Commentary: Immobility during COVID-19 and its effects on our sleep, physical activity and well-being
COVID-19 has changed the way we work, play and sleep. There are different strategies to better cope, says Yong Loo Lin School of Medicine’s Michael Chee.
SINGAPORE: Adequate sleep, exercise and a good diet are the trio of lifestyle factors critical for optimal health and well-being. Mobility restrictions arising from COVID-19 upset routines related to all three.
How are different people affected, what are the consequences of this imbalance and what can we do to restore balance?
Anna had been in her job for three years as a consultant when COVID-19 struck. Kept busy by a steady stream of deadlines, she was taken aback by the announcement of DORSCON Orange, but her steady nature kept her rooted.
When the World Health Organization (WHO) declared the pandemic, business continuity plans began to kick in at her office, but she still went to work. She started sleeping later, close to 1am and waking up later as well.
This trend jumped a gear when the circuit breaker was announced. Face-to-face meetings were replaced by Zoom calls that started after 9am and ploughed on into the evening. While she saved about an hour on the morning commute to work and another going home, the time saved seemed to disappear into online meetings.
Unlike her married colleagues with young children, who had to handle home schooling, Anna had fewer reasons not to be available for work calls. Her colleagues expected her to carry a relatively higher workload and she obliged.
CHANGE IN PHYSICAL ACTIVITY
Although Anna slept about 15 minutes more each night, and the difference in weekday and weekend sleep duration lessened, her physical activity took a big hit.
Her gym routine evaporated after the lockdown. Together with not having to walk to and from the MRT station her physical activity was reduced by 50 per cent compared to before the lockdown.
Bereft of her Friday night socialising, her Saturday morning retail therapy and having to field additional “crisis management calls”, Anna’s weekdays and weekends melded into one long, undifferentiated string of days.
A person like Anna made up about 50 per cent of about 1,000 participants in an ongoing population health study operated by the Singapore Health Promotion Board.
Aged between 21 to 40 years, these predominantly office workers have been wearing Fitbit sleep or activity trackers consistently for two years, yielding objective data about their rest-activity patterns.
READ: Commentary: Putting in 50 hours while WFH, it’s a struggle to draw the line between work and home
Is the change in Anna’s life healthy?
Most people are sleeping later but also getting up later. Young singles like Anna innately tend to sleep later than older adults. This is accentuated by an East Asian work culture that makes for longer hours at work and shorter nocturnal sleep compared to Nordic countries or in Australia.
A third cause of later sleeping and rising was unmasked during the lockdown. According to its longitude, Singapore belongs in the “+7 GMT” time zone. This was the case from 1905 to 1932. In 1941, we shifted to the “+7:30” time zone and to stay with Malaysia’s time zone we shifted to “+8 GMT” in 1982. This results in later sunrise and sunset.
The consequence of persistent exposure to later evening light is a delay in sleep times. Evening light tends to delay the circadian clock. Under normal conditions, with work and school start times relatively earlier in body clock terms, this results in shortened nocturnal sleep.
With the circuit breaker, the hour recovered from not having to commute to work has resulted in persons being able to follow their body clock and to wake up significantly later.
This modest sleep extension on weekdays may help offset the ill effects of sleeping later - increased risk of obesity, diabetes mellitus and cardiac events. Alongside this, reduction in the accumulated sleep debt over the workweek may be evidenced in the smaller difference in weekday-weekend sleep duration under lockdown conditions.
Interestingly, office workers also showed a 2 beat per minute reduction in resting heart rate. Commonly associated with better cardiovascular fitness, this favourable shift may indicate reduced exposure to stress, improved sleep or both.
While sleep in persons like Anna has gained from mobility restrictions, the decline in physical activity is worrisome.
It may not appear so, given the increased numbers of people walking and jogging. However, for many working adults and school children, physical activity associated with commuting and moving around the office contributes a substantial number of total steps. These have not been fully replaced by recreational walking.
Does a 30-minute High Intensity Interval Training (HIIT) make up for a 10-hour Zoom marathon? For the most part, no.
