As the world continues to grapple with the long-term impact of COVID-19, one lingering consequence that’s gained increasing attention is its effect on sleep. For millions of people, recovery from COVID-19 hasn’t meant a return to normalcy. Instead, they are faced with a complex condition known as Long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC). Among its many symptoms, disturbed sleep stands out as one of the most commonly reported and debilitating issues.
Long COVID can cause persistent insomnia, fragmented sleep, increased daytime fatigue, and even vivid nightmares. According to a 2022 study published in The Lancet Respiratory Medicine, nearly 63% of Long COVID patients reported sleep disturbances six months after infection, with many continuing to experience symptoms up to a year later. These sleep issues are not simply caused by stress or anxiety—they appear to be rooted in physiological changes triggered by the virus.
One leading theory is that inflammation plays a central role. COVID-19 can cause a prolonged immune response in the body, resulting in increased cytokine production. These inflammatory molecules, while part of the body's defense mechanism, can disrupt the brain’s sleep-regulating systems. Research published in Nature Reviews Neurology explains how systemic inflammation may interfere with the hypothalamus and brainstem—regions that control circadian rhythms and sleep-wake cycles.
Neurological symptoms are another contributor. Long COVID has been associated with cognitive impairment, headaches, and even dysautonomia (a malfunction of the autonomic nervous system). These issues can heighten arousal and make it harder for individuals to relax into sleep. A 2021 paper in Sleep Medicine Reviews found that people with Long COVID frequently report hypersensitivity to noise and light at night, along with restless legs or a racing heart, all of which are known to interfere with sleep onset and maintenance.
Mental health also intersects with Long COVID sleep disturbances. Many survivors of the virus experience elevated levels of anxiety, depression, and post-traumatic stress, which are known contributors to insomnia. A study from JAMA Network Open showed that individuals with Long COVID are significantly more likely to be diagnosed with new-onset psychiatric disorders, which may further aggravate sleep difficulties.
Sleep disorders such as sleep apnea may also emerge or worsen after COVID-19. Although research in this area is still evolving, a retrospective study from Cleveland Clinic found that individuals with sleep-disordered breathing had an increased risk of developing severe Long COVID symptoms, suggesting a bidirectional relationship between pre-existing sleep issues and post-COVID complications.
Given these multifaceted causes, treatment for Long COVID-related sleep problems often requires a comprehensive, individualized approach. Cognitive Behavioral Therapy for Insomnia (CBT-I), mindfulness practices, and guided light exposure have all shown promise. Additionally, physicians are exploring targeted medications that address both sleep disruption and the underlying inflammation or neurological dysfunction.
Understanding that sleep is not just a symptom but also a potential driver of recovery is crucial. Restorative sleep supports immune function, mental clarity, and emotional resilience—three areas that are often compromised in Long COVID patients. Prioritizing sleep health may not only help manage symptoms but also accelerate healing.
If you are struggling with sleep after a COVID-19 infection, it’s important to speak with a healthcare professional. Diagnostic evaluations and tailored treatments can make a significant difference, especially when symptoms persist beyond the acute phase of the illness.
Disclaimer: This article is intended for informational purposes only and does not constitute medical advice. If you are experiencing ongoing sleep problems or suspect Long COVID, consult with your doctor or a qualified healthcare provider for personalized care.
References
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Huang, C. et al. (2021). “6-month consequences of COVID-19 in patients discharged from hospital.” The Lancet Respiratory Medicine.
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Yong, S. J. (2021). “Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments.” Infectious Diseases (London).
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Nalbandian, A. et al. (2021). “Post-acute COVID-19 syndrome.” Nature Medicine.
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Taquet, M. et al. (2021). “6-month neurological and psychiatric outcomes in 236,379 survivors of COVID-19.” JAMA Network Open.
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Becker, J. H. et al. (2021). “Assessment of cognitive function in patients after COVID-19 infection.” JAMA Network Open.
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Cleveland Clinic (2022). “Sleep Apnea Linked to Long COVID Risk.” [clevelandclinic.org]
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Morin, C. M. & Bjorvatn, B. (2021). “Insomnia and the COVID-19 pandemic: A review of literature.” Sleep Medicine Reviews.