Covid-19 can ruin your sleep in many different ways — How it does it

Six weeks after a mild case of COVID-19 early in the pandemic, the Erika Thornes she started waking up every night between 2 and 3. Unable to fall back asleep, she would listen to podcasts, read and get on Twitter until 4 or 5. That started two years ago, and Thornes, a mother of three teenagers in San Diego, still struggles to sleep through the night.

Something similar happened to her husband during a recent COVID infection. He woke up suddenly at 3 am every night. His sleep improved when he stopped being positive, but the symptom was extreme while it lasted.

Nightmares. Days without sleep. Waking up in a panic in the middle of the night. Sleep for 18 hours a day. As COVID-19 has swept the global population, so have reports of sleep disturbances both during an infection and in the weeks and months afterward.

The relationships between him COVID and sleep are still under investigation, but studies show that bacterial and viral infections, in general, interfere with sleep through physical and psychological mechanisms. Recognizing the virus’ potential to disrupt sleep, experts say, can help people get the care they need.

How sleep and the immune system affect each other

Sleep is intricately intertwined with the immune system, a link both familiar and mysterious. Adequate rest can help prevent infections, according to evidence and observations dating back thousands of years. But infections can also disrupt sleep in complicated ways.

Animal studies show that viruses and bacteria alter both the time and type of sleep, says John Axelsson, director of the Sleep Lab at Stockholm University’s Institute for Stress Research in Sweden. When researchers inject rabbits or rodents with moderate doses of bacteria or viruses, the animals sleep more. They sleep longer without rapid eye movement, a deep state of rest considered important for recovery. and spend less time in dreamy REM sleep.

Cytokines, a class of molecules that can stimulate or slow inflammation, appear to play an important role in these patterns, Axelsson says. When healthy animals are sleep-deprived, levels of certain pro-inflammatory cytokines in the brain increase, causing the animals to sleep more than usual. When the scientists block these cytokines, the animals don’t sleep more — even when they’re sleep-deprived.

It’s harder to do the same kind of research in people, and the results are mixed about how sleep changes during illness. However, studies show that, at least to some extent, inflammatory molecules affect sleep in ways comparable to other animals. In studies from the 1990s and early 2000s, researcher Thomas Pollmächer and his colleagues injected people with pieces of bacterial cell walls, called endotoxins, and found that the mild activation of the immune system increased the desire to sleep and enhanced non-REM sleep.

But once the immune system was reinvigorated with increased cytokine levels and symptoms of illness, the humans experienced more disturbed sleep, not usually seen in animals. “The inflammatory system increases the drive to sleep,” says Axelsson. “But at the same time, it disrupts your sleep if you have a fever.”

To see how respiratory infections affect human sleep, Axelsson and colleagues recruited 100 healthy adults to keep a detailed sleep diary after they had the first symptoms of a respiratory infection by wearing a sleep tracker on their wrists. Out of the 100 volunteers, 28 people got sick. Overall, these people spent more time in bed and slept more after the onset of their symptoms, researchers reported in 2019.

But this was not a restful sleep. Infected people had trouble falling asleep, woken up more often, and had more restless sleep, especially when they were more symptomatic. As the symptoms subsided, sleep improved. Anecdotally, this is the same pattern that many people with COVID report – lots of sleep initially followed by insomnia or other disturbances while sicker. The normal urge to sleep more when you’re sick may be adaptive—helping the body fight off the invader, Axelsson says.

Why sleep problems persist after COVID infection

For many people, sleep problems don’t end on day 10 or when a person tests negative. To measure how often sleep problems persist, researchers looked at more than 650 long-term COVID patients who visited the Cleveland Clinic’s ReCOVer clinic between February 2021 and April 2022. Up to six months after infection, 41 percent reported sleep disturbances . An additional 7 percent reported disorders that were severe. Black patients, 12 percent of study participants, were three times more likely to report sleep problems than other groups — reflecting disparities seen throughout the pandemic, says Cinthia Peña Orbea, sleep specialist and lead author of the study, which was published in June. .

Elsewhere, there have been reports of narcolepsy after COVID-19, oversleeping, and physically realizing dreams with movements like kicking and talking rather than lying still with typical sleep paralysis, says Monika Haack, a psychoneuroimmunologist at Harvard Medical School in Boston. , who co-authored a 2019 review on the relationships between sleep and disease.

Peña Orbea’s study suggests that long-term COVID goes hand-in-hand with other chronic illnesses in causing sleep problems. About 60 percent of people with HIV and more than 50 percent of people with hepatitis C experience poor sleep, as do people with ME/CFS, also called chronic fatigue syndrome. People with inflammatory bowel disease, rheumatoid arthritis, and other inflammation-related diseases—all immune disorders—often suffer from a lack of sleep.

Haack is exploring the details of how the sleep disorder interacts with the immune system. In a soon-to-be-published study, she and her colleagues found that disrupted sleep in 24 healthy people led to the production of more molecules that prolong inflammation and, crucially, to suppression of molecules that normally stop that inflammation. Even after three full nights of recovery sleep, inflammation persists, highlighting the need to maintain good sleep in the first place.

Together, the evidence demonstrates that insomnia can cause or worsen many symptoms associated with both acute and prolonged COVID, including depression, fatigue, and brain fog. These symptoms in turn can make it difficult to sleep. “It’s always a two-way street,” Haack says. Insomnia, sleep apnea, and other disorders, he says, “can all reduce the quality, depth, continuity, or regularity of sleep and reduce the immune support functions that accompany normal sleep.”

Drug development for sleep disorders associated with COVID

Eventually, scientists may be able to develop drugs that affect cytokine levels to improve sleep, says James Krueger, an expert in the biochemistry of sleep at Washington State University in Spokane. But it’s a challenge because the relationship between cytokines and sleep is extremely complex. Some pro-inflammatory cytokines promote sleep at low concentrations, but at higher concentrations, lead to wakefulness and fragmented sleep. There are also anti-inflammatory cytokines that mostly inhibit sleep at low concentrations.

Hundreds of proteins interact to regulate the immune system and other processes, Krueger says. COVID and other infections modify these interactions. Targeting these molecules remains a work in progress. “For complex behaviors and brain processes like sleep, some new drugs have been developed in recent years,” he says. “Time will tell if it’s any better than previous drugs.”

How to improve sleep after COVID

Helping people get better rest during and after COVID infections starts with recognizing the importance of sleep, Haack says. This may include avoiding drugs that disrupt sleep, such as opioids, and reducing light, noise, and repeated awakenings for people who are hospitalized.

Establishing regular sleep routines with consistent bedtimes and wake-up times is often part of treating insomnia, Axelsson says. It can also help people limit time in bed to increase sleep efficiency and avoid excessive time spent awake.

Haack recommends mindfulness apps to reduce stress and anxiety. For her long-term COVID patients, Peña Orbea has seen cognitive behavioral therapy lead to improvements. “With insomnia, the brain is in a state of overstimulation,” he says. “We’re trying to bring back that stimulation of the mind.”

Physical activity and fresh air can help a subset of people who may have stopped going outside because of their illness, Axelsson says. But for many with long-term COVID, exercise can cause serious setbacks, underscoring the need for individualized medical care if sleep problems persist after the disease.

“Sleep disturbance can be quite normal during acute COVID infection, due to sleep-disrupting symptoms such as pain, cough, stuffy nose,” says Haack. “If sleep disturbances continue to persist beyond the acute symptomatic phase or begin to develop as a new symptom, then it’s time to seek help.”

National Geographic

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