Why COVID Insomnia Lingers and How to Sleep Better

From verywellhealth.com

Infection with COVID-19 has been associated with trouble sleeping—both during the infection, and even after the infection has resolved. Often labelled as coronasomnia, sleep difficulties are considered one of the long COVID or post-COVID effects.

Sleep problems after COVID-19 infection may include trouble falling asleep, trouble staying asleep, and feeling sleepy during the day.

One study reports that 76% of people who have recovered from COVID infection continue to experience insomnia months after the acute phase of the infection has resolved. Other reviews of studies (published in 2022) found lower percentages, with one review finding 37% and another 24% to 30%. These lower percentages are not much higher than the prevalence of sleep disturbances in the general population.

Why Does COVID Cause Insomnia? 

"Insomnia" is defined as "persistent difficulty falling asleep or staying asleep," which results in inadequate sleep and daytime sleepiness. Researchers have discovered that ongoing or previous COVID-19 infection produces insomnia in multiple ways.

Factors that contribute to coronasomnia include:

• Anxiety, which can be associated with the infection or the pandemic
• Depression
• Excessive dependence on electronic devices and social media
• Loneliness and detachment from other people
  
• Physical symptoms associated with COVID infection, such as gastrointestinal disturbances, pain, or difficulty breathing
  

COVID-Induced Inflammation 

The coronavirus also has been associated with effects on the brain, such as inflammation and a disruption in the gut-brain axis (also called the gut-brain connection), that may lead to insomnia.

Inflammation: The COVID-19 virus can cause inflammation that disrupts the blood-brain barrier (BBB). The BBB generally protects the brain from infections and medication side effects. A compromised BBB can lead to disturbances in brain function. Researchers have found that COVID-19 infection can disrupt the sleep cycle through inflammatory disruption of the BBB.

Disruption in the gut-brain axis: The bacterial environment of the stomach and intestines, known as the gut flora or gut microbiota, promotes a balance of digestion and immunity. Some people's gut flora is altered during and after COVID-19 infection. Changes in gut flora can affect brain activity, interfering with the body’s sleep cycle.

                                                                             shironosov / Getty Images

Who Is Most at Risk?

Some populations seem to be at a higher than average risk of insomnia associated with COVID-19 infection.

High-risk groups include:

• People who already had sleep disorders before getting sick from COVID-19
• People who had anxiety or depression before getting sick from COVID-19
• Individuals who did not get adequate medical attention when they were sick with COVID-19
  

What Can You Do?

Even if you are in one of the populations at risk of coronasomnia, you can still improve your sleep. Talking with a healthcare provider about your medical issues or discussing your mental health concerns with a therapist can help you get a diagnosis and the proper treatment to begin to resolve your sleep issues.

How Long Does Coronasomnia Last?

Research suggests that coronasomnia may begin to resolve within about 6 to 12 months after being sick from COVID-19. For many people, improvement of physical symptoms associated with COVID-19 infection often goes hand in hand with improvement in sleep.

Coronasomnia Anxiety Over Time 

It's important to note that factors contributing to coronasomnia are ever evolving.

For example, isolation and detachment from other people were more pronounced during the lockdown phase of the pandemic. Still, some people have remained isolated and have not resumed normal interactions at school, work, or socially.

Anxiety regarding contagious illnesses and health scares were high during the height of the pandemic. While that level of anxiety has lessened in the following years, some people are still anxious about infections.

Additionally, it’s important to note that some people with chronic diseases are still highly susceptible to contagious infections. While this concern was highlighted during the pandemic, the risk of catching any type of infection is ever present for people with a weakened immune system.

Long-Term Sleep Effects Post-COVID

Several long-term sleep effects are associated with post-COVID. Some of these effects overlap with sleep issues during COVID-19 infection—but some are unique to the post-COVID period. 

Post-COVID sleep problems include:

• Daytime sleepiness, napping, and resulting trouble falling asleep due to daytime naps
• Excessive reliance on sleep aids and trouble stopping the use of sleep aids
• Preoccupation with sleep or excessive worry about coronasomnia
• Racing thoughts when trying to sleep
• Waking up after having fallen asleep
• Worsening of underlying sleep apnoea (pauses in breathing during sleep)

What to Do If You Can’t Sleep

Difficulty sleeping is not uncommon, and many people experience this problem at some point in their lives. Daytime sleepiness, which can lead to naps, is a common consequence of insomnia. Napping during the day can lead to a cycle of difficulty sleeping again at night.

