Dissociated profiles of sleep timing and sleep quality changes across the first and second wave of the COVID-19 pandemic

Abstract

Previous work showed a significant impact of the COVID-19 pandemic on Italians' sleep both during the first wave, when a total lockdown (TL) was imposed, and during the second wave, when a partial lockdown (PL) was mandated (autumn 2020). Here we complement these data by describing the profile of sleep across four time-points: the first and second lockdown (TL, PL) and the months preceding them (pre-TL, pre-PL). An online survey was completed by 214 participants (M_age = 36.78 ± 14.2 y; 159 F) during TL and again during PL. All sleep-related questions (including items of the Pittsburgh Sleep Quality Index) required a double answer, one referred to the current lockdown and one to the month preceding the lockdown. Bedtime and rise time were delayed in TL and then advanced in pre-PL and PL. Similarly, time in bed increased in TL and then decreased in pre-PL and PL. Sleep quality worsened in the two lockdowns compared to the preceding periods and the proportion of poor sleepers correspondingly increased in both lockdowns. Sleep habits and quality displayed different profiles across phases of the pandemic. Sleep timing was altered during the first lockdown and then returned towards baseline (likely due to normalized working schedules). Instead, sleep quality, which markedly worsened during both lockdowns, appears particularly sensitive to changes in life habits and psychological factors, independently of sleep habits. Our findings also point to a possible role of acute and chronic stress (experienced during the first and second wave, respectively) in modulating sleep changes across the pandemic waves.

Keywords: Covid-19 pandemic; Sleep quality; Sleep schedules.

Fig. 1

Differences in (a) Bedtime, (b) Rise time, (c) Time in Bed, and (d) Sleep Onset Latency across the four time-points. Significant comparisons are indicated with asterisks (***: p ≤ .001; **: p ≤ .01; *: p ≤ .05). Error bars represent standard errors of the means.

Fig. 2

Differences in Pittsburgh Sleep Quality Index (PSQI) global scores across the four time-points. Significant comparisons are indicated with asterisks (***: p ≤ .001; **: p ≤ .01; *: p ≤ .05). Error bars represent standard errors of the means.

Fig. 3

Differences in number and duration of night awakenings and of naps across the four time-points. TL: Total Lockdown; Pre-TL: month preceding TL; PL: Partial Lockdown; Pre-PL: month preceding PL. Scores correspond to ratings on a 0–5 ordinal scale, with 0 indicating the absence of the characteristic and 5 its maximum expression (see Materials and Methods section for specific descriptors). Significant comparisons are indicated with asterisks (***: p ≤ .001; **: p ≤ .01; *: p ≤ .05). Error bars represent standard errors of the means.

Fig. 4

Differences in scores at the PSQI subscales across the four time-points. Higher Sleep Quality and Habitual Sleep Efficiency sub-scores indicate lower sleep quality and lower sleep efficiency, respectively. Significant comparisons are indicated with asterisks (***: p ≤ .001; **: p ≤ .01; *: p ≤ .05). Error bars represent standard errors of the means.