Post Covid-19 Insomnia

"When it affects sleep, a person’s entire life can be disrupted"

Up to HALF of patients recovering from COVID-19 reported difficulty sleeping as one of the ongoing symptoms in a survey of more than 1,500 people with Long Covid - resource Survivor Corp Facebook group.

Anedotely I have heard of long haulers being physically exhausted by evening but when they get into bed they “just can’t switch off to go to sleep” . Others have managed to get to sleep Ok but every night have this period of wakefulness around 3 to 5 am. I definitely fall into the latter group.

Prof. Meir Kryger, a sleep researcher at the Yale School of Medicine has seen long haulers with “really significant” symptoms related to sleep. Insomnia is a common occurrence.

What is insomnia?

Insomnia means a difficulty in going to (initiating) or staying (maintaining) sleep. It may be due to a lack of sleep or poor quality of sleep.

Pre pandemic insomnia is already one of the most common sleep complaints. It is estimated that 1 in 3 adults have bouts of Acute Insomnia - normally lasting a few days.

But 1 in 10 adults suffer ongoing difficulty sleeping, known as Chronic Insomnia - defined as insomnia that occurs more than 3 nights a week for over a month.

For some you may not be able to go to sleep or you may not be able to stay asleep. You may constantly wake up earlier than you would like and find yourself unable to go back to sleep.

Women are more likely to have insomnia than men. It is also more common among shift workers, people with low incomes, people who have a history of depression, those with chronic illness, and those who are physically inactive.

What are the causes of insomnia?

  • Medications that interfere with sleep

  • Caffeine

  • Anxious thoughts

  • Depression

  • Recent life events

  • Hormone changes - perimenopause

  • Poor bedtime habits - late eating, lack of routine, blue light from mobile phones

  • Lack of routine

  • Sleep disorders - such as sleep apnoea

  • Chronic pain

  • Medical conditions such as acid reflux, thyroid problems, stroke, or asthma

  • Stimulating substances - alcohol, nicotine, recreational drugs

  • Travel, especially between time zones

What are the symptoms of insomnia?

  • Frustration and preoccupation with your lack of sleep

  • Physical aches and pains - headaches and stomach aches

  • Impaired performance at work

  • Daytime drowsiness or low energy

  • Difficulty paying attention

  • Anxiety

  • Tension and irritability

  • Depression and mood swings

How is insomnia diagnosed?

  • Your medical history - discuss with your doctor

  • Your sleep history - keep a daily diary and discuss with your doctor

  • A physical exam - performed by your doctor to exclude medical causes

  • A sleep study - may be offered by your doctor if required. They may ask you to do a Epworth Sleepiness Scale

How is insomnia treated by doctors?

  • Medications - you may be offered a short term medication to help you get to sleep and stay asleep such as zopiclone. Please be warned that these are highly addictive and should be used for no more than a few days at a time. They can offer an antianxiety/ antidepressant such as a SSRI which raises the levels of serotonin in our brain and can help with sleep

  • Change in existing medication if that's what's causing the problem

  • Counselling/ Cognitive Behaviour Therapist to help relieve stress and other issues bothering you. For those with chronic sleep disturbances who do not respond to simpler measures referral may be needed to a CBT with specialized training in insomnia (CBTi)

  • Referral for a sleep study if a sleep disorder is suspected

How can we help ourselves?

  • Establish a daytime routine - Sleep-wake patterns can quickly erode if you are having to spend your days indoors, socially isolated, participating in zoom calls and watching television at night. You should wake up at the same time, dress up as if going to work, eat breakfast, work normally if able, preserving time for exercise if able and having dinner at the same time. Try and include exposure to bright sunlight in the morning

  • Establish a bedtime routine - phones away two hours before bed time (blue light from the screen can stimulate the circadian clock delaying sleep), take a relaxing bath or shower, lights down low, try to go to bed at the same time every night

