Daytime Sleepiness: A Symptom Of Coronavirus?

Sleep issues are a common symptom of COVID-19, with around 52% of people experiencing insomnia during their illness. This phenomenon has been termed 'coronasomnia' and can persist for months after the initial infection. However, it is important to note that sleep problems are not unique to COVID-19 and can be caused by various other factors. While fatigue is a well-known symptom of COVID-19, sleeping all day could also be indicative of long COVID, where people experience prolonged symptoms and side effects of the virus, such as fatigue, brain fog, and mental health issues, long after their initial recovery.

Sleep problems can persist after recovering from COVID-19

Feeling sleepy or lacking energy are common symptoms of COVID-19. However, sleep problems can persist after recovering from the initial infection, and are considered a symptom of long COVID.

Fatigue is a key symptom of COVID-19, and it can be worse than anything experienced previously. It is not just feeling tired, but an "extraordinary sense of weariness and a lack of energy that is not only physical but also cognitive, emotional, and mental".

The severity and duration of COVID-19 fatigue are often correlated with the severity and duration of the illness itself. For people who are hospitalised with COVID-19, it might take a few months before they recover their energy levels. For those who recover at home, it might take just one or two weeks for the fatigue to abate.

Fatigue is one of the most reported symptoms of long COVID, and studies suggest that a large number of people may continue to struggle with fatigue three to twelve months after infection. With long COVID, fatigue is also an aspect of post-exertional malaise, described as an "energy crash" following any activity that involves effort. For some people with long COVID, even a ten-minute walk can result in debilitating exhaustion that lasts for days.

If bothersome COVID symptoms, including fatigue, persist beyond three months, it is recommended to check in with a healthcare provider.

Factors contributing to coronasomnia

Coronasomnia is a term used to describe sleep disorders that develop due to stress, anxiety, or depression associated with the COVID-19 outbreak. Hailey Meaklim, a researcher at Monash University and a psychologist at the Sleep Disorder Centre of St Vincent’s Hospital, defines coronasomnia as "insomnia that began during the coronavirus pandemic". Insomnia symptoms include difficulty falling asleep, staying asleep, or waking up too early.

The COVID-19 pandemic has had a significant impact on sleep patterns, with large-scale studies reporting increases in clinical insomnia since the pandemic began. For instance, a study in China involving 5,461 individuals found a 37% increase in clinical insomnia, while another study in Canada with 594 respondents reported a 26.7% increase in overall insomnia symptoms, including fatigue, anxiety, sleep quality, and depression.

Several factors contribute to coronasomnia:

• Anxiety and stress: The COVID-19 outbreak caused significant stress and anxiety for many people, and these psychological factors are critical contributors to coronasomnia. The uncertainty, health concerns, and lifestyle changes associated with the pandemic disrupted sleep patterns and routines.
• Isolation and social distancing: Spending prolonged periods in isolation and practising social distancing to stay safe during the pandemic disrupted daily routines and sleep schedules. The lack of structure and routine can negatively impact sleep quality.
• Work-from-home culture: The increase in working from home during the pandemic led to less distinction between work and personal time, with many individuals working and sleeping at irregular hours. This disruption of standard office hours and daily routines contributed to coronasomnia.
• Increased screen time: With more people working and staying at home, there was also an increase in exposure to electronic devices such as TVs, computers, and phones. The blue light emitted by these screens can disrupt the production of melatonin, a hormone that regulates sleep.
• Physical symptoms of COVID-19 infection: Physical symptoms associated with COVID-19, such as gastrointestinal disturbances, pain, and difficulty breathing, can also contribute to coronasomnia. These symptoms can make it difficult to get comfortable and fall asleep or cause frequent awakenings during the night.
• COVID-induced inflammation: The COVID-19 virus 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 infection can alter the gut flora, which is the bacterial environment in the stomach and intestines that promotes digestion and immunity. Changes in gut flora can impact brain activity and interfere with the body's sleep cycle.
• Pre-existing sleep disorders and mental health conditions: Individuals who already had sleep disorders or mental health conditions such as anxiety or depression before contracting COVID-19 are at a higher risk of developing coronasomnia.

Long-term sleep effects post-COVID

Sleep issues are considered one of the long-term effects of COVID-19. Often labelled as "coronasomnia", these sleep difficulties can persist even after the infection has resolved. Research has shown that many people experience coronasomnia within six to twelve months after the infection. However, it is important to note that the factors contributing to coronasomnia are ever-evolving.

