Lyme Disease Sleep Disorders: Insomnia, Sleep Apnea, and Fatigue
Sleep disorders in Lyme disease extend beyond insomnia
Patients may experience non-restorative sleep, sleep apnea, circadian disruption, and daytime sleepiness
Recognizing these patterns may improve evaluation and recovery
Lyme disease can be associated with a wide range of sleep disorders. Patients may experience insomnia, non-restorative sleep, excessive daytime sleepiness, circadian rhythm disruption, restless legs syndrome, sleep apnea, sleep paralysis, narcolepsy-like symptoms, and other sleep-related complaints. These sleep problems can worsen fatigue, cognitive symptoms, mood, and overall quality of life.
Dr. Robert Bransfield, a New Jersey-based psychiatrist specializing in tick-borne illnesses, has described this broad spectrum of sleep disorders in patients treated in his clinical practice. His observations were published in Neuropsychiatric Lyme Borreliosis: An Overview with a Focus on a Specialty Psychiatrist’s Clinical Practice. [2]
Sleep disorders associated with Lyme disease
Sleep problems in Lyme disease extend well beyond insomnia. Patients may experience non-restorative sleep, excessive daytime sleepiness, circadian rhythm disruption, sleep apnea, restless legs syndrome, sleep paralysis, narcolepsy-like symptoms, and other sleep-related disorders.
Sleep disorders reported in Lyme disease patients
Bransfield reported that patients experienced:
- Non-restorative sleep
- Early insomnia
- Middle-of-the-night insomnia
- Early morning insomnia
- Excessive daytime sleepiness
- Loss or reversal of circadian rhythm
- Restless legs syndrome
- Paroxysmal nocturnal limb movements
- Sleep apnea (central and/or obstructive)
- Sleep paralysis
- Hypnagogic hallucinations
- Sleep attacks
- Cataplexy
- Narcolepsy
The combination of non-restorative sleep and chronic unremitting stress appeared to play an important role in disease progression, according to Bransfield.
He suggested that poor sleep and chronic stress may contribute to fatigue, cognitive impairment, compromised immunity, reduced regenerative function, decreased resistance to infectious disease, and neurodegenerative processes.
Non-restorative sleep
Many Lyme disease patients report sleeping through the night yet awakening feeling as exhausted as when they went to bed. This pattern, known as non-restorative sleep, differs from insomnia because the problem is poor sleep quality rather than insufficient sleep duration.
Non-restorative sleep may contribute to fatigue, brain fog, reduced concentration, pain amplification, and slower recovery. It is one of the most common sleep complaints reported by patients with persistent Lyme disease symptoms.
Insomnia is one of several Lyme disease sleep disorders
Insomnia is one of the most frequently reported sleep complaints among Lyme disease patients. Patients may have difficulty falling asleep, staying asleep, or returning to sleep after awakening during the night.
A prospective cohort study found that 41% of patients with early Lyme disease reported new-onset sleep difficulties. Learn more in Can Lyme Disease Cause Insomnia? Sleep Problems and PTLDS.
Poor sleep may contribute to fatigue, brain fog, mood changes, and reduced quality of life. Learn more about brain fog and cognitive dysfunction in Lyme disease.
Can Lyme disease cause sleep apnea?
Bransfield reported both central and obstructive sleep apnea among Lyme disease patients. However, current evidence does not establish Lyme disease as a common direct cause of obstructive sleep apnea.
Sleep apnea may contribute to daytime fatigue, impaired concentration, morning headaches, and non-restorative sleep. Because these symptoms can also occur with Lyme disease, it may be difficult to determine which condition is responsible. Some patients may have both conditions.
Formal sleep evaluation may be helpful when a patient has loud snoring, witnessed breathing pauses, gasping or choking during sleep, or excessive daytime sleepiness. Learn more in Can Sleep Apnea Be Mistaken for Lyme Disease Symptoms?
Can Lyme disease cause narcolepsy or daytime sleepiness?
Bransfield reported narcolepsy, cataplexy, sleep attacks, and excessive daytime sleepiness among patients seen in his practice.
Daytime sleepiness may result from poor nighttime sleep, coexisting sleep disorders, medications, or other medical conditions. A careful evaluation is often needed to determine the underlying cause.
The impact of sleep on recovery
Sleep plays an important role in immune function, tissue repair, cognitive performance, and overall well-being.
When sleep is disrupted, patients may experience worsening fatigue, increased pain sensitivity, reduced concentration, and slower recovery.
Some patients also report night sweats, which may further disrupt sleep quality and contribute to daytime fatigue.
For many patients, improving sleep quality becomes an important component of a broader recovery strategy. Learn more about fatigue in Lyme disease and recovery from Lyme disease.
