Sleep in a Global Pandemic

The emergence of COVID-19 and the measures taken in response to it across the globe have affected our way of life in profound ways. The various forms of lockdowns, quarantines, social distancing orders and such have put us all in novel situations, to say the least.

The emerging data, unsurprisingly, suggest that this situation have had significant and generally not all that positive effects on people’s physical and psychological well being across the world (Holingue, Badillo-Goicechea, et al;., 2020; Sibley, Greaves, et al., 2020; de Quervian, Dominque, et al., 2020). Work-from-home and study-from-home orders, for example, have been a blessing for some and a curse for others.


Knowing about the importance of sleep to human functioning and well being – physical, psychological, and social – we must wonder what this pandemic does to our sleep. In other words: What is happening to our sleep in the time of COVID?


When we try to interpret the latest data and what this means for our health and well being, we can use the Sleep Loop S.L.E.E.P.S. model as a handy tool to simplify and add clarity to the picture. Of particular importance here are the two S’s – Scheduling and Stress.



"The social and economic requirements of most modern societies are at a tension with the human biological clock."

The Good - Scheduling


So, it’s not all bad.


Several recent studies suggest positive changes in terms of when people go to sleep, how long they slept for and how regularly, in times of lockdowns. In other words, COVID lockdowns have had an inadvertent positive effect facilitating improvement in sleep scheduling largely through reducing the average Social Jetlag (Blume, Schmidt, & Cajochen, 2020; Wright, Linton, et al., 2020; Evidation, 2020).


OK…but what is Social jetlag??


To put it simply, the lifestyle structure and schedule at the centre of most modern societies - i.e. set hours and days for work and play that necessitate specific times of sleep and wake for most people - is essentially at odds with most people’s natural, biological timing of sleep. The social and economic requirements of most modern societies are at a tension with the human biological clock. This tension and the sleep scheduling patterns it leads to - such as going to bed and sleeping in significantly later on the weekends and holidays than on weekdays – is referred to as Social Jetlag.


Of course this mismatch is greater for some people than for others as we all differ in how our biological clocks are aligned. This difference is referred to as "chronotype", and you can learn more about it in the Sleep Loop Scheduling protocol.


However, regardless of chronotype and sleep preferences, social jetlag and sleep irregularity are major disruptors of sleep health in modern societies and are associated with a host of negative effects such as poorer professional and academic performance, higher risk of developing mental health issues, as well as higher risk of developing a variety of physical health issues such as cardiometabolic complications or obesity (Ronnenberg, Allbrendt, Merrow, & Vetter, 2012; Phillips, Clerx, et al., 2017; Hunag, Mariani, & Refline, 2014).


Drawing on information from over 70,000 people (and counting) who use wearable fitness and health trackers, recent research indicates significant improvements in sleep scheduling including sleep duration and regularity (Evidation, 2020). Overall, people tend to sleep more, and more regularly, when working from home than they did before lockdowns began. In fact, sleep time was seen to increase by 20% on average across the US. What is more, sleep timing and regularity improved significantly on both weekends and weekdays, a trend that was observed both in the US and across Europe (Blume, Schmidt, & Cajochen, 2020; Wright, Linton et al., 2020). This indicates that most people, not just those of a later-leaning chronotype, are likely to benefit from a slightly delayed sleep-wake schedule than that allowed by typical economic and social commitments.


These improvements in sleep regularity and scheduling are not insignificant. It appears that lockdowns and working from home have allowed the time and space for more natural sleep timing, with longer sleep time and significantly greater sleep regularity across the week and the weekend. Given the myriad of negative effects associated with sleep scheduling issues, this is an encouraging trend.


This is perhaps a learning opportunity that we can take with us as our working arrangements begin to return to their more traditional structures.


The Bad - Sleep Quality


Unfortunately, sleep in the time of COVID is not all great news.

The emergence of the COVID-19 pandemic has left a notable mark on people’s mental wellbeing. increases in population-wide felt mental distress and increases in experienced stress and burden have been observed across the world (Holingue, Badillo-Goicechea, et al;., 2020; Sibley, Greaves, et al., 2020; de Quervian, Dominque, et al., 2020). The real consequences of these trends for public mental health are yet to emerge, but they are unlikely to be positive.