• Daytime sleepiness, napping, and resulting trouble falling asleep due to daytime naps.
• Excessive reliance on sleep aids and difficulty stopping their use.
• Preoccupation with sleep or excessive worry about coronasomnia.
• Racing thoughts when trying to sleep.
• Waking up after falling asleep.
• Worsening of underlying sleep apnea (pauses in breathing during sleep).

Additionally, anxiety about insomnia can worsen the condition. Here are some measures that may help improve sleep:

• Avoid caffeine or alcohol late in the day or altogether.
• Schedule stressful tasks or problem-solving for the daytime to avoid thinking about them at night.
• Avoid napping late in the day.
• Get enough exercise, but avoid strenuous exercise within a few hours of bedtime.
• Incorporate relaxing activities into your bedtime routine, such as stretching or reading.
• Maintain a comfortable temperature in the bedroom.
• Manage stress and anxiety.
• Maintain a consistent sleep and waking schedule.

It is important to consult a healthcare provider if you consistently experience trouble sleeping or feel tired during the day. Treatment options are available and can help improve these symptoms.

Daytime sleepiness and its consequences

Daytime sleepiness is a common symptom of "long COVID", with up to 31% of people experiencing disrupted sleep several months after their initial infection. This can have a substantial impact on your quality of life, and it is important to address it.

Causes

There are several factors that contribute to daytime sleepiness after a COVID-19 infection:

• Anxiety: feelings of anxiety associated with the infection or the pandemic can disrupt sleep.
• Excessive screen time: spending too much time on electronic devices and social media can impact your sleep.
• Loneliness: detachment and isolation from other people can affect your sleep patterns.
• Physical symptoms: gastrointestinal disturbances, pain, or difficulty breathing associated with COVID-19 can make it hard to sleep.
• Inflammation: COVID-19 can cause inflammation that disrupts the blood-brain barrier, leading to disturbances in brain function and the sleep cycle.
• Gut flora changes: alterations in the gut flora during and after COVID-19 infection can affect brain activity and interfere with the body's sleep cycle.

Consequences

The consequences of daytime sleepiness can be far-reaching and include:

• Difficulty falling asleep at night, leading to a cycle of tiredness and napping during the day.
• Increased reliance on sleep aids, which can be difficult to stop using.
• Preoccupation with sleep or excessive worry about insomnia.
• Racing thoughts when trying to sleep.
• Worsening of underlying sleep apnea.

Strategies to Improve Sleep

If you are experiencing daytime sleepiness, there are several strategies you can try:

• Avoid caffeine and alcohol, especially later in the day.
• Schedule stressful tasks for the daytime to avoid thinking about them at night.
• Avoid napping late in the day.
• Get regular exercise, but avoid strenuous activity close to bedtime.
• Incorporate relaxing activities into your bedtime routine, such as stretching or reading.
• Maintain a comfortable temperature in your bedroom.
• Manage stress and anxiety through techniques such as meditation or journaling.
• Stick to a consistent sleep and waking schedule.

When to Seek Help

If you are consistently having trouble sleeping or feeling tired during the day, it is important to talk to a healthcare provider. They can help identify any underlying medical conditions or sleep disorders that may be contributing to your daytime sleepiness. Don't hesitate to seek help if you are struggling—treatment is available and can improve your symptoms.

Strategies to improve sleep

While sleeping all day is not a direct symptom of coronavirus, fatigue is a common symptom of the disease. This can include "brain fog and tiredness", as well as "headaches, achy muscles, poor decision-making, irritability, short-term memory problems, blurry vision, and poor concentration".

• Rest: When you are battling COVID-19, rest is critical. Even if you don’t have much of an appetite, focus on getting enough rest and sleep when you are acutely ill and during the week or two following.
• Healthy foods: Focus your diet on nourishing foods and drinks and avoid alcohol.
• Medication: Treat symptoms with over-the-counter medications such as acetaminophen or ibuprofen. If you are at high risk of serious complications, your doctor may prescribe antiviral medications.
• Pace yourself: If you are experiencing persistent, ongoing fatigue that interferes with your daily life, don't push yourself to exhaustion. Make sure you build rest into your activities, even for small things like walking up the stairs.
• Plan: Map out your activities for the day and the week. If you find that your energy or ability to concentrate dips at certain times, strategize accordingly.
• Prioritize: Figure out which items on your to-do list are essential and which can wait. Dump the stuff that doesn’t have to get done, or ask someone to help you.
• Exercise: Participating in physical activity can help improve your sleep.
• Interaction: Regular interaction with family members within the same household can help improve your sleep.
• Routine: Stick to a regular night-time sleep and wake-up time schedule.
• Stress management: Create a quiet and attractive environment suitable for sleep.

Frequently asked questions