Daytime Sleepiness: A Symptom Of Covid Or Something Else?

Sleep disturbances are a well-documented symptom of long COVID, which is generally regarded as the persistence or emergence of symptoms at least three months after a SARS-CoV-2 infection. During the acute phase of a COVID-19 infection, people can experience insomnia, which is defined as persistent difficulty falling asleep or staying asleep. This can be caused by anxiety, excessive screen time, loneliness, physical symptoms, and COVID-induced inflammation. While there is no universal definition of long COVID, the term generally describes symptoms that arise or persist one to three months after a COVID-19 infection.

Sleep disturbances during the acute phase of COVID-19

During the early stages of the pandemic, internet searches for insomnia increased by 58% in the United States compared to previous years, indicating a potential link between COVID-19 and sleep disturbances. This increase in insomnia may be attributed to heightened levels of stress, anxiety, and changes in daily routines caused by the pandemic.

Research has also found a connection between COVID-19 and eating disorders, with sleep disruptions being a contributing factor. The pandemic's impact on sleep patterns, such as reduced sleep quality and duration, may have played a role in exacerbating eating disorder symptoms.

Additionally, patients recovering from COVID-19 often experience a mixture of sleep problems, including insomnia and disruptions to their natural circadian rhythm, making it difficult to fall asleep at night and causing daytime sleepiness. These issues can persist for weeks or even months after the initial infection.

It is important to note that sleep disturbances can also be caused or exacerbated by pre-existing health conditions, such as obstructive sleep apnea, which is a risk factor for severe COVID-19. A comprehensive assessment of existing health problems and sleep habits is necessary to understand the root cause of sleep disturbances.

Post-COVID insomnia, or 'coronasomnia'

Post-COVID insomnia, or coronasomnia, is a common issue for people recovering from COVID-19. While coronasomnia is not an official medical condition, it does raise concerns about its impact on physical and emotional health over time. Sleep problems after a COVID-19 infection may include trouble falling asleep, staying asleep, and feeling sleepy during the day.

Factors that contribute to coronasomnia include anxiety, excessive use of electronic devices and social media, loneliness, physical symptoms associated with COVID infection, and COVID-induced inflammation. The latter can cause inflammation that disrupts the blood-brain barrier (BBB), which generally protects the brain from infections and medication side effects. A compromised BBB can lead to disturbances in brain function and the sleep cycle.

Additionally, changes in gut flora during and after a COVID-19 infection can affect brain activity and interfere with the body's sleep cycle. High-risk groups for coronasomnia include people with pre-existing sleep disorders or mental health conditions, and those who did not receive adequate medical attention during their illness.

Research suggests that coronasomnia may begin to resolve within about 6 to 12 months after the illness. To improve sleep during this time, it is recommended to establish a consistent sleep and waking schedule, limit caffeine and alcohol intake, avoid naps late in the day, exercise regularly, and incorporate relaxing activities into your bedtime routine. If sleep issues persist, it is important to consult a healthcare provider, as insomnia and daytime sleepiness can substantially impact your quality of life.

Factors contributing to coronasomnia

Coronasomnia is a term used to describe the broad scope of sleep problems related to the COVID-19 pandemic. It is not a direct result of a coronavirus infection but rather a lack of sleep resulting from disrupted daily routines, increased stress, and poor sleep patterns.

• Isolation and detachment from other people: The pandemic has led to greater degrees of social isolation, which can negatively impact emotional health and sleep.
• Increased screen time: With many places closed, people have relied on TVs, computers, and phones for entertainment. These devices emit blue light, which decreases melatonin production and throws off our circadian rhythms.
• Working from home: Without standard office hours, sleep schedules have been disrupted, and people are working, sleeping, and doing everything else at all hours.
• Pandemic-driven restrictions: Constantly changing plans and restrictions on activities can make it hard to maintain a normal routine, throwing off daily schedules and the body's internal clock or circadian rhythm.
• Stress and anxiety: Worries about personal health, family, work, and finances are common during the pandemic and can trigger sleep problems, including insomnia.
• Pandemic fatigue: The long-running waves of infections and virus variants have led to pandemic fatigue, associated with poor sleep.
• Caregiving roles: Attending to children who are kept home from school or taking care of a loved one who has COVID-19 can be demanding and weigh on a person's sleep.
• Undiagnosed sleep disorders: Limited access to healthcare facilities during the pandemic has meant that some people have gone without treatment for sleep disorders like obstructive sleep apnea (OSA).
• Reduced medical care: Many people have avoided seeking non-urgent medical care, meaning their pain and other sleep-disturbing symptoms may remain untreated.
• Excessive dependence on electronic devices and social media: This can contribute to insomnia, especially when coupled with increased screen time.
• Physical symptoms associated with COVID infection: Gastrointestinal disturbances, pain, or difficulty breathing can make it hard to get solid rest.
• COVID-induced inflammation: COVID-19 can cause inflammation that disrupts the blood-brain barrier, leading to disturbances in brain function and the sleep cycle.
• Disruption in the gut-brain axis: COVID-19 can alter the gut flora, which can affect brain activity and interfere with the body's sleep cycle.

