Sleep disruption is a common issue for many individuals infected with COVID-19. Evidence indicates COVID-19 can cause both short-term and long-term sleep problems. As many as 40% of people reported difficulties sleeping during the pandemic, with an estimated 36% experiencing insomnia symptoms during the first wave. This widespread problem highlights the need to understand its underlying causes.
Direct Physical Discomforts
Direct physical symptoms of COVID-19 are immediate reasons for sleep difficulties. A persistent cough frequently interrupts sleep, making it challenging to fall and stay asleep. Fever and chills, common with COVID-19, also create an uncomfortable environment not conducive to rest.
Nasal congestion and sinus pressure make breathing difficult, often leading to snoring or waking due to obstructed airways. Body aches and a sore throat contribute to discomfort, making it hard to find a comfortable sleeping position. Shortness of breath, experienced by about 40% of patients, significantly impacts sleep quality and links to persistent sleep disruption in long COVID cases.
Immune System Activation
The body’s biological response to COVID-19 disrupts normal sleep mechanisms. The virus triggers excessive immune system activation, leading to inflammation. This inflammatory response involves the release of signaling molecules called cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α).
While some cytokines promote daytime sleepiness, elevated pro-inflammatory cytokines disrupt consolidated sleep patterns at night. These substances interfere with the brain’s sleep-wake cycles, altering sleep architecture and reducing deep, restorative sleep. The body’s stress response during infection also increases cortisol levels. Persistently high cortisol makes it difficult to fall asleep or maintain sleep, contributing to insomnia.
Mental and Emotional Strain
Psychological factors also play a significant role in sleeplessness during a COVID-19 infection. Anxiety about the illness, its severity, recovery time, and potential for long-term effects like “long COVID,” can keep the mind racing. This constant worry activates the body’s “fight or flight” response, making relaxation and sleep challenging.
Stress from isolation, fear of transmitting the virus, and general apprehension contribute to an overactive mind that struggles to quiet down at night. Studies show an increase in anxiety and depression symptoms during the pandemic, strongly linked to insomnia and other sleep problems. Even mild COVID-19 infections can make insomnia more likely, especially in individuals with pre-existing anxiety or depression.
Medication and Lifestyle Factors
External factors related to treatment and daily routine changes can worsen sleep problems during COVID-19. Over-the-counter cold and flu medications, particularly decongestants containing pseudoephedrine, can have stimulant effects. Pseudoephedrine stimulates the central nervous system, making it difficult to fall asleep or disrupting sleep quality, especially if taken close to bedtime.
A disrupted daily routine, common when ill, impacts the body’s natural circadian rhythm. Increased napping, irregular sleep schedules, or prolonged bed rest can throw off the internal clock regulating sleep and wakefulness. This circadian rhythm misalignment can make it harder to initiate and maintain sleep at night, even as physical symptoms improve.