Insomnia, a sleep disorder characterized by difficulty falling or staying asleep, significantly impacts daily life. It can lead to fatigue, impaired concentration, and mood disturbances. The COVID-19 pandemic has brought increased attention to sleep health, with many individuals reporting new or worsened sleep problems. This article explores the relationship between COVID-19 infection and sleep disturbances, focusing on insomnia.
Understanding the Connection
COVID-19 infection has been linked to sleep disturbances, affecting many individuals during acute illness and recovery. Prevalence of these disturbances in post-COVID-19 conditions varies widely (6% to over 70%). An online survey revealed 78.58% of participants experienced sleep disturbances after COVID-19.
A study of non-hospitalized COVID-19 survivors in Vietnam found 76.1% had insomnia, with 22.8% severe. Another study found significant insomnia in 50% of individuals at initial visit, persisting in 42% at a subsequent visit. These problems can emerge within two weeks and last for 48 weeks or more after testing negative or hospital discharge.
Acute COVID-19 insomnia can differ from persistent or new-onset insomnia associated with long COVID. Long COVID refers to symptoms enduring for at least two to three months after initial illness onset. Average prevalence of post-COVID-19 insomnia is estimated around 24%, with some studies reporting rates as high as 49.6% among patients with PASC.
Factors Contributing to Insomnia
COVID-19 can trigger insomnia through a combination of physiological, psychological, and behavioral factors. Physiologically, the virus can directly affect the central nervous system, disrupting sleep. Inflammation and immune dysregulation from infection may also contribute. Respiratory symptoms like persistent coughing or shortness of breath can make it difficult to sleep during acute illness and potentially in long COVID.
Psychological factors play a role, with stress, anxiety, and fear related to illness, isolation, and pandemic changes contributing to insomnia. Higher levels of anxiety and depression correlate with worse insomnia severity in individuals recovering from COVID-19. The psychological burden of infection and quarantine can negatively impact sleep quality. Worry about potential job loss or the ability to cope with quarantine can also exacerbate sleep problems.
Behavioral changes during the pandemic also contribute to sleep disruption. Altered daily routines, like irregular sleep-wake cycles due to confinement, can disrupt the body’s natural circadian rhythm. Reduced physical activity and increased screen time, particularly in the evening, can interfere with sleep onset and quality. Furthermore, medication side effects can sometimes influence sleep patterns.
Strategies for Management
Managing COVID-related insomnia often begins with adopting robust sleep hygiene practices. Establishing a consistent sleep schedule, going to bed and waking up at approximately the same time daily, even on weekends, helps regulate the body’s internal clock. Creating a conducive sleep environment involves ensuring the bedroom is dark, quiet, and kept at a comfortable, cool temperature. Removing electronic devices, like phones and tablets, from the bedroom and avoiding screen time for one to two hours before bed can reduce exposure to blue light, which can interfere with melatonin production.
Avoiding certain substances before bed also supports better sleep. It is advisable to limit caffeine intake, especially in the afternoon and evening, and to avoid alcohol and tobacco before bedtime, as they can disrupt sleep architecture and cause awakenings. Eating heavy meals close to bedtime should also be avoided. If unable to fall asleep within 20 to 30 minutes, getting out of bed and engaging in a relaxing, non-stimulating activity in another darkened room until feeling sleepy again can be helpful.
Incorporating relaxation techniques into a bedtime routine can prepare the mind and body for sleep. Practices such as mindfulness, deep breathing exercises, or gentle yoga stretches can help calm the nervous system. Engaging in light to moderate exercise regularly during the day, but avoiding vigorous activity within a few hours of bedtime, promotes better sleep. Cognitive Behavioral Therapy for Insomnia (CBT-I) is an effective non-drug treatment that addresses the thoughts and behaviors contributing to insomnia, often recommended as a first-line therapy for chronic insomnia.
Seeking Professional Help
It is advisable to consult a healthcare professional if insomnia persists for more than a few weeks, significantly impacts daily functioning, or if self-help strategies prove ineffective. A doctor can assess the situation to rule out any underlying medical conditions that might be contributing to sleep disturbances, such as sleep apnea or restless legs syndrome. They can also evaluate for co-occurring mental health issues like anxiety or depression, which are frequently linked with insomnia and may require separate treatment.
Persistent daytime sleepiness that is difficult to resist, or experiencing brief episodes of falling asleep during waking hours, especially while driving or working, are clear indicators to seek medical advice. A healthcare provider can recommend appropriate treatments, which may include referrals to sleep specialists or therapists trained in CBT-I. Early intervention can prevent acute insomnia from becoming a chronic problem and improve overall well-being.