{"id":15997,"date":"2026-10-13T06:00:00","date_gmt":"2026-10-13T10:00:00","guid":{"rendered":"https:\/\/cov19longhaulfoundation.org\/?p=15997"},"modified":"2026-09-05T07:00:18","modified_gmt":"2026-09-05T11:00:18","slug":"the-covid-sleep-crisis","status":"publish","type":"post","link":"https:\/\/cov19longhaulfoundation.org\/?p=15997","title":{"rendered":"The COVID Sleep Crisis"},"content":{"rendered":"\n
For millions of people, COVID didn’t just steal their energy. It changed the way they sleep.<\/em><\/h5>\n\n\n\n

By John Murphy, CEO The COVID Long haul Foundation<\/p>\n\n\n\n

At 3 a.m., the house is silent.<\/p>\n\n\n\n

But inside your body, something is happening that you cannot explain.<\/p>\n\n\n\n

Your heart suddenly pounds. You are wide awake. Your mind is racing, although you aren’t particularly anxious. You fall asleep again\u2014but only for an hour. Then you wake up.<\/p>\n\n\n\n

Again.<\/p>\n\n\n\n

And again.<\/p>\n\n\n\n

Or perhaps your experience is the opposite. You sleep ten, twelve, even sixteen hours and wake feeling as though someone has drained the battery from your body.<\/p>\n\n\n\n

You are exhausted.<\/p>\n\n\n\n

Your brain is foggy.<\/p>\n\n\n\n

You want to sleep again.<\/p>\n\n\n\n

For many people who developed Long COVID, this isn’t an occasional bad night. It can continue for months or years.<\/p>\n\n\n\n

And increasingly, scientists are finding that these experiences are not imaginary, unusual or simply a matter of poor “sleep hygiene.”<\/p>\n\n\n\n

COVID can profoundly disturb the biology of sleep.<\/strong><\/p>\n\n\n\n

\n\n\n\n
“I slept 12 hours\u2014and then another six”<\/strong><\/h5>\n\n\n\n

Consider the experience of Eleanor, whose Long COVID story has been publicly published by the patient-support organization Positively COVID.<\/p>\n\n\n\n

At the height of her illness, she wrote that she was sleeping 12 hours at night and another six hours during the day<\/strong>.<\/p>\n\n\n\n

She had become so debilitated that she moved in with her parents because she could no longer stand long enough to brush her teeth.<\/p>\n\n\n\n

Her description of the accompanying illness is particularly revealing: overwhelming fatigue, dizziness, striking changes in the color of her hands and feet and severe cognitive problems.<\/p>\n\n\n\n

She described her brain fog as being on “autopilot”\u2014having conversations while feeling that she wasn’t really present in them.<\/p>\n\n\n\n

This is not the picture most people have of insomnia.<\/p>\n\n\n\n

It is something potentially more complicated:<\/p>\n\n\n\n

the brain can demand enormous amounts of sleep and still fail to produce restorative sleep.<\/strong><\/p>\n\n\n\n

\n\n\n\n
Another patient went in the opposite direction<\/strong><\/h5>\n\n\n\n

One Long COVID patient described the experience in almost exactly the opposite terms.<\/p>\n\n\n\n

Three months after a severe COVID infection, the person reported losing the ability to sleep normally.<\/p>\n\n\n\n

For three consecutive days, there was essentially no sleep.<\/p>\n\n\n\n

Eventually medication was required.<\/p>\n\n\n\n

The patient described simultaneous episodes of rapid heartbeat and powerful physical “surges” that felt like anxiety even though the person did not feel psychologically anxious.<\/p>\n\n\n\n

That distinction is worth considering.<\/p>\n\n\n\n

What feels like anxiety may sometimes be an autonomic event.<\/p>\n\n\n\n

The body may be generating a surge of sympathetic nervous-system activity\u2014raising heart rate and arousal precisely when the brain is supposed to be descending into sleep.<\/p>\n\n\n\n

This is one reason researchers have become interested in the relationship between Long COVID, dysautonomia and sleep.<\/p>\n\n\n\n

\n\n\n\n
“My brain won’t turn off”<\/strong><\/h5>\n\n\n\n

Another patient described a bizarre oscillation between extremes.<\/p>\n\n\n\n

After recovering substantially from Long COVID, a reinfection brought the sleep problems back.<\/p>\n\n\n\n

One night the person fell asleep around 4 a.m. and managed only five hours of sleep.<\/p>\n\n\n\n

