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| Year : 2023 | Volume
: 34
| Issue : 1 | Page : 8-13 |
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| Changing sleep patterns and anxiety due to Covid-19 home confinement among working population: A cross-sectional study |
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Ankit Yadav1, Mansi Atri2, Sonia Pareek3, Roomani Srivastava4, S Nithya5
1 Department of Dentistry, ESIC Dental College and Hospital, Rohini, Delhi, India
2 Department of Public Health Dentistry, ESIC Dental College and Hospital, Rohini, Delhi, India
3 Department of Public Health Dentistry, Government Dental College and Hospital Subhash Nagar, Jaipur, Rajasthan, India
4 Department of Public Health Dentistry, Manav Rachna Dental College and Hospital, Faridabad, Haryana, India, India
5 Department of Oral and Maxillofacial Pathology, ESIC Dental College and Hospital, Rohini, Delhi, India
Click here for correspondence address and email
| Date of Submission | 11-May-2022 |
| Date of Decision | 26-Nov-2022 |
| Date of Acceptance | 09-Feb-2023 |
| Date of Web Publication | 05-Jul-2023 |
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 Abstract | | |
Introduction: The COVID-19 pandemic took the entire world unawares and people were forced to stay indoors overnight. Due to this a drastic change ensued in lifestyle with many succumbing to various kinds of stresses and psychological problems. This study aims to study the changing sleep patterns and level of anxiety among the working population due to the COVID-19 Pandemic lockdown. Methodology: An online survey was conducted using a cloud-based website. The sleep patterns both prior to and during the lockdown period of the pandemic were assessed using a self-administered questionnaire. The level of anxiety during both these periods (before and during lockdown) amongst the working population was also assessed using the Generalized Anxiety Disorder Scores (GADS). Results: A total of 224 individuals participated in the study of which 52.7% were males and 47.3% were females. On analysis, the lifestyle and sleep deprivation scores showed that before the lockdown only 2.7% reported a low score out of total participants. However, this number was raised to 13.4% during the lockdown. The percentage of people reporting deteriorated sleep quality gradually increased with females reporting moderate to severe category of Generalized Anxiety Disorder scores as compared to Males. Conclusion: The study suggests that there has been a significant change in the sleep quality of the study participants due to Covid enforced lockdown which if unnoticed might lead to significant health problems. The effective use of programs like yoga, meditation, and deep breathing exercises, if followed timely could reduce psychological distress to some extent.
Keywords: COVID-19, generalized anxiety disorder, lifestyle, lockdown, sleep deprivation
How to cite this article:
Yadav A, Atri M, Pareek S, Srivastava R, Nithya S. Changing sleep patterns and anxiety due to Covid-19 home confinement among working population: A cross-sectional study. Indian J Dent Res 2023;34:8-13 |
How to cite this URL:
Yadav A, Atri M, Pareek S, Srivastava R, Nithya S. Changing sleep patterns and anxiety due to Covid-19 home confinement among working population: A cross-sectional study. Indian J Dent Res [serial online] 2023 [cited 2023 Oct 3];34:8-13. Available from: https://www.ijdr.in/text.asp?2023/34/1/8/380518 |
| Introduction | |  |
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as the 2019 novel coronavirus (2019-nCoV), was identified for the first time in China in December 2019 at Wuhan, with a spread of more than 81,000 confirmed cases (World Health Organization [WHO], 2020).[1] In January 2020, this coronavirus (COVID-19) spread to countries that are neighbors to China (Thailand, South Korea, Japan, and Australia), to the United States and Europe, including Italy. On March 11, the WHO declared SARS-CoV-2 a pandemic,[2] having infected more than 100,000 people across 100 countries.[1]
The Corona Virus Disease 2019 (COVID-19) epidemic has created a significant increase in fear, anxiety, stress, and depression among the population. Pandemics or natural disasters increase long-term situations of depression in populations. Experiencing more upsetting events in life and finding it difficult to cope with them are also predictors of anxiety, stress, and depression.[3] At present, the world is facing a critical situation in preventing the spread of this SARS–CoV-2 infection. In order to counteract and contain the viral spread, the governments of many countries enacted extraordinary measures to limit viral transmission and lockdowns proved to be the only choice taken up by many countries to limit the spread of infection and flatten the curve to ease the burden on the health care system. Being forced to stay at home means an altered routine which could be a trigger in developing cerebral problems like anxiety, depression, and wakefulness in susceptible individuals.[4]
An imbalance in the circadian cycle due to home confinement and isolation during lockdown is responsible for both physical and mental health conditions. One of the most constantly reported consequences of the work-from-home terrain is a revision of sleep-wake measures.[4] Sleep is a vital process that maintains homeostasis and quality of life. Quality of sleep can have an impact on health and general well-being. Exploration over the last decade has increasingly validated the claim that sleep disorders have a strong influence on the threat of contagious conditions, the circumstance and progression of a series of conditions, and the prevalence of depression. Sleep can be assessed by measuring parameters like sleep duration, sleep like quiescence, and the frequency and duration of awakenings throughout the night.[5]
The need to self-isolate and quarantine at home, and avoid social activities for recreation in which they had participated before the Covid situation could be potential reasons to induce stress and pave way for the likely development of health and sleep problems. Distressing information from news and social media- forwards such as daily statistics of the disease spread and deaths associated with it could further compound the situation.[6]
The first studies of COVID-19-associated sleep distress were reported in China. About a third of them were found in healthcare workers. About 35 of the participants in the study reported symptoms of general anxiety, 20 of depression, and 18 of poor sleep quality. The participants who were most upset about the epidemic also reported the most symptoms. Healthcare workers were clearly under great pressure and sleep deprived which was reflected in the high prevalence of mental health symptoms among them.[7]
”Home” can be equated to a safe and secure environment for mankind, work from home ideally should relax an individual and provide a positive state of health. However, the isolation, and the fear of succumbing to the pandemic, created a tense environment and individuals who worked from home during COVID-19 reported anxiety, stress, depression, and poor sleep quality.
