Pandemic Worry Keeping Americans Up at Night

Pauline Anderson

April 20, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

The rate of insomnia in the United States has more than doubled since the COVID-19 pandemic began, new research shows.

A national survey conducted by the American Academy of Sleep Medicine (AASM) reveals that almost 60% of Americans are now experiencing COVID-related insomnia.

Dr Fariha Abbasi-Feinberg

The incidence of insomnia in the general population is about 10% to 30%, Fariha Abbasi-Feinberg, MD, a sleep medicine physician in Fort Meyers, Florida, and member of the AASM's board of directors, told Medscape Medical News.

"So it is definitely double what it's been in the past. Some people are worried about getting sick from the virus, but there are a lot of economic anxieties, a lot of societal anxieties now. I feel like the stress level of the country in general has just been elevated over the last year," she added.

The research also shows that a growing number of people are turning to medication, supplements, or other substances to facilitate sleep.

Commissioned by the AASM, the online survey, which included 2006 adults across the United States, was conducted from March 11 to 15, 2021.

Sleep-Aid Use

Over half of respondents (56%) reported an increase in sleep disturbances since the pandemic began. Men were more likely than women to report such disturbances (59% vs 54%). The highest rate, at 70%, was among those aged 35 to 44 years. People in this age group were also most likely to use a sleep aid.

It makes sense that people in this age group are especially hard-hit by the pandemic, said Abbasi-Feinberg.

"These are people who are in the workforce and dealing with their work schedule and job stresses. They're parents of young children or at least children of school age and may be homeschooling their kids. And lots of them are in that sandwich generation and are caretakers to their parents. So they have been really squeezed," she said.

The most commonly reported sleep problem was insomnia or trouble falling and staying asleep (57%). More women (67%) than men (47%) experienced this sleep problem, and those aged 55 and older were most likely to report it.

Other problems reported by respondents included sleeping less (46%), having worse quality of sleep (45%), and having more disturbing dreams (36%).

The survey also showed that the struggle for a good night's sleep has led to an increase in the use of sleep aids. Over half (51%) of respondents reported using a medication, an over-the-counter supplement, or other substances to help them fall asleep.

Men were more likely than women to use a sleep aid (58% vs 44%). Results by age group showed that almost two thirds (65%) of those aged 35 to 44 years are using a sleep aid.

Most sleep-aid users reported taking them often (53%). Those aged 65 years and older were more likely to report such use (67%).

About 68% of respondents who regularly use sleep aids reported increased use during the pandemic. This rate was much higher among men (75%) than women (60%). The largest increase in sleep-aid use, at 81%, was among those aged 35 to 44.

Abbasi-Feinberg noted that a wide variety of over-the-counter sleep aids are available at pharmacies and that in some places, cannabidiol and other cannabis products can be legally purchased.

"So people are trying a lot of things before they come to talk to a physician" about their sleep problems, she said.

A Key Pillar of Health

Physicians are often hesitant to prescribe sleep medications to older patients "unless there's a real reason for it," Abbasi-Feinberg said. Typically, such medications are prescribed only after "a more in-depth evaluation and discussion about the benefits and risks."

For older patients, who may be taking other medications, possible side effects of sleep aids, such as loss of balance, "are more worrisome," she said.

In general, the survey results were consistent across the various regions of the United States.

Although the COVID vaccination rollout is underway, there continues to be concern about a fourth wave of the virus and an increase in variants of concern, said Abbasi-Feinberg.

It's important for physicians to routinely ask patients about sleep and how they're dealing with anxiety and to refer patients to a sleep specialist when necessary, said Abbasi-Feinberg.

"Sufficient sleep is one of the three pillars of a healthy lifestyle along with good nutrition and regular exercise," she said.

Physicians should remind patients about healthy sleep habits, including the avoidance of caffeine before bed.

"That might seem obvious, but believe it or not, I see people every single day who come in for sleep issues and they're drinking iced tea or coke before they go to bed," she said.

Adults should try to get about 7 hours of sleep a night, although some need more and others can get by with less, she added.

Despite the survey's concerning results, Abbasi-Feinberg is optimistic that as more people are vaccinated and the economy improves, people's lives and sleep patterns will return to normal.

Commenting on the survey findings, Yue Leng, MD, PhD, assistant professor, Department of Psychiatry and Behavioral Sciences, Center for Population Brain Health, University of California, San Francisco, noted that in general, older people experience more sleep disturbances and take more sleep medications than younger people. However, among survey respondents, seniors "seemed to be much less affected by COVID-related sleep disturbances and took fewer sleep aids than other age groups."

Leng, whose research focuses on the link between sleep and neurodegenerative diseases, said it "makes sense" that respondents aged 35 to 44 years were most affected by the pandemic. "This might be the age group whose life has the most changes as a result of COVID lockdown."

The survey was conducted by Atomik Research, an independent market research agency. The margin of error fell within ±2 percentage points with a confidence interval of 95%.

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