Changes in sleep pattern and dream activity across and after the COVID‐19 lockdown in Italy: A longitudinal observational study

Abstract

Summary A large body of evidence has documented the impact of the global COVID‐19 outbreak – and especially the lockdown period – on sleep quality and quantity. Here, we present the first Italian longitudinal study on sleep and COVID‐19 considering four different time points collected during lockdown (from 29 March 2020 to 3 May 2020) and a subsequent follow‐up period (October 2020). We used an online survey to collect socio‐demographic and COVID‐19 related information. Subjects were also asked to complete a sleep diary at each time point of the study. Our longitudinal sample included 147 participants. Statistical comparison across time intervals showed remarkable changes in sleep patterns during and after the lockdown. In particular, during lockdown we observed longer sleep latency, less ease of falling asleep, a higher total bedtime, and a lower dream frequency. The week‐by‐week evaluation described relatively stable patterns in the observed measures during the lockdown period, except for dream frequency, affected by a rapid increase in the early phase of lockdown. Our findings are in line with the current literature. Furthermore, the prospective longitudinal investigation comprising several time points offered the possibility of (a) observing the temporal dynamics and the different entities of such changes over time, and (b) reducing the typical memory bias for these studies.

The Oneiric Activity during and after the COVID-19 Total Lockdown in Italy: A Longitudinal Study

“…It should be noted that we did not send reminders to the individuals after inviting them to participate in the second survey, likely limiting the number of participants. Our final percentage of respondents at the follow-up (i.e., 21.3%) is similar to other longitudinal sleep studies during the pandemic [ 9 , 34 , 83 ].…”

“…These changes in oneiric activity co-occurred with greater ease of falling asleep and a reduced number of awakenings after the lockdown. Another Italian study [ 34 ] performed a week-by-week evaluation of sleep and dream diaries during the last period of the first TL (29 March 2020–3 May 2020), and a follow-up assessment during a post-lockdown (PL) period, characterized by eased restrictions (October 2020). Beyond reduced sleep latency, greater ease of falling asleep, and higher total bed time at the follow-up examination, an initial increase in dream frequency was observed during the TL, which remained stable until the end of the isolation period, followed by a PL reduction.…”

“…Crucially, in accordance with the hypothesis that dreams may represent a reliable index of well-being [ 32 ], these findings point to the importance of the assessment of dream features during the evolution of the pandemic. However, among these longitudinal studies, only one [ 34 ] focused on dreams during the period of eased restriction between the first and second pandemic waves (represented in Italy by summer and initial part of autumn 2020), which is important to clarify the effect of (total or partial) lockdown periods on dreaming. However, the number of dreams was the only available variable concerning the oneiric activity collected in that study.…”

Persistence of the Effects of the COVID-19 Lockdown on Sleep: A Longitudinal Study

“…Consistently, our results showed that the time spent at home after the lockdown was reduced, compared with the home confinement period, but it was significantly greater than the pre-lockdown period, suggesting that participants in our sample did not return to the habitual pre-pandemic daytime schedule immediately after the lockdown. It is worth noting that an Italian study found substantially stable sleep patterns during the lockdown through a week-by-week assessment of sleep diaries, followed by a reduction in sleep onset latency, time in bed, and dream frequency and an increase in the perceived ease to fall asleep 4 months after the end of the lockdown [ 36 ]. Therefore, it is possible that a longer period of time in a condition of relative stability and a further reduction in the restrictions are needed to observe major changes in sleep quality after the end of home confinement.…”

Emotional Distress and Associated Factors among the General Population during the COVID-19 Pandemic in China: A Nationwide Cross-Sectional Survey

“…A systematic review estimated that the prevalence of sleep problems during the COVID-19 pandemic was high and affected approximately 40% of people from general and health care populations [18]. A longitudinal study observed longer sleep latency, worse sleep efficiency, and massive sleep medication use, but an increased sleep duration and better daytime functioning, in Italian participants during the COVID-19 lockdown [19,20]. Moreover, the increase in sleep difficulties was associated with higher levels of depression, anxiety, and stress among Italian adults during the lockdown [21].…”