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.
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.
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