Sleep quality, mental health and circadian rhythms during COVID lockdown – Results from the SleepQuest Study

Abstract

<jats:p>Behavioural responses to COVID19 lockdown will define the long-term impact of psychological stressors on sleep and brain health. Here we tease apart factors that help protect against sleep disturbance. We capitalise on the unique restrictions during COVID19 to understand how time of day of daylight exposure and outside exercise interact with chronotype and sleep quality. 3474 people from the UK (median age 62, range 18 to 91) completed our online 'SleepQuest' Study between 29th April and 13th May 2020 − a set of validated questionnaires probing sleep quality, depression, anxiety and attitudes to sleep alongside bespoke questions on the effect of COVID19 lockdown on sleep, time spent outside and exercising and self-help sleep measures. Significantly more people (n=1252) reported worsened than improved sleep (n=562) during lockdown (p&lt;0.0001). Factors significantly associated with worsened sleep included low mood (p&lt;0.001), anxiety (p&lt;0.001) and suspected, proven or at risk of COVID19 symptoms (all p&lt;0.03). Sleep improvement was related to the increased length of time spent outside (P&lt;0.01). Older people's sleep quality was less affected than younger people by COVID19 lockdown (p&lt;0.001). Better sleep quality was associated with going outside and exercising earlier, rather than later, in the day. However, the benefit of being outside early is driven by improved sleep in 'owl' (p=0.0002) and not 'lark' (p=0.27) chronotype, whereas, the benefit of early exercise (inside or outside) did not depend on chronotype. Defining the interaction between chronotype, mental health and behaviour will be critical for targeted lifestyle adaptations to protect brain health through current and future crises.</jats:p>

Poor Sleep during the First Peak of the SARS-CoV-2 Pandemic: A Cross-Sectional Study

“…In Italy, cross-sectional investigations have suggested that while the number of hours spent in bed might have increased during lockdown [ 2 ], many individuals reported insomnia (43%) [ 19 ] and poor sleep quality (57%) [ 9 ]. Similar percentages of sleep deterioration (48%) were also shown in the UK [ 20 ], and a longitudinal study conducted in Italy confirmed the detrimental effects of the 40-day lockdown on all the parameters of the Sleep Quality Index [ 21 ], except for sleep duration [ 22 ]. Our cohort seems to confirm that sleep quality deteriorated during lockdown, as among those individuals who experienced a change in their sleep quality, 85.8% defined their sleep as poor.…”

“…Indeed, a recruitment bias emerged in our sample, as females and working-age individuals with a high education level are overrepresented compared to the general Italian population. While the overrepresentation of females is a feature common to other similar studies [ 2 , 9 , 16 , 20 , 28 , 30 ], it is likely that the biases observed in age and education reflect a high level of adhesion of participants who are also healthcare professionals or administrative staff of the LHA or of the major municipalities of the Province of Reggio Emilia, which disseminated the survey through their social media and websites.…”

“…The positive relationship between anxiety and poor sleep quality has been extensively investigated and was confirmed during lockdown [ 9 , 20 , 26 ]. While the cross-sectional design of our study does not allow us to verify whether the symptoms of psychological distress that we documented were related to the restrictions imposed to curtail the spread of the SARS-CoV-2 virus, a causal relationship is plausible, as also suggested by the literature [ 9 , 10 , 15 , 16 , 20 , 28 ]. The convenience sample investigated was recruited in the Province of Reggio Emilia, one of the most affected Italian provinces during the early phase of the pandemic.…”

Sleeping when the world locks down: Correlates of sleep health during the COVID-19 pandemic across 59 countries

“…Several demographic factors were associated with better sleep health, including older age, being partnered, and living in a country with a higher income classification. Older age has previously been associated with a better sleep quality and less lockdown-related sleep changes during the COVID-19 pandemic, 10 , 16 suggesting age as a protective factor for maintaining sleep health during quarantine and restriction measures. Being partnered and living in a higher income classification country—factors that are characterized by providing a certain degree of security and life stability—also were associated with better sleep health.…”

“… 10 Also, spending more time outside has been associated with better sleep in the general UK population, though being infected with COVID-19 contributed to worse sleep quality. 16 An investigation focusing on health care workers in Bahrain found that female sex and being a nonphysician health-allied member were correlates of poorer sleep quality and moderate-severe stress levels. 17 Finally, Wang et al (2020) reported that medical occupation, parental burden, death of a loved one, anxiety, and depression were correlates of poorer sleep quality among Chinese health care workers.…”