Many people who have had COVID-19 have experienced pulmonary (lung) complications and/or damage. Some have experienced neural complications causing central sleep apnea. This article discusses these issues and offers information on what to expect for treatment.

Updated February 14, 2024

Post infection complications

Many people who have had COVID-19 have experienced pulmonary (lung) complications which can be mild or serious, temporary or permanent. Some people may be fairly asymptomatic and may just feel run down or a little short of breath not realizing they have a more serious complication like pneumonia or a collapsed lung.

According to Hopkins Medical, COVID-19 can cause lung complications such as pneumonia, bronchitis, acute respiratory distress syndrome (ARDS), sepsis, or superinfection. Here are the top 3 factors that may affect COVID-19 lung damage:

Severity of the acute COVID-19 infection: Milder cases are less likely to have lung tissue damage, while severe cases and mechanical ventilators present a higher risk for tissue damage.
Health conditions: Age and pre-existing diseases such as COPD or heart disease are risk factors for lung damage from COVID-19.
Treatment: Timely medical care is important to minimize lung damage. Note: Mechanical ventilators increase the risk of lung damage, which means those who were intubated may need long term support with oxygenation.

Post infection lung damage

COVID-19 lung damage may include fibrosis, scarring, immobility/paralysis of the lung, paralysis/dysfunction of the diaphragm, reactive airway disease, atelectasis (collapsed lung) or asthma. In some cases, the cause may be inflammation of the lung, diaphragm, or the vagus nerve branch that controls the lungs and diaphragm. In other cases, the tissues of the lungs may be damaged and unable to complete the gas exchange that delivers oxygen to the blood, leading to low oxygen saturation rates.

In a normal healthy body, you would expect to see an oxygen saturation level between 97-100%. Others report low oxygen saturation levels (lower than 95%) or shortness of breath. Many of our covidCAREgroup members report that they require supplemental oxygen after having had COVID. All cells in the body need oxygen to survive so it’s important to work with your doctors which may include a pulmonologist or allergist, depending on your diagnosis and condition.

If you are on oxygen, keep using it with the goal of keeping your oxygen levels above 95% to prevent brain damage. An alternative to an oxygen tank may be an oxygen concentrator that is portable and easier to carry when you move about. Ask your PCP or pulmonologist about this. Remember to do deep breathing daily and cough that mucous up. Coughing is the only way to remove the mucous and the best chance you have for your oxygen saturations to return to 95 or higher.

Low blood oxygen levels present a risk to the heath and can lead to tissue death of the brain, nervous system, or other organs. When reading CT, MRI or X-ray reports, watch for phrases in the results section like atelectasis, ground glass opacities, lung wall thickening, alveolar blockages, or lung inflammation are noted, especially in the bases of your lungs.

Note on atelectasis: Atelectasis (collapsed lung) is very common and can easily be missed in those who have a high pain threshold. It is diagnosed with Xray or CT. It occurs when sticky mucous in the lungs interferes with lung to expansion when you inhale. This prevents air from passing into to your blood stream.

Treatment for pneumonia, bronchitis and other infections is focused on clearing the mucous where bacteria can grow by:

Medications like inhalers, antihistamines, and expectorants like Mucinex DM help to break up the mucous.
Staying well hydrated with water thins out the mucous making it easier to cough up.
Breathwork and deep breathing causes the lung walls to flex which releases the mucous from the wall and causes a productive cough to clear the mucous out, (productive meaning that you cough up mucous and spit it out).

If your doctor doesn’t already have you on medications you can ask about a seasonal allergy medicine like Allegra or Benadryl (H1 blocker), long acting inhalers (taken once or twice daily), a rescue inhaler (used every 4 hours as needed for shortness of breath), a steroid nasal spray, and/or other pulmonary histamine blocker medications like Singulair.