Additionally, anxiety about insomnia can worsen insomnia. If you can’t sleep, consider the following measures to make it easier to get asleep and stay asleep:

• Avoid caffeine or alcohol late in the day (or avoid them completely).
• Consider scheduling stressful tasks or problem-solving for the daytime, so you won’t think about them while trying to sleep.
• Do not take naps late in the day.
• Get enough exercise, and avoid strenuous exercise within a few hours before your intended bedtime.
• Incorporate relaxing activities into your bedtime routine, such as stretching or reading before your bedtime.
• Make sure your bedroom is at a comfortable temperature.
• Manage stress and anxiety.
• Try to have a consistent sleep and waking up schedule.

Sometimes, adding a few relaxing changes to your bedtime routine can help you fall asleep when you want to.

When to Contact a Healthcare Provider 

If you’ve consistently been having trouble sleeping or if you feel tired during the day, it’s important that you talk to a healthcare provider. Coronasomnia is common and may be associated with anxiety, depression, or prolonged effects of COVID-19. Living with insomnia and daytime sleepiness has a substantial impact on your quality of life, and treatment can help improve these symptoms.

Besides COVID-19 infection, there are many other reasons for insomnia and daytime sleepiness. Your healthcare provider can take a medical history, do a physical exam, and possibly run some diagnostic tests to help figure out what’s going on.

Your treatment will be guided by your underlying medical condition. In addition to anxiety, depression, and breathing difficulties, there are so many other problems that can make it hard to fall asleep—such as thyroid disease, diabetes, menopause, and more. Additionally, daytime sleepiness can be caused by anaemia, heart disease, thyroid disease, and more. All of these conditions are treatable—but you first need to have the correct diagnosis.

Summary 

Coronasomnia is becoming more recognized as a post COVID-19 problem. People who have recovered from COVID-19 infection sometimes experience months of insomnia and daytime sleepiness. Many factors are associated with coronasomnia, including anxiety, depression, napping during the day, and direct effects of inflammation from the virus itself. 

If you’ve been experiencing coronasomnia, it may be reassuring to know that you are not alone. So far, research shows that many people recover from coronasomnia within six to 12 months. In the meantime, you can take some steps to help improve your sleep, including incorporating healthy sleep habits and talking to a healthcare provider about your sleep issues.

Keep in mind that there are many causes of daytime sleepiness and insomnia—and it’s best to see a healthcare provider to get an accurate diagnosis rather than assuming your symptoms are due to a previous COVID-19 infection.

https://www.verywellhealth.com/covid-insomnia-8768044 

The Impact of COVID-19 on Mental Health: A Focus on Insomnia

From medriva.com

COVID-19 and Insomnia: A Closer Look

A survey conducted among 1,056 people in Vietnam who had contracted a mild form of COVID-19 revealed that a staggering 76.1% experienced insomnia after their recovery. The study further highlighted that 22.8% of the participants reported experiencing severe insomnia. The data indicated that individuals who had been diagnosed with anxiety or depression were more likely to suffer from sleep disturbances. This aligns with previous research that has associated sleep disturbance with symptoms of long COVID. The researchers involved in the study have recommended the implementation of interventions to mitigate the potential long-term negative impacts of the infection.

Connecting Mental Health Disorders and Insomnia

The study revealed a more disturbing trend among those individuals who were dealing with anxiety or depression. It found that people with depression were more than three times as likely to experience insomnia, while people with anxiety were nearly four times more likely to suffer from sleep disturbances. These findings emphasize the need for public health agencies to consider targeted interventions for those who have had milder cases of COVID-19 to mitigate the potential long-term negative impacts of the infection.

Trajectory of Mental Health Changes Post-COVID-19

A longitudinal study conducted to investigate the trajectories of mental health changes in individuals infected with COVID-19 found notable changes in mental health outcomes over time. Depression showed significant improvement, while anxiety and insomnia did not exhibit significant changes. The study identified younger individuals and those who experienced severe COVID-19 infection as high-risk groups with worse mental ill health. The main predictors of these changes in mental health outcomes were fatigue and post-COVID impairments. This emphasizes the need for ongoing assessment, support, and tailored interventions for the evolving mental health needs of individuals following a COVID-19 infection.

