COVID-19 infection often prevents restful sleep, even though the body desperately needs rest to fight the virus. This significant sleep disruption, sometimes called “coronasomnia,” is not just a side effect of feeling sick. The inability to fall or stay asleep stems from the virus’s direct impact on the body and the subsequent immune response. Successfully navigating recovery requires understanding the multiple mechanisms—physical, biological, and psychological—that conspire to keep you awake.
The Physical Symptoms Preventing Rest
The most immediate barriers to sleep are physical discomforts. Fever and chills disrupt the body’s thermoregulation, making it difficult to maintain the slight drop in core temperature needed to initiate sleep. These temperature fluctuations often spike at night when the immune system is active, leading to restless cycles of sweating and shivering that fragment rest.
Congestion and respiratory symptoms are particularly disruptive when lying down, as gravity allows mucus to pool. Lying flat exacerbates nasal blockage and triggers post-nasal drip, which irritates the throat and leads to persistent, hacking coughs that rouse you from sleep. This cycle of coughing and congestion makes sustained quiet breathing nearly impossible.
Body aches, known as myalgia, also prevent comfort. These persistent pains in the muscles and joints make finding a comfortable sleeping position difficult, often forcing frequent shifts in position. Thermal discomfort, respiratory effort, and pain ensure the body remains in a state of hyper-alertness.
Immune Response and Biological Sleep Disruption
The body’s internal fight against the virus actively interferes with normal sleep cycles on a chemical level. When the immune system detects SARS-CoV-2, it releases a surge of inflammatory signaling molecules known as cytokines. While some cytokines, like Interleukin-1 beta (IL-1β) and Tumor Necrosis Factor-alpha (TNF-α), are somnogenic at low concentrations—meaning they promote the feeling of sleepiness associated with being sick—high concentrations have an opposite, disruptive effect.
In a healthy state, sleep architecture is organized into repeating cycles of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. High levels of pro-inflammatory cytokines released during acute infection fragment this structure. These powerful chemicals act on sleep regulatory areas in the brain, inducing frequent, brief awakenings that prevent the consolidation of sleep stages.
This immune response can suppress REM sleep, the stage associated with dreaming and memory consolidation, and reduce the duration of deep, restorative slow-wave sleep (SWS). The result is shallow, unrefreshing sleep, leaving you exhausted but “wired.” This chemical interference can also temporarily disrupt the body’s master clock, or circadian rhythm.
Psychological Factors and Medication Effects
Sleep disruption is not solely physical; the mental strain of the illness contributes substantially to sleepless nights. Anxiety related to the infection—worry about symptoms, progression, or isolation—triggers the release of stress hormones like adrenaline and cortisol. Elevated cortisol levels, particularly at night, promote wakefulness and agitation, making it difficult to relax and fall asleep.
Disruption to daily life, such as being confined, can confuse the body’s natural sleep signals. Losing a structured routine weakens the circadian rhythm, leading to inconsistent sleep patterns. This psychological hyperarousal often persists even after physical symptoms subside.
Medications taken to alleviate symptoms can also complicate sleep. Over-the-counter cold and flu remedies frequently contain decongestants, such as pseudoephedrine, which function as central nervous system stimulants. This stimulating effect increases heart rate and blood pressure, leading to insomnia and agitation. Additionally, some people experience “paradoxical excitation” from first-generation antihistamines like diphenhydramine (DPH), commonly included in “nighttime” formulas. Instead of drowsiness, they experience restlessness and jitters, effectively turning a sleep aid into a stimulant.
Strategies for Improving Sleep While Sick
To counteract the forces preventing rest, specific strategies can help mitigate the illness’s effects. One effective way to manage respiratory symptoms is through positional changes. Elevating the head and shoulders using two or three firm pillows or a wedge pillow helps gravity drain mucus, reducing post-nasal drip and minimizing coughing fits.
Timing medication correctly is a powerful strategy. Stimulant decongestants should be avoided entirely in the afternoon and evening to prevent wakefulness near bedtime. Instead, prioritize long-acting pain and fever relievers, such as naproxen, which can provide up to twelve hours of relief from myalgia and fever, ensuring sustained comfort during the sleep window.
To address biological and psychological hyperarousal, focus on environmental controls and relaxation. Maintain a cool, dark, and quiet sleeping environment to support the body’s natural drop in core temperature and minimize external disturbances. Incorporating simple relaxation techniques, such as slow, deep breathing or meditation, before attempting to sleep can help lower elevated cortisol levels and calm the anxious mind. A humidifier can also soothe irritated airways, providing relief from dryness that exacerbates nighttime coughing.