As if the other ailments weren’t enough – the pandemic has caused a nocturnal health problem too.
Most of us know the benefits of a good night’s sleep. But sleep is more than just a feelgood practice – it’s essential to our health and wellbeing. Just one night of inadequate sleep has been found to be associated with negative cognitive outcomes such as forgetfulness, mood changes, reduced attention, poor decision-making, and reduced energy. Numerous studies have also shown long-term connections between chronic sleep deprivation or insomnia and adverse health outcomes. These can include hypertension (high blood pressure), diabetes, abnormal weight gain, cardiovascular disease, anxiety, depression, paranoia, and even suicidal behaviours.
When it comes to adult sleep recommendations, decades of scientific evidence point toward an optimal sleep duration of 7-8 hours per night. This research supports a “Goldilocks” type relationship between sleep duration and overall mortality (death) risk – not too little, not too much, with risk increasing as you move further from the optimal sleep range in either direction. While many factors can affect sleep quality – such as stress, anxiety, alcohol and sleep disorders – sleep scientists have recently begun exploring a new pandemic-related sleep disturbance. It even has a name: coronasomnia.
No rest for the worried
Coronasomnia is the term used to describe sleep disorders that develop due to stress, anxiety or depression associated with the COVID-19 outbreak. “Coronasomnia is really insomnia that began during the coronavirus pandemic,” says Hailey Meaklim, a researcher at Monash University and a psychologist at the Sleep Disorder Centre of St Vincent’s Hospital. “By insomnia symptoms, we mean people who are having difficulty falling asleep, staying asleep, or waking too early.”
While medical descriptions of insomnia date back to 1818, the COVID-19 pandemic is “one for the books” when it comes to sleep disturbances. In China, a large-scale survey study published in Sleep Medicine, involving 5,461 individuals, found reported levels of clinical insomnia to have increased by 37% since the beginning of the COVID-19 pandemic. Another survey study, published in SLEEP journal and undertaken in Canada with 594 respondents, compared pre-pandemic insomnia symptoms, from data gathered in 2018, to insomnia symptoms during the height of the pandemic (April-May 2020). Researchers found overall insomnia symptoms to have increased by 26.7% since 2018 – with a significant worsening of reported fatigue, anxiety, sleep quality, and depression.
Coronasomnia is not limited to countries with high incidences of COVID-19 infections. “New Zealand had really low rates of COVID-19,” says Meaklim, “but they saw just the same spikes in insomnia symptoms as places like the USA and South Africa, where they had much higher rates of transmission.” Indeed, a survey study (published in SLEEP journal) conducted during New Zealand’s first lockdown (April 2020) and involving 723 individuals, found that 45% of participants reported worsening sleep quality since the start of the covid pandemic.
A window to the world’s sleep
As the COVID-19 pandemic took hold in Australia, Meaklim noticed that patients at the Sleep Disorder Centre were also reporting significant sleep issues that seemed to be associated with the outbreak. “We just thought this is going to be such a significant sleep event, we better study it,” says Meaklim. Launching an online survey study (published in the Journal of Clinical Sleep Medicine), Meaklim and her colleagues examined reported sleep quality, stress, anxiety and depression in 2,724 individuals from 67 countries – grouping participants as those with pre-existing insomnia symptoms, post-pandemic insomnia symptoms, and no reported insomnia symptoms.
Analysis revealed that 77% of individuals with post-pandemic insomnia symptoms believed factors associated with the pandemic to be the source of their sleep disturbances. These individuals also reported significantly higher levels of stress, anxiety and depression compared to those with pre-existing insomnia and no insomnia symptoms. In individuals with pre-pandemic insomnia symptoms, 72% reported a worsening of their symptoms since the start of the COVID-19 outbreak, as well as significantly higher levels of stress, anxiety and depression, compared to those in the no insomnia group. Concerningly, suicidal ideation was reported by over 25% of participants from both of the insomnia groups – a significantly higher percentage than in the no insomnia group.
But not everyone was experiencing sleepless nights during the pandemic. “We saw a small group [12%] of participants with pre-existing insomnia report that their sleep had actually improved during the pandemic,” says Meaklim. “This was largely due to reductions in busyness with lockdowns and having more flexibility around their sleep-wake schedule. It seemed that work and/or commuting pressure was reduced for these individuals and so their sleep improved.”
Shifting sleep times and pandemic dreams
While psychological factors such as stress and anxiety are critical pieces of the puzzle when it comes to coronasomnia, human behaviour also plays a part. Indeed, in a further survey study published in Behavioural Sleep Medicine, Meaklim and colleagues found altered sleep-wake routines during the pandemic to be a key behavioural predictor of acute insomnia. “One of the biggest behavioural factors that contributed to insomnia symptoms was when people changed their sleep-wake routines,” says Meaklim. “It was mainly a shift of going to bed later and waking up earlier. People who did that were about three times more likely to develop insomnia than those who kept their sleep-wake patterns the same.”
Interestingly, what we dream also seems to play a role in coronasomnia. “One of the things that we were quite surprised at in our data was a relationship between people having coronasomnia and people having more bizarre kind of coronasomnia dreams,” says Meaklim. In this study, published in the Journal of Sleep Research, Meaklim and colleagues found that 55% of individuals who developed insomnia during the pandemic also reported dream changes, compared to only 36% of good sleepers.
Performing a qualitative analysis to tease out the key themes of these reported pandemic dreams, Meaklim and colleagues found that most participants described their dreams as having become vivid and “high definition” – but with a decidedly negative component. “We did see that people with insomnia – certainly people with coronasomnia – were having more anxious and death-related dreams, while the good sleepers seemed to be dreaming about more leisure and happy kind of things . . . so that was quite surprising,” says Meaklim.
A good night’s sleep
The good news is that sleep represents a malleable risk factor when it comes to both physical and mental health. Meaklim says there’s lots of things we can do to improve your sleep. Firstly, try to reduce our worry about it – just focusing on reducing stress levels will improve sleep quality. Next, avoid long naps during the day: prioritising a regular sleep-wake schedule can also improve sleep hygiene. “Our body clock – our circadian rhythms – are creatures of habit,” says Meaklim. “They love regular sleep-wake routines as well as lots of bright light during the day and low light at night . . . and that often also means staying off devices.”
Ensure sleep areas are cool, calm and quiet, and limit alcohol and caffeine intake.
Another essential consideration for sleep issues brought on by pandemic-related factors is to avoid accessing pandemic-related news stories in the evenings. “If you’re getting news coming in,” says Meaklim, “whether it’s pandemic news or news about new variants, it’s something we can’t control. We’re better equipped to deal with that information during the day rather than at night.”
For individuals struggling with long-term coronasomnia sleep issues, you don’t need to take it lying down.
“If your sleep problems have been going on for three months or more, we recommend you seek help,” says Meaklim. “Contact the Sleep Health Foundation Australia or the Australasian Sleep Association. Even having a chat with your GP can be a great thing.”
Deborah Johanson is a freelance medical and science writer from Auckland, New Zealand. She holds a PhD and Masters degree in Health Psychology, a Bachelors degree in Health Science, and has a clinical background as a Registered Nurse. While most of her research has involved healthcare robots, Deborah now writes about health, medicine, technology, and science.