Insomnia, or difficulty falling or staying asleep, is a common health complaint globally. The COVID-19 pandemic caused a major disruption to sleep health, leading to a surge in sleep issues worldwide, sometimes called “Coronasomnia.” This affected both people who contracted the virus and those who did not, highlighting the impact of widespread stress and routine changes. Up to 52% of people infected with SARS-CoV-2 experienced some form of sleep disturbance, which often extended beyond the acute illness and became a persistent problem.
The Acute Versus Persistent Nature of Sleep Disturbances
COVID-19 affects sleep in two distinct phases: during the active infection (acute) and in the long-term recovery period (persistent). Acute insomnia occurs while the body is actively fighting the virus, typically lasting for days or a few weeks. Physical symptoms such as fever, cough, shortness of breath, and body aches directly interfere with the ability to sleep comfortably or continuously.
For some individuals, sleep problems transition into a persistent, post-COVID state, often classified as a symptom of Post-COVID-19 Conditions (PCC) or “Long COVID.” This persistent insomnia develops or lingers weeks to months after the acute illness resolves. Prevalence estimates suggest that sleep disturbances are present in up to 70% of people with Long COVID, ranking as one of the most common lingering symptoms. Insomnia in this phase is a distinct, chronic sleep disorder that can last for months or even years.
Biological and Psychological Drivers of Sleep Loss
The underlying causes of post-COVID insomnia are complex, involving physiological changes from the infection and psychological responses to the pandemic. Biological drivers stem largely from the body’s immune response to the SARS-CoV-2 virus. The infection can trigger systemic inflammation, characterized by the release of pro-inflammatory cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-\(\alpha\)).
These inflammatory molecules can cross the blood-brain barrier and directly affect the central nervous system, a process known as neuroinflammation. This neuroinflammatory state disrupts the brain regions that regulate the sleep-wake cycle, contributing to insomnia. The virus may also cause changes to the brain’s internal clock, or circadian rhythm, leading to difficulty falling asleep and a reduction in restorative deep sleep.
Psychological factors also play a major part in maintaining sleep loss. Anxiety, stress, and fear related to the infection, financial instability, or social isolation are significant contributors. Elevated levels of anxiety and depression are strongly correlated with worse insomnia severity in people recovering from COVID-19. This is often classified as psychophysiological insomnia, where the initial illness trigger is replaced by learned associations of the bed with wakefulness and worry. Behavioral shifts during lockdowns, such as lack of natural light exposure and blurring of work-life boundaries, also destabilized the sleep-wake cycle.
Strategies for Managing COVID-Induced Sleep Disturbances
Cognitive Behavioral Therapy for Insomnia (CBT-I)
Non-pharmacological approaches are the preferred first-line treatment for persistent post-COVID insomnia. Cognitive Behavioral Therapy for Insomnia (CBT-I) is the most effective evidence-based intervention, focusing on changing sleep-related thoughts and behaviors. Core principles of CBT-I include stimulus control, which involves getting out of bed when awake for more than 20 minutes to break the association between the bed and wakefulness. Sleep restriction is another technique that temporarily limits the time spent in bed to condense sleep, helping to improve sleep efficiency.
Sleep Hygiene and Routine
Targeted sleep hygiene practices are also beneficial, particularly for those dealing with post-viral fatigue. Maintaining a consistent wake-up time every morning helps stabilize the body’s circadian rhythm. Exposure to bright, natural light early in the day is important for regulating this internal clock, and naps should be limited to short periods and avoided late in the afternoon.
When to Seek Professional Help
Managing post-viral symptoms requires a gentle approach to activity, avoiding the temptation to “push through” fatigue, which can worsen sleep problems. Relaxation techniques, such as deep breathing or meditation, should be integrated into a consistent routine before bed to lower stress and mental arousal. If insomnia persists for several months despite these behavioral strategies, or if it is accompanied by severe depression or anxiety, professional medical evaluation is warranted. A healthcare provider can rule out other underlying sleep disorders and refer to a sleep specialist for comprehensive treatment.