Long COVID Self-Management - Sleep

Your sleep may have changed after your recovery from COVID-19.

Reasons Your Sleep May Have Changed

Fatigue

You likely experienced fatigue, especially in early stages of your illness. When you are fatigued, you may want to sleep during the day, which can disrupt your day/night cycle.

Ongoing physical symptoms

The symptoms you experience could also make it hard to sleep (e.g., breathlessness, cough, fever, pain).

Stress

You were likely under a great deal of stress, which can also impact sleep.

Environment

Bright lights, sounds, and frequent awakenings in hospital could have disrupted your natural sleep cycle.

Medications

Certain medications can impact your sleep. Speak with your doctor if you have questions.

Some people may sleep poorly because they have a sleep disorder, like obstructive sleep apnea*.

The following information reviews ways that you can improve your sleep. Speak with your doctor if you continue to have problems. Other treatments may be necessary if you experience ongoing sleep problems or have a known sleep disorder.

Why is Sleep so Important?

Restores the Body

Sleep reduces the risk of developing medical conditions such as high blood pressure and heart disease. It also boosts the immune system.

Improves Thinking Abilities

When you sleep, your body clears any harmful chemical build-up in your brain. This helps it function better. Sleep also helps improve your ability to think clearer and solidify memories overnight.

Improves Emotional Well-Being

It might be harder to manage your emotions after a poor sleep.

How Does Your Body Regulate When You are Awake and Asleep?

Sleep / Wake Homeostasis

Your body tracks your need for sleep by a process called "sleep/wake homeostasis". It balances awake time with sleep needs (also called "the sleep drive"). Your sleep drive gets stronger the longer you are awake and tells you when you need to sleep. As you sleep, the sleep drive becomes weaker.

Circadian Rhythms

These are 24-hour cycles that bring balance to various body systems. One of the most important ones is the sleep-wake cycle.  Many things can impact circadian rhythms, including social activity, temperature and exercise. However, the most powerful factor is light. Being exposed to light cues the brain to send signals of alertness to the body. This limits the body from releasing melatonin, a hormone that aids in sleep. This is why your circadian rhythms are often linked to the light-dark cycle. When these are not regulated, your body’s systems do not function at their best. You may have trouble falling asleep, staying asleep, and end up with lower quality sleep. Sleep Cycle: There are two basic kinds of sleep:

Rapid-Eye Movement Sleep (REM) and Non-REM Sleep

Non-REM sleep is made up of three stages. Stage one is the time between being awake and getting to sleep. Stage two is a period of light sleep. And Stage three is a period of deep sleep. As you progress through these stages, your heart rate and breathing slow down, and your muscles relax.

During REM sleep, your heart rate and breathing increase and your brain wave activity is similar to when you are awake. Most of your dreaming occurs during REM sleep.

We tend to sleep best when we go through all three stages of sleep and when we listen to our body's "sleep clock".

Improving Sleep 

A Note on Medication for Sleep

Although sleeping pills can be helpful in the short-term, it is generally not recommended for long periods of time. Talk to your doctor if you have questions about them.

It is possible to have a good night’s sleep without sleeping pills.

Sleep Strategies to Consider

Use a Sleep/Wake Diary to Track Your Sleep

Identifying your current sleep habits is the first step towards making them better.

Set a Sleep Schedule

Try going to bed around the same time each night and getting up at the same time each morning. This makes the sleep/wake cycle stronger and more stable, which can help your body feel the sleep signals on a regular basis. One way to make sure you wake up at the same time each day is by setting an alarm clock.

Make Small Changes

Major changes to your sleep schedule can be disruptive. Instead, make small changes to help adjust your body clock, For example, try going to bed one hour earlier than usual. Or, you may find it easier to get up at the same time each day instead of changing the time you go to bed.

When You go to Bed, Avoid Staying Awake for More than 20 Minutes

You don’t want to make a link between your bed /bedroom and lack of sleep. If you are relaxed, sleep will eventually come. If you become frustrated or tense about not being able to sleep, your body will not relax. This will make falling asleep more difficult. In this case, it is best to get out of bed and do something relaxing. Avoid bright lights and electronics. Then, return to bed when you feel sleepy.

Avoid Napping During the Day

Napping can disrupt the sleep-wake cycle. If you nap during the day, it can be harder to fall asleep at night.