The deterioration in the quality of sleep impairs an individual's immunity. This study validates the consequences that a change in routine caused by the epidemic can affect their psychosocial equilibrium with a visible impact on their sleep. Sleep is often one of the first things to be affected when people feel pressed for time. People often overlook the potential long-term health consequences of insufficient sleep, and the impact that health problems can ultimately have on one's time and productivity. Generalized Anxiety disorder is a challenging yet common mental disorder that starts early in life and with its chronic course can exhibit a tendency to predict the subsequent onset of other disorders causing anxiety.[8] The GAD-7 is an initial screening tool for anxiety that comprises of a set of questions for assessing the probable causes of anxiety. Anxiety is scored as mild, moderate, and severe based on scores obtained [<10 (0-4 minimal anxiety; 5-9-mild anxiety), 10-14 (moderate) and >15(severe) respectively].[9]
The aim of this study is to assess the influence of sleep and sleeping patterns and their effect on the internal well-being of the working population during the COVID-19 lockdown. The objectives are to compare sleep quality prior to and during the Covid period using the GAD scale.
| Methodology | | |
A cross-sectional study was conducted among the working population associated with the employment state insurance scheme (both registered and without registration). The self-administered closed-ended questionnaire was designed to study the changing sleep patterns and Generalized Anxiety Disorder. To select the population the list of employees, email ID, and type of work done was taken from their employers. The link to the questionnaire was shared through the cloud-based website to all people who were allowed to work from home during the pandemic. A convenience sampling population n = 224 was taken from this working population.
The participants provided informed consent through a statement as a part of the survey questionnaire. The study was reviewed by the Institutional review board ethical committee (ref. ESICDCIEC/2020/P-30).
Study questionnaire
We developed 29 relevant questions related to sleep activity patterns. The linguistic translation of the English version of the questionnaire into the Hindi language, involved two stages: back translation technique and preliminary test using both versions. The questionnaire was translated by two accredited translators and then back was translated into English by two different accredited translators. English and Hindi versions were applied alternately to twenty bilingual volunteers by one trained and experienced interviewer, and the interviewer recorded the volunteers' comments and any difficulty that they had encountered.
To develop the final version discussion session with the accredited translators, the interviewer, and some of the volunteers was arranged, to clarify the subjects' comments. The comprehensibility of the translated version were assessed, and only minor changes were made to make the questionnaire more understandable.
The questionnaire demonstrated a high level of internal consistency and reliability assessed by an internal consistency analysis and a test-retest approach. A preliminary validation process was conducted by a qualitative approach/interview. Results of internal consistency showed a Cronbach's alpha of 0.84 or 0.86 for the first or second appointment respectively. Through the test-retest analysis, an intra-class correlation coefficient of 0.57 was recorded. Interviewed volunteers comprehended most questions well.
It was an anonymous study where the identities of all participants were kept confidential. The initial set of questions comprised demographic details. The questions investigated sleep habits (duration and bedtime) and sleep disturbances to evaluate the differences before and during the lockdown. There were questions regarding the quality of sleep and mode of awakening before lockdown and during the lockdown. There were a set of questions related to anxiety level and behavior change during the lockdown.
In this manner, a 'Lifestyle and Sleep Deprivation score' was determined for each individual. The highest score achievable was 26 and the lowest was 9. Those who scored between 20 to 26 were categorized as 'Good', 15 to 19 were considered 'Fair', and below 14 was considered 'Poor'. A pilot study validated the questionnaire. The questionnaire showed good internal validity with Cronbach's Alpha at 0.81.
