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Can't sleep? Japan expert warns 'COVID-19 fatigue' fraying autonomic nervous system

Dr. Osami Kajimoto, director of the Tokyo fatigue and sleep clinic, answers questions during an interview in Minato Ward, Tokyo, on April 8, 2021. (Mainichi/Masahiro Ogawa)

TOKYO -- I can't wake up even with an alarm clock. I can't sleep even when I go to bed. I feel tired. It seems that the number of such people is increasing these days. Could this be an early dose of the May blues that usually comes after the "Golden Week" holidays? "No, no, it may be due to the effects of the coronavirus pandemic," said Dr. Osami Kajimoto, 59, director of the Tokyo fatigue and sleep clinic.

    "Since last fall, the number of patients complaining of insomnia and fatigue has been increasing," said Kajimoto. When I visited the examination room of his clinic in Minato Ward, Tokyo, Kajimoto, wearing a white coat, started talking. He said that he is constantly receiving consultations about sleep disorders from both men and women. The doctor is a medical specialist who provides treatment and guidance to people with modern lifestyles to solve their "sleep problems" from the perspective of overcoming fatigue and preventing overwork.

    Kajimoto refers to insomnia as symptoms such as difficulty in sleeping, shallow sleep, and waking up much earlier than expected. Fatigue, on the other hand, is a decline in physical and mental performance. In the past year or so since the spread of the coronavirus, people have not only been nervous about preventing infections, but have also been living under pandemic conditions for a long period of time, resulting in widespread fatigue that can be called "coronavirus fatigue."

    According to Kajimoto, the reason behind this sleeplessness and fatigue is the change in the work system. "Immediately after the declaration of the state of emergency in April last year, the majority of companies switched to telework. But from around autumn, the number of companies that telework half the week and go to office the rest of the week has been increasing."

    If people work from home half of the week, many of them may find that the stress of commuting is reduced and their work environment is more comfortable than it was "pre- coronavirus."

    However, according to Kajimoto, "That's exactly the problem. For example, if you commute from the suburbs, it will take you at least an hour to travel and prepare for work, but with telework, you can save that time. A person who used to wake up at 7 a.m. may now wake up at 8 or 8:30 a.m."

    The problem, he says, is that the later mornings are leading to more late nights, which in turn leads to fatigue among those who have changed their "post-coronavirus" habits, such as looking at their cell phones, playing games, and watching videos in bed.

    "The parasympathetic nervous system should be dominant before going to sleep, but the sympathetic nervous system remains dominant because the brain is activated until just before going to sleep. This may be the reason why more and more people cannot sleep well under the coronavirus pandemic and become tired," said the doctor.

    This means that the key to solving the problem of insomnia under the pandemic lies in the autonomic nervous system. Autonomic nerves are nerve cells consisting of two systems: sympathetic nerves and parasympathetic nerves. They control the movement of internal organs and keep the body in a constant state regardless of one's will.

    Kajimoto served as the general manager of the "exploring the causes of fatigue" project, which was launched in 2003 in collaboration with universities, government agencies, pharmaceutical manufacturers and other bodies, and was involved in research to explore the mechanisms of fatigue. During the project, when examining how tired men and women were after exercising or working, the most obvious change in values was not in the muscles but in the brain.

    According to the medical specialist, the autonomic nervous system of the brain, which is the command center of the body, regulates the heartbeat, respiration, and body temperature without rest in order to keep the body in a stable state. This exhaustion of the autonomic nervous system is the "true nature" of fatigue.

    In the past, it was thought that the cause of fatigue was physical exhaustion or lactic acid buildup in the muscles, but recently it has become clear that the cause is more to do with the autonomic nervous system.

    "Think of light jogging. Your muscles won't be sore from that, but the autonomic nervous system continues to send out commands to the circulatory system, respiratory system, sweat glands, and other organs to operate properly in order to supply the necessary oxygen and regulate body temperature. It's not the muscles that get tired, but actually the autonomic nervous system."

    So, is there anything we can do to prevent the autonomic nervous system from functioning poorly?

    Kajimoto said, "Sleep is important. Just get some sleep." It is not enough to simply sleep, but it is necessary to get a good night's sleep and minimize the dysfunction of the autonomic nervous system.

    As stated by the doctor, autonomic nerve functions deteriorate as we age because the nerve cells are covered with active oxygen like rust. This "rust" can be removed if people sleep soundly, but if left untreated, it will continue to accumulate. Aging is what happens when this rust cannot be removed any longer, and sleep is important to prevent this decline. In order to improve the quality of sleep, it is important to eliminate factors that interfere with it.

    In other words, an easy way to prevent fatigue is "to get a good night's sleep in a comfortable environment." The first thing we need to do is to return to a more disciplined lifestyle that has become irregular due to telework under the coronavirus pandemic. However, it does not mean that you should stop staying up late and go to bed earlier.

    "You should keep your wake-up time constant, not your go to sleep time. When you wake up in the morning, the light in your eyes turns on your body. Please set up a rhythm by matching your morning time," said Kajimoto on what he feels is the best way to prevent aging.

    It is also important to take measures against the two major taboos that prevent a good night's sleep: sweating and snoring. On tropical nights in the summer, you should sleep with the air conditioning on. To prevent snoring caused by a narrowed airway, it is important to change the direction of your face and so on to create a pathway for oxygen.

    Let's start overcoming "coronavirus fatigue" by controlling your wakeup time, regardless of when you start work.

    (Japanese original by Soji Kawana, Digital News Center, Evening Edition Group)

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