COVID-19 hardships and self-reported sleep quality among American adults in March and April 2020: Results from a nationally representative panel study

Objective: To analyze the association between coronavirus disease 2019 (COVID-19) hardships and self-reported sleep troubles in a nationally representative sample of adults in the United States. Design: Prospective study in March and April 2020. Setting: Population-based. Participants: About 8130 respondents who participated in the Pew Research Center's American Trends Panel in March and April of 2020. Measurements: Self-reported sleep troubles were defined as a report of 3 or more days per week with trouble sleeping in March and April (separately). Respondents were asked about COVID-19 stressors such as COVID-19 Threat and COVID-19-specific hardships including pay cuts/hours reductions, job loss, and childcare difficulties. Logistic regression models were fit to test associations between COVID-19 hardships and sleep troubles adjusted for sociodemographic covariates (age, gender, race/ethnicity, region, marital status, nativity, education, income, health insurance, and past diagnosis of mental health problems). Results: Reported sleep troubles increased from March (29.0%) to April (31.4%). For March, we found that COVID threat, losing a job, getting a pay cut, and difficulty with childcare were separately associated with sleep troubles. In April, COVID-19 threat and difficulty with childcare, but not losing a job or getting a pay cut were associated with sleep troubles even after additionally accounting for reported sleep troubles in March. Conclusions: We found that COVID-19-specific stressors, especially a broad measure of COVID-19 Threat and stress over childcare, were associated with sleep troubles in March and April. These findings identified novel stressors related to COVID-19, which may affect the sleep of the American population.