Struggling to fall asleep, only to wake up in the middle of the night from a strange nightmare? Rising exhausted in the morning? These are all signs that you may suffer from COVID-related insomnia — colloquially known as COVIDsomnia or coronasomnia.
Doctors often resort to sleep medicine to treat these sleep disorders. Although meds may help COVID-19 patients get some sleep in the short term, these pills come with severe side effects, and there’s a high risk of patients becoming dependent on them to sleep. At Cognitive FX, we don’t believe this is a viable long-term solution for COVID long-haulers.
To make matters worse, insomnia is likely not the only long-term symptom caused by COVID that you may be experiencing. Long-haulers usually experience a wide range of other symptoms, such as fatigue, headaches, brain fog, and difficulty concentrating, to name just a few.
Instead of addressing individual effects of COVID-19 with different treatments, we treat long COVID as a whole. Our experienced team uses state-of-the-art technology to figure out how your body was affected by COVID and devises a plan to restore normal brain function. Our approach involves a combination of aerobic exercise and multidisciplinary therapies to address the specific issues that you’re experiencing, including insomnia and other sleep problems.
In this article, we’ll cover:
Of the COVID long-haulers who meet our screening criteria, over 90% show improvement after treatment at our clinic. Our long COVID patients report over 40% decrease in symptom severity in 13 symptoms after just one week of multidisciplinary therapy. To discuss your specific long COVID symptoms and whether you’re eligible for treatment at our clinic, schedule a consultation.
COVID-related insomnia refers to all sleep problems that emerged from the COVID-19 pandemic. Sleeplessness is the most common problem, but there are many other possible symptoms, including:
Studies show that anywhere between half and three-quarters of COVID patients experience some kind of sleep problems during their initial infection. This is not surprising given that common symptoms like cough and breathing difficulties can keep patients up at night.
In addition, staying in bed all day and sleeping whenever you feel sick disrupts your natural sleep-wake cycle and makes it harder to have uninterrupted sleep at night. The problem with this is that not getting enough sleep at night weakens your immune system, prolongs the infection, and makes you feel pain more intensely.
Most patients recover within a few weeks of infection, and their sleep patterns go back to normal. For some, however, issues during the acute infection develop into chronic insomnia with long-term consequences.
Months after the initial COVID infection, almost 50% of COVID long-haulers still experience sleep disturbances, some of which can be extremely severe. Insomnia is the most common complaint, but patients also report other sleep problems, such as daytime drowsiness, sleep apnea, sleeping too much (hypersomnia), physically enacting dreams with movements like kicking, or waking up tired in the morning.
All of these can affect the quality of sleep. Studies show that patients with long COVID not only sleep less overall during the night but also experience less deep sleep compared to healthy people. This loss of deep sleep is particularly worrying because it makes patients feel tired in the morning and affects cognitive skills such as concentration and memory. There are other factors involved, but lack of deep sleep may be partly responsible for the “brain fog” many long-haulers experience.
Further reading:
While researchers don’t know for sure what causes sleep problems in long-haulers, it is likely a combination of multiple factors. Some of these may include:
Structural changes in the brain after SARS-COV-2 infection may explain the sleep disturbances that some long-haulers experience. For example, a study using magnetic resonance imaging (MRI) found structural changes in the thalamus of long-haulers. This part of the brain is responsible for regulating sleep/wake cycles, which may explain the difficulties sleeping at night and drowsiness during the day.
Sleep problems may also arise due to disruptions in the way brain cells receive the resources they need to function normally.
In a healthy person, brain cells get oxygen and nutrients from a network of surrounding blood vessels. In simple terms, neurons can “order” what they need and have it delivered at the right time and to the right location. This dynamic mechanism is called neurovascular coupling (NVC).
In COVID long-haulers, however, this connection is disrupted in some areas of the brain. As a result, affected areas don’t operate normally, leading to many of the physical and cognitive symptoms these patients experience. Similarly to what happens with direct changes in the brain, if the affected areas include the hypothalamus and/or the brainstem (involved in regulating sleep/wake cycles), it can lead to sleep problems.
Researchers know that dysfunction of the autonomic nervous system (ANS) is an important feature of long COVID-19.
Briefly, coronavirus can affect two subsections of the ANS: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). The SNS can increase your heart rate, stimulate blood flow to your muscles, and increase muscle tension. These are all responses we need if we’re in “fight or flight” mode. In contrast, the PNS lowers heart rate, regulates digestion and bladder function, and slows down breathing rates. This is our body’s way to calm down and “rest and digest.”
