Study Claims 76% of Non-Hospitalized COVID-19 Survivors Struggle with Insomnia

Sleep is supposed to be restorative. Yet, for many, it has become a nightly battle. Millions who recovered from COVID-19 outside of hospital walls now find themselves wide awake, staring at the ceiling.

Insomnia has woven its way into their lives, bringing fatigue, restless nights, and anxiety-ridden mornings. It’s not just sleeplessness. It’s a haunting reminder that recovery doesn’t always mean healed. Why is this happening? And how can relief be found?

What Did This Study on Non-Hospitalized COVID-19 Survivors Reveal?

A national cross-sectional study based in Vietnam critically examines a lesser-discussed aspect of post-COVID health: insomnia. Researchers examined 1,056 COVID-19 survivors who recovered without hospitalization.

Findings reveal strong connections between mental health struggles—especially depression and anxiety—and sleep disturbances. These insights show how deeply COVID-19 continues to impact those who thought their battle was over.

Insomnia Prevalence: High and Widespread

Staggering findings emerged: 76.1% of non-hospitalized COVID-19 survivors reported insomnia after recovering. Such a high rate underscores that sleep struggles aren’t limited to severe or hospitalized cases. Instead, they affect countless individuals who battled COVID-19 outside medical settings.

Alarmingly, 22.8% experienced severe insomnia, revealing far more than mild disturbances. This points to deeper, pervasive sleep quality issues. Recovery from COVID-19 often extends far beyond the virus’s acute phase. Sleep health, in many cases, remains a major challenge.

76.1% with insomnia: This level of prevalence among non-hospitalized individuals highlights insomnia as a pervasive symptom.
22.8% with severe insomnia: For nearly a quarter of this group, sleep issues are substantial, affecting day-to-day functioning.

A Few Caveats

This is only one observational study. More research should be done to test the robustness of the findings. There could be something about the sample population that has biased the results. These insomnia figures seem very high! Here are a few things we’re watching out for:

All participants were selected from something the researchers call “COVID-19 patients’ network” which is sponsored by the Vietnamese government. Is there something about people wanting to affiliate with this group that makes them more inclined to suffer from post-covid symptoms such as insomnia? If they had no issues why would they need to be part of the group?
Small response rate. Only about 3% of people invited to take the survey ended up participating. Is it possible that people who were more anxious to participate are suffering more from symptoms they deem to be covid-related (such as insomnia)?
Participants rated their own insomnia. Is it possible this was exaggerated in a systematic way?
The rate of insomnia, 76%, in the sample population seems unreasonably high. One wonders if there was some sort of error in this calculation since, as the study says, insomnia in the general population is closer to 10-20%. Since nearly everyone was infected with covid during the pandemic, one would think that such a dramatic increase in insomnia would be noticeable by the whole world, similar to how people talked about the loss of olfactory sensations at the time.
The study is published in Frontiers, which as a scientific outlet, is not know for having the strongest peer review process.

Mental Health Associations: Depression and Anxiety as Key Predictors

Anxiety and depression stand out as powerful predictors of insomnia among COVID-19 survivors. Using the Insomnia Severity Index alongside the Depression, Anxiety, and Stress Scale-14, researchers evaluated participants’ mental health and sleep patterns.

Findings show a striking link: survivors experiencing depression or anxiety are far more likely to struggle with insomnia. For many, these mental health challenges aren’t just side effects. They’re central to why sleep remains elusive. Each symptom builds on the other, creating a cycle that’s hard to break without focused care.

Depression and insomnia link: Individuals with depressive symptoms had 3.45 times the odds of experiencing insomnia (OR 3.45; 95% CI 1.87-6.34).
Anxiety and insomnia link: Participants with anxiety symptoms faced a 3.93 times higher likelihood of developing insomnia (OR 3.93; 95% CI 2.52-6.13).

Common Sleep Quality Issues: Sleep Duration and Wakefulness

COVID-19 survivors reported distinct and troubling patterns of insomnia. Many faced repeated sleep disruptions, leaving them exhausted. Feeling truly rested and refreshed became a distant reality.

