The prevalence of insomnia in different COVID-19 policy phases: Longitudinal evidence from ITA.LI – Italian Lives

Abstract

Background This study investigated changes in the prevalence of insomnia in Italy during COVID-19, starting from the first lockdown period (8 March 2020). We hypothesized that lockdown precipitated increased prevalence of insomnia symptoms relative to the pre-pandemic period; b) the gradual relaxation of containment measures – post-lockdown period (Phase 2 and Phase 3) – reduced insomnia severity, leading to a relative recovery of pre-pandemic levels; and c) we tested age-related heterogeneity in sleep responses, with an expected higher increase in insomnia in younger and middle-age groups. Methods Analyses drew on a subsample (N = 883) of respondents to ITA.LI – Italian Lives, a recently established panel study on a probability sample of individuals aged 16 + living in Italy. To estimate patterns of change in insomnia, we first fitted a random-effects ordered logistic model on the whole sample. We then added an interaction term between policy phases and the respondent age to test whether the relationship between insomnia and policy phases differed across age groups. Analyses accounted for survey non-response weights. Results The fraction of respondents reporting moderate (“somewhat” + 0.159, S.E. 0.017) or severe (“very much” + 0.142, S.E. 0.030) sleep disturbances significantly increased during Phase 1. The prevalence of insomnia followed an inverted U-shaped curve across policy phases, with further increases from baseline levels (“somewhat” + 0.168, S.E. 0.015; “very much” + 0.187, S.E. 0.030) during Phase 2, followed by a relative reduction in Phase 3, although it remained significantly higher than in the pre-pandemic period (“somewhat”, + 0.084, S.E. 0.016; “very much”, + 0.045, S.E. 0.010). There were significant age-related differences in insomnia patterns, as the discrete change from pre-pandemic levels in the probability of not suffering from insomnia was negative and significant for the younger age group (− 0.269, S.E. 0.060) and for respondents aged 35–54 (− 0.163, S.E. 0.039). Conclusion There is reason to believe that the emergency policy response to the COVID-19 crisis may have had unintended and possibly scarring effects in terms of increased prevalence of insomnia. The hardest hit were young adults and, to a lesser extent, the middle-aged; however, older respondents (55 +) remained resilient, and their insomnia trajectory bounced back to pre-pandemic levels.

Changes in sleep quality and sleep disturbances in the general population from before to during the COVID-19 lockdown: A systematic review and meta-analysis

“…There was likewise an increase in the use of sleep medication. These results are, anew, consistent with those of other works in the literature ( 15 , 102 , 103 ). A significant increase in the prevalence of moderate to severe insomnia was uncovered by a study examining 900 Italian adults at the time the first rigid lockdown was implemented ( 102 ).…”

“…These results are, anew, consistent with those of other works in the literature (15, 102, 103). A significant increase in the prevalence of moderate to severe insomnia was uncovered by a study examining 900 Italian adults at the time the first rigid lockdown was implemented (102). The International COVID-19 Sleep Study, a multinational survey carried out across 14 countries, uncovered a 10% increase in a range of sleep disturbances including worse sleep quality, sleep onset and sleep maintenance problems, and greater use of hypnotics during the pandemic with respect to the precedent period.…”

“…The COVID-19 pandemic was in fact characterized by more than one wave and several sleep variables seem to have been undermined by the repeated implementation of strict restrictive measures, which may have determined an onset in sleep disturbances or aggravated them. Riva et al pointed out that the prevalence of insomnia did not diminish when pandemic restrictions were reduced or lifted but it began to normalize only several months later and it never returned to pre-pandemic levels ( 102 ). Two studies examining the evolution of sleep variables in Italian adults during the total and partial COVID-19 lockdowns found diversified sleep patterns.…”

Longitudinal investigation of a single variant SARS-CoV-2-outbreak in the immunologically naïve population of Ulvik, Norway

“…We are not able to establish whether insomnia in our study population exists as a consequence of the SARS-CoV-2 infection itself, because of pandemic related societal or socioeconomic factors or if COVID-19 increases the likelihood of insomnia [23]. During the pandemic insomnia has been shown to vary with social invasiveness of lockdown measures [24,25], and occur more often among persons with comorbidities, anxiety and/or depression and lower age [26]. The lack of similar ndings in our population could be due to a relatively healthy population or small sample size.…”