Unsurprisingly, accumulating evidence suggests that the unprecedented times we currently face, and the associated increase in felt stress, have led to decreases in sleep quality. So, despite sleeping more regularly, and more consistently, the quality of our sleep has been negatively affected.


Disruptions in sleep quality are associated with a host of negative effects, both physical and psychological (Goldsten, & Walker, 2014; Cappuccio, D’Elia, Strazzullo, & Miller, 2010; Buxton, & Marcelli, 2010). Most pertinent to our current situation, decreases in sleep quality are associated with increases in experienced stress and negativity in waking hours, which may have the unfortunate effect of further prolonging or deepening the trend towards increasing levels of daily stress and mental distress (Goldsten, & Walker, 2014).



"We can use the emerging data about sleep in the time of COVID-19 to pre-emptively guide our focus."

Sleep Fundamentals in the Time of COVID-19


So this brings us to the important question: what can we do to counteract these effects?

Thankfully, it’s not all doom and gloom. Preliminary data suggests that there are certain protective factors that may mitigate the negative effects that our COVID-induced living situations have been having on sleep quality.


Given the relationship between sleep and mental and physical health, including things such as immune functioning (and the likelihood of developing pneumonia; Patel, Malhorta, et al., 2012) and social isolation (Simon & Walker, 2018), good sleep is obviously crucial at this time. We can use the emerging data about sleep in the time of COVID-19 to pre-emptively guide our focus. This is where other aspects of the Sleep Loop S.L.E.EP.S. model come in handy.


Let’s call this: The Sleep in time of Corona Imperative:


Scheduling


We can make the most of this opportunity to increase the duration of our sleep on a nightly basis. More importantly, we may be in an opportune position to achieve greater consistency in our natural sleep-wake tendencies, and to increase the regularity of our sleep scheduling. Read more about sleep scheduling and how to complete a 7 Day Sleep Reset HERE.


Light


We must make sure to get adequate natural light exposure every day. With more people spending more time at home, indoors, working on computers under indoor lighting, it is crucial to get out into natural light for at least 20 minutes each day, or as much as we can. Allowing 60 minutes of healthy dark exposure prior to sleep is a simple way to improve your ability to get to sleep, and your total sleep quality. See more about light and sleep HERE.


Environment


Working and studying from home has many benefits, not the least of which being the improvements in sleep duration, scheduling and regularity. However, working and sleeping in the same house, apartment, or even room as many people do, can negatively affect our sleep environment. One of the most important environmental principles affecting sleep quality is the separation of our sleeping environment from other aspects of daily life. If this is compromised, as is likely under lockdowns or work from home orders, our sleep can be significantly worsened. We must make sure to create and maintain a clear separation between our sleep and work environments. Light, temperature, noise, the list of environmental factors that affect your sleep goes on. Find out how to minimise the negative effects your environment can have on your sleep HERE.


Eat and Drink


When we’re stuck at home working where we eat and eating where we work, it becomes easy to fall out of routines and reginmines when it comes to our diet. Whether it’s finding solace in chocolate more often than we normally would, or becoming lax with dinner times, these changes have a direct impact on our sleep and sleep quality. It remains important to maintain your routines around meal times and fueling your body with nutrients that your body and mind will thank you for. Find out more about how we can create better eating habits for a better nights sleep HERE.


Physiology


Emerging data suggests that one of the important factors that may mitigate a downfall in sleep quality under COVID-19 lockdowns is daily exercise. While it can be hard to find the motivation or to know what to do when we are stuck at home it is imperative to make this a priority. Learn more about sleep and physiology HERE.


Stress


We have seen in recent data that despite the improvements in sleep timing and regularity, significant decreases in sleep quality are likely to occur as a result of the stress experienced during lockdowns or quarantines. Therefore, it is paramount to learn the techniques to manage our stress and its effects on our sleep and sleep quality. Find out more about stress and sleep HERE.



While we hear a lot about the “new normal” we need to make sure we are doing all we can to adjust in ways our bodies and minds will thank us for. Maintaining healthy sleep habits is crucial, now more than ever. The damaging effects of disruptions to our sleep are very real and should not be taken lightly, so remember to be kind to yourself and your body.



