Introduction Behavioural responses to COVID-19 lockdown will define the long-term impact of psychological stressors on sleep and brain health. Here, we tease apart factors that help protect against sleep disturbance. We capitalise on the unique restrictions during COVID-19 to understand how time of day of daylight exposure and outside exercise interact with chronotype and sleep quality.
Methods Participants completed our online ‘SleepQuest’ Study between 29th April 2020- 13th May 2020 and were followed up between 5th November 2020 -2nd December 2020. The SleepQuest survey comprised a set of validated questionnaires probing sleep quality, depression, anxiety, and attitudes towards sleep alongside bespoke questions on the effect of COVID-19 lockdown on sleep, time spent outside and exercising and self-help sleep measures.
Results 3474 people from the UK (median age 62, range 18-91) completed the baseline data with 2781 participants followed up. Results showed sleep quality was negatively affected by the first UK lockdown restriction [mean PSQI at baseline 8.12 (2.92)] however from baseline to follow up, sleep quality improved (mean PSQI Difference=2.21; 95% CI=[2.12,2.33.]) Factors that predicted poor prolonged sleep quality were baseline sleep quality (P<0.001), anxiety (P<0.001) and attitudes towards sleep (P<0.01). Better sleep quality was associated with going outside and exercising earlier, rather than later in the day. However, the benefit of being outside early is driven by improved sleep in ‘owl’ (p=0.0002) and not ‘lark’ (p=0.27) chronotype, whereas the benefit of early exercise (inside or outside) did not depend on chronotype.
Discussion We have provided evidence to suggest anxiety and dysfunctional attitudes towards sleep predicted poorer prolonged sleep quality. Defining the interaction between chronotype, mental health and behaviour will be critical for targeted lifestyle adaptations to protect brain health through current and future crises.
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