Daytime Sleepiness: A Symptom Of Coronavirus?

The COVID-19 pandemic has had a profound impact on people's sleep patterns, with many individuals reporting insomnia and other sleep disturbances during and after their infection. This phenomenon has been dubbed coronasomnia, and it can be caused by various factors such as anxiety, excessive screen time, loneliness, physical symptoms of the virus, and changes in brain function due to inflammation. While insomnia is not listed as a key symptom of COVID-19, studies indicate that around 52% of infected individuals experience sleep disruptions. The pandemic has also led to cultural shifts and increased stress, anxiety, and depression, which can further contribute to sleep issues. Managing these mental health concerns and making conscious lifestyle choices are crucial steps in improving sleep quality.

Sleep can help fight off the virus

Sleep is essential for health, and getting enough of it can help your body fight off viruses like COVID-19. When your body is fighting off an infection, it needs more sleep to strengthen the immune system and increase the activity of certain immune cells, such as T-cells.

During the pandemic, around 52% of people with COVID-19 experienced sleep problems, and up to 31% of people with long COVID continue to have disrupted sleep. Sleep issues are likely in the 6 months after a COVID-19 infection, with 76% of people in one study reporting insomnia within this timeframe.

However, it's important to note that the relationship between COVID-19 and sleep is complex. While the virus can cause sleep problems, the pandemic has also disrupted sleep patterns due to factors such as stress, isolation, altered routines, and increased screen time.

• Keep a sleep diary to track your sleep patterns and identify any issues.
• Reestablish daily routines to help regulate your body's internal clock and promote a stable sleep-wake schedule.
• Prioritize natural light exposure during the day, especially in the morning, to promote healthier sleep at night.
• Stay physically active, as daily exercise is linked to better sleep.
• Find ways to unwind before bedtime, such as meditating, stretching, or journaling.
• Cut back on caffeine, especially in the afternoon and evening, as it can interfere with sleep.
• Minimize alcohol consumption, as it can cause sleepiness and reduce sleep quality.
• Create a healthy sleep environment by reducing noise and light and ensuring a comfortable temperature.
• Consult a doctor if you have persistent sleep issues, as they can help identify any underlying causes and provide guidance.

Sleep disruption can leave the immune system compromised

For example, restricting sleep to 4 hours for one night reduced natural killer (NK) cell activity to an average of 72% compared to those who had a full night's sleep. NK cells play a substantial role in killing tumour cells. Sleep loss has also been linked to a higher risk of infection. Restricting sleep to 4 hours per night for 6 days resulted in a greater than 50% decrease in the production of antibodies to the influenza vaccination, when compared to subjects who had regular sleep hours.

Sleep loss can also lead to the generation of inflammatory cytokines, which play an important role in the development of cardiovascular and metabolic disorders. Cytokines are protein molecules secreted by immune cells that signal other cells to promote inflammation.

The immune system is critical to overall health, and consistent sleep strengthens it, allowing for balanced and effective immune function. Lack of sleep, on the other hand, can throw off the immune system and make you sick. Sleep deprivation has been linked to both short-term illnesses and the risk of chronic diseases like diabetes and heart problems.

In the short term, the risk of infections is higher in people who sleep less than 6 or 7 hours per night. Studies have found that insufficient sleep makes it more likely to catch the common cold or the flu. Lack of sleep has also been connected to multiple long-term health problems, and this is believed to be related to the negative effects of sleep deprivation on the immune system.

In people who get sufficient sleep, inflammation during the night recedes back to a normal level before waking up. In people who don't get enough sleep, this self-regulating system fails, and inflammation persists, contributing to an elevated risk of diabetes, cardiovascular disease, pain, and neurodegenerative diseases.

Therefore, it is important to prioritize getting a sufficient amount of uninterrupted sleep every night to strengthen your immune system.

Anxiety, depression, and insomnia are linked

While sleeping all day is not a sign of coronavirus, a study has found that sleep issues are likely in the 6 months after a COVID-19 infection, affecting more than 3 in 4 people. The study also found that those with pre-existing anxiety or depression were at a greater risk of insomnia after COVID-19.

Anxiety, depression, and insomnia are closely linked. A study by H Ariel Bard and colleagues found that insomnia, depression, and anxiety symptoms interact and individually impact functioning. The study identified "uncontrollable worrying", "trouble relaxing", and "depressed mood/hopelessness" as the most connected nodes in the network.

Another study by Höglund and colleagues found that of a random sample of 3406 participants, 13.9% had been diagnosed with anxiety, 6.4% with depression, 28.6% with insomnia, and 14% reported self-perceived stress. The study also found that anxiety and stress are closely linked and are among the chief causes of insomnia.

A further study by Rob Newsom found that a majority of people with depression experience sleep issues. Approximately 40% of people with insomnia have clinical depression, and up to 80% of patients with depression experience bouts of insomnia. Sleep issues may influence the function of the neurotransmitter serotonin, which can contribute to the development of depression.

Treatment Options

Treating sleep problems can help alleviate depressive symptoms. Cognitive behavioral therapy (CBT) is a type of counseling that can be effective in treating depression and insomnia. CBT-I is a type of CBT that focuses on managing chronic insomnia. Medications such as antidepressants and serotonin reuptake inhibitors (SSRIs) can also help improve symptoms of depression and insomnia.

Sleep problems may persist for months after infection

A study published in February 2024 in Frontiers of Public Health found that sleep issues are likely in the six months after a COVID-19 infection, affecting more than 3 in 4 people. The study surveyed over 1,000 people who had recovered from COVID-19 and did not require hospitalization, with none of the participants having a history of insomnia or psychiatric conditions.

The results showed that just over 76% reported experiencing insomnia within six months of their initial infection, with nearly 23% reporting severe insomnia. The study also found that those with pre-existing chronic conditions such as cardiovascular disease, diabetes, and cancer had a "statistically higher rate of insomnia". Additionally, participants with depression or anxiety were more than three times as likely to experience insomnia.

The study's limitations included the fact that it was based on self-reported data rather than direct observations, and that it did not prove causation between COVID-19 and insomnia, only an association. However, the findings highlight the potential impact of COVID-19 on sleep, even for those with mild cases.

Long COVID, a chronic condition that causes symptoms long after the initial virus exposure, can also contribute to sleep issues. Individuals with Long COVID may experience extreme fatigue, brain fog, dizziness, and digestion issues for weeks, months, or even years after their initial infection. While the exact cause of Long COVID is unknown, one hypothesis suggests that it may be due to an autoimmune response triggered by the virus, leading to chronic inflammation and damaged tissues.

It is important to note that sleep issues can have various causes, and seeking medical advice is recommended for anyone experiencing persistent sleep problems.

Sleep may be affected by changes to daily life

Additionally, COVID-19 can cause physical symptoms such as gastrointestinal issues, pain, and difficulty breathing, which can further disrupt sleep. Research suggests that infection with COVID-19 is associated with trouble sleeping during and after the infection. This has been termed "coronasomnia," and it can last for months after the acute phase of the infection. Studies have found that a significant percentage of people who have recovered from COVID-19 continue to experience insomnia.

The impact of the pandemic on sleep is complex and multifaceted. It is important to recognize that sleep is fundamental not only for general health but also for a well-functioning immune system. Addressing sleep problems and maintaining healthy sleep habits are crucial for overall well-being.

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