• If you must nap, try to do so for no more than 30 to 60 minutes and try not to nap late in the day.
• Set an alarm.

• Ask yourself: am I physically tired (e.g., can’t keep eyes open) or could this be related to my mood (e.g., bored, wanting to escape feelings/stress)?

• Develop a nightly sleep ritual.

Regular Bedtime Routine

A regular bedtime routine can cue your mind that it is time to sleep. This will make it easier to fall asleep. So, consider spending time winding down before bed with relaxing activities. 

• Minimize use of bright lights and electronics: Bright lights and the blue light from electronic devices can decrease melatonin levels and make it harder to fall asleep.
• Try relaxing activities such as: listening to calm music or an audiobook, reading, stretching, or a warm bath.
• Focus on relaxation. For additional relaxation exercises, please visit Mindfulness & Relaxation: Exercise and Activities.
• Develop healthy daytime habits.

Daily Activities

Daily activities can also impact sleep. Here are some ideas for habits that can help improve a person’s sleep hygiene:

• Get physically active. Exercise during the day helps improve sleep. Try to avoid exercise right before bedtime, as this can make you feel more awake and make it difficult to fall asleep.
• Spend some time in the sun. Getting natural light, especially in the morning, can improve sleep. This cues your natural circadian rhythm, which is based on daylight and darkness.
• Reduce caffeine intake, especially in the late afternoon and evening. Caffeine increases chemical activity in the body and can cause issues with falling asleep. Coffee is a popular example of a product that has caffeine in it. Health Canada recommends no more than 400 mg of brewed coffee per day (which is about three 8 oz cups or 237 mL).
• Avoid nicotine. This can also keep the body awake. Avoid nicotine intake after 7:00 pm.
•  Reduce alcohol intake. Alcohol can make it easier to fall asleep, but it reduces the quality of sleep you have. You may not spend as much time in deeper stages of sleep (which are important for recovery!). You may also wake up once the sleepy effects of alcohol wear off.
• Eat a balanced diet. Good nutrition promotes good sleep. A light snack before bedtime can be helpful, as low blood sugar can disrupt sleep. Some foods that can help promote sleepiness include: warm milk, granola, oatmeal, yogurt, whole grain cereal, and chamomile tea (Note: not all types of tea are caffeine-free).
• Avoid using your bed during the day: Only use your bed for sleep and sex, as you want to build a link in your mind between your bed and sleep.

Suggestions for how to Create a Restful Environment for Sleep

• Keep your bedroom cool. Most people find that a temperature of 16-18 degrees Celsius is comfortable.
• Darken your room. This could mean using heavy window coverings or an eye pillow to block out light. Darkness helps the body make more melatonin.
• Cut out noise. Using a fan, humidifier, white noise machine, or ear plugs can help to create a quiet, relaxing feel in the bedroom.
• Decorate your bedroom using calming colours.
• Get comfortable. Try out mattresses, pillows, and bedding to see what is most comfortable.
• Declutter your room. A messy room can increase anxiety for some people.

Consider How Your Thoughts and Feelings May Cause Sleep Difficulties

It is worth checking your sleep expectations. Good sleep does not mean falling asleep immediately or never waking up at night. Even people who have positive sleep habits usually take time to fall asleep and can wake up once or twice during the night.

Anxiety

Some people begin to worry when they have trouble falling asleep. They may worry about how poor their sleep was, how missed sleep will affect their energy levels or other parts of their day. Some may worry about what they must do the next day. Checking the clock only adds to anxiety.

Worry Can Make it Harder to Fall Asleep

Schedule "worry time." Worries creep up on us around bedtime as we no longer have distractions like we do during the day. If you find that you often worry at bedtime, try to schedule worry time into your day. Try not to schedule it for right before bedtime. During worry time, write down all the worries you can think of. At bedtime, try to tell yourself to not focus on the worries until the next scheduled worry time.

Focus on the present moment instead of the future or past.

• For relaxation exercises, please visit Mindfulness & Relaxation: Exercise and Activities.
• A guided meditation using a meditation app, CD, or MP3.
• Listening to an audio book. These help focus our attention and do not need any light. Choose a book that is interesting enough to keep you focused, but not enough to keep you awake for long.

Consider your internal world and the negative effects of anxiety and depression. Improving sleep may also positively impact your mental health. Visit  managing stress, anxiety, and low mood for more information.