Sleep disturbance, often called “coronasomnia,” is a common experience during an acute COVID-19 infection. Studies estimate that a significant percentage of individuals who contract the SARS-CoV-2 virus experience insomnia. This widespread problem is not merely a result of general discomfort but stems from a complex interplay of physical symptoms, systemic biological changes, and psychological distress. Understanding these mechanisms can help explain why restful sleep feels so elusive.
The Role of Physical Symptoms
The most immediate barriers to sleep are the physical symptoms associated with the infection. Respiratory issues, such as nasal congestion, a persistent cough, and shortness of breath, force frequent awakenings throughout the night. These symptoms make sustained, comfortable breathing difficult, often requiring positional adjustments that interrupt the natural sleep cycle.
Fever and chills also severely disrupt the body’s thermoregulation, a process tightly linked to sleep onset and maintenance. The body’s core temperature naturally drops before and during sleep; however, a fever overrides this mechanism, making it difficult to find a comfortable temperature and stay asleep. Furthermore, generalized body aches, muscle pain (myalgia), and headaches are common complaints that make lying still for long periods nearly impossible. Finding a pain-free position becomes a constant effort that prevents the mind and body from fully relaxing into deeper stages of sleep.
Biological and Hormonal Drivers of Insomnia
The body’s own defense system actively works to keep the brain alert. The primary driver is the inflammatory response orchestrated by the immune system to fight the virus. When the body detects an invader, immune cells release signaling proteins called cytokines, such as Interleukin-6 (IL-6) and Tumor Necrosis Factor-alpha (TNF-α). The overall inflammatory state disrupts the delicate balance of neurotransmitters in the brain’s sleep centers. This systemic inflammation can lead to a state of hyperarousal, making it difficult to transition into and maintain deep, restorative sleep.
The fight against infection also elevates stress hormones, particularly cortisol. Cortisol is a wake-promoting hormone, and its sustained increase due to the body’s high-alert state contributes to a feeling of being “wired and tired,” further preventing the consolidation of sleep. The virus or resulting inflammation can also interfere with the body’s natural 24-hour internal clock, known as the circadian rhythm. Illness and the enforced change in daily routine, such as spending more time indoors with limited light exposure, can lead to a misalignment of this rhythm, causing delayed sleep onset or early morning awakening.
Psychological Factors and Anxiety
The mental and emotional stress of being ill adds another layer of complexity to sleep disruption. Worry about one’s health status, the fear of the illness progressing, or monitoring symptoms constantly can trigger anxiety that is counterproductive to sleep. This hypervigilance creates a mental arousal that keeps the brain active long after the body is ready to rest. Isolation during quarantine or the general stress of a major illness can also contribute to feelings of loneliness and emotional distress. These psychological factors are independently associated with an increased risk of developing insomnia symptoms. A common issue that develops is “sleep anxiety,” where the fear of not being able to sleep creates a self-fulfilling cycle of wakefulness. The more a person tries to force sleep, the more elusive it becomes, leading to frustration and heightened mental activity.
Strategies for Restful Sleep During Infection
Targeting the symptoms that impede sleep can provide significant relief during an acute infection. Using approved over-the-counter medications to manage pain, fever, and congestion shortly before bedtime can reduce the physical discomfort that triggers awakenings. For those with respiratory symptoms, adjusting the sleeping position, such as propping the head up with extra pillows, may help reduce post-nasal drip and ease coughing fits.
Maintaining certain sleep hygiene practices, even while sick, helps reinforce the body’s natural rhythm:
- Try to keep a consistent wake-up time, even if the previous night was poor.
- Limit daytime naps to 30 minutes or less to preserve the drive for sleep at night.
- Use simple relaxation techniques, such as deep breathing exercises or guided meditation, to help lower the mental arousal that contributes to anxiety-driven insomnia.
- Avoid screens and stimulating content, like news, for at least an hour before attempting to sleep.