Shortened sleep duration: Roughly one-third of participants experienced shorter sleep durations post-COVID.
Increased awakenings: Half of the participants reported frequent awakenings throughout the night. A hallmark of disrupted sleep that prevents deeper, restorative sleep cycles.
Difficulty falling asleep: A significant number struggled with sleep initiation. Common sign of anxiety-related insomnia.

Surprising Non-Factors: COVID-19 Symptoms and Duration

Severity or specific symptoms of COVID-19 infection showed no statistically significant link to insomnia in this study. Sleep struggles among survivors appear to stem more from the mental health aftermath than the virus’s physical effects. Recovery from COVID-19 goes beyond fighting the infection. It often leaves deeper scars on mental well-being. These findings emphasize the importance of addressing psychological health alongside physical recovery.

Duration of infection: COVID-19’s duration—whether brief or prolonged—showed no strong link to post-recovery insomnia. Recovery length didn’t dictate who would struggle with sleeplessness.
Symptom severity: Likewise, whether individuals experienced mild or more severe COVID-19 symptoms, this did not strongly predict insomnia.

This absence of a direct link between COVID-19 symptoms and insomnia directs attention to post-recovery mental health as a central factor. It also suggests that preventive and post-recovery care should focus heavily on mental health management. Even for those who experienced mild symptoms or short illness duration.

Additional Risk Factors: Chronic Conditions and Education Level

Two additional risk factors stood out as significant predictors of insomnia among the study population: pre-existing chronic conditions and higher education levels.

Chronic health conditions: People with conditions like diabetes, cardiovascular disease, or autoimmune disorders reported higher insomnia rates. Chronic illness often adds layers of stress, making restful sleep harder to achieve. Stress from managing ongoing health issues may heighten sensitivity to sleep disruptions. Living with these conditions can amplify the struggle for consistent, quality rest.
Higher education level: Interestingly, individuals with higher education levels showed an increased risk of insomnia. Perhaps it ties to work-related stress or a heightened awareness of health risks. Greater access to detailed health information could also fuel anxiety. Such connections deserve deeper exploration.

How Does Poor Sleep Impact Long-Term Health for COVID-19 Survivors?

Here’s how poor sleep shapes COVID-19 survivors future health:

Cognitive Impairment: Persistent sleep problems can have an effect on cognition. Poor concentration, impaired memory, and reduced problem-solving skills often follow. For COVID-19 survivors, lingering “brain fog” becomes even more pronounced. Neurological effects of the virus may intensify these struggles. Sleep deprivation limits the brain’s ability to repair itself and consolidate memories. Over time, this can contribute to a troubling decline in cognitive function.
Mental Health Disorders: Sleep and mental health share a complex, intertwined connection. Struggling with insomnia often heightens the risk of depression and anxiety. As stated above, among COVID-19 survivors, poor sleep has shown a powerful link to mental health challenges. These disruptions can intensify symptoms and make recovery even harder. Worse still, untreated insomnia may undermine the effectiveness of mental health treatments.
Immune System Dysregulation: Chronic sleep disturbances weaken immune function, making people more susceptible to infections, including respiratory illnesses. For COVID-19 survivors, maintaining a strong immune system is important. Robust immunity can help fend off reinfections and related health complications.
Cardiovascular Health Risks: Poor sleep raises the risk for cardiovascular issues like hypertension, inflammation, and surges in stress hormones. Add COVID-19’s impact on heart health, and the stakes get even higher. Together, these factors could drive up rates of heart disease and stroke.
Metabolic Changes and Weight Gain: Sleep loss disrupts the body’s metabolic balance, throwing hunger and stress hormones off course. Research reveals that inadequate sleep can trigger insulin resistance, promote weight gain, and heighten the risk of type 2 diabetes. Ongoing sleep issues make this even more concerning for COVID-19 survivors. These individuals face greater vulnerability to metabolic imbalances. Addressing their sleep health is crucial to restoring overall well-being.
Reduced Quality of Life: Poor sleep severely impacts quality of life. Fatigue makes simple tasks feel overwhelming. Mood swings and irritability strain patience and peace. Productivity plummets, making easy tasks feel like uphill battles. Relationships suffer as exhaustion affects every interaction. For COVID-19 survivors, these struggles make full recovery feel just out of reach.

