Poor Sleep Quality and Its Relationship with Individual Characteristics, Personal Experiences and Mental Health during the COVID-19 Pandemic

Abstract

While the COVID-19 has dramatically altered our lifestyle and sleep practices, the links between sleep, individual characteristics, personal experiences and mental health during the pandemic require further examination. This cross-sectional, multi-methods study examined differences in language used to describe personal experiences, and mental health, based on sleep quality during the early stages of the pandemic. N = 1745 participants (mean age 42.97 ± 14.46 years) from 63 countries responded to the survey. Sleep quality was assessed using the Pittsburgh Sleep Quality Index and mental health was examined using the Patient Health Questionnaire-9, the State Trait Anxiety Inventory, the Perceived Stress Scale and the UCLA-Loneliness Scale. Quantitative analysis of qualitative, language content of personal experiences was conducted using free-text responses and comments to a question on the survey. Almost 50% of the participants reported poor sleep quality, which was linked to a more negative emotional tone and greater mentions of money or finance related words. Good sleepers reported more positive emotional tone in their experiences. Greater reports of clinical state anxiety, moderate depression and moderate stress were observed in poor sleepers, even after accounting for demographics and pandemic-related factors such as loneliness, financial concerns and risk of contracting COVID-19 disease. Results from this study highlight an urgent need for sleep-related public health interventions. Practitioner education, sleep screening for those with mental health conditions, and encouraging people to adopt digital tools may help to reduce the burden of poor sleep on mental health. While the pandemic itself is a stressful and uncertain time, improving sleep can support positive emotion regulation, improving mood and consequential action.

Understanding the Impact of the COVID-19 Pandemic, Lockdowns and Social Isolation on Sleep Quality

“…Importantly, poor sleep quality has been linked to poorer mental health, both pre-pandemic and in the recent pandemic literature. 40 , 45 In the same global study, it has been shown that individuals who scored more than eight points on the PSQI had a three-fold increased prevalence of significant anxiety, stress and depressive symptoms, even when controlling for pandemic-related factors and demographics. 40 While further longitudinal studies are needed to uncover the directionality of these associations, it would appear that addressing poor sleep during lockdowns may help to mitigate some of the adverse mental health effects.…”

“…In one global survey, nearly three quarters of respondents indicated that their sleep patterns have changed as a result of lockdowns, with the majority indicating that their sleep and wake times were delayed compared to before the pandemic, and 43% of respondents indicating that their current sleep timing was more in line with their body clock. 40 Increasing flexibility in sleep-wake routines resulting from stay-at-home orders has clearly been of benefit to many in society who would have otherwise suffered with reduced sleep opportunity due to occupational and lifestyle commitments. However, for others, being afforded greater flexibility in sleep timing appears to have resulted in more irregular sleep-wake timing, which is known to have adverse effect on academic performance and health outcomes.…”

“… 41 , 42 Indeed, despite some initial benefits that were reported in some sections of western society as the pandemic progressed, the majority of populace has overwhelmingly described disturbed sleep patterns, and diminished sleep quality in comparison to pre-pandemic sleep patterns across the globe. 34 , 35 , 37 , 40 , 43 …”

“…In one global survey, 73% of respondents reported poor sleep quality, scoring more than five on the Pittsburgh Sleep Quality Index (PSQI), 40 with around 57% of respondents indicating that their sleep was worse currently compared to before the pandemic. 40 This is in line with other prevalence estimates of poor sleep of around 50–55% from Italy, 40 , 43 however much lower levels were reported around the same time in China (36%). 44 These differing rates are likely due to the predominantly female respondents in some surveys, potentially amplifying the prevalence rates of poor sleep.…”

Sleep Habits during COVID-19 Confinement: An Exploratory Analysis from Portugal

“…An online questionnaire concluded that being a woman, having an income monthly between 1000 and 5000 or >5000 CNY, not exercising and having a higher education level (baccalaureate and higher) were a risk factor for sleep disorder [37]. Nearly 50% of study participants reported poor sleep quality, which was associated with a more negative emotional tone and more mentions of money or finance-related words [38]. An online survey based in Italy helped to conclude that young people and women, as well as those with doubts about possible infection with COVID-19 and greater fear of direct contact with people infected with COVID-19 were at an increased risk of developing sleep disorders.…”