The next night, the person slept 16 hours<\/strong>.<\/p>\n\n\n\n

And still didn’t feel refreshed.<\/p>\n\n\n\n

The patient described the sensation simply as:<\/p>\n\n\n\n

“my brain won’t turn off.”<\/strong><\/p>\n\n\n\n

That phrase appears repeatedly in accounts from Long COVID patients.<\/p>\n\n\n\n

It is striking because it captures something conventional definitions of insomnia don’t always convey.<\/p>\n\n\n\n

The patient isn’t necessarily saying:<\/p>\n\n\n\n

“I’m worried about something.”<\/em><\/p>\n\n\n\n

They’re saying:<\/p>\n\n\n\n

“My body is exhausted, but whatever controls sleep will not let me stay asleep.”<\/em><\/p>\n\n\n\n

\n\n\n\n
Four years of broken sleep<\/strong><\/h5>\n\n\n\n

Another publicly posted account describes a person who has lived with Long COVID for four years.<\/p>\n\n\n\n

Sleep had become extraordinarily fragmented.<\/p>\n\n\n\n

The person reported sleeping for approximately an hour, waking, sleeping for perhaps another 45 minutes, waking again, and repeating the cycle.<\/p>\n\n\n\n

A formal sleep study reportedly found only about 1\u00bd hours of actual sleep during the night<\/strong>.<\/p>\n\n\n\n

The patient was relieved not to have sleep apnea\u2014but that didn’t solve the mystery.<\/p>\n\n\n\n

The sleep remained fragmented and non-restorative.<\/p>\n\n\n\n

This illustrates an important point.<\/p>\n\n\n\n

A negative sleep-apnea test does not mean:<\/p>\n\n\n\n

“Nothing is wrong with your sleep.”<\/strong><\/p>\n\n\n\n

It means that one important explanation has been investigated and apparently not found.<\/p>\n\n\n\n

There are many other possibilities.<\/p>\n\n\n\n

\n\n\n\n
A teenager who could not wake up<\/strong><\/h5>\n\n\n\n

The phenomenon isn’t restricted to older adults.<\/p>\n\n\n\n

Researchers have described a 13-year-old girl who developed severe hypersomnolence after a relatively mild COVID infection.<\/p>\n\n\n\n

Before COVID, she had no significant sleep problem.<\/p>\n\n\n\n

After infection, she developed insomnia, a major shift in her circadian rhythm, difficulty waking, brain fog and headaches.<\/p>\n\n\n\n

Her sleep duration was frequently 12 hours or more in a 24-hour period<\/strong>.<\/p>\n\n\n\n

She had difficulty getting out of bed, missed school and sometimes had to leave school early because of sleepiness and headaches.<\/p>\n\n\n\n

Formal testing subsequently found persistent hypersomnolence despite apparently adequate sleep during the overnight study.<\/p>\n\n\n\n

This is important because it demonstrates why simply telling someone to “get more sleep” can be meaningless.<\/p>\n\n\n\n

She was already getting enormous amounts of sleep.<\/strong><\/p>\n\n\n\n

The problem was that the sleep was not functioning normally.<\/p>\n\n\n\n

\n\n\n\n
The doctors who became patients<\/strong><\/h5>\n\n\n\n

Perhaps the most compelling evidence comes from physicians themselves.<\/p>\n\n\n\n

In a published account of two doctors who developed Long COVID, one physician described how the initial illness gave way to palpitations and insomnia<\/strong>.<\/p>\n\n\n\n

The problem was not simply difficulty falling asleep.<\/p>\n\n\n\n

The physician would fall asleep and then wake during the night with a pounding heart<\/strong>, sometimes remaining unable to fall back asleep for more than an hour.<\/p>\n\n\n\n

Physical exertion made things worse, producing profound delayed exhaustion.<\/p>\n\n\n\n

The physician described the experience as having a battery that had been completely drained.<\/p>\n\n\n\n

This type of first-person account is particularly powerful because physicians are accustomed to thinking in diagnostic categories.<\/p>\n\n\n\n

Yet here, the physician became the patient\u2014and encountered a syndrome that did not fit neatly into familiar categories.<\/p>\n\n\n\n

\n\n\n\n
Some patients experience both extremes<\/strong><\/h5>\n\n\n\n

Perhaps the strangest pattern is the oscillation between insomnia and hypersomnia.<\/p>\n\n\n\n

A patient may go from almost no sleep to extraordinarily long periods of sleep.<\/p>\n\n\n\n

Another person reported going through episodes of both insomnia and hypersomnia, sometimes sleeping 16 hours after a night of very little sleep.<\/p>\n\n\n\n