Prevalence of Anxiety and Depression Post-COVID-19

Another study reviewed the changes in the prevalence of anxiety and depression among COVID-19 patients during a two-year recovery period. The highest prevalence of anxiety was found at 3-6 months post-recovery, while the highest prevalence of depression was reported within the first month of recovery. The study also noted regional differences in the changes in prevalence of anxiety and depression, with anxiety prevalences in Asian countries being lower than non-Asian countries, and depression prevalences in Asian countries being higher than non-Asian countries.

Insomnia among Healthcare Workers during COVID-19

The impact of the COVID-19 pandemic on the mental health of healthcare workers has also been a subject of concern. A study of 1038 healthcare workers found significant associations between insomnia, resilience, COVID-19 anxiety, and social support. Insomnia was identified as a significant predictor for anxiety and depression, and was associated with various health issues. The study provides a theoretical framework for understanding insomnia among healthcare workers, including predisposing, precipitating, and perpetuating factors.

https://medriva.com/health/mental-health/the-impact-of-covid-19-on-mental-health-a-focus-on-insomnia/ 

Even Mild Cases of COVID Can Leave Lingering Insomnia

From medicinenet.com

Even mild cases of COVID can trigger insomnia in most people, a new study reports.

About three out of four people with mild COVID (76%) reported experiencing insomnia following their illness.

Further, nearly one in four (23%) said they'd experienced severe insomnia, according to results published Feb. 5 in the journal Frontiers in Public Health.

“If you experience insomnia after COVID-19, don't think that is normal,” said lead researcher Huong Hoang, head of the surgical nursing unit at Phenikaa University in Vietnam.

For the study, Hoang and colleagues surveyed more than 1,000 adults who'd been diagnosed with COVID but did not require hospitalization. The surveys were conducted between June and September 2022.

Half of the participants said they woke more often in the night. A third said they found it harder to fall asleep, had worse sleep and slept for less time.

The severity of COVID infection did not seem linked with the severity of insomnia, researchers noted. Although COVID patients without symptoms scored lower on an insomnia index, the difference was not statistically significant.

There were two groups of patients who did appear more likely to have insomnia following COVID -- people with a pre-existing chronic condition and people who scored highly for symptoms of depression or anxiety.

Both of those groups had a higher rate of insomnia than the rest of the COVID patients, researchers said.

However, the link between those two groups and insomnia can run in either direction, researchers noted. Insomnia can cause worse mental and physical health, but it also can be exacerbated by poor mental and physical health.

“Since this is a cross-sectional study, the relationship of anxiety and depression with insomnia cannot be fully investigated,” Hoang said in a journal news release.

Hoang offered some advice to COVID patients experiencing sleep problems. 

“If insomnia does not bother you much, you can take some simple actions, such as: taking a warm shower before bedtime, shutting your phone down at least one hour before going to bed, doing 30 minutes of exercise per day, and avoiding caffeine after 4 p.m.,” Hoang said.

"In case insomnia really troubles you, you can try some over-the-counter sleep aids,” Hoang added. “If they don't help, go to see a sleep therapist.”

https://www.medicinenet.com/covid_can_leave_lingering_insomnia/news.htm

Sleep Problems Increased During COVID-19 Pandemic, Possibly Due to Poor Sleep Hygiene

From ajmc.com

Sleep problems significantly increased between the first and second waves of the COVID-19 pandemic, which might be explained by detrimental sleep hygiene practices.

Sleep problems increased significantly between the first and second COVID-19 pandemic waves, and the interindividual variability surrounding this growth could be explained by detrimental sleep hygiene practices, according to a study in the Journal of Sleep Research.

Worse sleep hygiene practices were linked with a more exaggerated growth in sleep problems between spring 2020 and autumn-winter 2020 (b = .191; P = .013), even after controlling for relevant confounders like demographic factors, COVID-19–related information, and psychological distress.

The COVID-19 pandemic significantly affected physical and mental health around the globe, the researchers noted, and a large body of literature emphasized that sleep quality and sleep habits endured relevant changes during the pandemic.

