Among the many facets of life to take a hit throughout the COVID-19 pandemic is sleep. Some people have struggled to find healthy rest – it could be that their shut-eye is insufficient in length, or that it is not entirely restorative. Until now, details around who has encountered these difficulties the most, and why, have mostly remained in the dark.
New research by Dr. Frances Chung, ResMed Research Chair of Anesthesiology, Sleep and Perioperative Medicine at University Health Network (UHN), illuminates the pandemic’s impact on sleep. In one project, she and the International COVID Sleep Study (ICOSS), a group of sleep researchers from around the world, found that more than one-third of respondents reported symptoms of insomnia, and about one-fifth had probable insomnia disorder, or serious insomnia, during the first wave of the COVID-19 crisis. In another study, the researchers found that compared to pre-pandemic times, participants reported higher levels of dream recall frequency (DRF), or the ability to remember one’s dreams. Typically, elevated levels of DRF are tied to challenges in mental health and psychological well-being.
More than 22,000 people took part in the research team’s study on insomnia, anxiety and depression, plus associated risk factors, such as confinement and social isolation. Participants between the ages of 18 and 95 in 13 countries filled out a web-based survey between May and August 2020. Key results include the following:
- Almost 37 per cent of respondents reported symptoms of clinical insomnia, while about 17 per cent satisfied the criteria for a probable insomnia disorder. These figures are about twice as high as those seen before the pandemic.
- Respondents with insomnia symptoms may have sleep onset difficulties, sleep maintenance difficulties and early morning awakenings.
- For insomnia disorder and symptoms of insomnia, China and Japan had the lowest levels – about eight per cent of respondents had probable insomnia disorder, while about 24 per cent had symptoms. Meanwhile, Brazil, the U.K., Canada, the U.S., Poland and Norway had the highest rates, with more than 22 per cent of respondents meeting the criteria for insomnia disorder and more than 40 per cent reporting symptoms.
- Women and younger people reported higher rates than other groups.
- Risks of insomnia were higher in participants who caught COVID-19, reported greater financial burden, were in isolation for four to five weeks and lived alone or with more than five people in the same household.
- Aside from insomnia, 26 per cent of participants had probable anxiety and about 23 per cent had probable depression. These rates were significantly higher than the typical population-based prevalence rates of anxiety and depression.
“The rates of insomnia symptoms, insomnia disorder, probable anxiety and depression were very high during the first wave of the pandemic. When insomnia is chronic and persistent, it may result in adverse health outcomes, such as enhanced risk of depression, prolonged leave of absences from work and increased risk for hypertension,” Dr. Chung says. “The main implication of the findings is that health authorities must deploy large and efficient, population-based sleep and mental health prevention programs, as well as clinical interventions and resources, to assist at-risk individuals and reduce long-term adverse health outcomes and morbidity.”
COVID-19 creeps into dreams
Between May and July 2020, more than 19,000 people ages 18 and older in 14 countries completed a web-based survey that looked at connections between COVID-19, dreams and DRF, and related social, health and mental health factors. High DRF is defined as having dream recall three nights or more per week, whereas low DRF is having it fewer than three nights per week.
Findings to note include the following:
- Reports of high DRF increased by about nine per cent compared to pre-pandemic rates.
- About 36 per cent of women reported higher DRF – almost 10 per cent more than men.
- Those with psychological symptoms, nightmares and disruptive sleep behaviours, such as sleepwalking, experienced higher DRF.
- Those who had repeated disturbing thoughts, or symptoms of posttraumatic stress disorder, were associated with higher DRF.
- Respondents in Finland and the U.K. reported the highest rates of DRF – about 50 and 46 per cent, respectively. Reporting the lowest rates were China and Japan, with about 17 and 27 per cent, respectively.
“Dreams and dream activity are an often-forgotten expression of the existential situation of individuals. We suggest that disruptions in sleep patterns owing to the pandemic explain the rise in dream recall,” Dr. Chung says. “The wide-sweeping surge in DRF among study participants reflects the toll the pandemic has taken, and continues to take. COVID-19 is reflected in our dreams as an expression of the emotional intensity of the pandemic. There is reason to believe that the COVID-19 crisis will become a collective trauma, similar to other stressful events that people experience together, like hurricanes and terrorist attacks.”
Findings from both projects underscore the need to study sleep – or lack thereof – to deepen our understanding of the pandemic’s impact. Additional public health programs are required to support challenges to people’s sleep and associated mental health in times of crisis.
Dr. Chung says, “Sleep is important as it is an essential function that allows our body and mind to recharge, leaving us refreshed and alert when we wake up. Good sleep also helps the body remain healthy and stave off diseases.”
To get a good night’s sleep, Dr. Chung recommends the following:
- Stick to a sleep schedule. Go to bed and wake up at the same time each day.
- Exercise is good, but avoid it late at night.
- Avoid coffee and nicotine.
- Do not take naps after 3 p.m.
- Relax before bed (e.g., read, listen to music, take a hot bath).
- Ensure your bedroom is dark, cool and gadget-free.
- Do not lie in bed awake. If you find yourself still awake after staying in bed for more than 20 minutes, get up and do a relaxing activity until you feel sleepy.