Early Impact of the COVID-19 Outbreak on Sleep in a Large Spanish Sample

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) forced Spain to implement unprecedented lockdown restriction. In this context, different factors could worsen sleep quality, but the impact of the pandemic and lockdown on sleep is still mostly unknown. In this cross-sectional study, we describe self-reported sleep disturbances in people without mental health disorders from a large Spanish sample (n = 15,070). Methods: During the early phase of the lockdown (19-26 March), an online survey was launched using a snowball sampling method and included sociodemographic and clinical data along with the Depression, Anxiety, and Stress Scale (DASS-21) and the Impact of Event Scale (IES). Two items of the IES were employed to assess sleep characteristics. Descriptive and bivariate analysis and logistic regression models were performed. Results: Difficulty initiating or maintaining sleep were reported by 23.9% of the sample and was associated in the regression model with age (OR = 1.008, p = .003), female sex (OR = 1.344, p < .001), an income reduction >50% (OR = 1.248, p = .037), having one (OR = 1.208, p = .029) and two or more (OR = 1.299, p = .035) elderly dependents, drinking alcohol (OR = 1.129, p = .024), and a higher score on DASS-21 depression (OR = 1.148, p < .001), anxiety (OR = 1.218, p < .001), or stress (OR = 1.302, p < .001) subscales, whereas being able to enjoy free time (OR = 0.604, p < .001) and painting or listening to music (OR = 0.853, p = .012) were protective factors. Dreams related to COVID-19 were reported by 12.9% of the sample and were associated in the regression model with female sex (OR = 1.617, p < .001), being married (OR = 1.190, p = .015), self-employed (OR = 1.373, p = .032), or a civil servant (OR = 1.412, p = .010), having been tested for COVID-19 (OR = 1.583, p = .012), having infected family or friends (OR = 1.233, p = .001), reading news about coronavirus (OR = 1.139, p = .023), drinking alcohol (OR = 1.251, p < .001), and higher scores on DASS-21 depression (OR = 1.102, p < .001), anxiety (OR = 1.222, p < .001), or stress (OR = 1.213, p < .001) subscales, while protective factors were older age (OR = 0.983, p < .001) and being retired (OR = 0.625, p = .045). Conclusions: These findings could help clinicians and public health systems design and deliver tailored interventions, such as internet-delivered campaigns, to promote sleep quality in the general population.

Lifestyle changes and mental health during the COVID-19 pandemic: A repeated, cross-sectional web survey

“…The most noticeable changes were found in environmental exposures, physical activity and restorative sleep that seem to be the lifestyle behaviors most sensitive to the effects of strict lockdown and mandatory home isolation issued during the early phase of the pandemic. Several studies across the world have also observed the remarkable effects of confinement on these three behaviors ( Colley et al., 2020 ; Dal Santo et al., 2021 ; Qin et al., 2020 ; Rolland et al, 2020 ; Smith et al., 2020 ; Wiederhold et al., 2020 ). Moreover, a longitudinal study found a trend towards the disappearance of the sleep disturbances after the lockdown release in France ( Beck et al., 2021 ).…”

“…Growing evidence supports that COVID-19 pandemic has a significant impact on most lifestyle behaviors, especially during populations lockdowns ( Branchi and Giulani, 2021 ; Verdolini et al., 2021 ). For instance, research across the world estimates the prevalence of sleep disturbances between 21.9 and 55.8% ( Cellini et al., 2020 ; Dal Santo et al., 2021 ; Ernstsen and Havnen, 2020 ; Fu et al., 2020 ; Li et al., 2020 ) which in turn were significantly associated with anxiety and depressive symptoms ( Cellini et al., 2020 ; Ernstsen and Havnen, 2020 ; Fu et al., 2020 ; Li et al., 2020 ; Smith et al., 2020 ).…”

Sleep disorders and COVID-19

“…While most studies among the general population, by their very nature, include individuals in lockdown (which was essentially the norm in most countries around the world during the pandemic), some researchers have attempted to study the effects of lockdown and/or quarantine periods in particular on sleep dysfunction. A large Spanish study [ 20 ] conducted in over 15,000 subjects in the early phase of the lockdown showed high rates of difficulty initiating or maintaining sleep (23.9%), associated with higher age, female sex, reduction in income, having elderly dependents, alcohol use, depression, anxiety and stress; conversely, indulging in hobbies such as painting or listening to music were protective factors. A web-based study among 1,908 individuals in lockdown in six different countries (Greece, Switzerland, Austria, Germany, France, and Brazil) showed that sleep duration increased by a small amount (0.31 hours); 15% of participants characterized their sleep as bad and 37.9% as average during the lockdown week, and a third of individuals reported worse quality of sleep during the lockdown week than under normal conditions [ 21 ].…”

Stuck in a lockdown: dreams, bad dreams, nightmares, and their relationship to stress, depression and anxiety during the COVID-19 pandemic

“…Further, the presence of COVID-19 related nightmares has been associated with symptoms of generalized anxiety disorder in healthcare providers in Colombia (Monterrosa-Castro, Redondo-Mendoza, & Mercado-Lara, 2020). Similarly, the presence of COVID-19 related dreams in a large Spanish sample was associated with many factors, including having infected family or friends, reading news about coronavirus, and having higher depression, anxiety or stress scores (Dal Santo et al, 2021). With regards to specific features of dream content, Brazilian (Mota et al, 2020), U.S. (Barrett, 2020), Italian (Gorgoni et al, 2021;Iorio, Sommantico, & Parrello, 2020;Scarpelli et al, 2021), Canadian (Kilius et al, 2021) and Chinese (Wang, Zemmelman, Hong, Feng, & Shen, 2020) teams, all reported increases in negative dreams during the pandemic, including increase in themes of anxiety, sadness, aggressive interactions and preoccupations with health.…”

“…Lastly, in addition to the well-established notion that dysphoric dreaming reacts to stressors and is affected by psychopathology, an emerging body of research suggests that bad dreams and nightmares may exacerbate or even trigger increased stress response (Garcia et al, 2021), contribute to daytime distress (Gehrman, Harb, Cook, Barilla, & Ross, 2015;Gieselmann et al, 2020;Levin & Fireman, 2002) and symptoms of psychopathology, including anxiety (Roberts, Lennings, & Heard, 2009) and depression (Hedstrom et al, 2021). Thus, to account for the possibility of the bi-directional relationship between dreams, stress and psychopathology, we tested whether dream, bad dream and nightmare frequency, and the most frequent dream topics predicted levels of stress and symptoms of depression and anxiety.…”