Beyond Stress: Altered Sleep-Wake Patterns are a Key Behavioral Risk Factor for Acute Insomnia During Times of Crisis

Background: Stress is a common precipitant of acute insomnia; however, reducing stress during times of crisis is challenging. This study aimed to determine which modifiable factors, beyond stress, were associated with acute insomnia during a major crisis, the COVID-19 pandemic. Participants/Methods: A global online survey assessed sleep/circadian, stress, mental health, and lifestyle factors between April-May 2020. Logistic regression models analyzed data from 1319 participants (578 acute insomnia, 741 good sleepers), adjusted for demographic differences. Results: Perceived stress was a significant predictor of acute insomnia during the pandemic (OR 1.23, 95% CI1.19–1.27). After adjusting for stress, individuals who altered their sleep-wake patterns (OR 3.36, CI 2.00–5.67) or increased technology use before bed (OR 3.13, CI 1.13–8.65) were at increased risk of acute insomnia. Other sleep factors associated with acute insomnia included changes in dreams/nightmares (OR 2.08, CI 1.32–3.27), increased sleep effort (OR 1.99, CI1.71–2.31) and cognitive pre-sleep arousal (OR 1.18, CI 1.11–1.24). For pandemic factors, worry about contracting COVID-19 (OR 3.08, CI 1.18–8.07) and stringent government COVID-19 restrictions (OR 1.12, CI =1.07–1.18) were associated with acute insomnia. Anxiety (OR 1.02, CI 1.01–1.05) and depressive (OR 1.29, CI 1.22–1.37) symptoms were also risk factors. A final hierarchical regression model revealed that after accounting for stress, altered sleep-wake patterns were a key behavioral predictor of acute insomnia (OR 2.60, CI 1.68–5.81). Conclusion: Beyond stress, altered sleep-wake patterns are a key risk factor for acute insomnia. Modifiable behaviors such as maintaining regular sleep-wake patterns appear vital for sleeping well in times of crisis.