REFERENCES

Blume, C., Schmidt, M.H., Cajochen, C. (2020) Effects of the COVID-19 lockdown on human sleep and rest-activity rhythms. Current Biology, 30,:795-797. OI:https://doi.org/10.1016/j.cub.2020.06.021

Buxton, O. M. & Marcelli, E. (2010) Short and long sleep are positively associated with obesity, diabetes, hypertension, and cardiovascular disease among adults in the United States. Soc. Sci. Med. 71, 1027–1036.

Cappuccio, F. P., D’Elia, L., Strazzullo, P. & Miller, M. A. (2010)Sleep Duration and All-Cause Mortality: A Systematic Review and Meta-Analysis of Prospective Studies. SLEEP 33, 585–592.

Evidation (2020). COVID-19 Pulse: Delivering regular insights in the pandemic from a 150,000+ person connected cohort. https://evidation.com/news/covid-19-pulse-first-data-evidation/

de Quervain, Dominique, et al. (2020)“The Swiss Corona Stress Study.” OSF Preprints. Web. Preprint DOI: 10.31219/osf.io/jqw6a

Dong, L., Martinez, A.J., Buysse, D.J., Harvey, A.G. (2019) A composite measure of sleep health predicts concurrent mental and physical health outcomes in adolescents prone to eveningness. Sleep Health 5, 166-174, DOI:https://doi.org/10.1016/j.sleh.2018.11.009

Goldstein, A.N., & Walker, M.P. (2014). The role of sleep in emotional brain function. Annual Review of Clinical Psychology, 10, 679-708.

Holingue, C., Badillo-Goicechea, E. et al. (2020). Mental distress during the COVID-19 pandemic among US adults without pre-existing menta health condition: Findings from American trend panel survey. Preventitive Medicine, 139. DOI: https://doi.org/10.1016/j.ypmed.2020.106231

Huang, T., Mariani, S., Refline, S. (2012). Sleep irregularity and risk of cardiovascular events: The multi-ethnic study of atherosclerosis. J Am Coll Cardiol, 75, 991-999.

Patel, S. R., Malhotra, A., Gao, X., Hu, F. B., Neuman, M. I., & Fawzi, W. W. (2012). A prospective study of sleep duration and pneumonia risk in women. Sleep, 35, 97–101. https://doi.org/10.5665/sleep.1594

Phillips, A.J.K., Clerx, W.M., O’Brien, C.S., Sano, A., Berger, L.K., Picard, R.W., Lockley, S.W., Klerman, E.B., Czeisler, C.A. (2017). Irregular sleep/wake patterns are associated with poorer academic performance and delayed circadian and sleep/wake timing. Scientific Reports, 7, https://doi.org/10.1038/s41598-017-03171-4

Raan, S. Coogan, A.N. (2020). A cross-sectional study of the association between chronotype, social jetlag and subjective sleep quality in healthy adults. Clocks and Sleepi, 2, 1-6. DOI: https://doi.org/10.3390/clockssleep2010001

Ronnenberg, T., Allbrendt, K.V., Merrow, M. Vetter, C. (2012). Social jetlag and obesity. Current Biology, 22, 939-943. DOI: https://doi.org/10.1016/j.cub.2012.03.038

Sibley, C.G., Greaves, L.M., et al. (2020). Effects of the Covid-19pandamic and the nationwide lockdown on trust, attitudes towards government, and wellbeing. American Psychologist, 75. DOI: 10.1037/amp0000662

Simon, E. B. & Walker, M. P. (2018). Sleep loss causes social withdrawal and loneliness. Nature Communications. 9. 3146. DOI: 10.1038/s41467-018-05377-0

Wong, P.M., Hasler, B.P., Kamarck, T.W., Muldoon, M.F., Manuck, S.B. (2015). Social jetlag, chronotype, and cardiometabolic risk. The Journal of Clinical Endocrinology and Metabolism, 100, 4612-4620. DOI: https://doi.org/10.1210/jc.2015-2923

Wright,m K.P.Jr., Linton, S.K., Withrow, D., Casiraghi, L., Lanza, S.M., de la Iglesia, H., Vetter, C., Depner, C.M. (2020). Sleep in university students prior to and during COVID-19 Stay-at-Home orders. Current Biology, 30, 797-798. DOI:https://doi.org/10.1016/j.cub.2020.06.022


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