Pre‐pandemic sleep reactivity prospectively predicts distress during the COVID‐19 pandemic: The protective effect of insomnia treatment

Abstract

Summary The COVID‐19 pandemic is a rare stressor that has precipitated an accompanying mental health crisis. Prospective studies traversing the pandemic's onset can elucidate how pre‐existing disease vulnerabilities augured risk for later stress‐related morbidity. We examined how pre‐pandemic sleep reactivity predicted maladaptive stress reactions and depressive symptoms in response to, and during, the pandemic. This study is a secondary analysis of a randomised controlled trial from 2016 to 2017 comparing digital cognitive behavioural therapy for insomnia (dCBT‐I) against sleep education ( N = 208). Thus, we also assessed whether dCBT‐I moderated the association between pre‐pandemic sleep reactivity and pandemic‐related distress. Pre‐pandemic sleep reactivity was measured at baseline using the Ford Insomnia Response to Stress Test. In April 2020, participants were recontacted to report pandemic‐related distress (stress reactions and depression). Controlling for the treatment condition and the degree of COVID‐19 impact, higher pre‐pandemic sleep reactivity predicted more stress reactions (β = 0.13, ± 0.07 SE, p = 0.045) and depression (β = 0.22, ± 0.07 SE, p = 0.001) during the pandemic. Further, the odds of reporting clinically significant stress reactions and depression during the pandemic were over twice as high in those with high pre‐pandemic sleep reactivity. Notably, receiving dCBT‐I in 2016–2017 mitigated the relationship between pre‐pandemic sleep reactivity and later stress reactions (but not depression). Pre‐pandemic sleep reactivity predicted psychological distress 3–4 years later during the COVID‐19 pandemic, and dCBT‐I attenuated its association with stress reactions, specifically. Sleep reactivity may inform prevention and treatment efforts by identifying individuals at risk of impairment following stressful events.

The sleep response to stress: how sleep reactivity can help us prevent insomnia and promote resilience to trauma

“…The nascent prospective literate on sleep reactivity and traumatic stress shows that higher pre‐trauma FIRST scores engender a risk of PTSD and other deleterious outcomes following trauma (Neylan et al, 2021; Reffi, Drake, et al, 2022). Given sleep reactivity reliably predicts sleep disturbance following stressful life events, sleep reactivity might convey a risk of PTSD by predisposing individuals to acute sleep disturbances in the weeks after trauma.…”

“…Second, the authors administered an abbreviated version of the FIRST to minimise participant burden, raising the question of whether the sleep reactivity construct was adequately assessed. Our team sought to fill these gaps by leveraging data on the full FIRST scale collected 3–4 years before the COVID‐19 pandemic to examine pre‐pandemic sleep reactivity as a prospective predictor of traumatic stress reactions and depressive symptoms during the pandemic (Reffi, Drake, et al, 2022).…”

“…This revealed our sample had experienced relatively severe exposure to COVID‐19 (73.6% learned about a close friend or family member enduring life‐threatening illness or injury related to the coronavirus). Controlling for treatment condition and the severity of COVID‐19 exposure, higher pre‐pandemic FIRST scores prospectively predicted more severe traumatic stress reactions and depressive symptoms in response to, and during, the pandemic 3–4 years later (Reffi, Drake, et al, 2022). Further, patients with a high FIRST score (≥ 18) had over twice the odds of reporting clinically significant levels of both traumatic stress reactions (OR 2.65, 95% CI 1.51–4.67) and depressive symptoms during the pandemic (OR 2.72, 95% CI 1.69–4.38) (Reffi, Drake, et al, 2022).…”

“…Controlling for treatment condition and the severity of COVID‐19 exposure, higher pre‐pandemic FIRST scores prospectively predicted more severe traumatic stress reactions and depressive symptoms in response to, and during, the pandemic 3–4 years later (Reffi, Drake, et al, 2022). Further, patients with a high FIRST score (≥ 18) had over twice the odds of reporting clinically significant levels of both traumatic stress reactions (OR 2.65, 95% CI 1.51–4.67) and depressive symptoms during the pandemic (OR 2.72, 95% CI 1.69–4.38) (Reffi, Drake, et al, 2022). Taken together with Neylan et al (2021), excess sleep reactivity appears to amplify risk of adverse post‐traumatic sequelae.…”

“…Given the FIRST discerns who is most susceptible to acute insomnia after stress exposure, post‐traumatic sleep disturbances are one likely mechanism by which reactive sleepers are at increased risk of PTSD (Koren et al, 2002). Individuals most vulnerable to PTSD may be identified a priori using the FIRST and subsequently triaged by high versus low sleep reactivity to receive sleep‐focused treatment either prior to trauma (e.g., military deployment) or within its immediate aftermath (e.g., ED patients) to prevent PTSD and concomitant post‐traumatic sequelae (Reffi, Drake, et al, 2022). Indeed, our patients with high FIRST scores were more resilient to the pandemic if they received CBT‐I 3–4 years prior rather than sleep education only (Reffi, Drake, et al, 2022).…”