Sleep quality during the COVID-19 pandemic: not one size fits all

Abstract

Background: The COVID-19 pandemic imposes a long period of stress on people worldwide and has been shown to significantly affect sleep duration across different populations. However, decreases in sleep quality rather than duration are associated with adverse mental health effects. Additionally, the one third of the general population suffering from poor sleep quality was underrepresented in previous studies. The current study aimed to elucidate effects of the COVID -19 pandemic on sleep quality across different levels of pre-pandemic sleep complaints and as a function of affect and worry.

Method: Participants (n = 667) of the Netherlands Sleep Registry (NSR) were invited for weekly online assessment of the subjective severity of major stressors, insomnia, sleep times, distress, depression, and anxiety using validated scales.

Analysis: To investigate the overall impact of the COVID-19 pandemic on the sleep quality of people with and without a history of insomnia, we performed a mixed model analysis using pre-pandemic insomnia severity, negative affect, and worry as predictors.

Results: The effect of COVID -19 on sleep quality differs critically across participants, and depends on the pre-pandemic sleep quality. Interestingly, a quarter of people with pre-pandemic (clinical) insomnia experienced a meaningful improvement in sleep quality, whereas 20% of pre-pandemic good sleepers experienced worse sleep during the lockdown measures. Additionally, changes in sleep quality throughout the pandemic were associated with negative affect and worry.

Conclusion: Our data suggests that there is no uniform effect of the lockdown on sleep quality. COVID-19 lockdown measures more often worsened sleep complaints in pre-pandemic good sleepers, whereas a subset of people with pre-pandemic severe insomnia symptoms underwent a clinically meaningful alleviation of symptoms in our sample.

Keywords: Affect; COVID-19; Insomnia; Sleep quality; Worry.

Fig. 1

Association between retrospective pre-pandemic insomnia severity and changes in sleep during the COVID-19 pandemic. Clinically meaningful changes absolute difference ≥ 6 points [7]; are shown in dark purple, whereas non-meaningful changes are coloured green. The lower panel shows the relationship between the mean negative affect during the pandemic and changes in sleep separately for pre-pandemic good sleepers, people with mild sleep complaints, and people with (clinical) insomnia. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)