Escalation of sleep disturbances amid the COVID-19 pandemic: a cross-sectional international study.

Mandelkorn, Uri; Genzer, Shir; Choshen-Hillel, Shoham; Reiter, Joel; Meira E Cruz, Miguel; Hochner, Hagit; Kheirandish-Gozal, Leila; Gozal, David; Gileles-Hillel, Alex

STUDY OBJECTIVES The stress imposed by the COVID-19 pandemic and ensuing social isolation could adversely affect sleep. As sleep problems may persist and hurt health, it is important to identify which populations have experienced changes in sleeping patterns during the pandemic and their extent. METHODS In Study 1, 3,062 responders from 49 countries accessed the survey website voluntarily between March 26-April 26, 2020, and 2,562 (84%; age: 45.2±14.5, 68% women) completed the study. In Study 2, 1,022 adult US responders were recruited for pay through Mechanical Turk, and 971 (95%; age 40.4±13.6, 52% women) completed the study. The survey tool included demographics and items adapted from validated sleep questionnaires on sleep duration, quality and timing, and sleeping pills consumption. RESULTS In Study 1, 58% of the responders were unsatisfied with their sleep. Forty percent of the responders reported a decreased sleep quality vs. before COVID-19 crisis. Self-reported sleeping pill consumption increased by 20% (p<0.001). Multivariable analysis indicated that female sex, being in quarantine, 31 to 45-year age group, reduced physical activity and adverse impact on livelihood were independently associated with more severe worsening of sleep quality during the pandemic. The majority of findings were reproduced in the independent cohort of Study 2. CONCLUSIONS Changes imposed due to the pandemic have led to a surge in individuals reporting sleep problems across the globe. The findings raise the need to screen for worsening sleep patterns and use of sleeping aids, especially in more susceptible populations, namely, women and people with insecure livelihoods subjected to social isolation.