Sleep, interrupted

Sleep has become elusive for many as a result of the coronavirus pandemic, according to new research from Arizona State University’s Edson College of Nursing and Health Innovation.

From increased insomnia symptoms to poorer sleep quality and a shift in the time people go to bed and wake up, the struggle for a good night’s rest is real for people across the globe.

“Overall, sleep disturbances were heightened, with 56.5% of our sample reporting clinical levels of insomnia symptoms during the pandemic,” said Megan Petrov, Edson College associate professor.

While the data are not totally surprising, Petrov, who specializes in sleep research and led this project, says there is still cause for concern.

The findings were recently published in Sleep Health Journal. The study was conducted online with responses coming in from people living in 79 countries. 

Researchers were interested in the specifics of how various challenges presented by the pandemic, including lifestyles and livelihoods being upended, impacted people’s sleep.

 I found it unsettling to see how many people prior to the pandemic had incredibly restricted sleep opportunities."
— Associate Professor Megan Petrov

The changes reported by respondents tended to cluster around four major sleep pattern profiles:

• Delayed sleep.

• Sleep lost and fragmented.

• Sleep opportunists.

• Dysregulated and distressed.

 Infographic: How the pandemic has changed sleep patterns

In this Q&A for ASU News, Petrov explains the four sleep patterns observed and the percentage of people experiencing each one. She also shares some of what surprised her and worries her about the findings as well as what steps we can all take to increase the quality of sleep as we transition back to pre-pandemic routines.

“Valuing your sleep is not just a personal matter. By valuing your sleep, you are contributing to the communities you are a part of. Good sleep health increases your likelihood of being a safe, more productive member of society, and a more engaged family member, friend and co-worker,” she said.

Question: What does your recent research show about how the pandemic has affected individuals’ sleep around the world? And what are some next steps you’re suggesting as a result of this research? 

Answer: Almost two-thirds of our sample experienced a “delayed sleep” pattern, which was associated with little change in sleep duration or time spent in bed but rather a later bedtime, and increased nightmares and naps. 

The second most common sleep pattern change experienced by 20% of our sample was the “sleep lost and fragmented” pattern. Individuals that experienced this pattern went to bed later and had a shorter time in bed attempting to sleep. In essence, their sleep was restricted, lower in quality and they were less likely to compensate for it with naps. Women were more likely to experience this pattern than men. 

About one out of 10 individuals tended to be “sleep opportunists.” These were individuals that had significantly restricted sleep opportunities prior to the pandemic who then during the pandemic spent a lot more time in bed and had the longest sleep duration compared to any of the other profiles. Unfortunately, despite the better sleep these individuals also reported the greatest change in their daily routines, which was associated with a lower likelihood of being employed and greater family stress and discord.

Lastly, the least common sleep pattern profile was the “dysregulated and distressed” pattern experienced by 5% of our sample. These individuals had the worst sleep deterioration with accompanying heightened nightmares and naps and had the greatest insomnia symptom severity. 

These four profiles tell us that acute responses to a pandemic depend heavily on prior sleep history, gender and other household factors, which can inform clinicians and public health professionals to better identify at-risk groups and potentially personalize behavioral sleep health interventions.

Q: As a sleep scientist, what, if anything, has been the most surprising thing about how people’s sleeping habits have changed during the course of the pandemic? And on that same note, what’s been the most troubling?

A: We originally hypothesized that there would be large shifts in sleep patterns for the majority of the population characterized mostly by delayed bedtimes and increases in naps. Indeed that appeared to occur for many individuals. However, there were two changes that I found surprising. 

First, the large presence of “sleep opportunists.” I found it unsettling to see how many people prior to the pandemic had incredibly restricted sleep opportunities — increasing their personal risk for accidents as well as those around them — and only after experiencing quarantine, huge shifts in daily routine and possibly unemployment were they afforded better sleep opportunities. The experience of these persons reflects a serious public health and economic problem in our global society that we must address as we tackle our current and post-pandemic world. These individuals are likely vulnerable, disadvantaged and at risk for poor health and economic outcomes. 

Second, the substantial sleep deterioration experienced by one of four individuals in our sample — “sleep lost and fragmented” and “dysregulated and distressed.” Sleep disturbances can take on a life of their own independent of the acute event that may have instigated it. Thus, these persons may be at a greater risk for poor sleep health over the long term.

Q: Why is the quality of sleep so important?

A: Sleep is an essential part of living, just like air, water and food. Your health and functioning are compromised when the quality of the air you breathe, the water you drink and the food you eat are poor. This is also the case if your sleep is poor quality and insufficient in quantity.

Q: Now that things are really starting to open up again and people are expected to be back in the office, at school, social functions, etc., what are some things they can do to readjust their sleeping habits or perhaps create new, better ones?

A: The pandemic, thankfully, has not changed the essential ingredients of good sleep health. Essential ingredients include a consistent sleep/wake schedule, a safe and comfortable sleep environment free of distractions such as electronics, food, etc., sufficient sleep opportunity for your personal sleep duration need — the majority of adults need seven to eight hours of sleep for optimal functioning — daily exercise and good nutrition, and bright light during the day and dim light to darkness at night.

As we shift into new routines once again, this is a good time to reflect on what aspects of your sleep health have not been serving you well either pre-pandemic or since then. Ask yourself what could you do differently this time around to not settle into old habits, but instead to align your daily routine with the essential ingredients of good sleep health.

Q: What’s one piece of advice you’d give to people struggling to find a good sleep routine during this time of transition?

A: Monitor your sleep. You can do this with a daily sleep diary or app. Oftentimes, when you pay attention to your sleep over time, you can discover some low-hanging fruit for changes that can be made.

Q: Where can people find resources/support if they find themselves dealing with something beyond just an out-of-whack sleep routine?

A: Perhaps you are experiencing extreme daytime sleepiness and fatigue, trouble sleeping despite adequate opportunity and circumstances to get sleep, and/or experiencing other odd behaviors during the night. In these situations, it is best to seek professional support whether through a sleep medicine specialist or behavioral sleep medicine specialist.

Top photo: A new study found poor sleep and depressive symptoms were widespread and increased during the pandemic and that women were more affected than men. Photo from Canva.