Disruption to Sleep and Increased Use of Sleep Aids Since the Beginning of the COVID-19 Pandemic

Unhealthy sick Caucasian woman suffers from insomnia or headache during the day, takes sleeping pill while laying in bed with glass of water, depressed girl holds antidepressant medications, painkiller for menstrual pain, close up. Photo of Stressed woman drinking pill or medicine with glass of water on bed at home after wake up in the morning
As sleep problems persist globally amidst the COVID-19 pandemic, the study authors sought to identify which populations have experienced changes in sleeping patterns.

Sleep problems have been increasing world-wide since the onset of the COVID-19 pandemic. These findings, from a cross-sectional study, were published in the Journal of Clinical Sleep Medicine.

Participants were recruited for 2 online surveys by researchers from the Hebrew University of Jerusalem. The instruments used in the survey were:  the Insomnia Severity Index (ISI), the Pittsburg Sleep Quality Index (PSQI), and the National Sleep Foundation (NSF) Sleep Satisfaction Tool.

Survey 1 was available in 7 languages and was completed by 2562 individuals between March 26 and April 26, 2020 who responded to an invitation for a sleep study. Study 2 was available only in English and was completed by 971 residents in the United States between April 17 and April 20, 2020. Respondents were recruited through the Amazon Mechanical Turk for a survey without a description of sleep to avoid a self-selection bias of participants interested in sleep.

Participants in the first and second surveys were aged mean 45.18±14.46 and 40.36±13.61 years, 68.18% and 52.79% were women, 87.16% and 76.52% had a college degree, 65.14% and 45.42% were married, and 79.34% and 80.64% were living with a child aged £6 years, respectively. A total of 76% participants of survey 1 reported their location and were located in Israel (29%), South America (18%), Europe (14%), North America (12%), Asia (2%), and other (1%) countries.

All respondents indicated a substantial change to their sleep patterns since the pandemic. Early in the COVID-19 pandemic, participants had a significant increase of average sleep (change, 0.26 hours; P =.001), a decrease of nights with fewer than 7 hours of sleep (change, -5.70%; P =.001), a decrease of continuous sleep (change, -10.07%; P =.001), and an increase of sleeping pill use (change, 1.68%; P =.001). Later in the COVID-19 pandemic, participants had an increase of nights with fewer than 7 hours of sleep (change, 6.69%; P =.001) and an even greater increase of sleeping pill use (change, 3.50%; P =.001).

Worsening sleep during survey 1 was associated with women (odds ratio [OR], 1.45; 95% CI, 1.17-1.80; P <.001), individuals whose livelihood was affected by COVID-19 (OR, 1.38; 95% CI, 1.11-1.71; P <.01), those in quarantine (OR, 1.32; 95% CI, 1.08-1.61; P .01), and those who had a decrease of physical activity (OR, 1.25; 95% CI, 1.03-1.53).

During survey 2, poorer sleep associated with decreased physical activity (OR, 1.84; 95% CI, 1.36-2.51; P <.001), women (OR, 1.82; 95% CI, 1.33-2.50; P <.001), individuals whose livelihood was affected by COVID-19 (OR, 1.72; 95% CI, 1.25-2.38; P <.001), and those aged 31-45 years (OR, 1.63; 95% CI, 1.06-2.52; P <.05).

Individuals in survey 2 who worked in the health care profession were associated with worsening sleep (OR, 2.10; 95% CI, 1.14-3.93; P =.018).

This study may have included recall or generalized bias due to self-reporting.

The study authors concluded that the COVID-19 pandemic has increased sleep difficulties and use of sleep aids worldwide, especially among women, those who have been financially impacted, and health care professionals.


Mandelkorn U, Genzer S, Choshen-Hillel S, et al. Escalation of sleep disturbances amid the COVID-19 pandemic: A cross-sectional international study. J Clin Sleep Med. 2021;17(1):45-53. doi:10.5664/jcsm.8800