That pattern raises an intriguing possibility:<\/p>\n\n\n\n

Maybe Long COVID isn’t simply “causing insomnia.”<\/p>\n\n\n\n

Maybe in some people it is disturbing the sleep-wake regulatory system itself<\/strong>.<\/p>\n\n\n\n

\n\n\n\n
The biology of a broken sleep-wake system<\/strong><\/h5>\n\n\n\n

Sleep isn’t merely rest.<\/p>\n\n\n\n

It is an active biological state controlled by an intricate network involving the hypothalamus, thalamus, brainstem, cortex, autonomic nervous system, hormones, neurotransmitters and circadian clocks.<\/p>\n\n\n\n

COVID can potentially affect several of those systems.<\/p>\n\n\n\n

Researchers have now documented a remarkably broad spectrum of post-COVID sleep disorders.<\/p>\n\n\n\n

In a sleep-clinic study of 42 patients with post-acute COVID syndrome, researchers identified:<\/p>\n\n\n\n

    \n
  • obstructive sleep apnea;<\/li>\n\n\n\n
  • chronic insomnia;<\/li>\n\n\n\n
  • primary hypersomnia;<\/li>\n\n\n\n
  • REM sleep behavior disorder;<\/li>\n\n\n\n
  • newly developed circadian phase delay.<\/li>\n<\/ul>\n\n\n\n

    Seven patients met criteria for idiopathic hypersomnia and two for narcolepsy type 2. The investigators concluded that persistent severe sleep complaints following COVID warrant comprehensive clinical sleep evaluation.<\/p>\n\n\n\n

    That is a remarkable finding.<\/p>\n\n\n\n

    The problem isn’t one disorder.<\/p>\n\n\n\n

    It is an entire spectrum of sleep-wake abnormalities<\/strong>.<\/p>\n\n\n\n

    \n\n\n\n
    When the brain’s clock changes<\/strong><\/h5>\n\n\n\n

    Our bodies possess an internal timing system that coordinates sleep with daylight, hormones, temperature, metabolism and behavior.<\/p>\n\n\n\n

    COVID may disrupt that timing system.<\/p>\n\n\n\n

    One patient described falling asleep easily and sleeping normally during the first part of the night\u2014but experiencing chaos during the second half.<\/p>\n\n\n\n

    The reported symptoms included repeated adrenaline-like jolts, sudden increases in breathing and heart rate, sleepwalking, sleep talking, disturbing dreams and repeated awakenings.<\/p>\n\n\n\n

    The description sounds almost like the nervous system is repeatedly hitting an emergency reset button.<\/p>\n\n\n\n

    Whether that particular patient’s symptoms were caused by Long COVID cannot be established from a self-report.<\/p>\n\n\n\n

    But the phenomenon is biologically plausible enough to warrant investigation\u2014and similar symptoms have now appeared in clinical sleep research.<\/p>\n\n\n\n

    \n\n\n\n
    A possible clue deep inside the brain<\/strong><\/h5>\n\n\n\n

    One published case report offers an especially intriguing clue.<\/p>\n\n\n\n

    A 41-year-old woman reportedly developed complete insomnia lasting three weeks after COVID-19<\/strong>.<\/p>\n\n\n\n

    A conventional MRI was normal.<\/p>\n\n\n\n

    But SPECT brain imaging demonstrated reduced blood flow in both thalami.<\/p>\n\n\n\n

    The thalamus is deeply involved in regulating consciousness, arousal and sleep.<\/p>\n\n\n\n

    Follow-up imaging showed persistent abnormalities over time, although the pattern changed.<\/p>\n\n\n\n

    This is a single case, not proof of a general mechanism.<\/p>\n\n\n\n

    But it raises an extraordinary question:<\/p>\n\n\n\n

    Could COVID-associated sleep disorders sometimes reflect measurable changes in brain physiology even when conventional MRI appears normal?<\/strong><\/p>\n\n\n\n

    That question deserves considerably more research.<\/p>\n\n\n\n

    \n\n\n\n
    The sleep-apnea trap<\/strong><\/h5>\n\n\n\n

    There is another reason patients with Long COVID should not assume that every sleep problem is caused by the infection.<\/p>\n\n\n\n

    Sleep apnea is common.<\/p>\n\n\n\n

    It can produce daytime sleepiness, cognitive impairment, headaches, poor concentration and profound fatigue.<\/p>\n\n\n\n

    Those symptoms overlap almost perfectly with Long COVID.<\/p>\n\n\n\n

    A person can therefore have both.<\/p>\n\n\n\n

    And some patients report developing sleep apnea after COVID.<\/p>\n\n\n\n

    That makes objective sleep testing particularly important when symptoms are severe.<\/p>\n\n\n\n

