ABSTRACT
Introduction: The prevalence of insomnia and other sleep disorders increased during the COVID-19 pandemic. While general anxiety, which increased during the pandemic, may account for some of the rise in sleep complaints, other factors may also contribute to insomnia. Here, we examined the potential contribution of fear of dying from the novel coronavirus on the severity of insomnia. We hypothesized that those endorsing a high fear of dying specifically from COVID-19 within 12 months of their assessment would demonstrate more severe insomnia. Methods: From April 2020 through October 2021, 13,298 U.S. participants (18-92 years old;57.5% female) completed a online survey (~1,000 participants per month) that included an assessment of their perceived likelihood of dying from COVID in the next year, the Generalized Anxiety Disorder scale-7 (GAD-7), and the Insomnia Severity Index (ISI). We examined insomnia over the course of the first year of the pandemic and divided the sample into those who endorsed at least a 50% or greater perceived likelihood that they would die from COVID-19 in the next year versus those who endorsed a less than 50% perceived likelihood of dying from the illness. Results: Fear of dying (50% chance or higher) was associated with higher ISI scores (p<.00001) and tended to decline over the course of the year (p<.00001). A significant month x fear interaction (p=.021) suggested that individuals who believed they would die within the year showed significantly fluctuations in insomnia over the course of 13 months with peaks around June and October 2020. Even accounting for situational anxiety (GAD-7), those with a fear of dying still demonstrated higher insomnia levels than their counterparts (p<.00001). Conclusion: Self-perceived likelihood of dying from COVID-19 in the near future was associated with significantly elevated severity of insomnia, and this remained true even when controlling for a clinical assessment of generalized anxiety levels. These findings suggest that fear of succumbing to the novel coronavirus contributed significantly to the severity of sleep problems during the first year of the pandemic.