COVID-19 and Sleep: Everything You Need to Know

It is estimated that nearly 40% of people have experienced sleep disruptions during the pandemic, with insomnia being most prominent. This phenomenon led to the newly coined terms “coronasomnia” or “COVID-somnia.” Sleep is vital for physical and mental health, so COVID-related sleep loss can have serious consequences.

Although some people started sleeping longer during the lockdown portion of the pandemic, reductions in sleep quality were also common. For example, an increase in nightmares and nighttime awakenings caused many people to have more interrupted sleep.

Difficulty sleeping has affected large segments of the population including people infected with COVID-19, health care workers, and people in the general public who have felt the stress of a global health crisis.

Many social restrictions related to the pandemic–including stay-at-home orders–have been lifted, and sleep health is beginning to rebound. Nevertheless, people are experiencing ongoing sleep problems, especially given fears related to new variants or waves of infections that have contributed to the persistence of the COVID-19 pandemic.

There are multiple causes for disrupted sleep during the pandemic, and these issues may affect individuals in different and complex ways over time.

COVID-19 Infections

People who have COVID-19 are among the most likely to experience disrupted sleep during the pandemic. In many cases, fever, cough, and other COVID-19 symptoms can make it harder to sleep well. Medications to treat COVID-19 or its symptoms may also interfere with normal sleep.

While poor sleep was initially seen in hospitalized people with severe COVID-19, studies have also found sleeping difficulties in people who were never admitted to the hospital. Sleep problems and daytime fatigue are also common symptoms reported by people with long-lasting effects of COVID-19, also known as “long COVID.”

Altered Routines

The pandemic spurred major changes to everyday routines for people with and without COVID-19. Quarantines, working from home, and remote schooling are just a few examples of the dramatic ways that the pandemic upended typical patterns of daily life.

Altered routines can influence the body’s circadian rhythm, an internal clock that helps regulate normal timing of sleep. The pandemic has forced many people to change when and how much they get outside, exercise, and interact with others. All of these factors can modify circadian rhythm.

Stress

An important consequence of the pandemic has been an increase in stress, which can often lead to impaired sleep.

Worries about getting sick, frustration from disrupted routines, and scrolling through negative news on mobile devices before bed are just a few ways that the pandemic has magnified stress. Unsurprisingly, the people with the strongest feelings of stress during the pandemic have often reported the most difficulty with sleep.

Anxiety and Depression

For many people, the pandemic has negatively affected mental health. Multiple studies in different countries have found an increase in the number of people with symptoms of anxiety and depression since the start of the pandemic.

Both of these conditions have the potential to contribute to sleep problems like insomnia. In this way, the pandemic can worsen sleep through its negative effect on mental health. At the same time, insufficient sleep can cause or worsen conditions like anxiety and depression.

Social Isolation

Lockdowns at the start of the pandemic intentionally and abruptly cut off in-person social contact, and even without stay-at-home orders, many people continue social distancing.

The loneliness that can come from being isolated can worsen sleep. A lack of interaction with other people, including friends and family, can contribute to mental health challenges that can affect sleep.

Vivid Dreams

During the pandemic, many people have experienced an increase in dream activity, or “Covid dreams“, which may also mean a higher frequency of nightmares. Changes to dreams can disrupt sleep and may have a lasting effect on mental health.

Caring for Loved Ones

Being a caregiver for a loved one with COVID-19 has been linked to an increase in sleep interruptions. This may be related to the practical requirements of caregiving or the stress of taking care of someone who is sick.

Apart from taking care of someone with COVID-19, other types of caregiving duties during the pandemic, such as watching children who are taking classes remotely, may also play a role in sleep issues.

Reduced Access to Medical Care

During much of the pandemic, it has been difficult to see a doctor or receive medical testing, including in-person sleep studies.

Sleep studies are often needed to diagnose sleep disorders like obstructive sleep apnea, which affects breathing during sleep. As a result, some people with sleep problems may have gone undiagnosed and untreated because of the pandemic.

As with sleep disorders, people with health conditions that can harm sleep–such as arthritis and heart disease–may have had reduced access to medical care.

