Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.
Sleep Disorders & COVID-19 | COVID-Related Sleep Problems? | Causes of COVID-Related Sleep Issues | Psychological & Social Effects | Approaching the Problem
Overview
Since the COVID-19 pandemic started in December 2019, it has impacted nearly every aspect of our lives.
The effect of COVID on mental health and sleep quality has been a hot research topic since the early days of the pandemic.
Sleep doctors and scientists have noticed a significant increase in sleep disorders in COVID patients, healthcare workers, and non-patients alike.[1]
The coronavirus is linked to sleep problems, ranging from insomnia to circadian rhythm abnormalities and nightmares.[1]
The psychosocial and stressful effects of the pandemic have also played a crucial role in the skyrocketing prevalence of sleep issues.
Sleep Disorders & COVID-19
According to a large meta-analysis published in The Journal of Clinical Sleep Medicine, the global prevalence of sleep disorders during the pandemic is around 35.7 percent, equating to almost one in every three people.[2]
Sleep issues seem to be affecting everyone; however, the prevalence of sleep disorders during the coronavirus pandemic differs depending on which group you fall under.
- COVID-19 Patients: 74.8 Percent
Poor sleep quality is more common among patients with current or previous COVID-19 infection. Sleep problems in this group can be part of a post-COVID syndrome or caused by symptoms.
- Frontline workers: 36 Percent
Frontline workers are greatly affected by the pandemic. Increased work hours, dealing with critical patients, and fear of being infected can all contribute to anxiety, stress, and subsequent sleep problems in this group.
- The general population: 32.3 Percent
The change in daily routine combined with the social and economic effects of the pandemic might be causing more sleep problems in everyone during the pandemic.
A study published in JAMA analyzed the data of nearly 230,000 COVID-19 patients and compared them to non-infected individuals. The researchers found that patients infected with the coronavirus were almost three times more likely to complain of sleep problems after the infection.[3]
COVID-Related Sleep Problems
To date, current sleep studies have been unable to identify the exact sleep problems related to COVID-19. According to one meta-analysis, the most commonly observed corona-related sleep disorders include:
- Insomnia: Some have termed it “COVID-somnia” or “coronasomnia”[4]
- Worsening sleep apnea symptoms
- Circadian rhythm abnormalities (sleep-wake cycle problems)
- Post-traumatic-like sleep dysfunction
- Nightmares
- Restless legs syndrome
There’s still no direct causative link between COVID-19 infection and these sleep disorders. However, the incidence of these sleep issues seems to have significantly increased since the pandemic started.
Causes of COVID-Related Sleep Issues
Sleep medicine specialists are still not entirely sure what’s causing sleep issues during the coronavirus outbreak. In general, researchers have attributed the pandemic sleep problems to one or more of the following:
Post-COVID Syndrome
On the one hand, the virus can directly cause a cascade of biological reactions that might lead to insomnia and poor sleep quality. Researchers explain that this is part of the “post-COVID syndrome,” a condition similar to chronic fatigue syndrome (CFS).[5]
Patients with a post-COVID syndrome, called “COVID-19 long haulers”, complain of a wide variety of vague symptoms, including joint pain, brain fog, decreased concentration, and sleep disturbance. These symptoms can linger for months, significantly interfering with life quality.
Researchers suggest that persistent inflammation might be the mechanism behind post-COVID.
Current COVID Infection
The symptoms of COVID, such as coughing, fever, shortness of breath, and joint pain, can all lead to poor sleep quality.[2]
Coughing episodes can wake you up, and the persistent, annoying symptoms might prevent you from falling back to sleep.
Moreover, staying at the hospital for COVID treatment might also be responsible for poor sleep quality. Noisy neighboring patients, medical staff disruptions, beeping devices, lights, and sleeping in a new bed can lead to poor sleep quality.
Patients receiving non-invasive mask ventilation might also find it uncomfortable, affecting sleep quality.
Psychological & Social Effects
These factors can cause sleep disturbances in infected and non-infected patients alike.
The COVID-19 pandemic has affected nearly all aspects of daily living. Everything has changed from work to studying and leisure compared to two years ago.
We’ve developed new routines that can affect our sleep quality. We oversleep, work late at the home office, take naps between meetings, stay long hours in front of a monitor, and get limited sunlight during lockdowns.
These new routines and habits can significantly cause sleep problems during the corona pandemic.
The sudden change in life routines, fear of catching the disease, economic distress, and loneliness due to confinement and lockdowns are possible causes of corona-related sleep problems.
Numerous studies have already reported a significant increase in mental illness during the corona pandemic. One meta-analysis reported the prevalence of psychiatric disorders as follows:
- Stress: 29.6 percent
- Anxiety: 31 percent
- Depression: 33.7 percent [6]
The high prevalence of mental disorders during the pandemic might explain the rising numbers of patients with COVID-related sleep problems.
If you’re stressed, anxious, or depressed, you’re more likely to have poor quality sleep.[7]
Approaching the Problem
Data shows that the number of prescriptions for sleep-promoting drugs has increased compared to before the pandemic.
The challenge for sleep doctors right now lies in identifying the underlying causes of sleep disorders during the ever-recurring corona waves.
When mental illness is identified, proper evaluation by a psychiatrist is needed. Prescription antidepressants and mood stabilizers might consequently lead to improved sleep. Nevertheless, some psychoactive drugs might induce insomnia themselves, which might complicate treatment.
Patients are also encouraged to see a therapist if they’re having trouble dealing with the pandemic, the economic situation, or loneliness and working at home.
Most importantly, sleep medicine specialists and researchers are conducting studies to understand better how COVID-19 and sleep disorders are related. Soon, hopefully, we will be able to find more answers.
Resources:
- Bhat S, Chokroverty S. Sleep disorders and COVID-19. Sleep Med. Published online July 18, 2021. doi:10.1016/j.sleep.2021.07.02
- Jahrami H, BaHammam AS, Bragazzi NL, Saif Z, Faris M, Vitiello MV. Sleep problems during the COVID-19 pandemic by population: a systematic review and meta-analysis. J Clin Sleep Med. 17(2):299-313. doi:10.5664/jcsm.8930
- Abel KM, Carr MJ, Ashcroft DM, et al. Association of SARS-CoV-2 Infection With Psychological Distress, Psychotropic Prescribing, Fatigue, and Sleep Problems Among UK Primary Care Patients. JAMA Netw Open. 2021;4(11):e2134803. doi:10.1001/jamanetworkopen.2021.34803
- Gupta R, Pandi-Perumal SR. COVID-Somnia: How the Pandemic Affects Sleep/Wake Regulation and How to Deal with it? Sleep Vigil. Published online December 3, 2020:1-3. doi:10.1007/s41782-020-00118-0
- Logue JK, Franko NM, McCulloch DJ, et al. Sequelae in Adults at 6 Months After COVID-19 Infection. JAMA Netw Open. 2021;4(2):e210830. doi:10.1001/jamanetworkopen.2021.0830
- Salari N, Hosseinian-Far A, Jalali R, et al. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis. Glob Health. 2020;16(1):57. doi:10.1186/s12992-020-00589-w
- Oh CM, Kim HY, Na HK, Cho KH, Chu MK. The Effect of Anxiety and Depression on Sleep Quality of Individuals With High Risk for Insomnia: A Population-Based Study. Front Neurol. 2019;10:849. doi:10.3389/fneur.2019.00849
