Behavioural Sleep Dysfunction as a Mechanistic Driver of Long COVID Symptom Severity: An Integrative Psychophysiological Investigation

Sleep disturbances have emerged as one of the most persistent and debilitating symptoms reported by individuals with Long COVID. Prospective cohort work demonstrates that Long COVID is associated with shorter sleep duration, poorer sleep quality, and increased rates of moderate‑to‑severe sleep disturbance up to three years post‑infection. Mechanistic reviews highlight several biological factors that may underpin these disturbances, including neuroinflammation, cytokine imbalance, autonomic nervous system dysfunction, circadian disruption, and mitochondrial impairment, all of which can alter sleep–wake regulation and contribute to insomnia‑like symptoms. Pre‑infection sleep characteristics also appear relevant: longitudinal UK data show that poor sleep quality and greater variability in sleep efficiency are associated with an increased risk of developing Long COVID. These findings suggest that sleep may both predispose individuals to prolonged post‑viral symptoms and be adversely affected by the condition itself, underscoring a bidirectional relationship. Parallel evidence from behavioural sleep science, demonstrates that insomnia processes such as hyperarousal, irregular sleep schedules, and dysfunctional sleep behaviours negatively affect mood, psychomotor performance, daytime functioning, and overall wellbeing. These behavioural mechanisms may amplify symptom severity in Long COVID, which is already characterised by fatigue, cognitive impairment, autonomic dysfunction, and impaired physiological recovery. Current literature indicates that sleep dysfunction in Long COVID is likely multifactorial, arising from biological, behavioural, and autonomic pathways and may play a key role in shaping daily functioning and long‑term recovery trajectories. This provides a strong rationale for examining insomnia‑related behavioural processes as potential mechanistic contributors to Long COVID symptom burden and as targets for intervention. 94% of Loughborough’s research impact is rated world-leading or internationally excellent. REF 2021

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