiological barrier function. Generally speaking, our body begins to secrete melatonin at 9:00 p.m. To induce sleep impulses and sleep demand peaks after 11:00 p.m. I follow the circadian rhythm to make sure I receive 7-8h of sleep each night, specifically, I go to bed at 11:00-11:30 p.m. and wake up at 6:30–7:00 a.m. I will take a nap for no more than 30 min if I feel very sleepy around noon. At weekends, I play table tennis with my students and colleagues. Sometimes I jog or swim after work. I continue to engage in daily moderate-intensity aerobic exercise for 30–60 min, which is an efficient stress reliever. Exercise-induced fatigue is beneficial to sleep.
I also pay special attention to my diet, making sure to consume more vitamin-rich fruits and vegetables and adhere to nighttime diet regulation, which involves avoiding eating a lot of food or stimulating drinks (such as coffee, strong tea, and alcoholic beverages) at night. I would switch off electronics before going to bed because the blue light emitted by cell phones and computers can inhibit melatonin secretion and disrupt circadian rhythms. When I feel anxious, in order to adjust myself before going to bed, I'll do relaxation exercises. I sincerely hope that these tips would be helpful.
You have been dedicated to the research of sleep and mental health disorders and have authored many medical books and over 400 medical articles, with an h-index of 79. Among all of your excellent publications and achievements, what are the most important to you? What are you most interested in recently?
Prof. Lu: I am currently more concerned about how the COVID-19 outbreak may affect people's mental health, particularly the prevalence of depression-, anxiety-, and insomnia-related risk factors. COVID-19 spread worldwide all of a sudden at the end of 2019, posing a serious threat to people's lives and health. The restrictions brought by various prevention and control measures, the dissemination of information from many unknown sources, and the subsequent economic impact of the outbreak have caused the public to undergo tremendous psychological stress and panic, which has significantly increased the risk of various mental health problems such as depression, anxiety, insomnia, and addiction in the public, especially in various susceptible groups.,, Our recently published research demonstrated that within 6 months after the outbreak, the prevalence of mental health problems in the general population, health-care workers, and students showed an increasing trend.,,, In addition, women, individuals with a history of physical or mental illness, infected individuals, frontline workers, individuals with a history of close contact with infected ones, residents of high epidemic areas, and isolation were all risk factors that contribute to increased mental problems during the epidemic. Favorable social and family support and regular exercise can reduce the risk of mental illness during the epidemic.
During the epidemic, mental health problems were widespread among the general population. With the development of the epidemic, a variety of mental health problems continued to exist. I attach great importance to the psychosocial problems brought about by the epidemic and study its impact on people's physical and mental health, paying special attention to the vulnerable groups. To reduce the occurrence of public mental health disorders during the global epidemic and to protect and promote the mental health of people of all countries, we hope to implement a wide range of preventive and comprehensive interventions during the routine prevention and control period of the epidemic and in the postepidemic era.
In your clinical and teaching experience, are there patients or cases that impressed you?
Prof. Lu: I once treated a “special” patient in his 50s who claimed to experience chest tightness and gastrointestinal discomfort all the time. He had visited all the major hospitals in China and undergone a variety of diagnostic procedures, including magnetic resonance imaging, computed tomography scanning, gastroscopy, etc., to rule out other possible causes. After being examined at our hospital, he realized he suffered from somatization disorder. One of the characteristics of this disease is that no organic lesion can be confirmed as the explanation of patient's somatic symptoms, which in turn led to the patient's long-term repeated medical visits and serious social dysfunction.
From our conversations with the patient, we later discovered that he was used to the attention he received at work and was not psychologically ready for retirement. This “retirement syndrome” had brought him a number of bodily aches and pains. As a member of the health-care industry, I advocate paying more attention to patients' emotional needs and psychological problems in addition to their physical symptoms. Improving social adaptation and mental health problems should receive the same level of care as physical illnesses.
From the perspective of psycho-cardiology, what do you think are the important effects of sleep on the heart and mental health? For example, what's the interaction between sleep and cardiac rehabilitation, stress relief, etc.
Prof. Lu: When people are in a normal sleep state, the sympathetic nerve is inhibited and the parasympathetic nerve is excited. At this time, the heart rate slows down, the blood pressure decreases, and the heart load decreases, which is conducive to maintaining the stability of the cardiovascular system, thereby alleviating the condition of patients with cardiovascular diseases. On the contrary, sleep disorders can lead to autonomic nervous disorders, affect human metabolism, influence endocrine and immune system, increase the secretion of catecholamines, leading to vasoconstriction, increase blood pressure, accelerate breathing, increase metabolism, plasma-free fatty acid and triacylglycerol levels, and platelet viscosity, leading to coronary heart disease, heart failure, hypertension, arrhythmia, and a series of physiological and biochemical changes.
