The Associations Between Insomnia Symptoms and Emotional Regulation Among Typically Developing Adolescents during the COVID-19 Pandemic

Introduction A high prevalence of sleep disturbances was observed in adolescents during the coronavirus disease (COVID-19) pandemic. This has been interpreted as being related to disruptions in daily routines and social life caused by pandemic-related societal restrictions. Although the COVID-19 pandemic interrupted the routines of all adolescents, not all adolescents developed insomnia in response to pandemic-related changes. A reduced ability to regulate negative emotions is associated with a higher risk of developing insomnia, yet it is not known if it is associated with higher levels of insomnia in adolescents. Cognitive reappraisal, which consists of changing the way one thinks about potentially emotion-inducing events, is effective in downregulating negative emotion. Expressive suppression, which is changing the way one behaviorally responds to emotion-eliciting events, can decrease a positive emotional experience but does not alter the experience of negative emotion. The objective of this study was to examine the associations between insomnia symptoms in typically developing adolescents during the COVID-19 pandemic and the tendency to use cognitive reappraisal or expressive suppression to regulate emotions. It was hypothesized that high levels of insomnia symptoms among adolescents during the COVID-19 pandemic would be associated with more frequent use of expressive suppression and less frequent use of cognitive reappraisal when regulating emotions. Methods 49 adolescents aged 11-16 (M= 13.43, SD= 1.67) participated in the study during the first wave of the COVID-19 pandemic in Canada (May 15 to June 30, 2020). The Insomnia Severity Index (ISI) was used to assess the severity of nighttime and daytime components of insomnia. The Emotion Regulation Questionnaire was used to assess respondents' tendencies to regulate their emotions using cognitive reappraisal or expressive suppression. Results Higher ISI total scores were significantly associated with lower reappraisal scores on the Emotion Regulation Questionnaire. Conclusion A higher level of insomnia symptoms among typically developing adolescents during the COVID-19 pandemic was associated with less frequent use of emotional regulation strategy that is effective in downregulating negative emotion. Limitations: Given the cross-sectional design of the study, it is not possible to determine causality. Support (If Any) CIHR 418638 to Reut GruberRGPIN-2015-04467 to Reut Gruber

Children's Sleep During COVID-19: How Sleep Influences Surviving and Thriving in Families.

OBJECTIVE: The COVID-19 pandemic has the potential to disrupt the lives of families and may have implications for children with existing sleep problems. As such, we aimed to: (1) characterize sleep changes during the COVID-19 pandemic in children who had previously been identified as having sleep problems, (2) identify factors contributing to sleep changes due to COVID-19 safety measures, and (3) understand parents' and children's needs to support sleep during the pandemic. METHODS: Eighty-five Canadian parents with children aged 4-14 years participated in this explanatory sequential, mixed-methods study using an online survey of children's and parents' sleep, with a subset of 16 parents, selected based on changes in their children's sleep, participating in semi-structured interviews. Families had previously participated in the Better Nights, Better Days (BNBD) randomized controlled trial. RESULTS: While some parents perceived their child's sleep quality improved during the COVID-19 pandemic (14.1%, n = 12), many parents perceived their child's sleep had worsened (40.0%, n = 34). Parents attributed children's worsened sleep to increased screen time, anxiety, and decreased exercise. Findings from semi-structured interviews highlighted the effect of disrupted routines on sleep and stress, and that stress reciprocally influenced children's and parents' sleep. CONCLUSIONS: The sleep of many Canadian children was affected by the first wave of the COVID-19 pandemic, with the disruption of routines influencing children's sleep. eHealth interventions, such as BNBD with modifications that address the COVID-19 context, could help families address these challenges.

Pre-pandemic sleep behavior and adolescents' stress during Covid-19: a prospective longitudinal study.

OBJECTIVE: To prospectively document changes in adolescents' sleep before versus during the COVID-19 pandemic, and to examine their impact on adolescents' perceived stress. METHODS: Sixty-two typically developing adolescents participated in the study before (Time 1: January 15 to March 13, 2020) and during (Time 2: May 15 to June 30, 2020) the COVID-19 pandemic in Canada. At Time 1, each participant's sleep pattern was assessed in the home environment using actigraphy and sleep logs for seven consecutive nights. Adolescents completed a battery of questionnaires in which they reported on their sleep schedule, duration, and quality, as well as their activities at bedtime, their daytime sleepiness, and their social/emotional behavior. The participants' parents provided demographic information. At Time 2, each participant completed a sleep log, the same battery of questionnaires regarding sleep, and the Perceived Stress Scale. RESULTS: (1) Adolescents' reported sleep was of longer duration and on a delayed schedule during the COVID-19 pandemic compared to pre-pandemic. (2) A larger proportion of adolescents reported meeting or exceeding the recommended amount of sleep during the COVID-19 pandemic compared to pre-pandemic sleep. (3) "Social jet lag" disappeared during the COVID-19 pandemic. (4) A shorter reported sleep duration and higher level of arousal at bedtime at Time 1 were significant predictors of adolescents' perceived stress at Time 2-during the COVID-19 pandemic. (5) A higher levels of arousal at bedtime and lower reported sleep quality at Time 2 were concurrently associated with higher levels of perceived stress among adolescents, even when we controlled for the levels of pre-pandemic emotional or behavioral issues, sleep duration, or sleep quality. CONCLUSION: Sleep duration and cognitive-emotional arousal, which are both modifiable behaviors, were associated with adolescents' perceived stress during the COVID-19 pandemic. These behaviors could be useful targets for preventive interventions aiming to reduce adolescents' stress in the face of stressogenic situations, such as the COVID-19 pandemic.

The impact of COVID-19 related school shutdown on sleep in adolescents: a natural experiment.

OBJECTIVE: During the outbreak of the COVID-19 pandemic in 2020, high schools closed or transitioned to remote teaching. The aim of this study was to describe how the COVID-19 related school shutdown impacted the sleep behaviors of typically developing adolescents. METHODS: A qualitative study was conducted between April 28 and June 3, 2020 with 45 adolescents using one-on-one semi-structured phone interviews. RESULTS: The "natural experiment" caused by the shutdown of schools due to the COVID-19 pandemic led to a 2-h shift in the sleep of typically developing adolescents, longer sleep duration, improved sleep quality, and less daytime sleepiness compared to those experienced under the regular school-time schedule. DISCUSSION: These findings are consistent with previous studies showing that delaying high school start times could be an effective way to extend sleep duration, improve sleep quality, reduce daytime sleepiness and lower adolescents' stress during the school year. As many countries look for ways to reduce the number of interactions between students in schools so that physical distancing is feasible, following teens' delayed sleep biology could offer an affordable solution. For example, staggering arrival times by delaying school start time for older adolescents compared with younger adolescents can reduce the total number of students attending school at the same time. This strategy offers a practical means to reduce school density and the number of interactions between students which are needed to reduce the potential transmission of COVID-19 in schools, while improving adolescents sleep health.