In this study, researchers aimed to analyse changes in sleep problems across 3 waves of the COVID-19 pandemic and to pinpoint possible predictors of the interindividual variability surrounding these changes with a special focus on the role of damaging sleep hygiene practices.

The cohort consisted of 352 participants who completed an online survey of self-report questionnaires during 3 distinctive COVID-19 pandemic waves: T1 (Spring 2020); T2 (Autumn-Winter 2020); and T3 (Spring 2021).

Then, the questionnaires obtained information on sociodemographic and COVID-19–related factors, psychological distress (ie, the Depression Anxiety Stress Scale-21), sleep hygiene (ie, the Sleep Hygiene Index), and sleep problems (ie, the Medical Outcomes Study–Sleep Scale).

An average increase in sleep problems between T1 and T2 with significant interindividual variability was unveiled through latent change score modelling. No substantial changes were seen between T2 and T3 on average.

Also, the latent change score (LTS) model emphasized a significant change in sleep problems between the first pandemic wave and the second pandemic wave.

“Importantly, although the average extent of change was small, we identified significant interindividual variability, indicating that the rate of change was not uniform among all individuals,” the researchers wrote.

They noted that their findings also gave empirical support for the main hypothesis about the role of detrimental sleep hygiene practices in describing changes in sleep problems between T1 and T2. Precisely, the conditional LCS model denoted that individuals who reported poor sleep hygiene showed a greater increase in sleep problems.

Conversely, no average changes in sleep disturbances were seen between the second and third waves, which confirmed on the one hand that the COVID-19 pandemic had a significant impact on sleep problems, but the nonexistence of significant average changes between the second and third waves might be related to an “adaptation” to the pandemic, as suggested by previous studies.

Findings indicated that individuals with higher levels of sleep problems at T1 experienced less deteriorating between T1 and T2, while those with fewer sleep disturbances at baseline possessed a higher increase.

Discoveries of this study expand on former research about the detrimental effects of the pandemic on mental health, suggesting that interventions aimed at sleep hygiene practices might be beneficial for mitigating its damaging impact on sleep disruptions.

Due to these results, researchers argue that possessing a reliable tool to identify sleep hygiene behaviours and the ability to estimate future sleep problems could be beneficial for implementing clinical programs concentrated on insomnia and other sleep alterations in the post-pandemic time frame.

This is the first study to analyse sleep changes over 3 waves of the COVID-19 pandemic by implementing an LCS modelling approach to the best of the researchers’ knowledge.

There were some limitations in this study. First, there was a considerable dropout rate across the 3 periods of data collection. Additionally, the majority of the sample was made up of female respondents and young adults, which might limit the generalizability and external validity of the results to male and adult individuals. Therefore, future studies should strive for more representation to strengthen finding generalizability.

“This research serves as an essential update and extension of prior studies on the impact of the pandemic on mental health, suggesting that interventions targeting sleep hygiene practices may prove useful in mitigating the worsening of sleep disturbances during such challenging times,” the authors concluded.

https://www.ajmc.com/view/sleep-problems-increased-during-covid-19-pandemic-possibly-due-to-poor-sleep-hygiene 

"COVID-somnia" and the impact of long COVID on sleep

From cbsnews.com

When Priya Mathew recovered from a mild case of COVID-19 in November, she thought she was out of the woods. Then came long COVID.

"At one point I counted 23 symptoms," Mathew told CBS News. "The most alarming ones were shortness of breath, laboured breathing, heart palpitations."

One of the most crippling symptoms? Insomnia.

"Nothing worked. I would just lie awake in agony all night," she recounted. "It felt like electric shocks going through my body from my head down to my toes."

Mathew isn't alone. Dr. Emmanuel During, a psychiatrist and neurologist, has been seeing this in sleep patients at Mount Sinai Hospital.

For those with long COVID, he says insomnia is often related to pain and is resistant to treatment.

"Pain, which can occur at night as well, and a lot of autonomic imbalance, autonomic impairment, which is the ability of our body to control heart rate and blood pressures — that can lead to episodes of palpitation, night sweats," During explains.

Even for those without long COVID, the pandemic has robbed many of a restful night's sleep.

Nearly a third of Americans said they've experienced sleep disturbances since COVID began, according to a 2022 survey from the American Academy of Sleep Medicine. That's down from 56% the year before. The phenomenon is described as "COVID-somnia."

