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More than half the people surveyed in an online population study experienced serious sleep difficulties during the COVID-19 pandemic, but certain individuals reported better sleep.

While there was high variability in sleep changes, three distinct profiles of sleep-related behaviors emerged during the pandemic, reported Rebecca Robillard, PhD, of the University of Ottawa and the Royal's Institute of Mental Health Research in Canada, at the virtual SLEEP 2020, a joint meeting of the American Academy of Sleep Medicine and the Sleep Research Society.

"Our results suggest that the effects of the pandemic on sleep are more complex than just bad or good," Robillard observed.

"The pandemic involves a global external stressor with widespread consequences and for many, this leads to some degree of psychological distress, a phenomenon well known to interact with sleep," she said.

It also caused major changes in daily routines. "For some, confinement may lift off certain constraints -- for example, for those working from home -- while for others this might bring new challenges -- for example, increased family duties which may cause longer days and shorter nights," Robillard noted.

"From this perspective, the pandemic may bring people to change some of their sleep behaviors, such as the time at which they go to bed, wake up, and the overall time that they spend in bed. And these behavioral changes may also affect broader sleep outcomes like sleep quality, duration, the degree of social jet lag, and the frequency and severity of sleep difficulties."

In their study, Robillard and colleagues surveyed 5,525 Canadians, ages 16 to 95, from April 3 to June 24. Respondents had an average age of 55; 67% were female, 88% were white, and 64% had underage children. Shift workers and people who had traveled to another time zone in the past 30 days were excluded. Questionnaires asked about sleep patterns and mental health both during and before the pandemic.

The overall rate of any serious sleep difficulties -- including initiating sleep, maintaining sleep, or waking too early -- rose from 36% before the pandemic to 51% during it. "We also observed that 8% of our sample reported an increase in the frequency of sleeping medication used during the outbreak," Robillard said.

Zooming in on specific data points, the story was less clear. There was no overall significant change in (PSQI) scores, but 5.8% of respondents showed minimally clinically important improvement on the PSQI during the pandemic and 17.5% had minimally clinically important worsening.

Cluster analysis showed three pandemic sleep patterns:

• Extended time in bed, characterized by later wake-up times
• Reduced time in bed, characterized by later bedtimes and earlier wake-up times
• Phase delay, characterized by later bedtimes and wake-up times, with a small lengthening of time in bed

People in each profile group had different changes in sleep outcomes during COVID-19. While the extended time in bed group showed no major changes in sleep, the reduced time in bed group lost more than 1 hour of sleep on average. The phase-delay group had a significant lengthening of sleep latency and a reversal of their social jet lag (calculated as the difference between preferred and actual sleep schedules) during the pandemic. "While before the outbreak, they had earlier sleep schedules than their preferred times, during the outbreak they now had even later sleep schedules than their preferred times," Robillard said.

The highest rates of sleep initiation difficulties occurred in the phase-delay group. The highest rates of worsening in sleep maintenance and early morning awakenings were seen in the reduced time in bed group.

The three groups also had different psychological responses to the pandemic. Compared with the extended time in bed group, the reduced time in bed and phase-delay groups had higher rates of worsening in stress, anxiety, and depressive symptoms. These two groups also had more women, people diagnosed with mental disorders, and evening chronotypes.

Overall, new sleep difficulties during the pandemic were linked with being female, being employed, having family responsibilities, waking up earlier, chronic illnesses, higher stress levels, heavy drinking, and heavy television exposure. "Altogether, these factors may give rise to some insights to identify the people and the behaviors more at risk for adverse sleep outcomes in response to the pandemic," Robillard noted.

Limitations of the study include possible recall bias. "The findings highlight the need for tailored sleep interventions to address the distinct profiles of sleep problems that have emerged during this pandemic," Robillard said. "While some of these sleep problems may be transient for some people, it should be a high priority to ensure that they do not crystallize in chronic sleep disorders."

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