    A patient may spend ten hours in bed but experience dozens of respiratory or arousal events every hour.<\/p>\n\n\n\n

    The result is technically “ten hours in bed.”<\/p>\n\n\n\n

    Biologically, it may be something very different.<\/p>\n\n\n\n

    \n\n\n\n
    The mystery of “unrefreshing sleep”<\/strong><\/h5>\n\n\n\n

    Perhaps the most common phrase in patient accounts is not insomnia.<\/em><\/p>\n\n\n\n

    It is:<\/p>\n\n\n\n

    “I slept, but I didn’t sleep.”<\/strong><\/p>\n\n\n\n

    A 2025 review of Long COVID sleep disorders describes a range of problems including insomnia, hypersomnolence, sleep apnea, circadian disturbances and other abnormalities. The authors emphasize that the mechanisms are likely heterogeneous.<\/p>\n\n\n\n

    This may explain why sleep medications don’t necessarily solve the problem.<\/p>\n\n\n\n

    If the underlying problem involves circadian disruption, autonomic activation, sleep apnea, central hypersomnia or abnormal sleep architecture, simply inducing unconsciousness is not necessarily equivalent to producing normal restorative sleep.<\/p>\n\n\n\n

    \n\n\n\n
    The vicious cycle<\/strong><\/h5>\n\n\n\n

    And then something else happens.<\/p>\n\n\n\n

    Poor sleep makes everything else worse.<\/p>\n\n\n\n

    Brain fog worsens.<\/p>\n\n\n\n

    Pain becomes harder to tolerate.<\/p>\n\n\n\n

    Mood changes.<\/p>\n\n\n\n

    Reaction time slows.<\/p>\n\n\n\n

    Memory becomes less reliable.<\/p>\n\n\n\n

    Physical activity becomes more difficult.<\/p>\n\n\n\n

    Fatigue increases.<\/p>\n\n\n\n

    And because the person feels exhausted, they spend more time sleeping during the day.<\/p>\n\n\n\n

    Which can further destabilize the body’s circadian rhythm.<\/p>\n\n\n\n

    The cycle becomes:<\/p>\n\n\n\n

    COVID \u2192 disrupted sleep \u2192 cognitive dysfunction and fatigue \u2192 daytime sleeping \u2192 circadian disruption \u2192 poorer nighttime sleep \u2192 greater fatigue.<\/strong><\/p>\n\n\n\n

    Breaking that cycle may require treating the sleep disorder itself\u2014not simply telling the patient to wait for Long COVID to disappear.<\/p>\n\n\n\n

    \n\n\n\n
    Science is beginning to catch up with the stories<\/strong><\/h5>\n\n\n\n

    The patient stories are compelling.<\/p>\n\n\n\n

    But anecdotes alone cannot establish causation.<\/p>\n\n\n\n

    Fortunately, the emerging scientific literature is beginning to provide independent support.<\/p>\n\n\n\n

    In one prospective cohort, approximately one-quarter of patients with Long COVID reported sleep-related symptoms; insomnia was considerably more common than excessive sleepiness. Objective testing identified central hypersomnia and narcolepsy in a subset of patients with excessive sleepiness.<\/p>\n\n\n\n

    Another study of 530 post-COVID patients identified four cases of central hypersomnia after carefully excluding alternative explanations. Three met criteria for idiopathic hypersomnia and one for type 2 narcolepsy.<\/p>\n\n\n\n

    These are small numbers.<\/p>\n\n\n\n

    But they are important numbers.<\/p>\n\n\n\n

    They demonstrate that excessive sleepiness after COVID can sometimes correspond to a diagnosable neurological sleep disorder.<\/strong><\/p>\n\n\n\n

