Sleep Health Among Adolescents and Adults During the COVID-19 Pandemic: Introduction to the Special Issue

As I write the introduction for this special issue, it is nearly two years to the date when our lives changed in previously unimaginable ways as the world was hit by the 2019 novel coronavirus (i.e., COVID-19). Right now, many of us are even preparing to attend our first in-person conference, the World Sleep Society meeting – in Rome, Italy, no less! It is poignant and exciting (and if I’m honest, a little anxiety-provoking) to prepare for this trip, while reminded of the devastating images we witnessed on television in early 2020, as Italy went into its pandemic-related lockdown. Never did I imagine that two years in, we would still be living under the veil of the pandemic, though recent trends in case counts and increasing vaccine rates (in many countries; “Coronavirus World Map: Tracking the Global Outbreak, 2022) may give us all reason to be hopeful. Over the past two years, we have endured and adapted to the challenges of pandemic living – from far too many Zoom calls, to finding creative ways to get work done while simultaneously managing children and households, and trying to maintain some semblance of normalcy even when the world felt turned upside down. And through it all, our sleep colleagues, clinicians and researchers have continued to do the critical and pressing work to better understand and treat sleep problems that have emerged in the wake of the pandemic. That alone, gives me hope – to be surrounded by steadfast colleagues who persevered in conducting important work and addressing the critical public health problem of poor sleep health during these unprecedented times.

It is, therefore, my honor and pleasure to guest edit this special issue, which highlights some of the impressive research on sleep health during the pandemic, conducted by our Behavioral Sleep Medicine colleagues. The articles featured herein focus on a variety of populations both in the U.S. and abroad (Dal Santo et al., 2021), from adolescents (Potvin et al., 2022; Troxel et al., 2022) to older adults (Chin et al., 2022), and some focused on specific vulnerable populations, including adolescents with Type 1 diabetes (Griggs et al., 2022), American Indian/ Alaska Native youth (Troxel et al., 2022) and sexual and gender minority young adults (Tucker et al., 2022). Of note, many of the studies collected data in the first few months of the COVID-19 outbreak, which is a testament to our field’s recognition of the potential for the pandemic to have a profound impact on sleep, and the rapid deployment of data collection strategies (administered remotely) to better understand the growing public health problem in the midst of stay-at-home orders. The studies also utilized a range of methods, including qualitative and mixed methods approaches, which provide critical information concerning the “lived experience” of different populations during the pandemic as well as potential facilitators and barriers to sleep health during the pandemic (e.g.,(Griggs et al., 2022).

Collectively, findings underscore that while increases in poor sleep quality and insomnia symptoms were prevalent during the pandemic, there was considerable heterogeneity in the effects depending on the presence of specific risk or protective factors and across population groups. For example, in terms of risk factors, Potvin and colleagues (Potvin et al., 2022) found that a later chronotype, greater usage of electronic devices, and greater caffeine and cannabis consumption during the pandemic were associated with delayed sleep timing during the pandemic in youth. Several articles also identified potential protective factors, including social integration or engaging in pleasurable activities, that were associated with reduced risk of having poor sleep quality (Chin et al., 2022; Dal Santo et al., 2021) and may be important targets of intervention. Findings also demonstrate how COVID-19 has laid bare existing inequities in sleep health. For example, in a diverse sample of young adults, Tucker and colleagues (Tucker et al., 2022) found that sexual and gender minority (SGM) young adults perceived greater negative impacts of COVID-19 on their sleep and other behavioral health indicators, as compared to non-SGM youth. These findings and others (Jackson & Johnson, 2020) emphasize the importance of continuing to investigate the multi-level influences on sleep health disparities, and the importance of identifying population-level interventions. Further, consistent with several prior studies (Albrecht et al., 2022; Genta et al., 2021; Illingworth et al., 2022), some evidence highlights heterogeneity in how the pandemic has influenced specific dimensions of sleep. For example, my colleagues and I (Troxel et al., 2022) found increases in poor sleep quality among a sample of American Indian/ Alaska Native adolescents, while simultaneously finding significant increases in sleep duration. These findings point to the multi-level factors that influence sleep health, particularly among adolescents. In this respect, COVID-19 and the associated school closures created a natural experiment to study the impact of removing one of the primary constraints to sufficient sleep among adolescents – early school start times. While the evidence clearly suggests that teens slept more during COVID-19, the stress and increase in mental health problems likely contributed to an increase in poor sleep quality. The “natural experiment” of COVID-19 also revealed that when there is a perceived public health imperative (i.e., the threat of COVID exposure and illness), schools, communities, and societies at large, can and do adapt to the exigencies of the situation – sometimes overnight, as many schools shifted to remote learning with little to no advance notice. This is in stark contrast to the resistance that schools often face when considering delaying school start times, and the protracted implementation process (often lasting years) for schools to make such changes, despite the evidence in support of the policy change.

As we cautiously make the transition back to the “new normal”, these findings are an important reminder of how vital sleep is to every aspect of health and functioning, and how the stress of pandemic living, as well as the disruptions to daily rhythms and routines, can have a profound effect on sleep. Undoubtedly, this new transition back to “normal”, as welcome as it may be, will also come with a new set of challenges and adaptations that will also affect sleep and will offer many important opportunities for continued investigation. In particular, future research on the role of sleep and circadian disturbances in “long COVID” and the role of treating sleep disturbances to mitigate the enduring effects of COVID-19 is critical. Longitudinal research is also needed to examine how sleep changes and how such changes impact health and well-being as COVID-related restrictions are lifted and society returns to “normal”. Finally, as COVID-19 has revealed or exacerbated existing inequities in sleep and other health outcomes, it is critical for our field to continue to investigate the multi-level determinants of sleep health as well as multi-level interventions to advancing health equity.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by NIMHD R01 MD012190.