Sleep Management (Post-COVID Service)

Improving Sleep

Many people who have had COVID-19 have experienced changes or disturbances in their sleep. This can include struggling to get to sleep; waking frequently in the night; or waking early in the morning and not being able to get back to sleep. Difficulty with sleep can happen for lots of reasons. Whether you have always found sleep difficult or it is a new problem of your Long COVID, some helpful management strategies can be the first step to addressing this.   

You may have heard of ‘Sleep Hygiene’ which describes helpful behaviours around sleep. There are lots of resources describing this such as:

• NHS advice: Provides guidance and strategies to help promote sleep. https://www.nhs.uk/live-well/sleep-and-tiredness/how-to-get-to-sleep
• The Sleep Council: Provides advice about getting a restful night’s sleep, how to navigate common scenarios that impact sleep and provides a 30-day sleep plan. https://sleepcouncil.org.uk

These basic approaches a great first step. If you are still struggling the following may be useful if included in your regular routine:

In the morning:

One of the most important principles to help improve sleep is getting up at the same time, every day, even at the weekend or after a poor night sleep. It is key that you get out of
bed on the first alarm, avoid snoozing and staying in bed for longer. These are important to build up your sleep drive to help you sleep better the next night and improves the association of being in bed for sleep only.

Try to eat breakfast shortly after you get up in the morning. This is a helpful signal to your body that this is a wakeful time of day. If you regularly skip breakfast, try introducing
something light to eat first thing in the morning. 

Our natural sleep response is regulated by the sun rising and setting. It can be helpful to get lots of natural light, particularly in the morning to help correct your sleep cycle. 

During the day:

Try to avoid daytime naps, as they can affect your night-time sleep. If you feel tired in the day, try and establish if you are feeling tired or sleepy. When sleepy, you might struggle
to keep your eyes open or feel your head nodding if you are sitting. This is different to feeling tired and needing to take a rest. To manage tiredness and fatigue in the day, avoid
crashes, pace activities and have periods of complete rest throughout the day. Rest periods of meditation, breathing exercises or simply sitting quietly can be effective to help
restore energy rather than sleep. (See fatigue management leaflet). 

If you have to nap, keep it shorter, around 20 minutes.  

Manage anxiety and stress. This includes unhelpful thoughts about sleep in general, such as “I will not be able to fall asleep easily”. Write down these unhelpful thoughts around
sleep, and try and think of an alternative, more balanced thought to reassure yourself, such “sometimes I can sleep more easily, that might happen tonight”. Leaving some of
your worries about sleep go will allow you sleep more easily and feel more relaxed during the day. Be mindful that sleep is not the only thing that effects your energy during the day. Day time tiredness can also be due to stress or dehydration. Help to manage stress and anxiety by using relaxation techniques in the day or try journaling to manage your thoughts. (Please see Relaxation techniques leaflet.)

Caffeine is a stimulant which stays in your system for a long time. About a quarter of the caffeine ingested will remain in your body 12 hours later. If you are having sleep problems, it is important to reduce caffeine intake and avoid taking any after midday. Common things that contain caffeine include tea, coffee, energy drinks, and fizzy drinks.

In the evening:

Try not to go to bed until you feel sleepy and ready to sleep. Avoid lying in bed awake as this can build the wrong associations with bed and sleep. 

Only use your bedroom for sleep, sex, and getting dressed. Keep laptops and mobile phones out of the bedroom if possible.

Avoid stimulating activity in the hour before bed which might make you more alert. This should be a time for relaxation where possible.  Apps such as Instagram, Twitter, Facebook, and Tiktok can be a welcome distraction, but they can cause significant sleep problems. They are designed to trigger the reward pathways in our brain. This can be enjoyable, but also make it difficult to switch off and relax. Try to avoid using social media in the evenings before bed. #

Avoid having alcohol in the evening it may make you drowsy but reduces the quality of sleep and can cause you to wake earlier.

If you lie in bed awake for more than 20 – 30 minutes, get up, go to a different room (or different part of the bedroom), participate in a quiet activity then only return to bed when you feel sleepy. This could include reading, colouring, a puzzle. Do this as many times as needed during the night.  

If you are unable to sleep during the night, avoid snacking as eating during this time can disrupt your sleep cycle. 

These strategies do not always work right away but try to include them in your routine and they should help improve your sleep. 

Sleeping Tablets:

Sleeping tablets are a short-term strategy to try and correct your sleep cycle. This would usually be for 5 days or so to use alongside the strategies discussed above. Please discuss this with your GP if this is something you would like to try.