Sleep Disturbance, Duration Worse Amid the Pandemic Than in Years Past

March 31, 2021
Matthew Gavidia
Matthew Gavidia

Matthew is an associate editor of The American Journal of Managed Care® (AJMC®). He has been working on AJMC® since 2019 after receiving his Bachelor's degree at Rutgers University–New Brunswick in journalism and economics.

The number of days with sleep disturbance issues, such as difficulty falling and staying asleep, were greater in 2020 than in 2018, as was prevalence of both shorter and longer-than-recommended sleep durations during the pandemic.

The impact of the COVID-19 pandemic on sleep has been reported worldwide, with health care workers and adolescents noted as at-risk groups for significantly impaired sleep quality. Conversely, some studies have suggested that the pandemic has led to reduced daytime sleepiness in patients with narcolepsy and improved sleep quality in those working remotely.

So, just how different have sleep characteristics been amid the pandemic compared with years past?

Beyond the sleep difficulties that may arise for people who have COVID-19, a recent study published in Social Science & Medicine sought to examine this trend, particularly the difference in sleep duration and quality observed in 2020 vs 2018.

“Understanding how sleep has changed during this time is important because sleep plays a critical role in maintaining and promoting both mental and physical health,” said the study authors. “Notably, it plays a central role in the functioning of the immune system; healthy sleep is critical to prevent and recover from illnesses.”

The researchers derived sleep characteristics data of US adults from the 2018 National Health Interview Survey (n = 19,433) and of US adults recruited by Lucid, an online survey sampling company, during the COVID-19 outbreak (n = 2059).

Conducted via analysis of covariance (ANCOVA), the researchers compared the mean levels of each continuous sleep characteristic in 2018 vs 2020, with the clinical significance of the differences between the samples evaluated by predicting the prevalence of each clinically relevant sleep variable in a series of logistic regressions.

“Finally, to explore whether particular sociodemographic factors may be associated with greater differences in sleep between 2018 and 2020, age and race were examined as moderators in ANCOVA and logistic regression analyses when estimating the difference in sleep characteristics between 2018 and 2020,” added the study authors.

Based on ANCOVA results, there was a small, but insignificant mean difference (Mdiff) in sleep duration between the 2018 and 2020 samples (Mdiff = −0.05; 99% CI, −0.17 to 0.09).

However, mean levels of days with difficulty falling asleep (Mdiff = 1.13; 99% CI, 0.93-1.32), difficulty staying asleep (Mdiff = 0.62; 99% CI, 0.39-0.84), and not feeling rested (Mdiff = 0.76; 99% CI, 0.54-0.98) were larger in 2020 than in 2018.

“Thus, in comparison to 2018, US adults in 2020 reported approximately 1 more day a week with difficulty falling asleep, staying asleep, and not feeling rested,” said the researchers.

Furthermore, sleep duration of US adults was more likely to be shorter than recommended levels in 2020 than in 2018 (odds ratio [OR], 1.36; 99% CI, 1.14-1.62), as well as longer than recommended levels (OR, 2.32; 99% CI, 1.55-3.48).

When assessing sleep characteristics based on age, US adults 60 years and older had significantly smaller differences between 2018 and 2020 than all other age groups.

“Findings highlight sleep as a target in future research and interventions seeking to understand and reduce the effects of the COVID-19 pandemic,” concluded the study authors.


Hisler GC, Twenge JM. Sleep characteristics of U.S. adults before and during the COVID-19 pandemic. Soc Sci Med. Published online March 17, 2021. doi:10.1016/j.socscimed.2021.113849