Understanding Long COVID and Insomnia

If you think COVID-19 changed your sleep, you are not imagining it. Many people who report long COVID symptoms are noticing that their sleep has been affected. A group of researchers recently described the most common impacts of long COVID on sleep and how to treat them.¹

What is long COVID?

The authors describe long COVID as a condition "characterized by ongoing, returning, or new health problems after initial SARS-CoV-2 infection that persist for at least 12 weeks." Put more simply, symptoms stick around for over 3 months. The specific symptoms that linger often vary from person to person. And those symptoms may come and go for months at a time. It is a vague description, for sure.¹

As of now, there is no easy explanation for why some people recover fully from COVID after several days while other people develop long COVID. Researchers think the explanation is complicated and includes physical, psychological, and social factors.

Sleep and long COVID

Sleep-related symptoms are very common in long COVID. Between 14 and 45 percent of people with long COVID report sleep problems. This includes trouble falling and staying asleep, sleep apnea, and poor sleep quality.¹

How does long COVID lead to insomnia?

So, how can a run-of-the-mill COVID infection result in chronic insomnia? Again, researchers think the answer is complicated. There are likely several factors.

Pandemic-specific factors

The COVID pandemic brought about a lot of unique changes. This included social distancing and reduced overall physical activity. It is possible that these lifestyle changes contribute to insomnia. For example, physical activity can result in weight gain, which can worsen sleep.¹

Physical symptoms

Physical discomfort has a negative impact on sleep. It is not surprising to have a few nights of poor sleep if you are coughing a lot or have muscle aches. But if those physical symptoms persist in long COVID, they can have a lasting impact on your sleep.¹

Emotional and psychological factors

Psychological health can be impacted by COVID in several ways. Someone dealing with long-term COVID symptoms may experience frustration, depression, or anxiety. And the social stressors of the pandemic (social distancing, unemployment or under-employment, loss of loved ones) can also impact mental health. Of course, poorer emotional health can worsen sleep.¹

Body-wide inflammation

Researchers believe that all the factors above can combine to cause systemic inflammation. Our delicate nerves, tissues, and organs react to stress and invaders like the COVID virus by going on high alert. This is a healthy response that protects us, when it is time-limited. But when the threat is ongoing, our systems stay over-activated and cannot recover well.¹

This process affects many bodily functions, including sleep. Unfortunately, we need good sleep in order to reduce inflammation. So, inflammation and sleep problems can trigger each other in a constant loop.¹

Treating insomnia due to long COVID

Long COVID might trigger sleeplessness in a unique way. But the recommended treatment for COVID-related insomnia is not unique. That is because insomnia disorder usually persists because of other factors. Although 1 set of factors may trigger insomnia, other factors may keep it going long-term.

So, even though a COVID infection might have triggered your insomnia, your behaviors and thoughts are more likely to make it persist. For that reason, the authors of the study believe that standard insomnia treatments should work for insomnia associated with long COVID, too. They recommend starting with CBTI, a behavioral treatment for insomnia. CBTI targets the factors that keep insomnia going. And its relaxation strategies may also help with stress and anxiety related to long COVID.¹

The COVID pandemic changed a lot about our lives, including sleep. Fortunately, tried and true treatments for insomnia can help us find the “new normal” for our sleep.