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Sleeping well

 

This information is aimed at young people aged 12 years and above and their parents/carers. We recommend that children read this information with their parents/carers.  Parents/carers may find the information useful to help younger children by adapting the strategies to suit a younger age group.

If you have had COVID you might have symptoms that last for more than four weeks or several months. This is sometimes called long COVID, which is commonly used to describe signs and symptoms that continue or develop after an acute COVID infection for over 4 weeks, that cannot be explained by an alternative medical diagnosis.  This information gives you some ideas of things you can do to make sure that you or your child get back to your normal activities as easily and quickly as possible. If you are concerned that you are not getting better, please speak to your GP.

Improving sleep

It is common to experience problems with our sleeping pattern with long COVID. Some find it difficult to fall asleep, while others find they wake up more during the night. Improving your sleep is important for your well-being and energy levels.

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Tips to help improve your sleep

Body clock

Stick to consistent wake and sleep times as much as possible i.e. go to bed and get up at the same time each day.

When it gets dark your body releases a hormone (natural chemical) called melatonin, which sends a signal to your body that it is time to sleep. In the morning it releases another hormone called cortisol, which sends ‘wake up’ signals, letting your body know it is time to get up.

This is why it is important to get as much daylight as possible, and to have your bedroom dark at night.

Environment

  • Where possible, your bedroom should be for sleeping only and the rest of your day (working, playing, sleeping, resting) should be spent elsewhere – if this is not possible, try not to sit or lie on your bed during the day and start to develop the connection that your bedroom is just for sleeping
  • You are more likely to fall asleep if you’re feeling calm and there are no distractions in your bedroom – keep your bedroom as calm as possible by tidying away any schoolwork and other distractions, and taking screens out of your bedroom at night – this gives your brain the signal that ‘it is time to sleep now’
  • Make sure your bedroom is quiet, well-ventilated, dark and a comfortable (cool) temperature

Routine

  • Try to stick to a daily routine – this can help you to form good daily habits, and help you feel more productive and focused
  • Try to develop healthy habits (such as dressing, eating meals, gentle activity and a healthy consistent sleep routine)
  • Make a daily or weekly timetable of what you will be doing, including physical activity, leisure, meals, relaxation, and family-time, to keep some structure – please see the information on managing daily activity for how to do this within your energy limits

In the morning

  • Set your alarm and get up at the same time every morning – try not to get much more than an hour either side of this at the weekends
  • If you are getting to sleep very late gradually start to move your bedtime to an earlier time – it is really important to have a regular wake-up time to make sure you will feel sleepy later
  • If you are taking melatonin as prescribed by your GP, take it an hour before you want to go to sleep, and then “switch melatonin off” with bright light in the morning
  • Try to get up straight away
  • Open the curtains fully when you wake up – bright light helps you to wake up. Some lights mimic daylight and can be useful to turn on in the morning and try to get a good amount of daylight early in the day; this can be done by going outside, looking out of your open window or sitting on your doorstep.
  • Once you get up, get dressed into your day clothes, even if you have few plans for the day – your body will associate nightwear with winding down and going to bed
  • In the early days of getting better from a virus you may need additional sleep on the road to recovery trying to manage fatigue by sleeping more can make things worse – try to keep to 8.5 to 10 hours of sleep each night, even if you feel worse to begin with. It can take a couple of months to start to feel better

During the day

  • Do a comfortable amount of physical activity or gentle exercise each day and gradually build this up using pacing – refer to managing daily activity
  • Avoid daytime sleeping – this can disturb your sleep/wake cycle, quality of sleep and make getting to sleep and staying asleep at night more difficult
  • Limit screen time (TV, tablets, phones and computers) – take breaks after using screens for 60 to 90 minutes as this will help reduce eyestrain and headaches
  • Vary your activities during the day – for example, seeing friends, going to school, online learning, spending time with your family, including at mealtimes – what you are able to do will depend on your stage of recovery
  • Try to eat at regular mealtimes with snacks in between and try to avoid a heavy meal too close to bedtime
  • Sticking to regular mealtimes, even if you can’t manage a full meal, can be helpful to provide cues that support the body clock – for example, eating late at night can make falling asleep more difficult
  • Reduce caffeine intake as much as possible and avoid after midday; this includes coffee, chocolate, tea, fizzy drinks like colas or energy drinks

Wind-down routine                                                         

  • Try to go to bed at the same time every night and wake up at the same time each morning – you may need to shift these times over a few weeks if they have drifted by several hours
  • Eat your evening meal about 3 hours before bedtime
  • Try to switch off screens 1 to 2 hours before bedtime and take screens out of your bedroom at night – melatonin production is affected by light levels, doing stimulating activity before bed and by stress and worry – light from screen tricks your brain into thinking it is daytime and it stops you getting into deep restful sleep
  • Do eye-hand co-ordination activities, such as drawing or puzzles, instead of using screens
  • A preferred relaxing activity e.g. a bath, audio book before bed can be helpful

Getting into bed

  • Turn your clock around so it is facing away from the bedside
  • Gentle music before bed can be helpful – some people listen to white noise or soothing sounds (waves or rain)
  • Some people use a chapter or 2 of an audiobook to help relax
  • Some people use lavender or bergamot oil to help them relax before sleep – try putting 1 or 2 drops on a cotton wool ball next to your bed
  • Avoid physical activity just before bedtime as this stimulates your body rather than helping you to wind down – practising relaxation can help
  • If ideas and thoughts are buzzing around your mind, write them down or try to think about and deal with any issues earlier in the evening to help you relax later
  • Once you’re in bed, try not to think about the days’ activities, or what you will do in the future – think about nice places or events, or imagine relaxing images

Relaxation exercises

  • Resting and relaxing for short intervals during the day can give you more energy – your body needs rest to continue healing but avoid sleeping for long periods during the day and you might find short rests through the day are helpful, even when your symptoms are improving
  • Some people find relaxation, mindfulness, yoga or gentle stretching can be relaxing before bed – there are many sorts and it is important to find one that works for you
  • It is advisable to practise these types of strategies at first during the day in rest breaks, to build your skill and confidence before using them to help with sleep – start by practising at a time you feel calmer as it will help you to engage
  • Watching a comedy that makes you laugh a few hours before bed can produce endorphins that will help you to relax

Summary

  • Your sleep can be affected by lots of things
  • There are no quick fixes but understanding how sleep works for you can really help
  • You might need to practise your strategies consistently for 2 to 3 months, as it can take a while for change to happen
  • Making small, consistent changes to your sleep routine and habits can make a big difference

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More sources of information

Evelina London Children’s Hospital, for sleep tips, web www.evelinalondon.nhs.uk/our-services/hospital/sleep-medicine-department/coronavirus-sleep-tips.aspx

The NHS website has information on sleeping well, and how to get to sleep, web www.nhs.uk/live-well/sleep-and-tiredness

RaisingChildren.net, web www.raisingchildren.net.au/

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