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Optimal sleep health among frontline healthcare workers during the COVID-19 pandemic

To the Editor,

Since the start of the coronavirus disease (COVID-19) outbreak in December 2019 in Wuhan, China, it has been declared a pandemic and has now involved over 200 countries.A Adverse effects on the mental health of frontline healthcare workers (HCW) has been at the forefront of concerns,1 with insomnia being one of the most commonly reported symptom.2 Because of the fundamental role that sleep plays in emotion regulation and body homeostasis, sleep disturbance can have direct consequences on both emotional functioning and wellbeing.3 As physician wellbeing and patient safety are inextricably linked,4 it is imperative that we address sleep health for the sake of physicians and their patients.

Over 1,200 HCWs from 34 hospitals in China dealing with COVID-19 were surveyed for mental health and sleep problems in a recent cross sectional, survey-based, region-stratified study.2 Frontline workers involved in direct care of patients with COVID-19 were associated with the highest risk of insomnia (odds ratio [OR], 2.97; 95% confidence interval [CI], 1.92 to 4.60), followed by depression (OR,1.52; 95% CI, 1.11 to 2.09), anxiety (OR, 1.57; 95% CI, 1.22 to 2.02), and distress (OR, 1.60; 95% CI, 1.25 to 2.04).2 These self-reported symptoms were higher among nurses, women, and frontline HCWs, and in geographical areas with higher case infection rates.

During a pandemic, concerns about personal safety, transmitting disease to family members, stigmatization from being infected, shift work, and interpersonal isolation coalesce to disrupt sleep health. This can manifest by hyper-arousal states, as well as problems with anxiety and stimulus control (e.g., beginning to associate the bed with wakefulness, rather than restful sleep); all of these can have negative effects on physician wellbeing.5 Moreover, specific lifestyle modifications such as home confinement and self-isolation can also negatively impact sleep health. Anesthesiologists may be particularly susceptible to all the aforementioned concerns given our direct involvement with high-risk aerosol-generating medical procedures, shift work, and redeployment to areas outside some practitioners’ normal scope-of-practice such as critical care units. Important biological factors also influence sleep pathophysiology including age (e.g., decreased amounts of slow wave and rapid eye movement sleep, increased incidence of sleep disorders such as obstructive sleep apnea (OSA), sex (e.g., women self-report shorter and poorer sleep compared with men; higher incidence of OSA in men and post-menopausal women), psychosocial state (e.g., presence of depression, stress, loneliness), socio-economic status, race, and ethnicity.3 Furthermore, individual sleep patterns—e.g., the hypnotype (habitual sleep duration) or chronotype (morningness/eveningness preference)—can conflict with shift work, which requires inflexible work hours and disrupts circadian rhythm.3

Optimal sleep health is essential for the wellbeing of HCW, and thus the provision of safe patient care. Physician burnout has been associated with an increased risk of patient safety incidents (OR, 1.96; 95% CI, 1.59 to 2.40), poorer quality of care due to low professionalism (OR, 2.31; 95% CI, 1.87 to 2.85), and reduced patient satisfaction (OR, 2.28; 95% CI, 1.42 to 3.68).4 Given that sleep is even more disrupted during the COVID-19 pandemic, we herein present some useful sleep habits partly adapted from cognitive behaviour therapy for insomnia, relevant information and other resources for the frontline HCW (Table; and eFigure in the Electronic Supplementary Material). We are hopeful that optimal sleep habits, stress management, cognitive strategies for sleep, relaxation techniques, increasing awareness of common sleep disorders, and behavioural interventions may compliment institutional wellness programs and aid our colleagues during this stressful time.

Table Optimal sleep health advice for frontline healthcare workers while dealing with the COVID19 pandemic


  1. A

    World Health Organization. Coronavirus disease (COVID-19). Situation Dashboard. World Health Organization. Available from URL: (accessed May 2020).


  1. Alikhani R, Salimi A, Hormati A, Aminnejad R. Mental health advice for frontline healthcare providers caring for patients with COVID-19. Can J Anesth 2020; DOI:

    Article  PubMed  Google Scholar 

  2. Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020; DOI:

    Article  PubMed  PubMed Central  Google Scholar 

  3. Magnavita N, Garbarino S. Sleep, health and wellness at work: a scoping review. Int J Environ Res Public Health 2017; DOI:

    Article  PubMed  PubMed Central  Google Scholar 

  4. Panagioti M, Geraghty K, Johnson J, et al. Association between physician burnout and patient safety, professionalism, and patient satisfaction: a systematic review and meta-analysis. JAMA Intern Med 2018; DOI:

    Article  PubMed  PubMed Central  Google Scholar 

  5. Altena E, Baglioni C, Espie CA, et al. Dealing with sleep problems during home confinement due to the COVID-19 outbreak: practical recommendations from a Task Force of the European CBT-I Academy. J Sleep Res 2020; DOI:

    Article  PubMed  Google Scholar 

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COVID creatives and Victoria Robinson BA, Queens University, Charlotte, NC, USA for the creative help with the infographic.


Mandeep Singh serves on the medical advisory board of the Hypersomnia Foundation on a voluntary basis. The remaining authors declare no competing interests. Mamta Gautam is the CEO of PEAK MD Inc., through which she receives fees for academic grand rounds and conference keynote presentations, medical leadership development, healthcare consulting, and coaching physician leaders.

Funding statement

Support was provided solely from institutional and/or departmental sources. Mandeep Singh is supported by a Canadian Anesthesiologists Society Career Scientist Award, as well as the Merit Awards Program from the Department of Anesthesia at the University of Toronto.

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

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Correspondence to Mandeep Singh MBBS, MD, MSc.

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Optimal Sleep Health for Frontline Healthcare Workers During COVID-19

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Singh, M., Sharda, S., Gautam, M. et al. Optimal sleep health among frontline healthcare workers during the COVID-19 pandemic. Can J Anesth/J Can Anesth 67, 1471–1474 (2020).

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