Abstract
Studies performed across the COVID-19 pandemic waves point to the persistent impact of the pandemic on sleep and mental health. We expand these data by examining insomnia, pre-sleep arousal, psychosocial factors, and retrospective changes in sleep pattern during the COVID-19 second wave lockdown period in Georgia. Data were collected through an online survey (n = 1117). The prevalence rate of probable insomnia disorder was 24.2%. Clinically relevant somatic and cognitive pre-sleep arousal was present in 49.8% and 58.0% of participants, and high levels of anxiety, depression and social isolation were found in 47.0%, 37.3%, 47.2% of respondents, respectively. We observed high prevalence rates of worse sleep quality, delayed bedtimes and risetimes, longer sleep latencies, higher awakenings and shorter sleep durations, relative to the pre-pandemic period. COVID-19-infected participants showed more severe sleep and mental problems. Specific predictors differentially affected insomnia, somatic and cognitive pre-sleep arousal. Depression and COVID-19 infection emerged as vulnerability factors for pre-sleep arousal, which, in turn, was associated with a higher predisposition to insomnia disorder. We confirm the strong deteriorating impact of the COVID-19 pandemic on sleep and psychosocial well-being during the second wave lockdown period. The specific association between pre-sleep arousal, insomnia, and psychosocial factors is of clinical relevance for the prevention of severity and persistence of sleep and mental problems across the repeated lockdown/reopening waves. Modulation of pre-sleep arousal may prove beneficial to implement targeted interventions.
Highlights
The COVID-19 pandemic has encompassed every country and affected millions of people worldwide
We focused on the relationship between insomnia and pre-sleep arousal, a topic that has largely been overlooked in COVID-19 research
In addition to common predictors, anxiety was a specific predictor of pre-sleep arousal; chronic disease and access to medical services predicted the Pre-Sleep Arousal Scale (PSAS) somatic; social isolation was associated with PSAS cognitive and insomnia; depression and COVID-19 infection more likely affected insomnia through the impact on pre-sleep arousal
Summary
The COVID-19 pandemic has encompassed every country and affected millions of people worldwide. The unprecedented social, psychological and economic problems that arose due to lockdown measures inflicted a prolonged stress on people, affected physical and mental health, and adversely impacted sleep-wake patterns and prevalence rates of sleep disorders [1,2,3]. The measures undertaken to prevent the spread of COVID-19 vary across countries. On 21 March 2020, a state of emergency was announced in the country. On 23 May 2020, the state of emergency ended, and the curfew was abolished. The second wave of the COVID-19 pandemic started in autumn, 2020. Starting from 28 November, nationwide two-month restrictions were put in place, including a curfew from 21:00 h to 05:00 h, remote learning in schools and universities, a switch to online shopping by retailers, etc. Lockdown measures started to ease very slowly from 1 February 2021, and the ban on municipal transportation was lifted for weekdays from 8 February 2021 [6]
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