Although most patients diagnosed with COVID-19 will recover quickly, some people experience symptoms that linger well after they start testing negative again – including insomnia. Scientists already knew that insomnia was common in patients who had to be hospitalized, but a team of scientists in Vietnam began to wonder if mild infections might also affect sleep quality.
“As a sleep researcher, I received many questions and complaints from relatives, friends, and colleagues about their sleep disturbances after recovering from COVID-19,” said Dr. Huong T. X. Hoang of Phenikaa University Hoang who was the lead author of the article published in the journal Frontiers in Public Health under the title “Sleep quality among non-hospitalized COVID-19 survivors: a national cross-sectional study.”
“I found that the majority of papers focused on patients in hospitals where the environment of their treatment and quarantine would differ greatly from those with milder symptoms.”
Using Vietnam’s official network of COVID-19 survivors, the scientists recruited 1,056 people over the age of 18 who had been diagnosed with the new Coronavirus but had not been hospitalized in the last six months and who reported no history of insomnia or psychiatric conditions. They sent out a survey to these people for completion between June and September 2022.
The survey asked about sociodemographic characteristics like age, sex, chronic conditions, and the duration and severity of patients’ COVID-19 infection. It also measured symptoms of anxiety, stress, and depression experienced by patients. To investigate levels of insomnia, patients were asked to compare how well and how long they slept, as well as how easy it was for them to fall asleep in the last two weeks compared to before contracting COVID-19.
Participants said suffering from insomnia
Fully 76.1% of the participants reported that they had suffered from insomnia, and 22.8% of these people reported severe insomnia. Half the participants said they woke more often in the night, while a third said that they found it harder to fall asleep, slept worse, and slept for less time. The severity of their initial infection didn’t seem to correlate with the severity of the insomnia they experienced. Although asymptomatic COVID-19 patients scored lower on the insomnia index, the difference was not statistically significant.
“If you experience insomnia after COVID-19, don’t think that is normal,” said Hoang. “If insomnia doesn’t bother you much, you can take some simple actions like taking a warm shower before bedtime, shutting your phone down at least an hour before going to bed, doing 30 minutes of exercise per day, and avoiding caffeine after 4 pm. In case insomnia really troubles you, you can try some over-the-counter sleep aids. If they don’t help, go to see a sleep specialist.”
Two groups of people did have statistically significant higher rates of insomnia – those who had a pre-existing chronic condition and people who scored highly for depressive or anxious symptoms. Both groups developed insomnia at a higher rate than their peers. When the scientists looked at those patients who reported insomnia, their depression and anxiety scores were higher than the average scores of the entire sample. But these illnesses are not completely independent of each other. Insomnia can worsen mental and physical health, as well as being driven by poorer mental and physical health.
The scientists pointed out that the rate of insomnia reported by patients is not only much higher than the rate among the general population but higher than that reported for hospitalized COVID-19 patients. This could be partly due to the focus on recently recovered patients who may have lingering symptoms. Recently recovered patients may also be more stressed and sensitive to changes in their physical health, leading them to perceive their sleep as worse.
The scientists stressed that a holistic approach is needed to tackle all the factors contributing to insomnia and that further investigation of the relationship between COVID-19, mental health problems, and insomnia is needed.
“Since this is a cross-sectional study, the relationship of anxiety and depression with insomnia cannot be fully investigated,” cautioned Hoang. “In addition, collecting data online and a convenience sampling method can cause recall bias and selection bias. However, due to the situation in Vietnam at that time, collecting data via electronic invitation and convenience sampling was the most efficient and feasible strategy.”