COVID-19 linked to sleep difficulties and tiredness

sleep problems
sleep problems
  • Researchers reviewed the health records of nearly 12 million people in the United Kingdom to see if there was a link between SARS-CoV-2 infection and psychiatric disorders.
  • They discovered a link between SARS-CoV-2 infection and persistent sleep issues and exhaustion, but not with illnesses like depression, self-harm, or anxiety.
  • The researchers also discovered a possible correlation between SARS-CoV-2 testing and the later development of psychological disorders, which they believe is linked to health concerns.

According to research, many people report feelings of fatigue, mental fog, and sleep issues after receiving SARS-CoV-2. Other studies have found that people’s mental health is deteriorating, but not all of them have found anxiety or sadness.

According to experts from the University of Manchester in the United Kingdom, who published the current study, SARS-CoV-2 has infected roughly 37 percent of people in the United States, However, only around 1 out of every 4 people showed up for the testing.

The number of observational studies looking at the impact of SARS-CoV-2 infection is low. They can’t, for example, account for certain factors that affect a person’s chance of catching the virus, such as their work. Furthermore, certain people are more prone than others to seeking tests and seeking medical help.

One way to adjust for these factors is to compare the health outcomes of those who had a positive COVID-19 polymerase chain reaction (PCR) test result to those who had a negative test result.

The data for this study came from around 12 million people. The authors of the study compared the psychiatric health outcomes of people who tested positive for SARS-CoV-2 to those who did not.

The research was published in JAMA Network Open.

According to the researchers, SARS-CoV-2 was linked to an increased risk of sleep issues and exhaustion, but not to other psychiatric conditions, including depression, anxiety, or post-traumatic stress disorder.

Dr. Matthias Pierce, Ph.D., senior author of the study, told Medical News Today, “The findings with respect to sleep issues and weariness were what we expected.”

“Fatigue is linked to other deadly viruses including [severe acute respiratory syndrome (SARS)] and [Middle East respiratory syndrome (MERS)], as well as meningitis, hepatitis, and glandular fever.”

What astonished us was that those who tested negative for SARS-CoV-2 had a similar risk of mental discomfort as those who tested positive. This suggests that any rise in psychiatric disorders linked to SARS-CoV-2 testing could be due to the characteristics of people who take the test, “he added.

The findings show that health record analyses incorporating solely positive SARS-CoV-2 PCR test results may exaggerate psychiatric conditions caused by SARS-CoV-2.

Data analysis

The researchers used data from the Clinical Practice Research Datalink Aurum data set, which contains information on clinical events such as diagnoses, symptoms, and treatments that healthcare practitioners in the United Kingdom documented for 19 million patients.

Participants who were 16 years old or older and who visited health clinics between February 1 and December 9, 2020 were included in the study.

In total, the researchers included data from 11,923,105 people in their investigation. During the study period, 232,780 people (or 2% of the total) had a positive SARS-CoV-2 test result.

The researchers looked at the individuals’ medical records to see if they had any mental diagnoses or symptoms, such as depression, self-harm, or sleep conditions. They also looked at prescriptions for antidepressants and mood stabilizers, as well as prescriptions for psychotic medicines.

They discovered that people who got a negative test result were slightly more likely to be women, aged 16–24, or over 80, have a higher BMI, and have more prior health conditions.

The researchers also discovered that people who tested positive for SARS-CoV-2 were more likely to have had psychological disorders such as exhaustion or sleep problems, or to have gotten a psychotropic medicine prescription in the prior five years.

After controlling for ethnicity, smoking status, and BMI, the researchers discovered that 1.4 percent of people with positive test findings had a psychiatric morbidity at 6 months, while 0.9 percent of people with negative test results did.

A positive test result was linked to an increased risk of sleep disorders and prescriptions for drugs such as antipsychotics, nonbenzodiazepine hypnotics, and mood stabilizers.

Furthermore, the researchers found that people aged 80 and up were more likely to suffer from psychiatric conditions, that people aged 60–69 had the most fatigue and sleep problems, and that women had a higher overall risk of acquiring any condition than men.