The relationship between psychological stress and sleep disorders is complex. Studies have shown that long-term sleep problems related to excessive psychological stress can lead to excessive arousal of the cerebral cortex, confusion, inattention, memory loss, reduced learning efficiency, and serious psychological damage or physical diseases. On the contrary, good sleep can relieve pressure, be energetic, be in a high mood, improve cognitive function, improve psychomotor status, and prevent memory interference and memory decline after learning.
What kind of psychiatrist do you expect in future? What professional skills and medical literacy are necessary for a qualified psychiatrist?
Prof. Lu: As a psychiatrist, we should have excellent professionalism and basic skills. Second, psychiatrists should have a high degree of lifelong learning ability. Advances in modern technology have led to an increasingly more profound understanding of the brain, and it is believed that the development of our “Brain Science and Brain-Like Intelligence Technology” will further deepen our psychiatrists' understanding of the brain, so we should not limit our knowledge to our student years, but maintain the habit of lifelong learning. While focusing on understanding psychiatry, we should also strengthen the awareness of interdisciplinary communication. Interdisciplinary communication allows us to acquire advanced techniques and ideas from other disciplines, providing more evidence for scientific research, and better solutions for disease treatment.
In addition, psychiatrists should establish good medical ethics and a correct outlook on life, values, and death, strengthen their ability to communicate and empathize with patients, and maintain a good doctor–patient relationship. At the same time, psychiatrists should not only pay attention to the physical symptoms of patients but also care about their psychological problems and emotional needs.
Your research has had an important impact on psychiatry and sleep medicine, promoting and improving the construction of clinical diagnosis and treatment technology and the system of psychiatry in China. Could you please tell us how you achieved such a high achievement?
Prof. Lu: When I was a medical student, I aspired to become an excellent psychiatrist. My personal goal was the guiding force for my development. This goal encourages me to move forward and points out the direction for my struggle. This goal was a great challenge to me, as a student, at that time, and the only way to achieve it was to keep studying. Of course, achieving the goal is not shouting slogans, but working hard, thinking hard, taking risks, and going to the place where you are most needed and where you can achieve your self-worth.
In addition to unremitting efforts, we must find appropriate ways and means when doing scientific research. Scientific researchers should not be limited to a small field or scope, instead, they should pay attention to the most cutting-edge international research progress, increase the understanding of their research fields, and take fewer detours. In addition, scientific research should always be considered for its practical significance. Conducting research that can be applied to patients and improve patients' life qualities is the most essential.
You hold critical positions in many high-impact journals, including Associate Editor of Neuropsychopharmacology and Treatment Section in Drug Alcohol Depend, Associate Editor of Addiction, Editorial Board Member of International Journal of Neuropsychopharmacology, and so on. In consideration of your extensive experience in journal operations, could you please give some advice for the development of Heart and Mind?
Prof. Lu: First, I believe that the most important principle of an academic journal is to focus on academic ethics and resolutely resist academic fraud and misconduct. Honesty is the foundation of a journal. If academic fraud and academic misconduct are condoned, the negative impact on the journal will be enormous and the fundamental purpose of creating an academic journal will be deviated. Second, a good journal should capture the hot topics in the interested field and focus on research with practical significance. Emphasis should be placed on recent popular scientific hypotheses and research methods to better meet readers' needs. Third, a good journal should encourage interdisciplinary submission to expand the readership. Interdisciplinary collaboration is now becoming a new trend in scientific research, for example, the intersection of medicine and engineering has made many achievements in the field of psychiatry and psychology. The inclusion of these articles can attract the attention of readers from different fields to our journal, which will also bring more ideas to readers and improve the academic status of the journal. Finally, a good journal cannot be separated from the cultivation and construction of periodical talents. Periodical editors should be trained regularly to absorb excellent talents and improve the academic level of the journal.
| Editor's Note|| |
The research of mental health disorders and sleep medicine has been Prof. Lu's lifelong career. His achievements include but are not limited to developing novel nonpharmaceutical interventions for drug addiction, finding new targets in rapid antidepression therapy, and creating new methods in treating mental health disorders during sleep, which have been proven of theoretical significance and application value.,, During the interview, Prof. Lu concretely answered every question we asked in detail. Here are three major viewpoints he has specified:
- Sleep deprivation can lead to problems such as a disability in concentrating, mood changes, and memory loss. Staying up late for a long time can impair intestinal flora and can disrupt physiological functions.
- Individuals with prior physical illness history or prior mental illness history, infected individuals, frontline workers, individuals with a history of close contact with infected ones, residents of high epidemic areas, and isolation were all risk factors that contribute to the increased mental health problems during the pandemic. Favorable social and family support and regular exercise can reduce the risk of mental illness during the pandemic.,,
- Psychosomatic disease, an emerging type of mental disease, reveals that doctors should not only pay attention to the physical symptoms of patients but also care about their psychological problems and emotional needs. It is a tendency to develop a comprehensive and integrated treatment plan from the physical and mental perspectives.