Under normal circumstances, the PNS and SNS are both active and switch control back and forth throughout the day to meet your body’s needs at the time. For example, if you’re stressed because you’re late for work, the SNS will take over, but then when you relax at home in the evening, it’s the PNS’s turn to be in charge.
However, for long COVID patients, this healthy balance is replaced with permanent SNS dominance, which can cause symptoms such as abnormal heart rate, fatigue, shortness of breath, and headaches.
Further reading: Yes, COVID causes POTS and dysautonomia
SNS dominance can also lead to sleep issues. Sleep should be a period of PNS dominance, allowing our bodies to calm down and relax. However, if the SNS remains active, patients may experience trouble falling asleep and wake up frequently while sleeping.
It is well known that a COVID-19 infection can disrupt the body’s immune responses and trigger generalized inflammation in the body. This, in turn, can affect sleep. As part of this response, our cells produce a type of protein called cytokines in order to help fight the infection. Some of these cytokines are also involved in promoting sleep, and this is why we tend to feel sleepier when we’re fighting an infection.
It gets a little more complicated in long-haulers, though. Poor sleep compromises immune function, and, in turn, a poor immune response compromises sleep. It’s easy for these patients to start a downward spiral of low-quality sleep and fatigue, which inevitably aggravates other symptoms.
Want to find out if you’re eligible for treatment at our specialized clinic? Contact our team to schedule a consultation.
Sleep problems can also occur as the result of psychological problems caused by long COVID, including stress, anxiety, and depression. This is not surprising considering some patients experience multiple symptoms, some of which are debilitating.
The good news is that if your sleep problems are caused by anxiety and stress, therapy may help. Cognitive behavioral therapy for insomnia (CBT-I), for example, has been used successfully to treat these cases. At this stage, there aren’t any studies assessing CBT-I for COVID insomnia specifically, but it’s an effective treatment for women suffering from insomnia during pregnancy or menopause, older patients with dementia, and, in general, patients suffering with insomnia. A study showed that even CBT-I delivered virtually could help reduce rates of insomnia. If you want to try CBT, look for a certified practitioner at a psychiatry or psychology practice.
It’s possible that medications for other health problems can cause sleep problems in COVID long-haulers. Some corticosteroids, sedatives, beta-blockers, and anti-inflammatory drugs are known to cause insomnia and other sleep disturbances. If you’re struggling with sleep, ask your doctor if changing the times and/or doses of your medication could help you sleep better at night. This is known as chronotherapy, and it’s been shown to increase the efficacy of some meds. Make sure you check to see if any of your over-the-counter medications could impact sleep quality as well.
If you’ve been struggling to sleep for weeks or months due to long COVID, it may be tempting to see sleeping pills as an easy fix. These can be helpful for occasional use, but make sure you consult your doctor before taking any sleep aids.
We don’t usually recommend the use of sleeping pills for our patients (see below for more details about our treatment at Cognitive FX), but for your information, we list here the most common meds used to treat insomnia and other sleep problems.
Benzodiazepines: Benzodiazepines are classed as psychoactive drugs. At the moment, the FDA has approved five different meds to treat insomnia. These are not recommended for long-term use because there’s a high risk of abuse and dependence.
Nonbenzodiazepines: These drugs were created to treat the same conditions as benzodiazepines while avoiding severe adverse effects and abuse potential. They still require a prescription, and some patients experience side effects, including memory loss, poor balance, and falls.
Melatonin agonist: As natural light begins to fade in the evening, an area in your brain called the pineal gland starts to release melatonin. This hormone triggers feelings of sleepiness and relaxation and helps you sleep. Melatonin agonists enhance the activity of natural melatonin and can be used to treat patients who struggle to fall asleep. Side effects are less frequent than with benzodiazepines, but some patients still experience dizziness, nausea, and fatigue.
Orexin receptor antagonist: Orexins are chemicals that help the brain stay awake. Drugs classed as orexin receptor antagonists block their effect and can be used for patients who struggle to go to sleep or who wake up frequently at night.
Off-label treatments: Certain medications developed to treat other conditions may also be used to treat insomnia symptoms. These include antidepressants and antipsychotic medications. You should discuss the pros and cons of using these meds with your doctors before starting to use them.
Melatonin supplements: Melatonin is a hormone naturally created by the body in response to darkness and helps your body create a stable and healthy sleep-wake rhythm. Melatonin also plays an important part in the body’s immune system and inflammatory responses, and some researchers suggest that it may help long-haulers. Studies show that melatonin supplements improve sleep quality in patients with COVID-19 and reduce the severity of the disease. Melatonin supplements are usually safe, but it’s always best to check with your doctor before starting new supplements in case they interact negatively with your other medications or health conditions.
