Why can’t I sleep months after COVID? Understanding Post-COVID Insomnia

By Sina Hartung, MMSC-BMI, Harvard Medical SchoolReviewed by Eureka Health Medical Group
Published: June 25, 2025Updated: June 25, 2025

Summary

Insomnia that begins during or after a COVID-19 infection is common—about 40 % of long-COVID patients report new or worse sleep problems. Viral inflammation, autonomic nervous system shifts, and disrupted daylight routines all interact with stress to keep the brain in “wake” mode. The good news: most people improve within 6–12 months when red flags are ruled out and a targeted sleep plan, sometimes including medication or cognitive therapy, is started early.

Is post-COVID insomnia real, and why does it happen?

Yes—persistent trouble falling or staying asleep is one of the top five symptoms reported by long-COVID patients. According to the team at Eureka Health, "COVID can flip the body’s stress switch on and it sometimes stays stuck." Multiple mechanisms keep the brain alert even when you feel exhausted.

  • Inflammation can disrupt the sleep-wake clockCytokines released during infection alter the hypothalamus, delaying melatonin release by up to 90 minutes in laboratory studies.
  • Autonomic dysfunction keeps heart rate elevated at nightHeart-rate variability data show 20 % less parasympathetic tone in long-COVID patients, which the body interprets as a signal to stay awake.
  • Cortisol peaks shift toward the eveningItalian researchers found salivary cortisol at 10 p.m. was 36 % higher in long-COVID insomniacs than in recovered sleepers.
  • Daylight exposure often plummets during isolationLess than 30 minutes of morning sunlight reduces internal clock anchoring, lengthening the natural day beyond 24 hours.
  • More than three-quarters of COVID survivors report new insomnia within six monthsA Frontiers in Public Health survey of 1,056 Vietnamese adults found that 76 % developed post-COVID insomnia, and 23 % rated it severe, far above the 10–20 % seen in the general population. (CIDRAP)
  • Long-COVID cases are twice as likely to develop insomnia symptomsThe international ICOSS-II study (2,311 participants, 16 countries) showed long-COVID raised the risk of new insomnia symptoms two-fold (adjusted RR = 2.00) versus fully recovered peers. (PubMed)

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When does sleeplessness after COVID signal something dangerous?

Most post-COVID insomnia is benign, but a sudden change in sleep paired with specific symptoms can flag serious complications. "Always treat new chest pain, severe breathlessness, or snoring pauses as red-flag pairings with insomnia," warns Sina Hartung, MMSC-BMI.

  • Worsening shortness of breath at night can indicate silent hypoxiaOxygen saturation below 94 % while lying flat needs same-day medical review.
  • Frequent nighttime palpitations may reflect myocarditisStudies show up to 2 % of long-COVID patients develop heart inflammation that disturbs sleep.
  • Severe new headaches on waking could be a sign of blood-clot complicationsCall 911 if headaches come with vision changes or limb weakness.
  • Loud snoring with pauses raises concern for new-onset sleep apneaCOVID-related weight changes and airway inflammation increase apnea risk by 1.8-fold.
  • Depressed mood with suicidal thoughts requires immediate helpInsomnia triples suicide risk; contact the 988 Suicide & Crisis Lifeline in the U.S. right away.
  • Persistent sleep complaints beyond four weeks are very common after COVID-19Actigraphy data on 61 long-COVID patients showed 83.6 % had ongoing sleep disturbances more than one month post-infection, with an average Insomnia Severity Index of 16.3 (moderate insomnia), signaling the need for formal evaluation when symptoms linger. (NIH)
  • Combined insomnia and daytime hypersomnia can reflect neurological involvement in long COVIDIn a cohort of 189 long-COVID patients, 22.2 % reported insomnia while 3.2 % had central hypersomnia or narcolepsy, highlighting that both night-time and daytime sleep disruption warrant neurological assessment. (BMC)

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How long might post-COVID insomnia last, and who is most at risk?

Duration varies. In a U.K. cohort, 65 % improved within six months, but 15 % still had significant insomnia at one year. Risk rises with certain traits.

  • Women report longer persistenceFemale long-haulers had a 1.6-times higher odds of insomnia at 12 months.
  • Pre-existing anxiety doubles riskBaseline GAD-7 scores over 10 predicted chronic sleep disruption.
  • ICU admission extends recovery timelinePatients who needed ventilation averaged 10.5 months before returning to baseline sleep.
  • Night-shift workers struggle moreIrregular schedules compound circadian misalignment, delaying recovery.
  • One-quarter have insomnia beyond a yearIn a U.S. cohort of 246 COVID survivors, 28 % reported persistent sleep symptoms more than 12 months after infection. (PubMed)
  • Long COVID often triggers new-onset insomniaAmong patients without pre-pandemic insomnia, 60.6 % of long-COVID cases developed new sleep problems—twice the rate seen in short-COVID cases (adjusted RR 2.0). (PubMed)

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What can I do tonight to improve sleep quality after COVID?

Behavioral tweaks are first-line and work in roughly 60 % of long-COVID insomniacs. The team at Eureka Health notes, "A rigid wind-down routine matters more than total daylight hours right now."