Lin Lu, Academician of the Chinese Academy of Sciences, Director of National Clinical Research Center for Mental Disorders, Director of PKU 6th Hospital/Institute of Mental Health, and Director of PKU National Institute on Drug Dependence, China. [email protected]
Financial support and sponsorship
Conflicts of interest
Prof. Lin Lu is the Editor-in-Chief of the Heart and Mind journal. Doris Yang and Icey Zhang are editorial staff of the Heart and Mind journal. The article was subject to the journal's standard procedures, with peer review handled independently of Prof. Lin Lu and the research groups. There are no conflicts of interest.
| References|| |
Bao Y, Sun Y, Meng S, Shi J, Lu L. 2019-nCoV epidemic: Address mental health care to empower society. Lancet 2020;395:e37-8.
Liu L, Ni SY, Yan W, Lu QD, Zhao YM, Xu YY, et al.
Mental and neurological disorders and risk of COVID-19 susceptibility, illness severity and mortality: A systematic review, meta-analysis and call for action. EClinicalMedicine 2021;40:101111.
Zeng N, Zhao YM, Yan W, Li C, Lu QD, Liu L, et al
. A systematic review and meta-analysis of long term physical and mental sequelae of COVID-19 pandemic: Call for research priority and action. Mol Psychiatry 2022; 1-11. [Epub ahead of print].
Que J, Shi L, Deng J, Liu J, Zhang L, Wu S, et al.
Psychological impact of the COVID-19 pandemic on healthcare workers: A cross-sectional study in China. Gen Psychiatr 2020;33:e100259.
Liu JJ, Bao Y, Huang X, Shi J, Lu L. Mental health considerations for children quarantined because of COVID-19. Lancet Child Adolesc Health 2020;4:347-9.
Meng S, Dong P, Sun Y, Li Y, Chang X, Sun G, et al
. Guidelines for prevention and treatment of internet addiction in adolescents during home quarantine for the COVID-19 pandemic. Heart Mind 2020;4:95-9. [Full text]
Sun Y, Bao Y, Ravindran A, Sun Y, Shi J, Lu L. Mental health challenges raised by rapid socioeconomic transformations in China: Lessons learned and prevention strategies. Heart Mind 2020;4:59-66. [Full text]
Yuan K, Zheng YB, Wang YJ, Sun YK, Gong YM, Huang YT, et al
. A systematic review and meta-analysis on prevalence of and risk factors associated with depression, anxiety and insomnia in infectious diseases, including COVID-19: A call to action. Mol Psychiatry 2022; 1-9. [Epub ahead of print].
Macina C, Bendel R, Walter M, Wrege JS. Somatization and somatic symptom disorder and its overlap with dimensionally measured personality pathology: A systematic review. J Psychosom Res 2021;151:110646.
Saputra AT, Rahmawati D, Kaloh AP. The relationship between self-esteem and retirement syndrome among Angkasa Pura's former upper managerial retirees in facing retirement. IOSR Journal Of Humanities And Social Science (IOSR-JHSS) 2020;25:39-43.
Shi L, Chen SJ, Ma MY, Bao YP, Han Y, Wang YM, et al
. Sleep disturbances increase the risk of dementia: A systematic review and meta-analysis. Sleep Med Rev 2018;40:4-16.
Que J, Lu L, Shi L. Development and challenges of mental health in China. Gen Psychiatr 2019;32:e100053.
Xue YX, Luo YX, Wu P, Shi HS, Xue LF, Chen C, et al
. A memory retrieval-extinction procedure to prevent drug craving and relapse. Science 2012;336:241-5.
Li SX, Han Y, Xu LZ, Yuan K, Zhang RX, Sun CY, et al
. Uncoupling DAPK1 from NMDA receptor GluN2B subunit exerts rapid antidepressant-like effects. Mol Psychiatry 2018;23:597-608.
He J, Sun HQ, Li SX, Zhang WH, Shi J, Ai SZ, et al
. Effect of conditioned stimulus exposure during slow wave sleep on fear memory extinction in humans. Sleep 2015;38:423-31.
Wang Z, Chen WH, Li SX, He ZM, Zhu WL, Ji YB, et al
. Gut microbiota modulates the inflammatory response and cognitive impairment induced by sleep deprivation. Mol Psychiatry 2021;26:6277-92.
Shi L, Lu ZA, Que JY, Huang XL, Liu L, Ran MS, et al
. Prevalence of and risk factors associated with mental health symptoms among the general population in China during the coronavirus disease 2019 pandemic. JAMA Netw Open 2020;3:e2014053.