Abstract
The effects of the COVID-19 pandemic on sleep have been widely documented, but longitudinal evaluations during different phases of the “COVID-19 era” are needed to disentangle the specific consequences of the r145estrictive measures on sleep variables. The aim of this study was to assess the immediate effect of the lockdown’s end on sleep and sleep-related dimensions in an Italian sample, also considering the stress and depressive symptoms. We used an online survey to longitudinally collect data on sociodemographic, environmental, clinical, sleep, and sleep-related variables in two time points: during and immediately after the lockdown. The final sample included 102 participants. The large prevalence of poor sleep quality, clinically relevant pre-sleep arousal, and depressive symptoms, as well as poor sleep quality and pre-sleep arousal score observed during the lockdown, remained stable after its end. On the other hand, the prevalence of moderate-to-severe event-related stress and intrusive symptom scores exhibited a drastic reduction after the end of home confinement. Both bedtime and rise time were anticipated after the lockdown, while sleep quality exhibited only a trend of post-lockdown sleep disturbance reduction. Our findings point to a reduced stress level (specific for the intrusive symptomatology) after the end of the lockdown and persistence of sleep problems, suggesting two non-mutually exclusive hypotheses: (a) the strict restrictive measures are not the main cause of sleep problems during the pandemic and (b) home confinement induces long-lasting effects on sleep observable after its end, and a longer period of time might be needed to observe an improvement.
Highlights
The dramatic effects of the COVID-19 pandemic on mental health have been widely documented [1,2]
Post hoc LSD revealed that both lockdown (p < 0.00001) and post-lockdown (p < 0.00001) were characterized by a greater number of h/d spent at home compared to the pre-lockdown period
We observed that the alarming prevalence of individuals with poor sleep quality, clinically relevant pre-sleep arousal, and depressive symptoms remained high after the lockdown
Summary
The dramatic effects of the COVID-19 pandemic on mental health have been widely documented [1,2]. Home confinement can affect several areas of our daily experience (e.g., light exposure, social relationships, work schedules, physical activities, family management, use of electronic devices), which, in turn, are associated with changes in mood, stress levels, and sleep In this view, an intriguing question is how sleep, together with overall mental health, changes during the different phases of the pandemic. In Austria, Pieh et al [16] highlighted the long-lasting effects of the COVID-19 pandemic on depressive, anxiety, and insomnia symptoms after 6 months from the beginning of the lockdown, even though a slight improvement of stress and well-being was observed Another Italian study highlighted a clear dissociation between changes in different sleep features 4 months after the end of the lockdown [9], suggesting that a longitudinal evaluation of sleep during different phases of the pandemic should be performed considering multiple sleep dimensions, with the aim to avoid simplistic generalizations
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