Workplace sedentariness is a major health risk factor and increases all-cause mortality, cardiometabolic disorders in addition to impairing musculoskeletal and bone health. Sitting through online meetings for extended periods is unhealthy and a brief burst of exercise does not make up for it.
Further, just as it is impossible to sustain properly performed HIIT beyond 30 minutes, for most people sustained attention declines within minutes of concentrated effort.
A long string of online meetings is not productive because most people tune out after a while and may fail to take heed of important points. Breaks between online meetings help recharge attention, but they have to be taken, not simply wished for.
Leaders would do well to take note. Persons working from home must be given the opportunity periodically get up, move around and mentally recharge.
ALIGNING MULTIPLE BODY CLOCKS
The new normal is an opportunity to recalibrate how we work. Time saved from commuting should be channelled to improving productivity, freeing time for creative thought, recreation as well as building community and family ties.
Minimally, a person working from home should stand up and walk around a few minutes every half an hour, get exposure to outdoor light, preferably in the morning for at least 30 minutes and not have to field evening or late-night calls except on occasion.
Meetings should be kept efficient or terminated. Time saved should not be frittered on cyber-loafing and constant news-checking. A different routine should be in place for weekends, allowing for downtime, time with family and non-work activity.
In contrast to Anna’s fairly regular routine, Thomas, an undergraduate, found the move from traditional classroom learning to e-learning liberating.
Ever pushing boundaries, he’s discovered a way to supplement his educational experience by joining online classes and conferences held in different time zones, opportunities unique to this period of lockdown.
However, while Anna’s routine shifted later it is regular. Thomas’ timetable, if that term could be used, is totally chaotic. Post circuit-breaker, his sleep patterns were constantly changing.
He experimented with sleeping four hours starting from 6am one day, two hours at noon and then changed to another schedule a few days later. His meals were irregular, and he snacked more than usual. He put on weight but figured he’d burn it off later.
Beyond sleep duration, its regularity also matters as does the timing of feeding and physical activity.
Besides the master clock deep in the brain, there are cellular clocks in the liver, digestive system, heart and even skin. Desynchronisation between different body clocks occurs when meal times and sleep times are misaligned and poses significant risks to health and well-being.
It is possible to keep to an alternative sleep or activity schedule, but it should be stable and have a main sleep period together with appropriately aligned eating and exercise times.
Speaking of messed up lives, Shankari’s - another case I know of - took a real tumble during the COVID-19 lockdown. Already unsure if her job would remain in the coming months, she has neighbours who smoke, litter and make noise at odd times of the day and night.
Her brother does not get along with her parents, yet everyone has to stay under the same roof at this time. To find relief, Shankari checks her social media account frequently and watches online movies. However, she feels increasingly isolated despite being on multiple chat groups.
RESILIENCE DURING COVID-19
Inability to sleep, nocturnal awakening, early morning rising or some combination of these, suggest a significant breakdown in mental well-being. The early recognition of such is important.
Some have the resilience within them to ride out crises. Such individuals have the ability to take on one problem at a time, fixing things that can be remedied, while letting go of issues that cannot be changed.
Additional personal actions one can take to reduce emotional stress include staying away from toxic individuals and limiting one’s exposure to upsetting news. Others will benefit from early intervention and professional help. Hiding under a rock will not make difficult problems disappear.
Finally, as in any crisis, there are some who will take to challenge like a duck to water. Mark, a network specialist, experienced initial anxieties about COVID-19 but soon, literally hit his stride.
He thrived on the flexibility of operating from home and working for a boss who understood creative individuals respond better to coaxing than key performance indicators enforcement.
His work on dynamic bandwidth allocation algorithms makes it possible for persons who have to work from home to have fuss-free connectivity.
In between coding, he kept up with friends and found time for athletic pursuits. By the end of the circuit breaker, he was clocking personal bests in his runs and cycles.
Not everyone may be as fortunate as Mark, but we can collectively take a leaf out of suggestions made on each of the four life stories portrayed here. Mobility restrictions from COVID-19 are a huge challenge but we can emerge stronger with the right approach.
Prof. Michael Chee leads the Centre for Sleep and Cognition at the Yong Loo Lin School of Medicine, National University of Singapore. The names quoted in this commentary are not the actual names of the participants in the study.