Changes in Sleep-Wake Patterns and Disturbances Before and During COVID-19 in Urban American Indian/ Alaska Native Adolescents

ABSTRACT

Background

COVID-19 has profoundly affected sleep, although little research has focused on high-risk populations for poor sleep health, including American Indian/Alaska Native (AI/AN) adolescents.

Methods

This is the first longitudinal study to examine changes in sleep with surveys completed before the pandemic and during the early months of COVID-19 in a sample of urban AI/AN adolescents (N = 118; mean age = 14 years at baseline; 63% female). We use a mixed-methods approach to explore how COVID-19 affected urban AI/AN adolescents’ sleep, daily routines, and interactions with family and culture. Quantitative analysis examined whether pandemic-related sleep changes were significant and potential moderators of COVID-19’s effect on sleep, including family and community cohesion and engagement in traditional practices.

Results

: Findings demonstrate changes in sleep, including increases in sleep duration, delays in bedtimes and waketimes, and increases in sleep-wake disturbances (p’s <.001). Higher levels of family cohesion and higher levels of engagement in traditional practices moderated pandemic-related increases in weekday sleep duration. Qualitative analyses revealed changes in adolescents’ sleep and daily behaviors, as well as strategies adolescents used to cope with pandemic-related disruptions in sleep and routines.

Conclusion

Findings demonstrate positive and negative changes in sleep during COVID-19 stay-at-home orders, including simultaneous increases in sleep duration and sleep-wake disturbances. Results highlight the importance of considering multi-level influences on adolescent sleep, such as early school start times, family dynamics, and cultural factors. A multi-level approach may help guide prevention and intervention efforts to improve adolescent sleep health.

Acknowledgments

The authors would like to thank all study participants, their family members, and our community partners. The authors also thank study coordinators (Jennifer Parker, Keisha McDonald, Nina Ozbardakci), survey research group technological team (Evelyn Bogdon, Roberto Guevara, and Eric Min), and our data collection team.

Disclosure statement

WMT serves on the editorial board for Behavioral Sleep Medicine and Sleep Health and serves on scientific advisory board for Feelmore Labs and sleepfoundation.org. No other conflicts of interest were reported by the author(s).

Role of Funder/Sponsor

The NIH had no role in the design and conduct of the study.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

This work was supported by the National Institute on Minority Health and Health Disparities under Grant R01 MD012190 (MPIs: Troxel, D’Amico, Dickerson).