Prospective longitudinal study of 'Sleepless in Lockdown': unpacking differences in sleep loss during the coronavirus pandemic in the UK

Abstract

Objectives: COVID-19 is having a disproportionate impact on Black, Asian and minority ethnic (BAME) groups and women. Concern over direct and indirect effects may also impact on sleep. We explore the levels and social determinants of self-reported sleep loss among the UK population during the pandemic, focusing on ethnic and gender disparities.

Setting: This prospective longitudinal study analysed data from seven waves of the Understanding Society: COVID-19 Study collected from April 2020 to January 2021 linked to prepandemic data from the 2019 mainstage interviews, providing baseline information about the respondents prior to the pandemic.

Participants: The analytical sample included 8163 respondents aged 16 and above who took part in all seven waves with full information on sleep loss, defined as experiencing 'rather more' or 'much more' than usual sleep loss due to worry, providing 57 141 observations.

Primary outcome measures: Self-reported sleep loss. Mixed-effects regression models were fitted to consider within-individual and between-individual differences.

Results: Women were more likely to report sleep loss than men (OR 2.1, 95% CI 1.9 to 2.4) over the 10-month period. Being female, having young children, perceived financial difficulties and COVID-19 symptoms were all predictive of sleep loss. Once these covariates were controlled for, the bivariate relationship between ethnicity and sleep loss (1.4, 95% CI 1.6 to 2.4) was reversed (0.7, 95% CI 0.5 to 0.8). Moreover, the strength of the association between gender and ethnicity and the risk of sleep loss varied over time, being weaker among women in July (0.6, 95% CI 0.5 to 0.7), September (0.7, 95% CI 0.6 to 0.8), November (0.8, 95% CI 0.7 to 1.0) and January 2021 (0.8, 95% CI 0.7 to 0.9) compared with April 2020, but positively stronger among BAME individuals in May (1.4, 95% CI 1.0 to 2.1), weaker only in September (0.7, 95% CI 0.5 to 1.0).

Conclusions: The pandemic has widened sleep deprivation disparities, with women with young children, COVID-19 infection and BAME individuals experiencing sleep loss, which may adversely affect their mental and physical health.

Keywords: COVID-19; epidemiology; mental health.

Figure 1

Prevalence of reported sleep loss before and during the pandemic among all participants aged 16 and above in Understanding Society mainstage survey in 2019 and Understanding Society: COVID-19 Study wave 1 to wave 7. Source: Authors’ analysis, Understanding Society: COVID-19 Study, 2020. Number of respondents: n=29 685 (prepandemic 2019), n=15 668 (April 2020), n=14 154 (May 2020), n=13 437 (June 2020), n=13 075 (July 2020), n=12 170 (September 2020), n=11 472 (November 2020), n=11 299 (January 2021). All proportions are unweighted. Black lines represent women in different ethnicities and grey lines represent men. BAME, black, Asian and minority ethnic.

Figure 2

Prevalence of reported sleep loss at each wave of the Understanding Society: COVID-19 Study (n=8163) by Gender (A) and Ethnicity (B). Source: Authors’ analysis, Understanding Society: COVID-19 Study, 2020. All proportions are weighted using each wave cross-sectional individual web survey weight, beta version. BAME, black, Asian and minority ethnic; BESWN, British/English/Scottish/Welsh/Northern Irish.