How Can Non-Hospitalized COVID-19 Survivors Improve Their Sleep Quality?

Better sleep for non-hospitalized COVID-19 survivors calls for a mix of approaches. From lifestyle tweaks to proven therapies, here’s how to start improving rest:

Establish Consistent Sleep Schedules: Maintain a consistent sleep schedule by going to bed and waking up at the same time daily. Doing so helps regulate the body’s internal clock. Consistency strengthens the natural circadian rhythm, which can gradually ease insomnia. For many trying to rebuild their lives, irregular sleep disrupts this rhythm. Restoring balance becomes essential for achieving a sense of normalcy.
Optimize Sleep Environment: Minimize noise, reduce light, and keep the room cool to create a sleep-friendly environment. Comfortable bedding goes a long way in promoting better sleep. Small adjustments like these can make a noticeable difference in sleep quality.
Practice Good Sleep Hygiene: Adopt behaviors that promote restful sleep through effective sleep hygiene. Avoid caffeine and heavy meals before bed. Limit screen time and try relaxing activities like reading or gentle stretching.
Engage in Regular Physical Activity: Moderate exercise, such as walking, yoga, or swimming, can improve sleep quality. Physical activity reduces stress hormones, promotes fatigue, and helps stabilize mood. Factors that can directly benefit COVID-19 survivors with insomnia.
Cognitive Behavioral Therapy for Insomnia (CBT-I): CBT-I offers a powerful, non-drug solution for tackling the behaviors and thoughts fueling insomnia. Research consistently shows its effectiveness in breaking the cycle of poor sleep. Proven to reduce anxiety-driven sleeplessness, CBT-I helps restore restful nights.
Mindfulness and Stress Management: Meditation, deep breathing exercises, and progressive muscle relaxation calm the mind and prepare it for sleep. Such techniques are especially useful for easing anxiety. COVID-19 survivors struggling with sleep disturbances often benefit greatly from these practices.
Monitor Nutrition and Substance Use: Limiting alcohol, nicotine, and heavy, late-night meals can prevent sleep disruptions. Foods rich in magnesium and tryptophan (e.g., nuts, seeds, turkey) may also support better sleep.
Seek Professional Guidance: When insomnia lingers despite self-care, consulting a sleep specialist or therapist is essential. Specialists provide tailored treatments and pinpoint hidden factors affecting sleep quality. Conditions like sleep apnea, often overlooked, could be the root of ongoing restlessness.

What Sleep Support Can You Find at The Insomnia and Sleep Institute of Arizona?

Insomnia deeply affects both health and daily life. Quality sleep isn’t a luxury; it’s vital for overall well-being. Our team at The Insomnia and Sleep Institute of Arizona specializes in treating insomnia with precision and care. Cognitive Behavioral Therapy for Insomnia (CBT-I) remains a cornerstone of our approach. Every step is designed to bring lasting relief and better sleep.

What is CBT-I? It’s a non-medication approach proven to help people struggling with insomnia. CBT-I targets the root causes of sleeplessness by reshaping thoughts and behaviors around sleep. No sedatives and no temporary fixes. Just effective, evidence-based methods to help you fall asleep, stay asleep, and wake up feeling restored.

Our care goes beyond CBT-I, offering comprehensive solutions for your needs. We focus on thorough evaluations, accurate diagnoses, and customized treatment plans.

Struggling with insomnia? There’s help here.

References:

Thi, H., Yeung, W. F., Thi, Q., Le, C. T., Thi, A., Bui, Q. V., Thi, Q., & Quach, L. H. (2023). Sleep quality among non-hospitalized COVID-19 survivors: a national cross-sectional study. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1281012

Disclaimer: The information provided here is not intended to diagnose or treat any medical condition. Please speak with a healthcare professional for personalized guidance.