COVID-19 and Sleep and Daytime Problems During the First Phase of the Pandemic

Man trying to sleep in his bed but feeling frustrated
In an international study, researchers assessed the occurrence of sleep and daytime problems during the first phase of the pandemic.

Patients with COVID-19 in the first phase of the pandemic had a significant increase in sleep problems, fatigue, and excessive sleepiness, according to a study published in BMJ Open.

Researchers believe sleep could have a bidirectional relationship with COVID-19. For example, poor sleep may potentially impact in vivo antibody responses to new antigens, and therefore increase the risk of contracting COVID-19, the researchers explained. It’s also hypothesized that the pandemic may lead to practical and emotional issues that could affect sleep. The objective of the current study was to assess the impact of the first phase of the pandemic on sleep and daytime problems, in addition to country-specific differences in the rates of these problems.

The findings are based on responses to a survey questionnaire that was administered in 14 countries, including the United States, between May and August 2020. Researchers investigated potential changes in the frequency and presentation of sleep and daytime problems related to COVID-19 and confinement.

A total of 25,484 individuals participated, and 22,151 responders (86.9%) provided complete data and were included in the analysis (mean [SD] age, 41.8 [15.9] years; 66% female). Of the cohort, 3.0% (n=739) reported that they had COVID-19—404 (54.7%) had tested positive and 50 (6.8%) did not know if they had tested positive. About 42% stated that they were confined to their home during the pandemic, and 55.9% reported having financial issues related to the pandemic.

The prevalence of poor sleep quality, sleep onset problems, sleep maintenance problems, fatigue, excessive sleepiness, and falling asleep during the daytime increased by about 10% or more. Sleep quality worsened in about 20% of responders and improved in about 5%. Also, 6.9% of responders reported an increase in hypnotic use, and 20.8% reported worsening of sleep quality.

In a fully adjusted multiple logistic regression model that adjusted for ethnicity, presence of problems before the pandemic, confinement, financial suffering, and COVID-19 severity in each country, only poor sleep quality, early morning awakening, and sleepiness were significant.

The fully adjusted model also showed that confinement was positively associated with poor sleep quality and sleep onset problems and that financial suffering during the pandemic was associated with all sleep and daytime problems. Hypnotic use had the highest odds ratio (2.03 [1.50 to 2.75]).

The researchers noted that their findings are limited by the subjective reports and that mild disease may have occurred without the responders knowing it. Also, only responders who knew that they had COVID-19 were included in the analysis, and financial suffering was based on a single question.

“As sleep and health share a bidirectional relationship, such problems were significantly associated with COVID-19, but also with confinement and especially with financial suffering,” stated the researchers. “On a global level, the social and psychological effects seem to play a more important role than the biological effects of COVID-19 as a disease on these sleep and daytime problems.”

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Partinen M, Holzinger B, Morin CM, et al. Sleep and daytime problems during the COVID-19 pandemic and effects of coronavirus infection, confinement and financial suffering: a multinational survey using a harmonised questionnaire. BMJ Open. Published online December 13, 2021. doi: 10.1136/bmjopen-2021-050672

This article originally appeared on Neurology Advisor