Unknown mechanisms

The exact mechanism that links SARS-CoV-2 to sleep issues is unknown. Inflammation, according to Dr. Pierce, could be a factor:

“How people recover from illness is highly diverse and is influenced by a variety of biological, psychological, and social factors. Long after the acute phase of illness, people can have an inflammatory response to viral infection and struggle to return to normal physical functioning.”

Dr. Aaron Bunnell, associate professor of rehabilitation medicine at the University of Washington School of Medicine in Seattle, told MNT that “[the cause of weariness] is likely multifaceted.”

“Sleep disorders, persistent autoimmune or systemic responses to the infection, impacts on other organ systems — neuropathies, autonomic myopathies, etc. — and myalgic encephalomyelitis/chronic fatigue syndrome” are among the possibilities.

“[Sleep disorders following SARS-CoV-2] may be due to inflammatory responses or blood-brain barrier dysfunction. Sleep disturbance is also seen in myalgic encephalomyelitis/chronic fatigue syndrome,” he added.

Health anxiety

The researchers discovered that the rates of anxiety, sadness, and psychosis were similar across those who had good results and those who received negative results after doing sensitivity analysis.

Individuals who obtained negative PCR test results were also more prone than the general population to acquire psychiatric conditions, according to the researchers. This could indicate that there are unobserved confounders associated to the likelihood of undergoing a test and the risk of acquiring a psychiatric condition during the pandemic, according to the researchers.

These unobserved characteristics, according to the researchers, are most likely related to occupation and health worry. They point out that while many people were on furlough or working from home during the pandemic, people in particular industries, such as healthcare, continued to work as usual, perhaps putting them under undue stress.

According to the researchers, persons seeking a COVID-19 test may have already experienced health anxiety, which could suggest future mental illness.

This is significant, according to the authors, because those who had negative test results were more likely to have had mental illness than those who had positive test findings.


The researchers also looked into the incidence of psychological conditions among flu patients. They discovered that people who had influenza during the same time period as SARS-CoV-2 were more likely to acquire psychological symptoms.

This could be because people with influenza who visited a clinic were more likely to have a severe infection or a previous health condition than people with SARS-CoV-2.

The findings contrast previous studies that analyzed data from the United States and indicated that people with positive SARS-CoV-2 test results are twice as likely to suffer psychiatric disorder as those with influenza.

This could be because prior studies did not follow up on individuals with SARS-CoV-2 infection from the same date, nor did they account for patient distance from hospitals or hospital capacity, according to the authors.

While there is a link between SARS-CoV-2 and sleep issues and exhaustion, the researchers conclude that there isn’t necessarily a link between the illness and other psychological conditions.

Some limitations

The study’s authors acknowledge that their findings have significant limitations. Despite the fact that 8.7% of the UK population had antibodies for SARS-CoV-2 by December 2020, indicating they had previously infected the virus, only 2% of the study participants obtained positive results.

According to the researchers, this suggests that many people in the group with negative test results had previously been infected with SARS-CoV-2 but were asymptomatic or did not report their infection.

If these people were misclassified, their results would be less sensitive to any links between SARS-CoV-2 and psychological health.

“Future research might focus on mechanisms of fatigue, and sleep problems, and to further understand if there are psychiatric risks to [SARS-CoV-2] infection,” said Dr. Pierce. “Interventions should focus on prevention as well as ameliorating symptoms and improving quality of life via different interventions.”

Dr. Bunnell added, “I think [these findings] support some of the previous efforts to really examine fatigue and sleep as a key component to rigorously assess and manage in these populations,”

“Multiple studies are looking at patient-reported outcomes [and] objective sleep assessments in these populations,” he continued. “Many other studies are looking at inflammatory markers, brain and vessel imaging, and biomarkers to try and understand the biologic mechanisms associated with these symptoms.”

As more data from this study becomes available, the impact of SARS-CoV-2 infection on sleep should become clearer.