Making Sense of Covidsomnia
I was hospitalized because of severe insomnia during the pandemic. Why do I, and so many others, struggle with sleep in the time of Covid?
On my first day at a psychiatric hospital in Hartford, Connecticut, I tested positive for Covid-19 and was confined to a small room with two twin beds.
What am I supposed to do with these, I thought. I couldn’t even make use of one bed, let alone two.
In the weeks before, I had developed a severe case of insomnia that kept me on my feet most nights. Somehow pacing around during a slow-burning panic was preferable to lying still through it.
Hours after being admitted, I sat in a plastic chair, watched through the window as a crescent moon rose up over the nearby cemetery, and braced myself for my first night in the hospital.
A nurse — gowned, gloved, and masked — arrived at my door at 10 p.m. She handed me two tablets, Ativan and Seroquel, and a glass of water to follow. “Good luck,’’ she said on the way out, cautioning: “Don’t overthink it.”
I flipped off the lights and chose the bed nearest the window. Once under the covers, I inserted earplugs to drone out the clamoring of neighboring patients, and pulled a surgical mask over my eyes.
Then nothing happened. Two hours passed. Still nothing.
Thoughts that would become dreams never came. Instead, my mind was blank and my heart was pounding.
I stood up, walked to the adjoining bathroom, and turned on the shower. I sat defeated in the dark hoping the warm water might drown out a creeping fear that I’d never recover. I couldn’t stop wondering why I had been so unlucky.
As it turns out, I wasn’t alone.
While I didn’t know it at the time, millions of Americans were right there with me, lying awake in the dark. Rates of insomnia had spiked to unprecedented levels during the pandemic.
Data is still being gathered, but information from early in the lockdown paints a bleak picture. Just in the first few weeks of the shutdown in 2020, prescriptions for sleep medications increased nationally by 14.8 percent. In the first year of the pandemic, insomnia increased by 26.7 percent over levels recorded before Covid, according to the Oxford Academic medical journal Sleep.
This swell led experts to coin the term Covidsomnia.
“Clinically, it’s a real thing,” said Dr. Naina Limbekar, a sleep neurologist at Boston Medical Center. “I have a lot of patients anecdotally who have cited Covid as the reason for their insomnia struggles. I always ask what triggered it, and Covid definitely has been cited many, many times over the past couple of years.”
Researchers and sufferers are still trying to piece together the factors responsible for the tidal wave of sleeplessness, and expert opinions on the matter are often in disagreement. But it seems to me to be critical that this link between Covid-19 and sleep continues to be interrogated because impaired sleep, if not addressed, can result in devastating downstream consequences.
“Sleep is not a luxury,” said Dr. Limbekar. “It’s a priority that you need to address just like if you have high blood pressure or diabetes. Otherwise, it can silently kill you over time.”
Insufficient sleep has been linked to heart disease, obesity, depression, and can progressively lead to an overall increase in the risk of death.
Researchers have long understood that events contributing to excess worry and stress are linked with disturbed sleep. For example, according to a report in the New England Journal of Medicine, in the wake of the September 11, 2001, terrorist attacks, adults living in Manhattan experienced increased levels of insomnia — levels similar to the first wave of the pandemic.
“People complain of worsening anxiety or depression due to Covid and these psychiatric disorders can be accompanied by sleep disturbances,” said Dr. Dallas Marsh, a psychiatrist in Staten Island.
Additionally, proximity to perceived danger is strongly connected to sleep quality. Nearly every frontline health care worker in one study reported diminished sleep during the pandemic.
Lifestyle changes like disrupted work routines and increased isolation, both of which I experienced in the months leading up to my hospitalization, are also correlated with poor sleep. And lack of sleep can contribute to anxiety, which in turn can impede sound sleep. I became hostage, along with many others, to this vicious cycle.
However, not all lifestyle changes had a detrimental effect on sleep.
“Though there is evidence that insomnia rates rose, the shift in societal norms to allow continued work from home has generally allowed people to extend their sleep duration, especially in the mornings,” said Dr. Andrew Varga, a professor at the Icahn School of Medicine who specializes in sleep medicine.
As the pandemic carried into 2021, it became evident that a second, distinct group of people was also suffering from disturbed sleep. Around 25% of Americans diagnosed with Covid-19 are known as long-haulers, or patients with long Covid whose symptoms persist for weeks or months after their initial period of infection. Of this group, one in four grapple with insomnia, according to a study of 18,000 patients.
“Brain fog, memory issues, and sleep changes are all common symptoms of long Covid,” said Dr. Limbekar.
Some long Covid patients see their conditions improve over time, but others are plagued by debilitating symptoms while full recoveries elude them.
How long will this go on? As many aspects of life return to normal, will cases of Covidsomnia, or its severity, decrease?
Once again, experts are not all in agreement.
“I would speculate that insomnia rates will fall again as societal life returns to normal,” said Dr. Varga.
“Things take time to resolve,” said Dr. Limbekar. “When you’ve had such a huge social impact from Covid — I don’t think it’ll be an overnight decline in cases of insomnia.”
That first night in the hospital, I finally dozed off as the sun was rising around 6 a.m. The nurse woke me two hours later for breakfast. I grabbed the graph paper I’d been using to track my hours slept, and groggily shaded in two boxes. The trend reminded me of a cardiogram: holding steady for a while at a two; occasionally bouncing up to six, and then dropping to zero before repeating the cycle.
A nurse practitioner and a social worker entered at eleven a.m. Keeping their distance because I could have been infectious, they stood in the doorway and probed my story for details that might help pinpoint a root cause.
“Have there been any big changes in your life recently?” said the social worker.
I told them I’d spent six months living in relative isolation at my parents’ home in Connecticut before moving to Washington, where, after a few weeks, I began losing sleep.
The nurse practitioner scribbled the words “adjustment anxiety” on my chart under the diagnosis section. In hindsight, this assessment appears to fit quite neatly into the category of Covidsomnia. But, it also seems possible — though not as likely — that my positive test in the hospital was picking up on an old infection. If that were true, the illness itself, not stress related to the pandemic, may have triggered my insomnia, which would make me a long-hauler. I doubt I’ll ever know the answer.
After the sun went down, and I’d gulped down my medication, I strapped in for another long night. Once the lights were off and my eyes were closed, it was only a matter of minutes before my heart was racing, inexplicably, at a rapid clip.
Exhausted, I got out of bed and paced around in the dark. I flicked on the bathroom lights and looked at my reflection in the mirror, noticing a pair of dark bags that had appeared under my eyes.
After hours of pacing and intermittent showering between attempts to sleep, I once again drifted off around six a.m. I shaded in two more boxes on the graph paper the next morning.
This miserable routine continued for eight more nights before I was finally discharged. Though I had not demonstrated dramatic improvement, the psychiatrist said I was stable enough to continue receiving care as an outpatient. He also voiced concern about keeping me in isolation any longer.
That secluded experience in the hospital was a low point, but it was far from the end of my sleep troubles. Two more months passed before I could string together several well-rested nights in a row.
Even now, one year after my hospitalization, a prowling fear still lives in the back of my mind. When my head hits the pillow at night, countless thoughts drift in and out of focus, but one remains hard to shake, and it’s something I never thought to consider before the pandemic: Will I be able to sleep?