Statistical-analysis
Data collected was compiled using Microsoft Office Excel Spreadsheet and analyzed using Statistical Package for Social Sciences (SPSS) version 20. Both descriptive and analytic statistics were done. The frequency distribution of all responses was determined. Association of Lifestyle and Sleep Deprivation Score with respect to the gender and age group were analyzed using Chi-square Test for both sets of scores that is before and during the lockdown. Any association between Lifestyle Score and GAD score was also determined using the Chi-square test. A P-value less than 0.05 was considered statistically significant.
| Results | | |
The present study was conducted to determine the effect of the COVID-19 Lockdown on anxiety levels, sleep deprivation, and lifestyle habits of individuals. A total of 224 individuals participated in the study of which 52.7% were males and 47.3% were females. About 58% of the study population was in the age group of 25 years and above and 42% were between 18 to 25 years. On analysis, lifestyle, and Sleep Deprivation Scores showed that before the lockdown only 2.7% of study participants had a poor score, however, this number raised to 13.4% during the lockdown. There was a sharp decrease in those reporting “Good” scores when compared with before and during the lockdown. These differences were found to be statistically significant [Table 1]. | Table 1: Comparison of lifestyle and sleep deprivation scores before and during lockdown
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A comparison of Lifestyle Scores before and during lockdown with respect to gender was done [Table 2]. While there was no significant difference between scores reported by the two genders before the lockdown, and during the lockdown, a statistically significant difference between the two was found, with a sharp increase in the number of females reporting poor scores. This corroborated with the analysis of GAD scores with respect to gender, where it was seen that a greater number of females fell in the moderate to the severe category than males and this difference was statistically significant [Table 3]. | Table 2: Association of gender with lifestyle and sleep deprivation before and during lockdown
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[Table 3] and [Table 4] analyze the association of different age groups with Lifestyle and GAD Scores. No significant difference was seen in the two age groups. Both age groups were equally affected by the lockdown. Sleep quality is another important aspect that was explored in this study and its association with General Anxiety Disorder was determined. Those with severe levels of anxiety disorder reported that their sleep quality deteriorated during the lockdown. The percentage of people reporting deteriorated sleep quality gradually increased from the group having Minimal GAD Score to those having a Severe GAD Score. This difference was found to be statistically significant [Table 5]. | Table 4: Association of age group with lifestyle and sleep deprivation before and during lockdown
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| Discussion | | |
Our results show that sleep duration and sleep timing of healthy individuals in a pre-quarantine terrain are in agreement with preliminarily reported data. The present study was conducted amongst 224 participants between the age group of 18-25 + years. We found significant changes prior to and during COVID-19 sleep patterns amongst our population with predominant changes seen among females. The result was similar to studies done in India,[10] Russia,[11] China,[12] and Italy.[13],[14] A negative impact on sleep was seen due to home confinement. There was a change in routines with most people getting up late, working from home, and having alternate meal times which disrupted the circadian rhythms. At the same time social isolation, and increase stress levels and disrupted nighttime sleep. Our results reported a statistically significant association between age and sleep problems and anxiety, the findings are in accordance with the systematic review on sleep and anxiety.[6] while the results obtained by another online survey of a Chinese population showed the prevalence rates of health symptoms such as depression and anxiety to be 43.7 and 37.4. respectively, a study carried out in Singapore, reported the prevalence rate as 22.9%.[15] The difference could be due to the difference in population and the tools used. In China, the adolescents were included in online data collection, and in Singapore, general health questionnaires were given to folks who came for a clinical visit. The GAD score in the present study was also found to be statistically significant in females in all age groups with prevalence reported in approximately 50% of the individuals.
The changing sleep patterns observed in our study can be explained by (i) the fear of death in COVID-19, (ii) quarantine and lockdown-related changes in sleep-wake-up habits with delayed bedtime, and sleep onset time, and (iii) the national and global death statistics that are commonly and routinely reported by the social media and news. Prior research has also revealed higher levels of psychological distress and significant symptoms of mental illness in various populations since the start of the pandemic.[6]
In the current study, demographic factors showed an impact on cerebral health problems during the COVID-19 epidemic. Age, female gender, a chronic medical illness, higher anxiety scores, and low social support were identified as risk factors for poor psychological health problems, such as anxiety and insomnia similar to reports from other studies. The sleep disturbance pattern was significant among subjects in the present survey which was similar to studies from China,[12], and Spain.[16] This might be due to uncertainty of the future and concern about unemployment in the family. This study does have certain limitations, like the data and relevant analyses presented were derived from a cross-sectional design, and it was not possible to make causal inferences for all conditions. Secondly, the study was limited to the COVID-19 outbreak, and we used a web-based survey method to avoid possible infections, so the sampling of our study was convenient and voluntary. Therefore, the possibility of selection bias should be considered. Thirdly due to the sudden occurrence of the disaster, the individuals were not assessed for their psychological conditions before the outbreak. Sleep questions were self-constructed although a pilot study was done to validate them. The study, however, provides essential insight into the burden of mental health-related repercussions of COVID-19 which is an issue that needs much attention from the health sciences community at large.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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Correspondence Address:
Dr. Mansi Atri
Associate Professor and Head, Department of Public Health Dentistry, ESIC Dental College and Hospital, Rohini, Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijdr.ijdr_407_22
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5] |
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