  • Anchor wake-up time within a 30-minute window dailyConsistent rising resets circadian rhythm even if you slept poorly.
  • Get 10 minutes of sunlight or 5,000-lux lamp exposure before 9 a.m.Morning light lowers nighttime cortisol by 15 % in two weeks.
  • Limit bed to sleep and intimacy onlyRemoving phones and work materials retrains the brain to associate the mattress with sleep, cutting sleep-onset latency by 20 minutes on average.
  • Try a 6-minute diaphragmatic breathing drillHeart-rate variability improves enough to drop perceived arousal by 30 % in pilot trials.
  • Avoid caffeine after noon and alcohol within three hours of bedtimeBoth reduce REM sleep; alcohol rebound wakefulness peaks about four hours after the last drink.
  • Put phones and tablets away at least 60 minutes before bedAfter mild COVID, 76.1 % of participants reported insomnia; researchers advised a one-hour digital curfew to lower pre-sleep arousal and improve sleep onset. (Frontiers)
  • Write down next-day worries, then switch off the lightNHS Long-COVID guidance suggests listing concerns on paper and keeping the bedroom dark to calm the mind, a simple step that can ease nighttime wakefulness. (NHS)

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Which tests and treatments do doctors consider for post-COVID insomnia?

Evaluation starts with basic labs and may progress to sleep-focused medications or therapies. "Not every patient needs a prescription; sometimes ruling out thyroid or iron problems fixes the issue," says Sina Hartung, MMSC-BMI.

  • Basic panel often includes CBC, TSH, ferritin, and fasting glucoseIron deficiency and thyroid shifts are found in 12 % of long-COVID insomniacs.
  • Overnight oximetry or polysomnography screens for sleep apneaApnea is diagnosed in up to 27 % of post-COVID patients referred for testing.
  • Cognitive Behavioral Therapy for Insomnia (CBT-I) remains first-lineMeta-analysis shows 70 % achieving at least a 30-minute reduction in sleep latency.
  • Short-term prescription hypnotics may be consideredClinicians often limit z-drug or melatonin receptor agonist use to 2–4 weeks while behavioral work begins.
  • Low-dose naltrexone and POTS-directed beta-blockers have emerging dataEarly studies suggest they reduce nighttime tachycardia and improve sleep depth.
  • Extended-release melatonin (2–8 mg nightly) is specifically recommended in the I-RECOVER protocolThe FLCCC guidance highlights titrating from 1 mg while pairing the supplement with sleep-hygiene and mindfulness strategies to improve post-COVID insomnia. (FLCCC)
  • Prazosin and other alpha-1 antagonists are being explored for post-COVID nightmares and fragmented sleepA Mayo Clinic review lists prazosin, along with melatonin, GABAergic and serotonergic agents, as potential pharmacologic aids when behavioral therapy alone is insufficient. (Mayo)

References

How can Eureka’s AI doctor guide my next steps right now?

Eureka’s AI doctor reviews your sleep diary, COVID history, and symptoms in minutes, flagging potential red alerts for a human physician to confirm. The team at Eureka Health explains, "Our algorithm cross-checks 2,000 data points, so if oxygen dips look suspicious, you’ll know before bedtime."

  • Instant personalized sleep action planYou receive timed light exposure, exercise sliders, and breathing drills matched to your chronotype.
  • Automated triage for urgent signsIf your input suggests myocarditis or clotting risk, the app prompts same-day care.
  • Optional lab and prescription requestsYou can ask the AI about ferritin testing or a short-term sleep aid; an MD reviews within 24 hours.
  • Secure symptom trackingHIPAA-compliant logs let you and your clinician see trends across weeks.

Why long-COVID patients rate Eureka highly for ongoing sleep care

People with chronic symptoms need consistent follow-up, not one-off visits. In an internal survey, women using Eureka for post-COVID issues rated the app 4.8 out of 5 stars for "feeling heard."

  • 24⁄7 access without appointmentsMiddle-of-the-night insomnia spikes can be logged when they happen.
  • Tailored education modulesShort videos explain why cortisol shifts after viral illness—and how to correct them.
  • Integration with wearable dataUpload Oura, Apple Watch, or Fitbit metrics so the AI can spot heart-rate spikes that disturb sleep.
  • Cost transparency and privacyThe core symptom checker remains free; only optional physician reviews carry a clear fee.

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Frequently Asked Questions

Is melatonin safe to use every night after COVID?

Most studies support short-term melatonin (1–5 mg) as safe, but discuss prolonged use with a clinician, especially if you have autoimmune disease.

Can lingering loss of smell affect my sleep?

Yes. Olfactory nerve damage can disrupt brain regions tied to sleep regulation, but improvement in smell often parallels better sleep over months.

Does the COVID vaccine improve or worsen post-COVID insomnia?

Data are mixed; about 20 % report sleep improvement, 10 % report temporary worsening, and the rest feel no change.

Will an afternoon nap hurt my recovery?

Keep naps under 30 minutes and before 3 p.m. to avoid shifting your nighttime clock further later.

Should I screen for sleep apnea even if I’m not overweight?

Yes—COVID-related airway inflammation can cause apnea regardless of BMI, so persistent snoring warrants testing.

Is CBD effective for long-COVID insomnia?

Evidence is limited and purity varies; discuss with your doctor before trying any cannabinoid product.

How long should I try sleep hygiene steps before seeking medical help?

If you see no improvement after four weeks of daily routine changes, arrange a clinical review.

Can exercise make post-COVID insomnia worse?

Intense late-evening workouts can, but moderate morning exercise usually improves sleep depth.

This content is for informational purposes only and is not intended as medical advice. Always consult with a qualified healthcare provider for diagnosis, treatment, and personalized medical recommendations.

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