Why careful sleep evaluation matters
Editor’s note: I have also found that Lyme disease patients can suffer from a broad range of sleep disorders. However, it can be difficult to determine whether Lyme disease itself or a coexisting medical condition is responsible for the sleep disturbance.
I have found that antibiotic treatment often improves sleep-related symptoms in some patients, although additional evaluation and treatment may be necessary when other sleep disorders are present.
Frequently Asked Questions
Can Lyme disease cause insomnia?
Yes. Insomnia is one of the most commonly reported sleep complaints among Lyme disease patients. Patients may have difficulty falling asleep, staying asleep, or returning to sleep after awakening. A prospective study also found new-onset sleep difficulties in many patients with early Lyme disease.
Can Lyme disease cause sleep apnea?
Sleep apnea has been reported among Lyme disease patients, but current evidence does not establish Lyme disease as a common direct cause of obstructive sleep apnea. Because symptoms can overlap and both conditions may coexist, formal sleep testing may be needed to establish a diagnosis.
Can Lyme disease cause narcolepsy?
Narcolepsy-like symptoms, sleep attacks, cataplexy, and excessive daytime sleepiness were reported by Bransfield among patients with Lyme disease treated in his practice.
Can Lyme disease cause excessive daytime sleepiness?
Yes. Excessive daytime sleepiness and fatigue may occur in Lyme disease patients and may be related to poor sleep quality, coexisting sleep disorders, medications, or other contributing factors.
Can Lyme disease affect circadian rhythm?
Some patients report disruption or reversal of normal sleep-wake patterns, which may affect daytime function, sleep quality, and overall quality of life.
Clinical Takeaway
Lyme disease may be associated with a broad spectrum of sleep disorders, including insomnia, non-restorative sleep, excessive daytime sleepiness, circadian rhythm disruption, sleep apnea, restless legs syndrome, sleep paralysis, and narcolepsy-like symptoms.
Recognizing these sleep disturbances is important because they may worsen fatigue, cognitive symptoms, pain, mood, and overall quality of life. A careful evaluation can help identify Lyme disease, coexisting sleep disorders, autonomic dysfunction, medication effects, or other contributing conditions.
Because sleep problems often involve more than insomnia alone, recognizing the full spectrum of Lyme disease sleep disorders may lead to a more comprehensive evaluation and improve recovery.
Related Articles
Learn more about sleep, fatigue, and nervous system symptoms associated with Lyme disease:
Can Lyme Disease Cause Insomnia? Sleep Problems and PTLDS
Lyme Disease Insomnia: Why You Wake Up at 2–3 AM
Why Lyme Patients Feel “Tired But Wired”
Brain Fog and Cognitive Dysfunction in Lyme Disease
Fatigue in Lyme Disease
References
- Weinstein, E. R., Rebman, A. W., Aucott, J. N., Johnson-Greene, D., & Bechtold, K. T. Sleep quality in well-defined Lyme disease: A clinical cohort study in Maryland. Sleep. 2018;41(5):zsy035.
- Bransfield, R. C. Neuropsychiatric Lyme borreliosis: An overview with a focus on a specialty psychiatrist’s clinical practice. Healthcare (Basel). 2018;6(3):104.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
This has been a problem for me. Since have a long disease I can’t seem to fall asleep and wake several times during the night I am over the top trying to find sleep remedies
I have had Lyme Disease for 20 years and am dealing with all of the symptoms that everyone else is dealing with, but, I can’t seem to overcome the depression. Does anyone have any suggestions on natural treatments for Lyme related depression?
5 htp helps me some
Hi Missy,
I realize your post is 2 years old and I hope you are doing well. I have had some luck with CBD oil. I take 6000mg/day. Find a credible and knowledgeable source (my LSLD MD directed me to a credible source), as you should not be ordering this product online without any knowledge of what you are doing. I started on a very low dosage and worked my way up till an array of symptoms (joint pain, arthritis, GI issues, depression, etc.) started to taper off.
Missy, I have lyme since 2013 , the days seem to be getting longer, i get past the depression by think of the people that i know have been paralized, head injurys , strokes that would give there right arm to have only lyme disease, help kept the depression part of my head in check.Try to treat you sell every chance you can afford to, and think of the positive times / things that lay in the days ahead of you
God Bless.
God bless
An amino acid called L- Theanine 200mg OTC works for the sadness & depression Lyme disease creates.
the lyme illness and epstein barr have been present for me since July of this year. In the last two months Ive had insomnia related problems ongoing. I have been on several antibiotics, changed my diet, yet still cannot function to work full time. I have night sweats, and pretty much might get four hours of sleep on a good night. I am implementing self help tools such as meditation, eft, tapping, and other personal development work, but I remain unable to sleep through the night. My body tingles and wakes me up regularly. I have a coaching business and can barely run this at the present time. I am taking suggested herbals, and am about to try another sleep aid since trazedone has not worked that well. Before the lyme and epstein barr had hardly been sick very rarely. Yet I am aware that these infections ht at cross road times and don’t happen always at the bite of the tick for lyme. Any help would be great!