Apnea

So far we have talked about lung damage, but apnea is another post COVID complication that affects oxygen levels. If you have trouble sleeping through the night, you don’t feel refreshed in the morning when you wake up, or if you have moments when you stop breathing, you could have apnea. Based on a literature review, the medical world focuses on sleep apnea, although a lot of our followers talk about “forgetting to breathe” when awake, so they periodically have to take a breath intentionally to restart their breathing, which technically fits the apnea definition.

Sleep apnea is a disorder where breathing is interrupted repeatedly during sleep, characterized by loud snoring and episodes of interrupted breathing. People with sleep apnea stop breathing for longer than 40 seconds in their sleep, and oxygen desaturation can dip into the 70s or lower. The risks with sleep apnea include brain damage, but the condition also interrupts your sleep when your brain senses it is not receiving enough oxygen and triggers a burst of adrenaline to wake you up and startle you into taking a breath. This puts your body into fight or flight state, stressing your body and slowing down your recovery. Undiagnosed or untreated sleep apnea can lead to serious complications such as heart attack, glaucoma, diabetes, cancer, and cognitive and behavioral disorders.

Two types of sleep apnea:

Obstructive sleep apnea (OSA), which is the more common form that occurs when throat muscles relax and block the flow of air into the lungs. This often happens in older adults or those who are overweight.
Central sleep apnea (CSA), which occurs when the brain doesn't send proper signals to the muscles that control breathing. This can be a result of Neuro COVID.

What Is Central Sleep Apnea?

Central sleep apnea (CSA) is when you regularly stop breathing while you sleep because your brain doesn’t tell your muscles to take in air. It’s different from obstructive sleep apnea, in which something physically blocks your breathing. But you can have both kinds together, called mixed sleep apnea.

Central sleep apnea usually happens because of a serious illness, especially one that affects your lower brainstem, which controls breathing. In very young babies, central sleep apnea causes pauses in breathing that can last 20+ seconds.

Long COVID can affect the nervous system and the brain. One way this can manifest is with central sleep apnea. Just like everything else related to long COVID, this could be mild or severe, temporary or permanent. Many of our followers report that they now use a CPAP machine for sleeping.

Central Sleep Apnea Symptoms

The main symptom of CSA is pauses in breathing. It usually doesn’t cause snoring, the way obstructive sleep apnea does.

Symptoms may also include:

Being very tired/fatigued during the day.
Waking up often during the night.
Having headaches in the early morning.
Trouble concentrating.
Memory and mood problems.
Not being able to exercise as much as usual.

Central Sleep Apnea Risk Factors

Central sleep apnea can affect anyone from infants to the elderly. It is more common among older people, especially those over 65. They may have health conditions or sleep patterns that make them more likely to get CSA.

Health conditions that may be linked to central sleep apnea include:

Congestive heart failure
Hypothyroid
Kidney failure
Neurological diseases such as Alzheimer’s, Parkinson’s, or Lou Gehhrig’s Disease (amyotrophic lateral sclerosis/ALS)
Damage to the brainstem from stroke, injury, or infection related inflammation or encephalitis

Central Sleep Apnea Treatment

Treatment depends on the cause of your apnea and might involve taking medicine for heart failure or stopping an opioid medication.

Some general sleep apnea treatments can also make you feel better:

Keep a healthy weight.
Avoid alcohol and sleeping pills, which make your airway more likely to collapse while you sleep.
Sleep on your side instead of on your back.
Use nasal sprays or breathing strips to keep air flowing if you have sinus problems or nasal congestion.
Get plenty of sleep.

After being officially diagnosed with sleep apnea, a doctor may recommend continuous positive airway pressure (CPAP) to ensure oxygen levels don’t drop too low when sleeping.

A CPAP machine forces a constant stream of air into your nose and/or mouth through a mask you wear while you sleep. The air pressure is just enough to keep your upper airway tissues from collapsing and blocking your breathing. Alternatives to CPAP can include similar devices called adaptive servo-ventilation (ASV) and bilevel positive airway pressure (BPAP).

Is COVID-19 lung damage reversible?