Due to her own battle with sleep deprivation, Mathew shared she couldn't work for at least a month.

"Any little task took way too much energy. Just taking a shower, I had to rest for three hours after that," she explained. 

Mathews wrote about her experience for the online news outlet Axios, where she works. Like many people coping with long COVID, she says her initial infection seemed like a "mild" case. 

"Very soon I realised: If I'm going to get better, I need to completely change my life," she wrote. "...When my body needs rest, I rest."

Over the past four months, she estimates her symptoms have improved by 60-70%.

Doctors say it's critical to stick to good sleep hygiene habits, including regular bedtimes and no screens late at night. If you have trouble sleeping, doctors say it's a good idea to consult a sleep specialist, because insomnia may reveal other health issues, like sleep apnoea.

https://www.cbsnews.com/news/long-covid-insomnia-sleep/ 

How Covid can disturb your sleep and dreams – and what could help

From indianexpress.com

There's no simple explanation for why catching COVID may increase nightmares, but mental health may again play a role

By the end of 2022, more than 650 million COVID infections had been reported to the World Health Organisation.

With the true number likely much higher, and the tally increasing by hundreds of thousands every week, the scientific community has been focused on understanding the impact of COVID on our physical health, mental health and brain function.

In the early stage of the pandemic, sleep scientists charted the costs and benefits of lockdowns on sleep patterns. The main finding was that we slept more in lockdown but the quality of our sleep was worse.

Now a second wave of data is beginning to explain how becoming infected with COVID is affecting our sleep and even intruding into our dreams.

The most recent meta-analysis, a review of all the currently available scientific literature, estimates that 52% of people who contract COVID suffer from sleep disturbances during the infection.

The most common type of sleep disturbance reported is insomnia. People with insomnia typically find it difficult to fall asleep or stay asleep, and often wake up early in the mornings.

Worryingly, sleep problems sometimes persist even after recovery from the infection. A study in China found that 26% of people who were admitted to hospital with COVID showed symptoms of insomnia two weeks after discharge.

And a US study showed that people who had been infected with COVID were more likely than people who had never been infected to have trouble sleeping, even up to a month after a positive COVID test.

Sleep difficulties and long COVID

While most people recover from COVID quickly, some continue to have symptoms in the longer term. People suffering from long COVID seem very likely to face persistent sleep problems.

A 2021 study surveyed more than 3,000 people with long COVID. Almost 80% of participants self-reported sleep problems, most commonly insomnia.

A more recent study collected data on both sleep duration and quality using smart wristbands. Participants with long COVID slept less overall and got less deep sleep than participants who had never had COVID.

Loss of deep sleep is particularly concerning, as this type of sleep reduces how tired we feel and strengthens concentration and memory. Lack of deep sleep may be partly responsible for the commonly reported “brain fog” during and after COVID.

The fact COVID often interferes with sleep is also worrying because sleep helps our immune system to fight infections.

                           Sleep issues can happen to Long Covid sufferers (Source: Getty Images/Thinkstock)

Why does COVID affect our sleep?

There are many reasons why a COVID infection might lead to poor sleep. One review identified physiological, psychological and environmental factors.

COVID can have a direct impact on the brain, including the areas that control both wake and sleep states. We don’t yet have a clear understanding of how this works, but possible mechanisms could include the virus infecting the central nervous system or affecting the brain’s blood supply.

Typical symptoms of COVID include fever, coughing and breathing difficulties. These are also well known to disturb sleep.

Poor mental health can lead to sleep problems and vice versa. There’s a strong link between catching COVID and mental health issues, particularly depression and anxiety. This can be caused by worries about recovery, loneliness or social isolation. Such anxieties may make sleeping harder.

Meanwhile, hospitalised COVID patients can face additional difficulties trying to sleep in busy hospital environments where sleep is often disturbed by noise, treatment and other patients.

What about dreams?

The International COVID-19 Sleep Study, a global research project involving sleep scientists from 14 countries, recently released its findings into dreaming.

The study surveyed infected and uninfected participants about their dreams. Both groups had more dreams after the start of the pandemic than before. Intriguingly, the infected participants had more nightmares than the uninfected participants, while there was no difference between the groups before the pandemic.

