The COVID-19 pandemic has brought to light how much we rely on our routines and the downstream consequences when our habits are forced to change. Good, regular sleep relies on good sleep hygiene including waking up at the same time every day, having access to sunlight during the day, and limiting caffeine, nicotine, and alcohol near bedtime. It is well-known that sleep is often disrupted during times of stress and sometimes creates bad habits that outlast the initial stressful event. Therefore, it is important to determine if sleep is negatively impacted by the population-wide stressor that is COVID-19 to predict the downstream negative physical and mental health outcomes. In our study, we were interested in exploring if people were experiencing more insomnia symptoms at two different time points early in the pandemic: May and August of 2020.
To investigate the mechanism underlying insomnia during the pandemic, we incorporated known risk factors of insomnia and new potential risk factors unique to the pandemic. One such risk factor is depression. Depression and insomnia are thought to influence each other, with depression associated with the onset of insomnia symptoms, and insomnia included as part of the diagnostic criteria for major depressive disorder. Also, sometimes when we experience anxiety or worry, we engage in behaviors to make ourselves feel better in the short-term (i.e., safety behaviors). Although these behaviors may reduce anxiety for a little while, often these behaviors can make the anxiety worse in the long run. Therefore, we included two risk factors specific to the pandemic, COVID-19-related worry (e.g., I worry that I will lose my employment; I am worried I will not be able to handle being in quarantine) and COVID-19-specific safety behaviors (e.g., stockpiling food and water, disinfecting packages/mail). We included these variables to determine if factors specific to the pandemic were associated with higher risk of insomnia symptoms.
We decided to use online crowdsourcing techniques to obtain a community sample from across the United States. Overall, 321 individuals completed self-report measures at two time points (May and August). At the first timepoint, our model included whether individuals were under stay-at-home orders in their region, age, sex, race, depression, COVID-19 worry, and three COVID-19 specific safety behaviors (i.e., stockpiling, cleanliness, avoidance). This model explained 68.1% of the variation in insomnia symptoms and depression was the only predictor of insomnia at this first timepoint. Interestingly, when we compared the first timepoint and a time point three months later, only insomnia symptoms at time 1 predicted insomnia symptoms at time 2. These findings suggest that depression may contribute to insomnia at a single timepoint, but we did not have evidence suggesting that depression leads to insomnia symptoms three months later. However, we also found persistence of insomnia symptoms, with insomnia present at the same level at both timepoints.
With regard to COVID-19-specific factors, we found that the presence of COVID-19 worry and safety behaviors were persistent and continued across both time points. To put this another way, COVID-19 worry and stockpiling behaviors at the first timepoint predicted safety behaviors three months later and cleanliness and avoidance behaviors at the first timepoint predicted avoidance behaviors 3 months later. This data suggests to us that worry and safety behaviors associated specifically to the pandemic appear to be persistent and are in place even after the stay-at-home orders and other similar restrictions were reduced across the country over this time period. Although based on our data, COVID-19 worry and safety behaviors do not appear to be contributing to insomnia symptoms.
Overall, we found that insomnia symptoms and depression symptoms were related at a single time point but that depression did not predict later insomnia symptoms. We also identified that COVID-19-related worry and safety behaviors appear to be consistent across our two time points, even though restrictions had lessened during this three-month period across the country. Given the importance of sleep to physical and mental health, it is important that researchers continue to study how sleep has been impacted by the current crisis.
Read the full paper: Pizzonia, K., Koscinski, B., Suhr, J. A., Accorso, C., Allan, D. M., Allan, N., P. (2021). Insomnia during the COVID-19 pandemic: the role of depression and COVID-19-related risk factors. Cognitive Behaviour Therapy. doi:10.1080/16506073.2021.1879241
Photo by: Carlos Ebert