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Research Briefs

April 20, 2022

Poor Sleep Patterns Associated with Anxiety, Depression Symptoms During the Pandemic

In a study of U.S. adults, insufficient sleep duration and inconsistent timing of sleep were associated with anxiety/depression symptoms and new or increased substance use

Levels of adverse mental and health symptoms and substance use have increased dramatically among U.S. adults during the COVID-19 pandemic. While individuals cannot change many of the factors related to the stress and burden of the pandemic, one lifestyle factor they may be able to influence is sleep. A new study led by investigators at Brigham and Women’s Hospital highlights the important interconnection between sleep patterns and mental and behavioral outcomes, such as anxiety and depression symptoms, and substance use. The study, which leverages data collected both from wearable devices before the pandemic and in June 2020, found that short sleep duration and inconsistent sleep timing were associated with adverse mental health symptoms. Results are published in Sleep Health.

“Our study speaks to the importance of sleep for mental health, especially in the context of stressful episodes,” said corresponding author Mark Czeisler, AB, of the Department of Psychiatry at the Brigham. “Making an effort to prioritize sleep and develop a regular sleep schedule can offer protection during these times.”

Czeisler and colleagues developed The COVID-19 Outbreak Public Evaluation (COPE) Initiative (www.thecopeinitiative.org) to survey adults about attitudes, behaviors, and beliefs about COVID-19 mitigation efforts and to assess mental and behavioral health during the pandemic. The team also leveraged data from almost 5,000 active users of WHOOP, a commercial, digital sleep wearable company based out of Boston. The researchers compared sleep data from before and during the pandemic.

About 15 percent of the 5,000 users responded to the researchers’ survey. Compared to pre-pandemic, in June 2020 participants experienced:

  • Longer sleep duration, and more consistent sleep timing during the pandemic: On average, participants got 15 more minutes of sleep each night. Sleep timing was more consistent for participants during the pandemic. Participants went to bed later but woke up even later during the pandemic.
  • Variable changes to sleep: Not all participants had better sleep during the pandemic — a subset, in fact, experienced changes in the opposite direction.
  • Mental and behavioral health: About 20 percent of participants screened positive for anxiety or depression symptoms and 30 percent screened positive for burnout. About 20 percent reported an increase in substance use to cope with stress.

The team found that participants who slept less than 6 hours a night pre- and/or mid-pandemic had higher odds of anxiety, depression, and burnout symptoms. Lower sleep consistency was also associated with increased odds of mental and behavioral health symptoms.

The team notes that the WHOOP users who participated in this study were 71 percent male and 77 percent non-Hispanic white — their findings, therefore, may not be generalizable to the national population. The study was launched at the outset of the pandemic and captures early data, but the research team is interested in following up to study how people who experienced mental health symptoms in June 2020 have incident or persistent mental health symptoms or are no longer experiencing them — and what role changes in sleep may have in these findings.

“In addition to sleep during the pandemic, people’s sleep patterns before the start of the pandemic were associated with their odds of mental health symptoms during the pandemic,” said Czeisler. “We don’t know the direction of this relationship — the degree to which mental health influences sleep, sleep influences mental health, or both — but we do see evidence of the important role of sleep during the pandemic, especially as we look for modifiable risk factors that could help improve mental health.”

 

Disclosures: M. Czeisler and co-authors Matthew Weaver, Charles Czeisler, Mark Howard, and Shantha Rajaratnam reported receiving a grant from the CDC Foundation with funding from BNY Mellon, a grant from WHOOP, Inc., and a gift from Hopelab, Inc., all to support The COPE Initiative. Co-author Emily Capodilupo is a paid employee of and has equity interest in WHOOP, Inc., and has equity interest in ARCHANGELS. Additional disclosures are reported in the paper, cited below.

Funding:
There was no specific funding for survey data collection. M. Czeisler was supported in part by a 2020 Australian-American Fulbright Scholarship funded by The Kinghorn Foundation, and by a grant from WHOOP, Inc., to Monash University acting through its Faculty of Medicine, Nursing and Health Sciences. C. Czeisler is the incumbent of an endowed professorship provided to Harvard University by Cephalon, Inc.

 

Paper cited: Mark É Czeisler, Emily R Capodilupo, Matthew D Weaver, Charles A Czeisler, Mark E Howard, Shantha MW Rajaratnam. “Prior sleep-wake behaviors are associated with mental health outcomes during the COVID-19 pandemic among adult users of a wearable device in the United States.” Sleep Health. 2022. DOI: 10.1016/j.sleh.2022.03.001.