Daytime Sleep And Covid: What's The Link?

Sleep and Covid-19 have a complex relationship. While sleeping a lot is a natural response to illness, spending too much time in bed can disrupt your natural sleep-wake cycle, making it harder to sleep at night. This can weaken your immune system, prolong the infection, and make you feel pain more acutely.

Covid-19 can also cause insomnia, with studies showing that anywhere between half and three-quarters of Covid patients experience some kind of sleep problem during their initial infection. This can be caused by symptoms such as coughing and breathing difficulties, but also by psychological factors such as stress, anxiety, and depression.

For some, sleep issues during the acute infection develop into chronic insomnia with long-term consequences. Months after the initial infection, almost 50% of Covid long-haulers still experience sleep disturbances, with insomnia being the most common complaint.

There are many ways to try and improve your sleep when suffering from Covid-19. These include taking a hot shower before bed, using medication to mitigate symptoms, drinking lots of water, tea, or electrolyte drinks, and using a humidifier to improve nasal breathing.

Sleep disruptions during the night

COVID-19 Infection Factors

The COVID-19 virus can cause direct changes to the brain, affecting the thalamus, which regulates sleep/wake cycles, and potentially leading to difficulties sleeping at night and drowsiness during the day. The virus can also cause neurovascular coupling (NVC) disruption, affecting how brain cells receive the resources they need to function normally. If the affected areas include the hypothalamus or brainstem, sleep problems may arise.

Additionally, COVID-19 can cause dysfunction of the autonomic nervous system (ANS), specifically the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). In long COVID patients, the healthy balance between these two systems is disrupted, leading to permanent SNS dominance, which can cause abnormal heart rate, fatigue, shortness of breath, and headaches, as well as sleep issues.

The inflammatory response triggered by the virus can also affect sleep. As the body fights the infection, it produces cytokines, which promote sleep. However, in long-haulers, poor sleep compromises immune function, leading to a cycle of low-quality sleep and fatigue that can aggravate other symptoms.

Lifestyle and Environmental Factors

Lifestyle and environmental factors can also contribute to sleep disruptions during the night. These include excessive screen time before bed, vigorous exercise after 7 pm, and consuming caffeinated or alcoholic drinks later in the day. The COVID-19 pandemic has also brought about significant disruptions to daily routines and schedules, leading to increased stress and anxiety, which can further impact sleep quality.

Tips for Improving Sleep

To improve sleep quality and reduce disruptions during the night, it is recommended to maintain a consistent sleep and wake schedule, even on weekends. Creating a relaxing bedtime routine that includes activities such as meditation, progressive muscle relaxation, or breathing exercises can also help prepare the body and mind for sleep. Reducing screen time before bed and limiting caffeine, alcohol, and vigorous exercise close to bedtime can also promote more restful sleep.

For those struggling with long COVID insomnia, seeking medical advice and considering cognitive behavioral therapy for insomnia (CBT-I) may be beneficial.

Sleep aids and medication

If you are struggling with sleep, it is important to seek help. Sleep is life, and your body needs it to survive.

If you are experiencing insomnia in the wake of COVID-19, it is recommended to try simple actions first, such as taking a warm shower before bedtime, turning off your phone at least one hour before bed, exercising for 30 minutes per day (but not too close to bedtime), and avoiding caffeine after 4 pm.

Over-the-counter sleep aids may help, but if insomnia persists, it is important to see a doctor or sleep therapist.

Cognitive behavioural therapy (CBT) is considered the gold standard of insomnia treatment. CBT focuses on identifying thoughts, feelings, and behaviours that are contributing to insomnia symptoms.

If you are looking for additional sleep support, it is suggested to try melatonin, a natural sleep hormone that regulates the sleep-wake cycle. Start with 3 milligrams about 30 minutes before bedtime. Melatonin is non-habit forming and may give you the boost you need to fall asleep.

If you are struggling to sleep for weeks or months due to long COVID, it may be tempting to see sleeping pills as an easy fix. However, it is important to consult your doctor before taking any sleep aids.

The most common medications used to treat insomnia and other sleep problems include:

• Benzodiazepines: These are classed as psychoactive drugs. Currently, the FDA has approved five different meds to treat insomnia. However, they are not recommended for long-term use due to the high risk of abuse and dependence.
• Nonbenzodiazepines: These drugs were created to treat similar conditions as benzodiazepines but with fewer adverse effects and less abuse potential. They still require a prescription, and some patients experience side effects such as memory loss, poor balance, and falls.
• Melatonin agonist: As natural light begins to fade in the evening, the body starts to release melatonin, which triggers feelings of sleepiness and relaxation. Melatonin agonists enhance this process and can be used to treat patients who struggle to fall asleep. Side effects are less frequent than with benzodiazepines but can include dizziness, nausea, and fatigue.
• Orexin receptor antagonist: Orexin receptor antagonists block the effect of orexins, chemicals that help the brain stay awake. These drugs can be used for patients who struggle to fall asleep or wake up frequently at night.
• Off-label treatments: Certain medications developed to treat other conditions, such as antidepressants and antipsychotic medications, may also be used to treat insomnia symptoms. It is important to discuss the pros and cons of using these medications with your doctor before starting them.
• Melatonin supplements: Melatonin is a hormone that helps regulate the sleep-wake cycle and plays a role in the immune system and inflammatory responses. Studies show that melatonin supplements improve sleep quality in patients with COVID-19 and reduce the severity of the disease. Melatonin supplements are generally safe, but it is recommended to check with your doctor before starting any new supplements.
• Natural products: Some patients turn to natural supplements, such as valerian, chamomile, and kava, to reduce insomnia symptoms. There is some evidence that these products can be helpful for occasional use, and they are typically non-toxic and non-habit forming. However, it is advisable to inform your doctor if you are taking these products to ensure there are no interactions with other medications.