  • Reduce alcohol, coffee and smoking

  • Last drink before 8 pm so no unwelcome toilet trips

  • Lavender - in a bath, shower or under the pillow

  • Magnesium - low levels of this mineral may make it harder for you to fall or stay asleep. Studies show that magnesium supplements improve sleep in older people and those with restless legs syndrome. Present in nuts and leafy greens. It is available as a cream to rub into your legs, or as a supplement. Too much magnesium can lead to cramps and nausea

  • Chamomile tea - extracted from a daisy-like plant has a calming effect due to an antioxidant called apigenin. It works on certain brain cell receptors that help you relax and fall asleep. Chamomile is safe, but it can interact with certain medicines. Sip a mug of tea before bed

  • Melatonin - this can help with out natural circadian rhythm, doses vary from 2 mg slow release on the NHS, to 10 mg on the internet. Again recommended short term use only

  • Weighted blankets - traditionally used by ADHD patients but now evidence can help relieve anxiety and aid sleep

  • Ear plugs and eye masks to block out external light and sounds

  • White noise machine - again distracts you from external noises, such as heating coming on, noise from the street. I particularly find this useful as a distraction from my tinnitus.

  • Supplements:

GABA - gamma-aminobutyric acid. A chemical in the brain that boosts relaxation and sleep.

Valerian - a plant has been used as a sleep aid for hundreds of years. Safe in the short term, but it sometimes may give you headaches and stomach aches. Take 300-600 milligrams up to 2 hours before bed.

CBD oil - cannabidiol found in hemp plants. It won’t get you high but it can help fall asleep. One study found that people who took it felt less anxious and slept better within a month. It can cause nausea.

Glycine - an amino acid can aid sleep. It may raise the amount of serotonin. Glycine supplements are viewed as safe.

5 HTP- 5-hydroxytryptophan a compound that your body uses to make melatonin. Side effects include nausea and headaches.

Tart cherry juice - Tart cherries are a natural source of melatonin. Early research shows that drinking tart cherry juice raises the amount of melatonin in your body. Sip a cup about an hour or two before bedtime.

Tryptophan-Rich Foods -

Dairy foods contain tryptophan, which is a sleep-promoting substance. Other good sources include nuts and seeds, bananas, honey, and eggs.

What are the long term complications of insomnia?

  • Low mood

  • Poor focus and attention

  • Susceptibility to infections

  • Increased risk for heart disease

  • Increased risk for stroke

  • Increased risk for diabetes

  • Excessive weight gain or obesity

  • Depression

  • Increased risk for injury to yourself or others, such as a car accident caused by driving while drowsy

Covid- 19 and Insomnia?

An acute covid-19 infection has led to some patients developing severe insomnia for a variety of reasons.

Some Covid-19 survivors have a fear of falling asleep because they think something horrible is going to happen to them. In those who develop this fear , but don’t actually have low blood oxygen at night or never stop breathing, they may benefit from psychiatric counselling.

Some wake up short of breath and have low blood oxygen, indicating chronic respiratory symptoms after the initial disease.

Others appear to have developed an abnormality in their central nervous system. They have a problem in the way their brain in controlling their breathing during sleep. This central sleep apnea — where the brain temporarily stops sending signals to the muscles that control breathing — can be helped with a CPAP machine that keeps the airway open

Of those with Long Covid many are suffering from severe insomnia. Many wake in the early hours and are unable to get back to sleep. Some have noticed a lowering of their oxygen levels (desaturating) during sleep with no explanation as to why.

Research into Covid-19 and insomnia:

A recent paper Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA” Taquet et al

highlights that in patients with no previous psychiatric history, a diagnosis of COVID-19 was associated with increased incidence of a first psychiatric diagnosis in the following 14 to 90 days. They demonstrated an increased risk in anxiety disorders, insomnia, and dementia. This risk was independent of known physical health risk factors for COVID-19, but could not exclude possible confounding by socioeconomic factors.

I have not seen any research into Long Covid and Insomnia yet but will keep you informed when I do :-)

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