After COVID-19, a patient’s lungs can recover, but not overnight. Recovery from lung damage takes time. There’s the initial injury to the lungs, followed by scarring. Over time, the tissue heals, but it can take three months to a year or more for a person’s lung function to return to pre-COVID-19 levels.

During the healing process you may experience symptoms such as pain or stinging when breathing deep, shortness of breath, or sensitivity to smells and fragrances. It is similar to a bone break that needs 12 weeks to heal. As the bone strengthens and muscle re-grows, you experience discomfort from this healing. This happens with the lungs as well.

Is central apnea reversible?

If the central apnea is mild and directly related to an active infection, there is a possibility that central apnea could reverse once you are recovered. If you are fortunate enough for this to happen, be aware that you will be vulnerable to episodes in the future.

If the central apnea is caused by damage to the breathing control center in the brain, which can happen from functional neurological disorder, chronic neural inflammation, hypoxic brain injury, stroke or vasculitis, it is likely permanent. The good news is that treatment protocols are effective in minimizing complications.

Things you can do to help yourself

Minimizing physical & psychological stressors is essential in recovery from Long COVID.

Nutrition: Try to eat protein and fresh vitamin rich foods daily and avoid chemicals, preservatives, sugars, fast foods, prepared foods and high histamine foods.
Don’t skip meals. Your body needs protein, vitamin C, and vitamin D to heal from any injury or illness. A low histamine or low carbohydrate (sugar) diet is recommended by doctors treating Long COVID (PASC), and many people report a reduction in symptoms within 1-3 days of the diet change, including decreases in sneezing, itching or hives, irritable bowel syndrome, body pain, along with a reduction in swelling and inflammation.
Hydration: A minimum of eight 8 oz glasses of plain water daily is recommended.
Avoid drinks with chemical additives. You can easily make a fresh electrolyte drink yourself by adding a dash of mineral rich Epsom salt and a piece a fruit like a raspberry for flavor instead of spending money on commercial drinks like Gatorade that contain chemicals and sit in plastic bottles for long periods of time. Remember that caffeine and alcohol have dehydrating effects.
Sleep hygiene: Getting 7-9 hours of sleep so your body can repair itself.
You need at least 4 hours of uninterrupted sleep to get into the restorative phase of sleep.
Avoid stimulating activities after dinner like thrilling movies or books, arguments, negative news or frustrating stimuli.
If you wake up frequently or with a startle, you may be experiencing drops in your oxygen level, which signal your brain to release adrenaline to force you to take a breath. This could be a temporary inflammation issue or more enduring sleep apnea. Ask your doctor for a sleep study to evaluate your need for a CPAP or BiPAP, a machine that pushes air into your lungs when it senses an apneic episode (periods of not breathing).
Stress management: Stress affects every component of your life.
The only thing you can control about stress is your reaction to it. Try to avoid or minimize your exposure to stressful situations: Turn off the news, make family visits that end unpleasantly short, wait for the morning to have intense discussions, let go of things that annoy you but don’t really matter in the big scheme of things, avoid intense conversations or entertainment in the evening.
Exercise within tolerance: Pace yourself and do not push your body to extremes in any way.
For some this may mean seated breathing exercises, walking to the mailbox. Rest when your body says to slow down. Gradually build on your activity endurance as your body cues you to progress. This can be hard to gauge, because when you feel good you naturally do more, but if you do too much you may experience symptom flare ups 1-3 days later as the post exertion inflammation builds. Some people describe this as post exertional malaise, others experience severe recovery set backs.
Breathwork: You can literally stop the fight or flight reaction by taking slow deep breaths.
Deep slow breathing shuts down the adrenaline flow, slows your heart rate, lowers your blood pressure and decreases stress related histamine release. When you do this, your blood reroutes back to your brain and nervous system to allow you to think clearly. It also allows your body to use its energy and oxygen to heal your inflamed nerves and organs.

Long COVID Solutions

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