Sleep and mental health

Quality sleep is crucial for good mental health, but sleep issues can worsen mental health conditions, and mental health problems can lead to poor sleep. Poor sleep has been found to increase negative emotional responses to stressors and decrease positive emotions. It can also make it harder to cope with even minor stressors and impact our ability to perceive the world accurately.

There is a bidirectional relationship between sleep and mental health, where sleeping problems may be both a cause and consequence of mental health problems. For example, insomnia can be a symptom of anxiety and depression, but it can also contribute to the onset and worsening of these mental health issues.

Additionally, certain mental health conditions can further disrupt sleep patterns. For instance, people with bipolar disorder may feel less need to sleep during manic periods, but may sleep excessively during depressive periods. Similarly, people with schizophrenia are more likely to experience insomnia and circadian rhythm disorders, which can be exacerbated by the medications used to treat the condition.

Addressing sleep issues can be an important part of managing mental health. Cognitive behavioral therapy (CBT) is a type of counseling that can help improve both sleep and mental state by examining and reframing negative thought patterns. Improving sleep habits, such as maintaining a steady sleep schedule, winding down before bedtime, avoiding stimulants, and getting regular exercise and natural light exposure during the day, can also positively impact both sleep and mental health.

During the COVID-19 pandemic, sleep disturbances were linked to higher levels of psychological distress. The pandemic created a host of new challenges to sound sleep, with increased stress and uncertainty, changes to daily routines, and reduced physical activity. This led to an increase in insomnia and related sleep problems, which were labeled as "Coronasomnia."

Sleep and immune function

Sleep is a powerful regulator of immunological processes. Sleep and the circadian system bidirectionally communicate with the central nervous and immune systems, mediated by shared signals such as hormones, neurotransmitters, cytokines, and chemokines.

The sleep-wake cycle is the most prominent manifestation of the circadian rhythm, with immune parameters like leukocyte numbers, function, proliferation, and cytokine production exhibiting peaks and nadirs in synchrony. For example, the early resting period is characterised by a pro-inflammatory state, with increased production of pro-inflammatory and Th1 cytokines, while cytotoxic effector functions prevail during the wake period.

Sleep has been shown to enhance immune defence and facilitate the formation of immunological memory. Studies have demonstrated that sleep after vaccination can enhance the subsequent adaptive immune response, with a stronger and more persistent increase in the number of antigen-specific Th cells and antibody titres.

Prolonged sleep curtailment, on the other hand, has been associated with a persistent low-grade systemic inflammation and immunodeficiency, increasing the risk for various diseases.

During the COVID-19 pandemic, many individuals experienced sleep problems during their initial infection, and for some, these issues developed into chronic insomnia with long-term consequences. Almost 50% of COVID long-haulers still experience sleep disturbances months after the initial infection.

While the exact causes of sleep problems in long-haulers are not yet fully understood, it is likely a combination of multiple factors, including direct changes to the brain, neurovascular coupling disruption, dysfunction of the autonomic nervous system, inflammatory response, and psychological problems.

Treatment for COVID-related insomnia typically involves medication, such as benzodiazepines, nonbenzodiazepines, melatonin agonists, and orexin receptor antagonists. However, these medications may have side effects and a high risk of abuse and dependence. Alternative treatments include cognitive behavioural therapy for insomnia (CBT-I), chronotherapy, and natural products like valerian, chamomile, and kava.

Sleep and brain health

Sleep is essential for brain health and cognitive function. It is during sleep that the brain consolidates memories and clears plaque-forming amyloids and tau proteins associated with Alzheimer's disease. The brain also undergoes a cleanup process to get rid of toxins that have accumulated throughout the day.

A lack of sleep can affect your levels of neurotransmitters and stress hormones, making it more difficult to think and regulate your emotions. Sleep problems may also increase the risk of developing certain mental illnesses, such as depression and anxiety.

Research has shown a correlation between sleep disturbances and various neurological diseases, including stroke, cognitive ageing, dementia, and Parkinson's disease. For example, people with Parkinson's disease often experience REM sleep behaviour disorder, in which they physically act out their dreams, for years before their diagnosis.

The quality and quantity of sleep are both important. Most adults need 7-8 hours of sleep per night, although this can vary between individuals. If you are getting enough sleep, you should feel awake and attentive during the day and be able to carry out your daily activities.

To improve your sleep, it is recommended that you practice good sleep hygiene. This includes making your bedroom as comfortable, quiet, and dark as possible, and avoiding bright lights from electronic devices. It is also important to avoid stimulants such as caffeine and alcohol close to bedtime, as well as heavy meals, which may trigger acid reflux and disturb sleep.

If you are experiencing insomnia or other sleep problems, it is important to address them. Cognitive behavioural therapy (CBT) can be an effective treatment for insomnia, particularly if it is caused by anxiety and stress.

Frequently asked questions