Circadian rhythm disruption

The circadian rhythm is a biological clock that regulates and facilitates an individual's ability to respond and adapt to daily changes in the external environment. It includes almost all physiological and behavioral functions in an organism, such as the cardiovascular, gastrointestinal, neurological, and immune systems. The circadian rhythm is reset daily by the master clock in the body, located in the suprachiasmatic nucleus (SCN) in the hypothalamus.

Circadian Rhythm and COVID-19 Severity

The circadian rhythm plays a crucial role in the severity of COVID-19 infection. The defense system in the body follows a rhythmic pattern, and the relationship between circadian timekeeping, host immunity, and host-virus interactions is a developing concept. The host's susceptibility to the SARS-CoV-2 virus has been reported to be dependent on the biological clock in the body.

Shift Work and Circadian Disruption

Shift workers are at a higher risk of developing diet-related chronic illnesses such as obesity, type 2 diabetes mellitus, and cardiovascular disease compared to non-shift workers. This is due to the disruption of the circadian rhythm, which is also attributed to their poor food habits. Shift workers are more prone to eating on a 24-hour basis, and the sleep constraint increases the levels of leptin and ghrelin, thus increasing appetite at night.

Immunity and COVID-19

The human body's immune response is divided into innate and adaptive immunity. While innate immunity responds rapidly and non-specifically to pathogens, adaptive immunity reacts more slowly but in a specific manner, producing a long-lived immunological memory. During the SARS-CoV-2 infection, the adaptive immune response can target the four structural proteins of the virus: the envelope, spike glycoprotein, membrane, and nucleocapsid.

Circadian Rhythm and Immunity

The circadian rhythm regulates both the innate and adaptive immune responses, which include various immune cells and proteins. A disruption in the circadian rhythm can lead to a dysregulation of these immune responses, resulting in a compromised immune system.

In conclusion, circadian rhythm disruption can increase the severity of COVID-19 infection by compromising the immune system. Shift workers are particularly vulnerable to circadian rhythm disruption and are at a higher risk of developing chronic illnesses, making them more susceptible to the virus. Further studies are needed to understand the complex interactions between the circadian rhythm, immunity, and COVID-19 fully.

Sleep problems and mental health

Sleep is essential for maintaining good mental health. Not getting enough sleep or poor-quality sleep can increase the risk of mental health disorders. While insomnia is often a symptom of psychiatric disorders like anxiety and depression, it is now recognized that sleep problems can also contribute to the onset and worsening of different mental health issues.

The Impact of Sleep Deprivation on Mental Health

Sleep deprivation can increase negative emotional responses to stressors and decrease positive emotions. It can also make it more difficult to cope with stress and regulate emotions. Sleep-deprived individuals may experience increased anxiety and distress levels, and have trouble making decisions, solving problems, controlling their emotions and behavior, and coping with change.

The relationship between sleep and mental health is bidirectional, meaning that sleep problems may be both a cause and a consequence of mental health issues. This relationship is observed in various mental health disorders:

• Depression: Around 75% of people with depression experience insomnia, and many also suffer from excessive daytime sleepiness and hypersomnia (sleeping too much). Poor sleep may induce or exacerbate depression, creating a negative feedback loop.
• Anxiety: Anxiety disorders have a strong association with sleeping problems. Worry and fear contribute to a state of hyperarousal, which is considered a central contributor to insomnia. Chronic insomnia may be a predisposing trait among people who go on to develop anxiety disorders.
• Post-Traumatic Stress Disorder (PTSD): People with PTSD frequently replay negative events in their minds, suffer from nightmares, and experience a state of being constantly alert, all of which can interfere with sleep.
• Bipolar Disorder: Sleep patterns change considerably depending on the emotional state of individuals with bipolar disorder. During manic periods, they usually feel less need to sleep, while during depressed periods, they may sleep excessively.
• Schizophrenia: People with schizophrenia are more likely to experience insomnia and circadian rhythm disorders.
• Attention-Deficit/Hyperactivity Disorder (ADHD): Sleeping problems are common in people with ADHD, who may have difficulty falling asleep, experience frequent awakenings, and suffer from excessive daytime sleepiness.
• Autism Spectrum Disorder (ASD): Children and adolescents with ASD have a higher prevalence of sleep problems, including insomnia and sleep-disordered breathing, which can contribute to a worsening of symptoms and quality of life.

Improving Sleep and Mental Health

Given the close connection between sleep and mental health, improving sleep can be a beneficial component of treating many psychiatric disorders. Here are some general tips to improve sleep:

• Keep a consistent sleep schedule, even on weekends.
• Set a bedtime that allows you to get at least 7 hours of sleep.
• Establish a relaxing bedtime routine to help transition from your day.
• If you're having trouble falling asleep, don't lie in bed awake. Get out of bed and do something relaxing until you feel tired.
• Create a healthy sleep environment by avoiding bright lights and loud sounds, keeping the room cool, and limiting electronics in your bedroom.
• Exercise regularly, but not within a few hours before going to bed.
• Avoid caffeine, nicotine, and alcohol close to bedtime, as these substances can disrupt sleep.

Frequently asked questions