To sleep perchance to dream - not; Nyctophobia from COVID-19 induced hyposmia

Abstract Objective: Increase awareness of the correlation between nyctophobia and hyposmia in individuals with COVID-19. Background: Fear of sleep (nyctophobia) has been attributed to various conditions ranging from benign nocturnal panic attacks and Morvan's syndrome. Positional dependent hyposmia as an origin of nyctophobia has not heretofore been described. Case presentation: This 52-year-old woman presented with sudden onset of loss of smell and taste with COVID-19, which returned to 85% of normal. However, her symptoms worsened when she would lie down to 30% of normal but would improve with standing, moving, and sitting. Requiring her to stand for hours before her sense of smell would return led to her nyctophobia that forced her to move around all the time. Conclusions: Nyctophobia, a fear of positional dependent loss of smell, highlights the importance of smell to a narcissistic perception of self. This can be understood that the olfactory lobe is anatomically part of the limbic system. Deposition of memory engrams is facilitated as manifest with olfactory evoked nostalgia seen in 84% of the general population. The importance of smell is thus intrinsic to an individual's well-being, and the threat of loss of such sensation with a change in position with sleep was the precipitating event leading to nyctophobia in this subject. Assessing for fear of loss of smell in those with nyctophobia, especially with past COVID-19 infection, allows for an increased understanding of etiology and indicates potential treatment approaches.