It can be difficult to notice sleep. When we sleep well, time passes almost unnoticed. While our other health practices involve effort – exercising, eating nutritious foods, flossing – sleep apparently involves the absence of action. It’s practically a non-event. And so the science of sleep can slip into the realm of self-care, as if good sleep is an indulgence, like massage, rather than an essential ingredient of life, like oxygen.
COVID-19 has changed that. The world went to bed in February 2020, but it’s still waiting to sleep. Take the sleep away, and it’s hard to notice anything else.
Collectively, we have experienced higher rates of insomnia during the pandemic. I recently co-authored a study in which 22,330 adults from 13 countries reported their COVID-19 and pre-COVID-19 sleep patterns. The results, published in sleep medicine in November 2021, were surprising.
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During the early stages of the pandemic, 36.7% of respondents experienced clinical symptoms of insomnia and 17.4% met criteria for insomnia disorder. These rates were double those of pre-pandemic levels. As insomnia disorders have increased globally, they have peaked in Brazil, the UK, Canada, the US, Poland and Norway. Another international study, published in The Lancetfound that healthcare professionals suffered from twice as many sleep disorders as the general population.
Stressful life events are among the top factors associated with sleep problems, and the pandemic has brought many of them: economic upheaval, childcare challenges, isolation and, of course, COVID-19 itself.
The sleep crisis has exacerbated the mental health crisis: people who sleep poorly on a regular basis are twice as likely to have mental health problems. In this same study, 25.6% of respondents said they were anxious and 23.1% said they were depressed. As with sleep disturbance, both rates were significantly higher than pre-pandemic levels.
Although this study focused on the effects of insomnia on mental health, sleep disturbances also compromise physical health: they are associated with conditions as serious as heart disease and stroke. A circular association exists between the three: people with insomnia tend to have more mental and physical illnesses; people with mental and physical illnesses tend to suffer more from insomnia.
Lack of sleep was a problem even before the pandemic. Minimizing sleep is often seen as a life hack, or worse, a virtue. Confusing an essential element of health with a lifestyle choice is nothing new. Consider tobacco, which for decades has been associated more with glamor than cancer. Until 1994, hospitals even offered spaces where doctors and patients could smoke. Also consider exercise. A generation ago, most doctors wouldn’t think to ask a patient about their cardio habits, which seemed more relevant to building an attractive physique than a healthy body.
One of the unfortunate legacies of the pandemic is that it has created the conditions to show what happens when we deprive ourselves of sleep on a global scale. It wasn’t just cloudy mornings and late nights, but increased rates of depression and anxiety. But we can also find hope in this study. It reveals the potential that exists – on an individual and public health level – if people and health care providers remember that a good night’s sleep is a medicine that promotes better mental and physical health.
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