"Long Covid" - Mental Health Consequences

‍

“Long Covid” Mental Health Consequences 

At Cognito we see the impact the Covid-19 pandemic is having on people's lives every day. In fact, this pandemic is what accelerated our launch of Cognito because of the gap in treatment options locally. Two years of living in pressure cooker-like conditions has worsened existing mental health conditions, triggered a spike in new cases of anxiety and depression diagnosis and even created a brand new threat to long term physical and mental wellness in the form of long-covid.

Our Cognito team is rapidly researching new peer reviewed articles and studies on “Long Covid'' and mental health, to keep up to date with emerging information about these complex issues and best treatment protocols.  What we currently know is that many sufferers of long-covid experience increased mental health problems, especially insomnia. 

Insomnia and Long Covid

Insomnia is a disorder affecting approximately 35% of people worldwide that inhibits the ability to fall asleep, stay asleep or results in random periods of wakefulness without the ability to fall back asleep. Sleep is a crucial component to physical and mental health, so any disruptions in the commonly required 7-8 hours of sleep a night can deplete energy levels, affect mood, and cause a number of other negative health effects. The occasional night of poor sleep quality is common, a few days or short period of insomnia is called acute insomnia and is often caused by stress. When irregular sleep, or inability to sleep persists long term, this is called Insomnia. 

7 Common causes of Insomnia

1. Physical illness/pain - Restless leg syndrome
2. Anxiety, depression, other mental health symptoms
3. Stress
4. Irregular sleep schedule
5. Medication
6. Neurological symptoms
7. High sugar/caffeine diet
   

What do we know about “Long Covid” Insomnia?

“Long Covid” is a term coined by those affected by it. The scientific community however, is struggling equally to name the phenomena as they are to diagnose and treat it. The current working name for long covid is post-acute sequelae of SARS-CoV-2 infection or PASC (or similar versions of this acronym.)

The science faculty at McGill university in Montreal, refers to “Long Covid” as a “debilitating puzzle” because the condition is poorly defined and studies lack a focused control group. Despite the difficulty in defining this phenomena, empirical patient reports are common and profound. The most recurring reported symptom of “Long Covid” is Insomnia. 

The CDC (Centre for Disease Control) has defined PASC as symptoms from a Covid-19 infection that persist 4 weeks after initial onset while the WHO (World Health Organization)  extends that timeline to 2-3 months. Despite the uncertainty of acronyms, the report of symptoms are widespread and grueling.

In one of the largest and most well documented studies of long covid, over 4000 patients with confirmed Covid-19 and persisting symptoms filled out a survey which lead to a conclusion that not only is long covid real, but it affects every organ system in the body.

What are the symptoms of Long Covid (PASC) ?

• Insomnia
• Anxiety, increased anxiety
• Depression
• Memory loss
• Brain fog
• Prolonged loss of smell/taste
• Heart palpitations/chest pain
• Fatigue
• Extreme thirst and perspiration
• Menstrual issues
• Diarrhea
• Skin issues
  

How to treat insomnia? Treating insomnia symptoms caused by Long Covid

Unfortunately, there is no clear treatment path for Covid “Long Haulers”. Instead, people suffering from “Long Covid” look to mitigate the severity of their individual symptoms. Most “Long Haulers” have one main symptom that persists long after initial contraction and recovery from Covid-19, for approximately 30% of this group, that symptom is Insomnia. 

Cognitive Behavioural Therapy, or CBT-I when treating insomnia, is an excellent method because it helps people develop healthy sleeping patterns and avoid things that might negatively affect sleep.

Some strategies learned through CBT-I include: 

• Education - Learning about what sleep does for your body. Understanding insomnia.
• Cognitive restructuring - Unlearning automatic thoughts about sleep. Removing the “worry” of not sleeping
• Light therapy - Using artificial light to control your bodies internal clock 
• Sleep restriction - By reducing the amount of time in bed, your body begins to crave sleep. Slowly increase time in bed as the amount of sleep increases.
• Stimulation control - Cutting out everything in the bedroom except for sleep and sex
• Relaxation techniques - breathing exercises, meditation, progressive muscle relaxation (PMR)
• Intentional passive wakefulness -  Also called “paradoxical intention” - tricking your brain to sleep by trying to remain awake.
• Exercise 
• Nightly routine
• Homework - Sleep log, journal
  

Medication for insomnia

Physicians strongly recommend Cognitive behavioural therapy (CBT-I) as the best approach to begin treating insomnia. Doctors often only prescribe “sleeping pills” for two weeks at a time because of the varying results, side effects, and dependency issues. However, there are a few medications for insomnia that are safe for regular use. 

Examples include:

• Eszopiclone (Lunesta)
• Ramelteon (Rozerem)
• Zaleplon (Sonata)
• Zolpidem (Ambien, Edluar, Intermezzo, Zolpimist)

There are also many over the counter sleep aids such as melatonin. 

The path to a better nights sleep

Sleep is essential for a healthy body and mind. Insomnia can be a side effect of many mental health issues, and can also occur on its own for a variety of different reasons. In 2022, Insomnia is presenting itself as a prolonged symptom of post-acute sequelae of SARS-CoV-2 infection or “Long Covid”. Covid “Long Haulers” are suffering from a myriad of symptoms long after their initial diagnosis and other symptoms have subsided. Amongst these people, insomnia is present in over one third. 

At Cognito Health, we treat people suffering from Insomnia, whether as a result of Covid-19 or not, by starting with a regimented CBT-I routine of at least two sessions every month. Should these cognitive behavioural therapy sessions still need additional help, we can prescribe and closely monitor insomnia medication. 

If you are suffering from any “Long Covid” mental health symptoms, have Covid induced insomnia, or Insomnia in general, complete our free mental health assessment today and get paired with our clinical team to start on your path towards a better nights sleep, and towards feeling like yourself again.