A man in bed looking at the clock
Sleeping Well
A man in bed looking at the clock

Why are we talking about sleep?

Many people recovering from COVID notice that their sleep has changed when compared to their sleep before they became unwell.

Some people find it difficult to fall asleep or stay asleep, and others find they wake up earlier than usual and can’t get back to sleep. It might be that you are waking up feeling unrefreshed, like you haven’t slept at all, in which case you might find it helpful to also read the information on fatigue.

 

Why might sleep be affected by COVID?

There are many reasons why your sleep may have changed as a result of COVID.

The experience of being in a hospital setting can disrupt the natural sleep cycle because:

  • A lack of natural daylight can interfere with the production of a chemical in our brain called melatonin. It is this chemical that makes us feel sleepy.
  • Hospitals are noisy, busy places. There are always people around and it can be noisy with alarms beeping on equipment, especially in intensive care units. This means patients can be easily disturbed (even more so if they are light sleepers to begin with).
  • You are sleeping in a hospital bed which may not be as comfortable as your own bed.
  • The medications that have been used to treat you can impact on your sleep too.

If you have had a stay in hospital, you might have had some very distressing experiences. For some people, these experiences can replay in their mind as thoughts or dreams about what happened, making it hard to fall or stay asleep. This is made worse if you had delirium (e.g. hallucinations, delusions and confusion whilst you were unwell).

 

Even if you have not been in hospital, being ill at home can get in the way of a good night’s sleep

  • Symptoms of COVID include breathlessness, a dry cough and fever; each of which can make it difficult to sleep. Another common symptom is fatigue which can lead to daytime sleeping which disrupts the day/night cycle.

It is natural to feel frightened about being unwell with COVID. This fear puts the body into a state of high alert (also called fight-flight). This prepares the body and mind for action, not rest and can make it almost impossible to sleep.

 

What does a sleep cycle look like?

REM  
Stage 1 – Light sleep
Stage 2 – Deeper sleep
Stage 3 – Deepest sleep

Sleep is made up of several stages varying from light to deep sleep with periods of rapid eye movement sleep (REM). During REM sleep, the eyes of the sleeper move quickly and jerkily under the eye-lids. This is the stage of sleep in which dreaming occurs. It is common to wake up during lighter stages of sleep and this is not something to worry about.

 

What can I do to improve my sleep?

Sleep hygiene is the name given to a set of practices designed to help you prepare you for sleep. Alongside these practices, it is important to also take care of your routine in other respects e.g. making sure that you are eating well and exercising

 

In the Evening Getting Ready for Bed Your Sleep Time During Sleep Time
    
Avoid caffeine, nicotine and alcohol

Develop a bedtime ritual to prepare you for sleep

Keep to regular ‘going to bed’ and ‘wake up’ times

Do not clock watch!

Avoid heavy meals within 2 hours of bedtime
  
Reduce light, temperature and noise in the room

Keep the bedroom for sleep and intimacy only
If awake for longer than 20 minutes, get out of bed, wind down and return when tired.

Avoid energtic exercise within 2 hours of bedtime

Wind down with quiet time spent reading, listening to music etc
    
Banish screens from the bedroom (TV, iPad, mobile etc)
Do no worry about not sleeping. The more you worry, the more you wake up.

 

Sleep Hygiene Tips:

Do’s:

  • Get up at the same time every morning, even on weekends and holidays.
  • Keep a notepad by the side of the bed to jot down things that come to mind. This will help you to park the thought and return to sleep
  • If it is possible, try to have the bedroom at a cool temperature.

Don’ts:

  • Avoid taking naps if you can.
  • Don’t go to bed hungry or thirsty.

 

What if I am having bad dreams?

Bad dreams can prevent a good night’s sleep. The content of the dreams may or may not be related to your experiences of being unwell with COVID. Either way, they can wake us up, prevent us getting back to sleep or be so unpleasant that we avoid sleep. One technique for managing this is called The Dream Completion Technique. This is explained below.  

 

The Dream Completion Technique

If you are dreaming about your experience of being unwell, it is important to remember that it is in the past and what is happening is just a dream. They are your dreams and you are in charge of what happens. It is okay for you to change what happens and know that there is nothing to fear in your dream. If you do not remember the dream just the unpleasant feeling you have when you are woken up, you can still use this technique by thinking about an alternative feeling that would feel better.

  1. Think about your most recent nightmare or bad sleep experience; you don’t need to analyse what it means or re-live the whole thing. Just think about the point where you woke up

  2. What would you want to happen next in the dream that feels good?

    • Take some time on this – what we are looking for is a new direction for the dream to take – something brief and simple and just as powerful as the bad dream.
    • While bad dreams can feel very real to you, remember dreams do not follow the same rules as real life so your imagined solution does not need to be something that could happen in reality.
    • It could be a way of gaining complete control in a way that maybe you couldn’t when you were unwell with COVID.
  3. Write down your solution, read it and imagine a different ending to your dream.

  4. Your dreams themselves may or may not change through this technique, but you can reduce their power over you by changing the ending of the dreams when you are awake.

 

What do I do if this does not seem to help?

If none of the tips above seem to be helping, do make an appointment with your GP and they will discuss the options with you.

There are some medications that can be used for a short time to help to break the cycle of poor sleep, some can be purchased in pharmacies, and others require a prescription from your GP.

A specific form of psychological therapy (talking) has been shown to be effective this is called Cognitive Behavioural Therapy for insomnia (CBT-i). It may be available free on the NHS through your local “Improving Access to Psychological Therapies (IAPT)” which you can access online or over the telephone. They may arrange for you to have access to an app you can use on your mobile phone to help establish healthy sleep habits. You can refer yourself to your local IAPT service without seeing your GP.

If intrusive memories about distressing experiences when you were in hospital make it difficult for you to get to sleep and/ or dreams about that time are continuing to disrupt your sleep then do mention this to your GP, or another health professional as these may be symptoms of post-traumatic stress disorder (PTSD). A specific form of psychological therapy (talking) that is effective in treating PTSD is called Trauma focused cognitive therapy (tf-CBT) and is also available free through your local IAPT service.

You can refer yourself to your local IAPT service without seeing your GP.

Find your local talking therapy (IAPT) service here: https://www.nhs.uk/service-search/find-a-psychological-therapies-service

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