Natural products: Patients sometimes resort to natural supplements, such as valerian, chamomile, and kava, to reduce insomnia symptoms. There is some evidence that some of these products can be helpful for occasional use, with the added bonus of being non-toxic and non-habit forming. It’s always advisable to inform your doctor that you’re taking these products to ensure that there are no interactions with other medications.
Further reading: Natural treatment options for long COVID
At Cognitive FX, our treatment doesn’t involve the use of medication. We don’t treat each symptom as an isolated problem to be solved; instead, we realize that long COVID symptoms are all related. Therefore, we treat long COVID as a whole using a combination of physical exercise and multidisciplinary therapy.
Before treatment starts, all patients must undergo a detailed medical examination. Our team will ask you about your symptoms and medical history and conduct a physical, cognitive, and psychological assessment to determine how long COVID is affecting your health. This assessment includes a:
Patients also complete a brain imaging scan called functional NeuroCognitive Imaging (fNCI) that’s designed to determine how and where the virus affected brain function. This scan checks how your brain is working in about 100 regions, as well as how these regions communicate with each other, while the patient performs a series of standardized cognitive tasks.
Once this examination is finished, our therapists gather all the information from the various tests and design a treatment plan to target specifically the areas of your brain that were most affected by COVID-19.
Typically, this involves a combination of aerobic exercise and multidisciplinary therapies. The aim is to take advantage of a process in the brain called the post-exercise cognitive boost (PECB). PECB triggers the release of chemicals in the brain, including one called brain-derived neurotrophic factor (BDNF). BDNF improves communication between different areas of the brain and promotes the growth of brain cells. As a result, the patient’s brain is more flexible and can benefit more from subsequent therapy.
Therapies used during treatment include:
Each patient will have an unique combination of exercises from these therapies to address their symptoms. Some therapies can be administered in quick succession or even in combination with each other. For example, our therapist may ask you to balance on a Bosu ball while tossing color-coordinated balls back and forth and naming an animal for each letter of the alphabet. This forces your brain to activate specific areas so you stay balanced, catch the ball, and think of the next animal name — all at the same time. This encourages the restoration of healthy neurovascular coupling as the brain grapples with the increased demand for resources in multiple brain regions simultaneously.
Throughout the day, patients are also given opportunities to rest and relax so their brains can recover before the next therapy. This may include a neuromuscular massage to the neck and shoulders, breathing exercises, or mindfulness meditations, for example. For patients with insomnia, these activities can be extremely helpful to re-teach the brain how to relax and unwind. Some of these exercises can also be done at home, which further helps the patient’s recovery.
After treatment, our patients repeat the initial evaluation, including the physical and cognitive assessment, and discuss with our team how their symptoms changed during treatment. Patients also undergo a second fNCI scan, which allows our team to assess their progress and suggest ways to move forward. For example, if we feel that you may benefit from further therapy in a particular area (such as vision), we can refer you to suitable specialists.
Further reading: Vision problems after COVID
Finally, you will meet with one of our therapists to go over your results and receive a series of homework exercises. This usually includes physical exercises, cognitive activities, visual and vestibular exercises, and relaxation techniques designed to help during your recovery. These exercises take about an hour to complete. Initially, patients should do them five times a week, but the frequency can be reduced as symptoms improve.
Since the COVID pandemic started, we’ve treated dozens of patients with long COVID. All were experiencing several different symptoms, including headaches, brain fog, and dizziness, among others.
After treatment, patients experienced significant improvements in many lingering symptoms of COVID-19. Most patients reported an overall improvement in quality of life and say their symptoms are easier to cope with in their daily lives.
If you’re experiencing insomnia or other sleep-related problems and are considering coming to Cognitive FX for treatment, it’s worth mentioning that our previous patients experienced better sleep after treatment.
Meanwhile, scores in areas such as fatigue tend to improve once the patient has time to rest and recover at home. Treatment is intense, after all! Visual problems tend to respond more slowly; patients with notable vision problems often need continued therapy at home for full improvement to take effect.
Want to find out if you’re eligible for treatment at our specialized clinic? Contact our team to schedule a consultation.
Recovering from long COVID is not easy, and struggling to fall asleep or waking up frequently during the night only makes things worse. Here we suggest a series of tips to help you sleep better at night and improve your general well-being. Not every sleep habit we suggest will work for everyone, so you may have to try different approaches to see what is effective for you.
Of the COVID long-haulers who meet our screening criteria, over 90% show improvement after treatment at our clinic. Our long COVID patients report over 40% decrease in symptom severity in 13 symptoms after just one week of multidisciplinary therapy. To discuss your specific long COVID symptoms and whether you’re eligible for treatment at our clinic, schedule a consultation.
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