When infected with the virus that causes COVID-19, a significant disruption to sleep is a near-universal complaint. This sleep disruption, often manifesting as a temporary form of insomnia, affects an estimated 52% of people who contract the illness. The difficulty stems from a complex interplay between the body’s aggressive immune response, the mechanical interference of physical symptoms, and the psychological burden of being sick. Understanding these three distinct forces explains why restful sleep seems impossible during the acute phase of the illness.
The Immune System’s Disruption of Sleep Cycles
The primary biological reason for fragmented sleep during illness lies in the body’s robust inflammatory response to the invading virus. When the SARS-CoV-2 virus is detected, the immune system releases powerful signaling proteins called cytokines, such as Interleukin-6 (IL-6) and Tumor Necrosis Factor-alpha (TNF-α). These molecules are part of the innate immune response, but they also act directly on the brain.
These pro-inflammatory cytokines interfere with the brain’s sleep-wake regulatory centers, including the hypothalamus, which controls the body’s internal clock, or circadian rhythm. Elevated levels of IL-6 are strongly associated with sleeping problems. This systemic inflammation induces a state known as “sickness behavior,” which includes daytime fatigue and malaise, but paradoxically leads to highly fragmented, non-restorative sleep at night.
The intense immune activation causes a neuro-immune crosstalk where the inflammatory markers cross the blood-brain barrier. This process can lead to the neuropsychiatric manifestations often seen with COVID-19, including sleep disorders. The resulting inflammation alters neurotransmission and brain function, making it difficult for the body to settle into the deep, continuous sleep required for rest.
Physical Symptoms That Hinder Rest
The physical symptoms of COVID-19 act as barriers to continuous rest. A persistent, dry cough is one of the most common disrupters, as fits can awaken a person multiple times throughout the night. This constant physical irritation fragments the sleep architecture, preventing entry into deeper, more restorative stages.
Severe nasal and sinus congestion can force mouth breathing, leading to a dry throat, snoring, and repeated awakenings due to the sensation of breathlessness. Fever and chills create significant thermoregulation issues, making the body unable to find a comfortable temperature. The cycle of sweating followed by chills forces frequent adjustments to bedding and clothing, which pulls the body out of sleep.
Intense myalgia, or muscle and body aches, makes lying still for long periods nearly impossible. The discomfort from joint and muscle pain can result in a condition sometimes called “painsomnia,” where the physical ache prevents the relaxation needed for sleep initiation and maintenance. These physical obstacles compound the overall difficulty of achieving restful sleep.
The Impact of Mental Stress and Isolation
The final layer of sleep disruption is psychological and behavioral, stemming from the unique circumstances of a COVID-19 infection. Acute illness anxiety is a major contributor, as worries about worsening symptoms, especially breathing difficulties, can trigger hypervigilance. This state of constant monitoring keeps the nervous system activated, making it difficult to relax into sleep.
Stress related to isolation and the disruption of daily routine further complicates the problem. When confined, the usual cues that regulate the sleep-wake cycle, such as consistent mealtimes and exposure to natural light, are lost. This lack of structure can lead to an irregular sleep schedule, weakening the body’s natural drive to sleep.
Many people also engage in increased screen time while lying sick in bed. The blue light emitted by devices suppresses the production of melatonin, the hormone necessary for signaling the body to sleep. This combination of emotional stress, fear, and poor sleep hygiene creates an environment for insomnia to take hold.
Practical Steps for Better Sleep During Illness
Managing sleep while ill requires a proactive approach that targets both the physical symptoms and the psychological stress. Prioritizing symptom relief before bedtime is beneficial, which may involve taking pain relievers or decongestants as directed to minimize coughing and body aches during the night. This reduction in physical discomfort allows for a more continuous block of sleep.
Optimizing the sleep environment can make a significant difference. The ideal room temperature is slightly cooler, generally between 60 and 67 degrees Fahrenheit, to help the body’s natural temperature drop for sleep. Using an extra pillow to elevate the head can help ease nasal congestion and reduce the severity of coughing fits, making breathing easier.
Maintaining some semblance of a sleep schedule is important, even when sick, by aiming to go to bed and wake up around the same time each day. Reserve the bed primarily for sleep, avoiding work, eating, or excessive screen time there to strengthen the mental association between the bed and rest. If unable to fall asleep after 20 minutes, getting out of bed to do a relaxing activity like reading in low light before trying again.