The World Health Organisation writes that approximately six in every 100 people who have Covid-19 develop what WHO calls post-Covid-19 condition. The NHS refers to it as post-Covid syndrome, or simply long Covid.
For years I managed to avoid catching Covid-19, but I wasn’t going to be safe forever and unfortunately, I caught it near the end of 2025. In the following weeks I developed increasingly disturbing heart, throat and dizziness problems as well as issues with my digestive system and temperature regulation. Things felt badly wrong. Fear and anxiety can greatly exacerbate any physical problem, especially if you have no explanation for your symptoms. It was only after I was told that I had vagus nerve dysregulation following a viral infection that I began to relax and started exploring what this meant.
Long Covid and vagus nerve dysregulation
Since 2020 there has been extensive research into long Covid and vagus nerve dysregulation is increasingly being recognised as a key and sometimes central feature of the ongoing problems that some people have after their Covid-19 infection is long gone. In their article ‘Vagal nerve stimulation for the management of Long COVID symptoms’, Malik Khan and colleagues write that Covid-19’s pathological effects are largely attributed to an abrupt and intense inflammatory response of the immune system, which can damage the vagus nerve.
The vagus nerve runs from the brain down through the face, throat, heart, lungs and digestive system, sending signals between the body and the brain. Damage to the vagus nerve can cause several systems to become unstable at the same time, with an unusual mix of symptoms: heart problems, dizziness, difficulty swallowing and speaking, problems with temperature regulation and also digestive system problems including nausea and bloating. Making things worse, patients also usually suffer from fatigue, mental exhaustion and what they call brain fog. Fatigue and mental exhaustion are very easily worsened by even mild physical or mental exertion.
An over-active sympathetic nervous system leads to inflammation
Khan and colleagues write that the invasion of the vagus nerve by a Covid-19 infection causes an imbalance between the sympathetic and parasympathetic nervous systems, leading to the activation of the sympathetic system and causing systemic inflammation. The vagus nerve is the primary component of the parasympathetic nervous system which is the body system for resting and healing, and for regulating heart rate, digestion and immune responses. The sympathetic nervous system, on the other hand, is the body’s automatic defensive system making us ready for fight or flight and alerts us to any possible danger.
The imbalance between the two systems in patients with long Covid leads to a far too easily activated sympathetic nervous system, making things worse for patients; they experience increased feelings of anxiety, distress and worry as the body is more often on high alert for danger.
Long Covid recovery: a combination of approaches
As its name implies, long Covid is a long, drawn-out condition from which it can take many months to recover; the body has its own natural healing abilities, but nerve regrowth and the formation of new neural pathways can take a long time and is quite unlike the recovery from a skin wound or a broken bone.
There are things we can do that can help. However, there is no single device, pill or activity that can solve the problems from the damage to the vagus nerve. Since long Covid is a multisystem problem, a combination of approaches may be needed during the weeks and months of gradual improvements towards recovery.
Khan and colleagues write that boosting the function of the vagus nerve can be one way to overcome the imbalance between the sympathetic and parasympathetic systems and return to the normal body state. To help heal that imbalance, there are ways to activate the parasympathetic nervous system. Choosing to avoid stressful situations therefore becomes crucial as well as doing what may help in calming the mind.
Calming the mind
Relaxing breathing exercises are a good way to calm the mind. Breathing exercises with a longer exhale than inhale are found to reduce anxiety and to increase parasympathetic activity.
Sound can send vibrations through the body and there is evidence that humming while breathing out stimulates the parasympathetic nervous system while slowing down the sympathetic nervous system. Listening to sounds of water or nature sounds is another way to reduce stress and calm the nervous system.
Yoga is known for its positive effects on reducing anxiety and calming the mind and there are now ongoing studies looking at the effects of regular yoga exercise in patients with long Covid.
Some suggest stimulating the vagus nerve by splashing the face twice a day with cold water. There is also some preliminary evidence that vagus nerve stimulation with an electronic device may help some long Covid patients.
Long Covid patients are also advised to stay well hydrated by drinking plenty of water every day, as this helps the body remove waste and toxins. It also helps our short-term memory and attention, while dehydration is associated with having negative effects on our energy levels and our mood.
Reducing chronic inflammation
Khan and colleagues write that numerous investigations have verified that people with long Covid display an unusual chronic profile of inflammation that lasts for months. When this happens, the immune system is constantly active and may cause damage to healthy tissues and delay healing. Stress and anxiety can also increase levels of inflammation.
Physical exercise has been found to help reduce inflammation and improve mood regulation, mental clarity and memory. Yoga is also associated with lowering levels of inflammation, and so this and other forms of gentle regular exercise may be beneficial.
A healthy anti-inflammatory diet is recommended for people with other inflammatory disorders and may be beneficial for patients with long Covid. Patients already have some cognitive problems, and since high consumption of ultra-processed food is associated with cognitive decline, ultra-processed foods are best avoided.
Having some direct exposure to sunlight leads to the production of vitamin D, strengthens our immune system and can stimulate anti-inflammatory pathways while also stimulating the production of serotonin which boosts our mood.
Certain vitamins and minerals support nerve regrowth. Magnesium is important, particularly as magnesium supplements have been found to have benefits in improving memory and cognition, while a deficiency in magnesium contributes to systemic low-grade inflammation. Magnesium supplements together with vitamin D have been found to alleviate mild to moderate depressive symptoms related to long Covid.
Working towards recovery from brain fog
Khan and colleagues write that vagus nerve dysfunction is considered a potential neurological factor contributing to cognitive impairments associated with long Covid.
After the most troublesome physical problems from long Covid have softened enough, it can become possible to start challenging the brain by focussing on small but slightly difficult tasks with the aim of regaining those lost mental abilities, improving alertness and focus, and the ability to concentrate properly once again.
In a study of people with long Covid who had brain fog, patients were given Constraint-Induced Cognitive Therapy (CICT) regularly over a period of many weeks. CICT is designed to challenge the brain to do certain tasks. The study found that the large majority of the long Covid patients who had been given CICT were then able to return to work, and many showed very large improvements in their higher-level skills. These study results are very encouraging, showing that regaining cognitive abilities is possible.
Understanding of long Covid helps recovery
Patients with long Covid can have such an unusual mix of debilitating symptoms that, when viewed from the outside, some may think it is exaggerated or all in the mind, but the understanding and recognition of long Covid as well as other post infectious disorders is growing.
Recovery from long Covid is extremely slow, but now, with a better understanding of the medical issues, patients can use that knowledge and feel motivated to persevere in taking those many small steps towards their own recovery.
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