I have found treatment for Babesia helpful for some patients. The sweats sometimes suggested Babesia. I also look for other illnesses. I also evaluate for other illnesses and seek consultations for other illnesses. Call my office at 914 666 4665 if you have any questions.
I have had chronic Lyme for 20 years, as I get older it gets worse. Long hibernation sleeps, bone deep fatigue
I have had LD for over 30 years. I was bitten in Scarsdale NY, and perhaps multiple times more as our house backed up to a wooded reserve with a variety of woodland animals. At present and over the years, I’ve developed an increasing serious and frightening sleep awakening panic attack like syndrome. I’ve been given an anti anxiety pill which is my only help. For fibromyalgia I have another pill for the deep aches and pain despite massage and swimming when possible in NY.
No one understands this ‘sleep to awake’ anxiety attack syndrome but it is paralyzing and causes me to shake and shiver (sweats during night). Now confined mostly at home. We are now in Clearwater Florida because of a disastrous fire in our apt bldg in Bronxville NY in 2019.
Remarks or comments welcome. I’ve been seen by the best lyme literate doctors in Westchester county and one in Manhattan. None had a clue except it could be continued Babesia and/or Bartonella.
I am sorry to hear you are still sick. My Lyme and tick borne disease patients often feel tired and wired likely from a fight or flight like response. It is a tough life if antibiotics treatment fails.
Is antibiotic treatment for recent tick bitten patients only?
A single dose of doxycycline was proposed for a tick bite if found within 72 hour. I have been opposed to a single dose of doxycycline until evidence emerges that a single dose can prevent Chronic Neurologic Lyme. I have to use clinical judgement to determine if treatment is necessary and for how long.
Omg
I’ve been awake for 52 days. I’m so miserable. I do not know what to do. I have had Lyme disease 33 years & was re-infected 5 years ago. I had a bulls eye ring huge. Went to ER & they laughed at me. I use to get medication, but not anymore. I was in hospital 8 days on IV antibiotics. I had Rocky Mtn too & had only 20% life expectancy. That was 33 years ago. I’m an RN retired & mother of 3 children grown. My 34 yo daughter has incurable brain cancer. If I don’t get sleep soon I feel like I’m going to die. I have Mitral valve prolapse. My heart has palpitations constantly. Idk where to get any help. There’s crazy treatments for Lyme like dialysis & chemo. I need sleep.
Thank you,
Cheryl
I have not used diagnosis or chemo.
Hi, I don’t know if you’ve researched various alternative treatments, but sun lamps are known to help with different issues, including resetting circadian rhythm. I have chronic lyme and use mine for 20 minutes every morning in bed when I wake up. Soaking in Epsom salt may help relax you before bed as well, and help detox at the same time. Perhaps you’ve tried these things already, and maybe it’s so severe with you that it won’t touch your issues. I figured I’d offer the suggestion anyway. I’m so sorry you’re suffering this way, and about your daughter as well. Relaxing your nervous system is extremely important, as it affects your immune system nevatively, which will make lyme symptoms worse. Probiotics, supplements, vitmains, diet changes are extremely important. You can find what supplements to use and what the lyme diet is online. Its important to heal at a cellular level, because thats where lyme hides. Unfortunately the medical system fails people with lyme time and time again. Most doctors are not lyme literate and don’t know how to properly treat it, which is why I still have it even though I was treated right away. Now it’s too late for antibiotics to work. Marijuana can also help as well, especially with sleep. It’s good that it’s legal now. Take such, such good care of yourself, mama. Good luck.
My friend has Lyme and isn’t able to sleep now.
Would you be willing to talk to her?
Maybe you have a suggestion that will help her.
She’s talking about not “dealing” with it anymore
I can give you a number through my email.
Please and thank you ❤️
Hi Sue,
I have had Lyme for many many years like you and experience these horrendous ‘panic attacks’ which wake me up in the night. I believe it is cortisol hitting the enotoxins floating around your body which are produced as you sleep. My sleep has been has been hugely improved though by taking high quality magnesium glycinate ( a double dose taken throughout the day) and by wearing high quality blue light blocking glasses in the afternoon and evening.. The glasses have been so very helpful. All the very best . Such a tricky disease to live with and navigate
Twenty years ago gynecologist and urologist thought that I had Lyme disease but hospital test for it was negative but that test was not reliable and both agreed I had Lyme disease and gave me antibiotics. Fast forward to now I have autoimmune diseases, two strokes,fibromyalgia, etc no one helps. It is 6 am and no sleep. I need help
I advise my patient with similar histories to include a doctor experienced in chronic Lyme disease manifestations.