Predictors of acute insomnia during the COVID-19 pandemic beyond perceived stress

ABSTRACT

Introduction Stress is a common precipitant of acute insomnia and likely contributed to increased reports of sleep disturbances during the COVID-19 pandemic. However, many other sleep and lifestyle changes may have also precipitated acute insomnia. This study aimed to clarify which factors, beyond perceived stress, contributed to the development of acute insomnia during the COVID-19 pandemic. Methods The study consisted of 578 participants with acute insomnia and 741 good sleepers. Participants completed an online survey assessing insomnia symptoms, sleep, lifestyle changes and mental health during the COVID-19 pandemic. Logistic regression analyses were conducted to identify contributing factors to acute insomnia when controlling for demographic differences between groups. Results Perceived stress was a significant predictor of acute insomnia during the pandemic (p<.001). However, after adjusting for stress, individuals who altered their sleep timing (p<.001) or increased their use of technology before bed (p=.037) during the pandemic were at a 3-fold increased risk of acute insomnia. Other sleep factors associated with acute insomnia included dream changes (p=.001), sleep effort (p<.001), and cognitive pre-sleep arousal (p<.001). For pandemic factors, being very worried about contracting COVID-19 (p<.002) and more stringent COVID-19 government restrictions (p<.001) increased the risk. Anxiety (p<.001) and depressive (p<.001) symptoms, as well as the personality trait of agreeableness (p=.010), also contributed to acute insomnia. Discussion To reduce acute insomnia during the COVID-19 pandemic, public health messaging should promote stress reduction and mental health care, but also modifiable behaviours such as keeping consistent sleep patterns and reducing technology use before bed.