Treatment for Sleep Disturbances in Long COVID
Cognitive and behavioral therapy (CBT) is the most effective treatment for sleep disturbances in patients with Long COVID. While there is limited specific guidance on treating sleep disturbances in Long COVID, the available evidence suggests non-pharmacological approaches should be prioritized.
Understanding Sleep Disturbances in Long COVID
Sleep disturbances are highly prevalent in Long COVID, affecting approximately one-third of patients 1. These disturbances include:
- Insomnia symptoms
- Hypersomnia
- Poor sleep quality
- Daytime sleepiness
- Sleep inertia
- Nightmares
Treatment Algorithm for Sleep Disturbances in Long COVID
First-Line Treatment: Cognitive and Behavioral Therapy
- CBT has demonstrated effectiveness for sleep disorders and should be the initial approach
- This includes sleep hygiene education, stimulus control, sleep restriction, and cognitive restructuring
- Regular exercise is a protective factor against sleep disturbances (OR = 0.77,95% CI: 0.63-0.93) 2
Second-Line Treatment: Supportive Measures
- Maintain adequate hydration
- Use of honey for symptom relief if cough is contributing to sleep disturbances 3
- Development of practical indoor exercise programs to improve sleep quality 2
Third-Line Treatment: Consider Melatonin
- May be considered for sleep regulation, though evidence specifically for Long COVID is limited
- Low risk of adverse effects compared to other sleep medications
Risk Factors for Sleep Disturbances in Long COVID
Several factors increase the risk of sleep disturbances in Long COVID patients:
- Older age (OR: 1.42,95% CI: 1.1-2.64) 2
- Female gender (OR: 1.35,95% CI: 1.16-1.59) 2
- Poor self-reported health status (OR: 5.59,95% CI: 4.32-7.23) 2
- Psychological factors and number of post-acute symptoms 1
Pathophysiological Mechanisms
Sleep disturbances in Long COVID may be related to:
- Persistent inflammation 4
- Autoimmune mechanisms 4
- Mitochondrial dysfunction 4
- Neuroinflammation affecting brain regions involved in sleep regulation 4
- Psychological trauma from the infection and its consequences 5
Important Considerations and Pitfalls
- Avoid using nirmatrelvir-ritonavir for treating sleep disturbances in Long COVID, as it is indicated for acute COVID-19 within 5 days of symptom onset, not for Long COVID symptoms 6, 3
- Sleep disturbances may be part of a broader constellation of symptoms and should not be treated in isolation
- Sleep disorders can persist for months after initial infection and may require ongoing management 7
- The relationship between sleep disturbances and cognitive impairment in Long COVID should be recognized, as both frequently co-occur 7
- Avoid overuse of sedative medications which may worsen daytime functioning
Monitoring and Follow-up
- Schedule virtual follow-up 1-2 weeks after initiating treatment 3
- Assess for improvement in sleep quality, daytime functioning, and other Long COVID symptoms
- Consider treatment escalation if no improvement is observed after 4-6 weeks of CBT
While pharmacological treatments like nirmatrelvir-ritonavir are recommended for acute COVID-19 6, 3, they are not indicated for Long COVID symptoms such as sleep disturbances. The current evidence supports cognitive and behavioral approaches as the most effective strategy for managing sleep disturbances in Long COVID patients.