Quality Sleep Extremely Elusive for Most During Pandemic, Survey Shows

Damian McNamara

March 26, 2021

Fewer than 1 in 10 people report they are getting "very good sleep" at night — just one of several eye-opening findings about the state of sleep quality during the COVID-19 pandemic in new data from University College London researchers.

In a survey of more than 70,000 people, only 7.7% now report their sleep as "very good," for example, down from 39.4% in March 2020.

"The study results overall are somewhat expected and surprising at the same time." Josué Pinto, MD, told Medscape Medical News when asked to comment.  

"Indeed, the percentage of people reporting very good sleep quality is quite low. A higher number of people reported very poor sleep quality at the start of the New Year, when the UK was facing a rising number of new cases," said Pinto, of the Pulmonology Department at University Hospital Center of São João in Porto, Portugal.

The proportion is now decreasing, he added, along with a lower community transmission rate.

Many factors could be driving this drop in sleep quality. Lead author Daisy Fancourt, PhD, and colleagues found people with lower household incomes, with a mental or physical health condition, with lower levels of education, and those from ethnic minority backgrounds were more likely to report "very poor" sleep quality.

"This could be due to a wide range of factors, such as disruption to routines and the changes in living circumstances that lockdown has caused," co-author Elise Paul, PhD, UCL senior research fellow in Epidemiology & Health Care, stated in a news release.

"Stress is also likely to be a factor," she added, particularly for people living with lower household incomes or in other challenging circumstances.

Possible protective factors include age greater than 60 years, male sex, and absence of children in the home, according to the weekly report posted online March 25 by UCL COVID-19 Social Study Investigators.

Stress around unemployment and finances was higher among those living with children, they noted.

The proportion of people reporting "very poor sleep" varied over time, almost doubling from 5.4% in autumn 2020 to 10.1% in January 2021, for example. Although the proportion dropped somewhat since the beginning of this year, it remains at approximately the same level it was last summer.

Vaccine Hesitancy Also Dropping

The UCL investigators also evaluated COVID-19 vaccination rates. More than half (52.5%) of people have already received at least one dose of the vaccine, for example.

"It was rather surprising to find out that these results are related to a cohort in which half of the participants have already received at least one dose of COVID-19 vaccine," Pinto said. Therefore, fear of becoming infected may not be the main driver of poor sleep quality "as opposed to financial or social concerns."

Approximately one third of the most hesitant respondents in the autumn have received at least one vaccine dose since then. Furthermore, more than 1 in 5 of people in the "very unlikely" group have now changed their minds, reporting they are "very likely" to get vaccinated by the end of this month.

At the same time, only 1% of the "very likely" group moved to the "very unlikely" vaccination group.

Despite these positive trends, continued public health messaging remains essential to maximize the number of people getting vaccinated, the researchers note.

Fears Changing Over Time?

In an study this past October looking at COVID-19 and sleep quality from Pinto and colleagues, "the socio-economic context and knowledge of the virus were completely different," Pinto said.

The previous study was performed from March until May, corresponding to the first COVID-19 outbreak and lockdown in Portugal. "By that time, the absence of effective therapy and lack of a vaccine led to fear in the population," Pinto said.

Almost 70% of participants reported poor sleep quality. In addition, frequent awakenings were the most prevalent complaint.

There are some similarities between the two studies. For example, Pinto also found adults older than age 65 years reported a better sleep quality. Namely, older age was a protective factor for difficulties falling asleep, waking up too early and nonrestorative sleep complaints.

"We believe this may be explained by the fact that younger patients experienced more pronounced lifestyle changes during the lockdown, while simultaneously facing employment and economic insecurity. We also observed that women reported a worse sleep quality, a finding described in literature that addresses the complex relationship between gender and sleep health," he said.

The Nuffield Foundation, Wellcome, and UK Research and Innovation (UKRI) provided funding for the study.

Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology and critical care. Follow Damian on Twitter:  @MedReporter.

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