    \n\n\n\n
    The question doctors should ask<\/strong><\/h5>\n\n\n\n

    Perhaps the most important change is a simple one.<\/p>\n\n\n\n

    When a Long COVID patient says:<\/p>\n\n\n\n

    “I can’t sleep,”<\/em><\/p>\n\n\n\n

    the next question should not simply be:<\/p>\n\n\n\n

    “How much caffeine are you drinking?”<\/em><\/p>\n\n\n\n

    And when someone says:<\/p>\n\n\n\n

    “I sleep twelve hours and I’m still exhausted,”<\/em><\/p>\n\n\n\n

    the response shouldn’t simply be:<\/p>\n\n\n\n

    “You need to exercise more.”<\/em><\/p>\n\n\n\n

    The clinician should ask:<\/p>\n\n\n\n

    What kind of sleep problem is this?<\/strong><\/p>\n\n\n\n

    Is it insomnia?<\/p>\n\n\n\n

    Sleep apnea?<\/p>\n\n\n\n

    Central hypersomnia?<\/p>\n\n\n\n

    A circadian disorder?<\/p>\n\n\n\n

    Periodic limb movements?<\/p>\n\n\n\n

    REM sleep behavior disorder?<\/p>\n\n\n\n

    Autonomic arousals?<\/p>\n\n\n\n

    Medication-related sleep disruption?<\/p>\n\n\n\n

    Or some combination?<\/p>\n\n\n\n

    \n\n\n\n
    The bedroom may become a laboratory<\/strong><\/h5>\n\n\n\n

    This may ultimately be one of the most productive directions in Long COVID research.<\/p>\n\n\n\n

    Instead of relying exclusively on questionnaires, investigators can measure sleep objectively.<\/p>\n\n\n\n

    Polysomnography can examine brain waves, breathing, oxygenation, heart rhythm and muscle activity.<\/p>\n\n\n\n

    Actigraphy can track sleep-wake cycles over extended periods.<\/p>\n\n\n\n

    Wearable devices can provide additional information about heart rate and movement.<\/p>\n\n\n\n

    Researchers can combine those measurements with neurological testing, autonomic measurements, inflammatory markers and other biological data.<\/p>\n\n\n\n

    The goal would be to determine whether distinct sleep signatures correspond to distinct forms of Long COVID.<\/p>\n\n\n\n

    If they do, sleep could become more than something to treat.<\/p>\n\n\n\n

    It could become a window into the disease itself<\/strong>.<\/p>\n\n\n\n

    \n\n\n\n
    Listen to the people who cannot sleep<\/strong><\/h5>\n\n\n\n

    There is a tendency in medicine to distrust symptoms that are difficult to measure.<\/p>\n\n\n\n

    Sleep presents a special problem because the patient is unconscious when much of the disease is occurring.<\/p>\n\n\n\n

    But the stories are remarkably consistent.<\/p>\n\n\n\n

    One patient sleeps 16 hours and remains exhausted.<\/p>\n\n\n\n

    Another cannot sleep for three days.<\/p>\n\n\n\n

    Another wakes every hour.<\/p>\n\n\n\n

    Another experiences pounding heartbeats in the middle of the night.<\/p>\n\n\n\n

    Another develops a profoundly delayed sleep schedule.<\/p>\n\n\n\n

    Another acts out dreams.<\/p>\n\n\n\n

    Another cannot wake up for school.<\/p>\n\n\n\n

    Another spends years trying to remember what normal sleep felt like.<\/p>\n\n\n\n

    These aren’t identical disorders.<\/p>\n\n\n\n

    But taken together, they tell us something.<\/p>\n\n\n\n

    COVID appears to have disturbed sleep in a substantial number of people\u2014and in some patients, the disturbance can become a persistent neurological problem.<\/strong><\/p>\n\n\n\n

    The science is still developing.<\/p>\n\n\n\n

    The mechanisms remain uncertain.<\/p>\n\n\n\n

    And Long COVID is almost certainly not one disease with one biological explanation.<\/p>\n\n\n\n

    But the patient stories have already established something that should be difficult to ignore:<\/p>\n\n\n\n

    For some people, COVID didn’t simply make them tired.<\/strong><\/p>\n\n\n\n

    It changed the machinery that determines when they sleep, how they sleep\u2014and whether sleep restores them at all.<\/strong><\/p>\n\n\n\n

    And sometimes, the first place to look for what COVID did to the brain isn’t the doctor’s office.<\/p>\n\n\n\n

    It’s the bedroom.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

    For millions of people, COVID didn’t just steal their energy. It changed the way they sleep. By John Murphy, CEO The COVID Long haul Foundation At 3 a.m., the house […]<\/p>\n","protected":false},"author":2,"featured_media":16001,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59,536,537,949,1426,1422],"tags":[],"class_list":["post-15997","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-brain-fog","category-sleep","category-sleep-deprivation","category-sleep-disturbance","category-sleep-latency","category-sleep-wake-disorders"],"_links":{"self":[{"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/posts\/15997","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=15997"}],"version-history":[{"count":3,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/posts\/15997\/revisions"}],"predecessor-version":[{"id":16000,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/posts\/15997\/revisions\/16000"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/media\/16001"}],"wp:attachment":[{"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=15997"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=15997"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=15997"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}