Many individuals report difficulty sleeping during or after a COVID-19 infection. This widespread phenomenon, sometimes referred to as “coronasomnia,” reflects a complex interplay of physical, immunological, neurological, and psychological factors. Around 52% of individuals who contract COVID-19 experience sleep disturbances during the infection, with insomnia being the most common type reported. This issue can persist, with studies indicating that up to 31% of people with long COVID continue to experience disrupted sleep.
Acute Physical Symptoms
During an active COVID-19 infection, the body’s immediate physical responses can directly impede sleep. Symptoms such as fever and chills create a sense of discomfort that makes it difficult to relax and fall asleep. Body aches and muscle pain, common with viral infections, contribute to restlessness and an inability to find a comfortable sleeping position.
A persistent cough or nasal congestion can also significantly disrupt sleep continuity. These respiratory symptoms may lead to frequent awakenings throughout the night, preventing the sustained sleep cycles necessary for true rest. The discomfort from a sore throat further adds to the challenge of achieving restful sleep. Even medications used to treat these symptoms can sometimes contribute to sleep disruptions.
Immune System Interactions
Beyond the overt physical symptoms, the body’s immune response to SARS-CoV-2 plays a significant role in disrupting sleep. When fighting the virus, the immune system releases various inflammatory molecules, known as cytokines. These cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), are crucial for coordinating the immune defense but can also directly influence sleep-regulating centers in the brain.
This systemic inflammation can induce feelings of malaise and profound fatigue, which, paradoxically, do not always translate into restful sleep. Instead, the altered physiological state can lead to an increase in wakefulness and a reduction in the quality of sleep, including changes in sleep architecture like decreased deep sleep and rapid eye movement (REM) sleep. The immune system and sleep have a bidirectional relationship; while inflammation disrupts sleep, poor sleep can also lead to increased inflammatory responses, potentially worsening the illness.
Neurological and Psychological Factors
COVID-19 can affect sleep through both direct neurological impacts and significant psychological stress. The virus has the capacity to directly influence the central nervous system, potentially leading to symptoms like brain fog, headaches, or other neurological issues that disturb sleep patterns. Research suggests the virus may affect areas of the brain that regulate sleep and wake states, though the exact mechanisms are still being investigated.
Accompanying the physical and neurological effects are considerable psychological factors. The anxiety, stress, and fear associated with being ill, coupled with the uncertainty of the illness’s progression and potential long-term effects, can significantly heighten arousal. Social isolation during illness and concerns about financial stability further contribute to mental distress. These psychological burdens can make it exceedingly difficult to quiet the mind and achieve sleep, even after the acute physical symptoms subside.
Post-Infection Sleep Changes
Sleep problems can frequently persist even after the acute COVID-19 infection has resolved, forming a component of what is known as “long COVID.” Common post-COVID sleep issues include chronic insomnia, excessive daytime fatigue, and the development or worsening of sleep-disordered breathing. Insomnia is particularly prevalent, with studies finding that up to 76% of non-hospitalized individuals reported experiencing it within six months of infection. This can lead to reduced overall sleep time and less deep sleep, leaving individuals feeling unrefreshed despite sleeping.
Several factors contribute to these lingering sleep disturbances. Ongoing, low-grade inflammation in the body may continue to disrupt sleep-regulating pathways. Dysfunction of the autonomic nervous system, which controls involuntary bodily functions like heart rate and breathing, has also been implicated, potentially leading to issues such as orthostatic intolerance that affect sleep. The persistent neurological effects of the virus, including brain changes or neurovascular coupling disruptions, can also play a role in chronic sleep problems and associated symptoms like brain fog. The psychological toll of a prolonged illness and recovery can continue to impact sleep for weeks or months after the initial infection.