Medical Isolation During Covid-19 Pandemic Tied to Sleep Problems

By Lisa Rapaport

May 20, 2020

(Reuters Health) - People under medical isolation due to suspected or confirmed Covid-19 infections or possible exposure are at increased risk for sleep problems and may be in need of psychological interventions, a Chinese study suggests.

Researchers examined data from 14,505 online surveys completed in February 2020 in China that asked, among other things, about isolation and sleep status. A total of 707 respondents said they were under medical isolation, remaining at home because they were infected, suspected of being infected, exposed to people with confirmed or suspected infections, or had recently traveled to Covid-19 hotspots.

Overall, 76.7% of the people under medical isolation reported difficulty falling asleep at least once in the previous week, and 79.5% of them had experienced early awakenings in the prior week.

The prevalence of sleep problems wasn't as high among people under self-isolation who didn't meet any of the criteria for medical isolation; 51% of these respondents had trouble falling asleep and 56% experienced early wake-up times in the prior week.

Even among people who were not isolating at all, 42.3% had trouble falling asleep and 49% woke up early in the previous week, according to the survey results published in Sleep Medicine.

"The stress and fear caused by the pandemic itself may contribute," said Andrew Steptoe, a professor of psychology and epidemiology at University College London in the UK.

"In addition, many people are suffering from loss of income or even jobs, from lack of help with child care, worry about relatives and so on," Steptoe, who wasn't involved in the study, said by email. "So there are many other aspects of people's experience over this period that may contribute to difficulty sleeping."

Even if they don't have Covid-19, it's possible that people in isolation had higher rates of sleep disturbance because isolation itself is linked to insomnia, Steptoe said.

At the same time, symptoms of Covid-19 like fever and increased inflammation may contribute to sleep problems, Steptoe said. Isolation can also increase symptoms of depression, which may be exacerbated for people living with a life-threatening disease, Steptoe added.

"The signs of sleep disturbance in this study - difficulty falling asleep and waking up early - are often found in depressed or anxious individuals," Steptoe said.

Sleep problems were more common among first-line epidemic responders (86%) than among people in other occupations (77.2%), the study also found.

Difficulties with sleep appeared to shift over time, with 74% of people in isolation for any reason reporting sleep issues over the first week, 84.8% over the second week, and 65.2% after at least two weeks in isolation had passed.

"The fact that rates were particularly high among healthcare workers, and that sleep problems tended to decrease after two weeks of isolation, suggests that the psychological distress caused by the disease was a major driver of the sleep problems," Steptoe said.

The researchers didn't share details on the specific survey questions asked or the response rate. Senior study authors Dr. Jianbo Liu and JianPing Lu, both of Shenzhen University in China, didn't respond to emails seeking comment.

SOURCE: Sleep Medicine, online April 21, 2020.