Insomnia and sleep characteristics in post COVID-19 fatigue: A cross-sectional case-controlled study, 2023, Rauwerda, Knoop et al

https://www.sciencedirect.com/science/article/abs/pii/S0022399923003793

Journal of Psychosomatic Research
Available online 14 October 2023, 111522

Nynke L. Rauwerda, Tanja A. Kuut, Annemarie M.J. Braamse, Irene Csorba, Pythia Nieuwkerk, Annemieke van Straten, Hans Knoop,
Insomnia and sleep characteristics in post COVID-19 fatigue: A cross-sectional case-controlled study
Author links
a
Amsterdam UMC location University of Amsterdam, Department of Medical Psychology, Meibergdreef 9, Amsterdam, the Netherlands
b
Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
c
Department of Medical Psychology, Hospital Gelderse Vallei, Ede, the Netherlands
d
Amsterdam Institute for Infection and Immunity, and Amsterdam Public Health, Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
e
Department of Clinical Psychology & Amsterdam Public Health Research Institute, VU University, Amsterdam, the Netherlands

Received 25 August 2022, Revised 7 October 2023, Accepted 11 October 2023, Available online 14 October 2023.

https://doi.org/10.1016/j.jpsychores.2023.111522Get rights and content

Abstract
Objective
Following COVID-19 many patients report persistent fatigue and insomnia. Given the overlapping features, insomnia can be underdiagnosed in post-COVID-19 fatigue patients. This study aimed to determine insomnia severity, prevalence of clinical insomnia and sleep characteristics of post-COVID-19 fatigue patients. Data of post-COVID-19 fatigue patients were compared with those of patients with chronic fatigue syndrome (ME/CFS), a condition resembling post-COVID-19 fatigue.

Methods
In this cross-sectional case-controlled study, insomnia severity, assessed with the Insomnia Severity Index (ISI), and prevalence of clinical insomnia (ISI score ≥ 10), were determined in patients with post-COVID-19 fatigue (n = 114) and compared with ME/CFS (n = 59) using ANCOVA and logistic regression, respectively. Linear regression analyses were used to evaluate whether mood, concentration problems, pain, fatigue (assessed with questionnaires) and diagnosis were associated with insomnia. Sleep characteristics were determined with a sleep diary and accelerometer in post-COVID-19 fatigue and compared with ME/CFS using ANCOVA.

Results
In patients with post-COVID-19 fatigue mean (SD) insomnia severity was 11.46 (5.7) and 64% reported clinical insomnia. Insomnia severity was significantly associated with depressive symptoms (ß = 0.49, p = 0.006) and age (ß = 0.08, p = 0.04). The mean (SD) subjective sleep duration was 7.4 (1.0) hours with a sleep efficiency of 82 (11)%. Several subjective sleep characteristics of the post-COVID-19 fatigue patients differed from ME/CFS patients; only sleep duration, being significantly shorter in post-COVID-19 fatigue patients (p = 0.003), seemed clinically relevant (d = 0.58).

Conclusion
Insomnia severity and prevalence of clinical insomnia are high in patients with post-COVID-19 fatigue. Insomnia should be assessed and if present treated with insomnia focused therapy.

 

What if the usual "insomnia focused therapies" don't work on post-Covid or ME because of their different mechanism? If the therapies are psychiatric--and fail, I expect a lot of blame on the patients for not trying hard enough, rather than "your theory is wrong".

 

That's the worry and why the putting CFS into a box of 'symptom-focused treatment' was a devastating red herring.

Instead of seeing any changes as 'clues' and wanting to put the picture together as to what e.g. the more specific aspects of the 'changed sleep' were and might be due to (and if they varied with different things e.g. exertion) the symptom gets slewed off to someone who treats the same as if it were a healthy person with generic 'insomnia'.

Sorry but as a layperson I've always thought this is just stupid because look at how when anyone gets e.g. glandular fever or raging tonsilitis noone thinks that their changed sleep in the thick of that is anything to remark on other than being part of the body dealing with those conditions. You'd hardly if you weren't a really stupid doctor take someone with tonsilitis and decide the most important thing to focus on is telling them they are badly behaved or their condition is caused by them not falling asleep at 9pm or getting up at 7am. And if there were a bacterial issue that needed antibiotics or some other complications (like quincy causing apnea or spleen issues and so on)...

So it surely is just chucking important data and clues down the metaphorical toilet.