Sleep is always important, but the benefits of being well-rested may be more significant during the pandemic. Getting enough hours of quality sleep can contribute to better health and well-being by:

• Supporting the immune system, which may reduce the risk of infection with the COVID-19 and help vaccines be more effective
• Enhancing mood and emotional wellness during stressful times
• Maintaining effective brain function, including decision-making and adapting to change

While there are many ways that the pandemic can disturb sleep, a number of tips may help protect against these disruptions and facilitate better sleep:

• Create consistent routines: Although the pandemic has reshuffled many elements of everyday life, try to restore key routines throughout the day. This may help with the body’s timekeeping, which is how it tracks and regulates different activities, including sleep.
• Have a sleep schedule: Budget enough time for sleep each night, and, as much as possible, attempt to go to bed and wake up at the same time every day.
• Restrict excess time in bed: With more time at home during the pandemic, it may be tempting to spend more time in bed. However, to improve sleep, it’s best to only use the bed for sleep and sex. Too much time spent awake in bed can make it harder to fall asleep.
• Cut back on screen time: Whether it’s watching a series, reading the news, or playing a game, screen time can activate the brain in ways that make sleep more difficult.
• Make time for exercise: Being physically active can help relieve pandemic-related stress and reduce the chances of sleep disruptions.
• Seek out daylight: Sunlight is a critical driver of the body’s circadian rhythm, so getting exposure to natural light, especially early in the day, can promote a better sleep-wake cycle.
• Learn relaxation techniques: Calming the mind and body can prevent stress and anxiety from interfering with sleep. Experiment with different ways of relaxing like reading, deep breathing, or meditation, to find what works best.
• Limit alcohol and caffeine intake: Drinking coffee or alcohol too late in the day can change the body’s normal sleep cycle and affect both the quantity and quality of sleep.

When to Talk To a Doctor

While changes to routines and habits can improve sleep during the pandemic, there are times when it is important to talk to a doctor. Consulting with a doctor is recommended if any of these issues are present:

• Persistent, severe, or worsening sleep problems including difficulty falling asleep, staying asleep, or maintaining a regular sleep pattern
• Daytime sleepiness, fatigue, or lack of concentration, especially if it affects safety while driving or impairs work or school performance
• Feelings of anxiety, depression, or acute stress
• Abnormal breathing during sleep, including loud snoring with choking or gasping sounds

A health professional can review these symptoms along with your overall health. This may help diagnose a specific health issue or determine whether additional testing, such as a sleep study, is needed.

Depending on the diagnosis, a doctor may be able to recommend non-medical treatment like a virtual program for mindfulness or cognitive behavioral therapy for insomnia (CBT-I). These types of programs are designed to counteract negative thinking about sleep and may help in the short-term while also building resilience against sleep difficulties in the future.

As appropriate, a doctor can also suggest other treatments that may be beneficial, including medications to enable sleep or to address underlying health issues that can interfere with sleep.

Getting good sleep supports the immune system and may help people with COVID-19 more effectively fight the infection. Unfortunately, COVID-19 increases the likelihood of reduced sleep quality.

Furthermore, improved sleep may support recovery from serious COVID-19. Getting better sleep may also help reduce lasting stress and mental health problems that can occur after recovering from COVID-19.

Bothersome symptoms of COVID-19 can make it harder to sleep well, but certain tips may help people with COVID-19 get better rest.

• Practice good sleep habits: Routines can play a role in sleep, so it is often helpful to have a consistent sleep schedule, find ways to relax before bedtime, and avoid excess caffeine intake, especially at night.
• Improve the sleep environment: While people with COVID-19 may not have complete control over their bedroom setting, especially if they are in the hospital, it may be beneficial to make even small adjustments to promote sleep. Keepling lights low and reducing or blocking out noise are examples of steps to promote better sleep.
• Address sleep disorders or other underlying problems: People who have a sleep disorder like insomnia or sleep apnea should receive standard treatment to address the condition. It may also help to take steps to treat other health issues that affect sleep.
• Ask the doctor about sleep aids: In some cases, a doctor may prescribe medication to facilitate sleep. For example, melatonin can improve sleep in people hospitalized with COVID-19 and may enhance disease recovery.

A doctor can offer the most specific guidance about improving sleep based on a person’s symptoms of COVID-19, the nature of their sleeping problems, and their general health. It is important to consult with the doctor before starting any treatment or taking any drug or supplement for sleep.

While COVID-19 is complex, there are helpful resources that explain vital information in an accessible way. When researching COVID-19, it is important to seek out trusted sources of evidence-based information, including:

• U.S. Centers for Disease Control and Prevention (CDC)
• World Health Organization (WHO)
• U.S. National Institutes of Health
• Vaccine Finder