Sleep difficulties

Sleep is essential for our mood, memory and metabolism. It impacts on every part of our lives and when we don’t get enough it can impact on both our physical and mental wellbeing.  Sleep deprivation can also lead to weight gain and puts us more at risk of things like sleep apnoea.

There is no disputing that sleep is fundamental to our health and wellbeing.

It has been found that up to 40% of patients who have post Covid syndrome (long COVID) symptoms are struggling with their sleep, this could be a new or exacerbated sleep difficulty following Covid infection.

Why this is more prevalent following Covid infection remains unclear although it is completely normal to sleep more during infection and for some, it might be difficult to get back into their normal sleep routine.  Some medications cause sleep disturbances too.  Being indoors more and not being exposed to natural daylight can also cause disruption to our circadian rhythm (or body clock).  Sleep disturbances can also be caused by low mood and anxiety.  If you are concerned please do speak to your GP.  There are also some helpline numbers at the bottom of this page.

Types of Sleep Difficulties

Sleep difficulties can take the form of delayed sleep onset (lying in bed for more than 15 -20 minutes and struggling to get off to sleep), waking up during the night and struggling to get back to sleep for some time afterwards, you might also wake up too early in the morning.  It could of course, be any combination of these.

Understanding the brain/body connection for sleep

Understanding the mechanisms relating to sleep can help to understand what is happening and give you more insight into things that you can put in place to help achieve better sleep.

What happens when we are asleep?

When you fall asleep at night you cycle through a number of stages – these are known as sleep stages.  A typical sleep cycle in an adult lasts around 90 minutes and depending on your total sleep duration, you may have several of these during the night.

What makes up a sleep cycle?

It is completely normal to wake up during the night although for many people they are not aware.  It is how you respond to the night wakening which counts.

What governs sleep?

Scientists call this ‘sleep homeostasis’ but we can refer to this as our sleep drive.

In principle, the longer we are awake the more our sleep drive builds – similar to how hunger slowly builds after a meal.

Usually when we have been awake for around 16 hours our sleep drive should be at its richest.  But like hunger, we know if we snack between meals we may not be as hungry at our next meal, naps can also affect sleep pressure. A short nap up to 20 minutes does not appear to affect sleep pressure and some people find naps beneficial.

As human beings we also have something known as a circadian rhythm or sleep/wake cycle.

We are governed by night and day over a 24 hour period.  There is a group of cells within the brain called the suprachiasmatic nucleus (SCN) that control when we feel sleepy and when we feel alert.  You might find that you are more sleepy in the afternoon and this is due to a natural peak in the mid-afternoon of this sleep/wake cycle.

What helps achieve better sleep?

You may have heard of something called Sleep Hygiene?  – this is nothing to do with cleanliness but refers to creating a routine and an environment which is sleep friendly.

Here are some suggestions but you can find more on the Your COVID Recovery website.

Bedroom Environment

• Check your bedroom temperature – is it too warm or too cold? The temperature should be around 16-18 °C /60-65 °F.  Your bedroom should be dark and quiet (blackout curtains are very helpful, particularly in the summer months).  
• Try to keep your bedroom as a place for sleep – avoid watching TV, working, gaming etc in the bedroom.
• Clear your bedroom of clocks – checking them helps your brain to keep more accurate track of time and is not helpful for regular night waking. Keeping check of the time can cause you to worry that you only have a certain number of hours left to sleep so try not to look at the time when you are trying to sleep.

Routine/Behaviours

• Sleep/wake cycle, as mentioned above, is governed by our 24 hour circadian rhythm. Try to keep to a regular wake time and ensure as much natural daylight as possible as soon as you can after waking.
• Caffeine is a stimulant and can mask the build-up of sleep drive – some people are more sensitive to the effects than others but it’s worth bearing in mind that caffeine has a half-life of 5-7 hours (this means that half of the chemicals from caffeine have left your body in this time). It is also worth noting that caffeine is not just present in coffee or tea, many painkillers, soft drinks and dark chocolate also contain a level of caffeine.
• Alcohol may help people to fall asleep quicker, but it is better to avoid or cut down before bedtime. Alcohol is broken down very quicky by the body and during the second half of the night it can cause frequent early morning waking – it can also stop people from entering into REM sleep which can lead to a number of health problems.  Of course, having a lot to drink also can cause more visits to the loo and drinking on a regular basis can lead to an alcohol dependency.  It is not sleep’s friend.
• Nicotine, like caffeine is a stimulant which can disrupt sleep, it can also make restless legs much worse. If you do smoke, try to think about quitting all together, the health benefits are huge.  If you aren’t able to do this right now, try to have you last cigarette 2 hours before you plan to go to bed.
• Exercise can be good for sleep but please ensure that you have checked with the Long Covid clinic before embarking on any high-intensity (exercise that makes you out of breath) before carrying out any exercise programme. If you do any exercise try and keep this away from bedtime (at least 4 hours before) otherwise it can stop you from getting to sleep.
• Technology – avoid looking at bright screens for at least the last 30 minutes before bed. The blue light omitted from screens (mobiles, TVs & tablets) can all stimulate your brain into thinking it is still daytime.
• Although you might feel fatigued with Long Covid, do not go to bed until you feel tired enough to sleep. If you find that you are lying in bed for more than 15-20 minutes, as hard as it may feel, get out of the bedroom and do a non-stimulating activity in a dim room.  This could be reading but adult colouring books and jigsaws have been found to help too.  Only return to your bed when you feel tired enough to sleep.

There are also sleep mediations which can help soothe a busy mind.  Once learnt you can replicate without any technology once in bed.  Here are some examples:

Progressive-Muscle-Relaxation.mp3

Guided relaxation and mindfulness for patients

Bedtime meditation video – NHS