There’s no simple explanation for why catching COVID may increase nightmares, but mental health may again play a role. Poor mental health is often accompanied by nightmares. The International COVID-19 Sleep Study team found the infected group showed more symptoms of conditions such as anxiety and depression.

Getting help

The close links between sleep and both mental and physical health mean that prevention and treatment of disturbed sleep have never been more important, and will require creative solutions from governments and healthcare providers.

If you’ve had trouble sleeping during or after COVID, or are having more bad dreams than you used to, you’re not alone.

Both short- and long-term insomnia can often be treated with cognitive behavioural therapy (CBT) that you may be able to access through your doctor.

                                         Darkness can help improve your sleep quality (Source: Pexels)

For less severe sleep problems, the European Academy for Cognitive-Behavioural Treatment of Insomnia has compiled recommendations, some based on principles applied in CBT, that you can follow at home.

These include:

*Keeping a regular sleep-wake schedule

*Restricting thinking about things that make you feel stressed to specific times of day using your bed only for sleep and sex going to bed and getting up when you naturally feel inclined to do so

*Sharing feelings of stress and anxiety with family and friends

*Reducing sleep disruption due to light exposure by making sure your bedroom is as dark as possible

*Exercising regularly in daylight avoiding eating close to bedtime.

https://indianexpress.com/article/lifestyle/health/covid-disturb-sleep-and-dreams-8365615/

Suggestions for a good night's sleep

From eu.coshoctontribune.com

By Emily Marrison

When I went out to feed the goats on a recent morning, I was happily greeted by two of my favourite does. Luna and Corona were two of my son’s first kids on our farm. Corona’s name will forever remind us she was born in April 2020. It is interesting how many names out there are associated with the pandemic. One that caught my eye this week is coronasomnia, from an OSU Extension Live Healthy Live Well blog by my colleague Jenny Lobb.

Coronasomnia is insomnia that has been worsened by or developed from the stress associated with the pandemic. Certain groups of people have an increased risk including people who have had COVID-19, frontline and essential workers, unpaid caregivers, women, young adults, and people of color. According to the Sleep Foundation, health care workers have been more than twice as likely to report anxiety and depression during the pandemic, which has affected their sleep.

Prior to 2020, about one-third of Americans experienced regular sleep deprivation. That number jumped to about 40% during the pandemic. Whether you have experienced insomnia in the past or these sleep troubles have come on more recently, there are steps you can take to improve your sleep.

The American Association of Sleep Medicine offers the following tips:

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations. “Catching up” on sleep has been associated with increased risk of heart disease.
• Set a consistent bedtime that is early enough for you to get at least 7 to 8 hours of sleep. It may be helpful to set an alarm on your phone or watch to remind you to begin your bedtime routine.
• Napping during the day may do more harm than good. A brief nap of 10 to 20 minutes may be refreshing, but if you struggle with insomnia try eliminating daytime naps altogether.
• It may sound childish but establishing a bedtime routine is helpful to trigger your mind and body to prepare for sleep. This could involve turning down lights, reading (not from an electronic screen), or taking a warm bath. Avoid drinking alcohol or caffeine or eating a large meal.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature. It may be helpful to keep it dark with light-blocking (blackout) curtains.
• If you don’t fall asleep within 20 minutes, get out of bed. Go do a quiet activity without a lot of light exposure. It is especially important to not get on electronics.

Lobb also shares that in addition to the habits above, establishing daily routines and getting outside at least once each day, ideally in the morning, can help reinforce your natural sleep-wake cycle. Finding ways to cope with stress is also important, as stress makes sleep difficult. Exercise, mindfulness practice and taking breaks from the news are all ways to reduce and manage stress.

The Alaska Sleep Clinic has found that sleep disturbance can be successfully addressed by offering prayers. “Prayers enhance our faith, make us optimistic, and help us relax. When we offer prayers, our mind produces happy hormones, which alleviate stress. Furthermore, prayers remind us that the Creator is there to decide the best for us. Thus, this belief and connection help us feel free from worldly matters.”

Today I’ll leave you with this quote from Wilson Mizener: “The amount of sleep required by the average person is five minutes more.”

Emily Marrison is an OSU Extension Family & Consumer Sciences Educator

https://eu.coshoctontribune.com/story/news/local/2022/12/11/suggestions-for-a-good-nights-sleep/69714846007/