Two years into the pandemic (that's right, folks — it's not over), we've learned enough to know that symptoms of a COVID-19 infection can be tricky. For one, they can change with each new dominant variant. Secondly, COVID symptoms can vary from person to person, regardless of the variant, due to factors like pre-existing illnesses and your viral load. And whether or not you've had COVID yourself, you've probably had some periods (or maybe, two years) of poor-quality sleep. But what about during an infection? Is COVID insomnia one of the symptoms? What about after an infection? In other words, can COVID cause insomnia?
In short, it's complicated and depends on the context of the question. So, to help cut through the confusion and get some answers, Scary Mommy spoke with multiple physicians with experience treating COVID-19 and sleep disorders. After all, sleep isn't something we can afford to miss. Here's what to know about COVID insomnia.
Is insomnia a symptom of a COVID-19 infection?
No, insomnia is not a documented symptom of a COVID-19 infection. The CDC has kept an updated list of official COVID-19 symptoms since the beginning of the pandemic, and while fatigue has consistently been one of the most common, insomnia isn't on the list.
But while insomnia is not a recognized symptom of a COVID-19 infection, many of the respiratory symptoms like coughing and fevers may disrupt sleep indirectly, says Abhinav Singh, MD, FAASM — a sleep physician, the medical director of the Indiana Sleep Center, and a medical review expert at SleepFoundation.org.
Another possibility is that someone with COVID-19 may be experiencing insomnia for any number of other reasons, says Karen Jablonski, MD, a physician board-certified in neurology and sleep medicine, as well as a physician clinical reviewer for Magellan Healthcare. "Insomnia is one of the most common symptoms encountered in medical practice," she tells Scary Mommy. "Insomnia can precede or accompany medical or psychiatric disorders and also be a response to physical or psychological stressors. Patients often have one or more risk factors or medical problems that may be contributing to insomnia."
So, just because insomnia is not a documented symptom of an infection, that doesn't mean COVID won't affect your sleep.
Is it normal to deal with insomnia after having COVID-19?
At this point, you probably know someone who has had COVID but never fully recovered. Maybe they even developed new symptoms weeks or months after their initial infection. The Centers for Disease Control and Prevention (CDC) refers to these as "post-COVID conditions," and the National Institutes of Health (NIH) has dubbed them PASC (Post-Acute Sequelae of SARS-CoV-2 infection). But this collection of symptoms and new conditions is more commonly known as "long COVID," and before that, "long-haul COVID."
Often, these newly developed symptoms and conditions include insomnia. "In people who develop PASC, most will have severe insomnia or nonrestorative sleep after the infection — despite not having had insomnia during the acute infection," Jacob Teitelbaum, MD, an immunity expert and board-certified internist, tells Scary Mommy.
This is something that Federico Cerrone, MD, a pulmonologist specializing in sleep medicine, has seen since he began treating long-COVID patients in October 2020 at the Atlantic COVID Recovery Center in New Jersey, where he is co-director. He estimates that roughly 30 to 40% of the clinic's patients develop insomnia or sleep issues, but he says it may be even more. "At the outset of care, we specifically ask questions about sleeping patterns and try to help them with their sleep issues since sleep is important to recovery," he tells Scary Mommy. "We actually have unmasked different sleep issues in these patients such as sleep apnea, as well as insomnia."
According to Jablonski, the physical symptoms of long COVID are among the many aspects of the condition that can disrupt sleep. "The residual inflammation throughout the body may be a factor," she explains. "In the body's attempt to combat chronic inflammation, sleep quantity and quality can be compromised."
Along the same lines, Cerrone says that one of the major causes of insomnia is any stress on the body — like an infection. "Many [long COVID] patients will develop acute insomnia, and then a large percentage will go on to suffer chronic insomnia," he explains. "They often need help in recovering their sleep cycle."
There are also the psychiatric effects of long COVID, including anxiety and depression, which play a significant role in a person's sleep. Some people develop more complicated conditions. "Many long-COVID patients experience mood disorders," Cerrone says. "We still do not know all the effects of COVID on the brain."
Can stress from the COVID-19 pandemic cause insomnia?
COVID infections aside, let's not forget that stress is also a major culprit of insomnia. So, if your sleep has been markedly disrupted over the past two years, you're not alone. In fact, it's been such a common response that it's sometimes referred to as "coronasomnia." (Though that's not an official medical term.)
"Stress related to the COVID-19 pandemic and disruption of normal routines have contributed to the increased rates of insomnia," Jablonski explains, noting that two studies have indicated that there has been an increase in insomnia by approximately 7% during the pandemic.
On top of that stress, two years of social isolation and other measures to prevent the spread of the virus have disturbed our daily routines — something Jablonski says has been making our sleep quality even worse. "Daily routines such as waking up in the morning, showing up at work, eating meals, and attending social gatherings serve as timekeepers (zeitgebers) for sleep-wake rhythms to remain in sync with the cycle of day-night," she explains.
In other words, the pandemic has thrown our routines and circadian rhythms all out of whack.
What should you do if COVID is keeping you up at night?
If it feels like COVID-19 — whether it’s long COVID or the psychological effects of living through a pandemic — is wrecking your sleep habits, a few small tweaks could help:
- Follow a consistent routine, especially at bedtime.
- Avoid day-napping so you don’t throw off your sleep cycle.
- Squeeze in some vitamin D and exercise, which maintain bodily rhythms.
- Minimize blue screens around bedtime.
- Try relaxation methods like meditation or mindful breathing.
- Take a warm bath or shower about an hour before bed.
- Designate your bedroom as a sleep-only zone (no working or watching TV).
- Adjust the temperature until you find your most snooze-inducing setting.
- Keep a sleep journal to discuss patterns with your doctor.
*When dealing with insomnia, you might be tempted to drink a glass of wine to relax, but this could actually worsen your sleep troubles. A side effect of lack of sleep can also cause you to grow more irritated. This added stress may disturb your rest even more. Sleep also gives our bodies the strength to fend off illness, so if we aren't getting enough, it could leave you more vulnerable to other sicknesses.
If you’re suffering from serious sleeplessness, though, reach out to your primary care provider or a sleep expert for medical guidance on effective treatments.
Abhinav Singh, MD, FAASM, a sleep physician, the medical director of the Indiana Sleep Center, and a medical review expert at SleepFoundation.org
Karen Jablonski, MD, a physician board-certified in neurology and sleep medicine, as well as a physician clinical reviewer for Magellan Healthcare
Jacob Teitelbaum, MD, an immunity expert and board-certified internist
Federico Cerrone, MD, a pulmonologist specializing in sleep medicine and co-director at the Atlantic COVID Recovery Center
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