The onset of the COVID-19 pandemic had a significant impact on sleep quality and mental health, with women suffering more than men in both areas — a difference that researchers believe may be due to the traditional role of women as caretakers in their homes.

The findings, published in late October in Frontiers in Global Women’s Health, were the result of an investigation led by researchers at the University of Calgary. Data from 573 participants was gathered between March 23 and June 7, a period of time during which much of the world was experiencing lockdown measures to combat the spread of the coronavirus. Participants reported sleep issues of varying severity, as well as notably increased levels of anxiety during that period of time.

In terms of sleep issues, 66.8% of respondents reported poor quality of sleep, with 39.2% reporting clinical insomnia. Anxiety was assessed using the State-Trait Anxiety Inventory, a commonly used measure in clinical settings to help diagnose anxiety. The sample at large scored an average of between 55 and 59 on that scale — a figure that exceeded the cutoff of 40 for clinically significant anxiety.

The study highlighted the sex and gender differences between males and females, with females reporting lower quality of sleep and sleep efficiency, plus greater symptoms of insomnia, anxiety and depression than their male counterparts. For men, only depression symptoms appeared to play a significant role in predicting sleep quality.

The research also notes that a Kaiser Family Foundation poll reported how women expressed greater concerns and worries about the coronavirus during the period of time that the University of Calgary survey was being conducted. The KFF found that 68% of women were worried about the health of their family, compared to 56% of men, and 50% of women were concerned about losing income due to workplace closure, compared to 42% of men.

“The greater worry and anxiety in women in relation to their role as caregiver clearly reflects differences in gender roles and norms,” the study said.

Veronica Guadagni, a postdoctoral fellow at the University of Calgary and an author of the study, said that she wasn’t entirely surprised by the discrepancy in results between men and women, due to previous research that had highlighted how women tend to be more vulnerable to these kinds of disorders in general.

Guadagni’s personal experience during the onset of the pandemic also contributed to her decision to quickly start researching the impact it was going to potentially have on mental health. As a native of Italy who still has family members living there, Guadagni had been aware of the spread of COVID-19 before it took hold in North America, and she was able to quickly formulate a survey and research plan to begin collecting data before the end of March.

“On March 16, when the government declared the state of local emergency, I found myself working from home with a 6-year-old in grade 1 to be homeschooled, plus the worry of my family being back in Italy, and about the situation in Canada in general,” Guadagni said. “So I felt very overwhelmed, and I thought I wouldn’t be the only person to experience this. Particularly, I started to think about the role of women in families in society in general, and I … thought that this situation would have been a greater load for women, compared to men.”

While the survey found that increased levels of anxiety and depression were predictive of sleep disorders, previous research has also shown that sleep issues can exacerbate mental health issues. The intertwined nature of poor sleep and mental health disorders can create a cycle that can be difficult to analyze, Guadagni said.

“When screening for depression, one of the criteria or symptoms is either an inability to sleep, or too much sleep,” Guadagni noted. “Sleep problems are basically a part of the diagnosis of depression, so sometimes it’s very hard to understand what comes first.”

Guadagni stressed that individuals who are experiencing troubles falling asleep and staying asleep should be doing what they can to observe good sleep hygiene. This involves having a set routine before going to bed, avoiding the use of electronics at least 30 minutes to an hour before going to bed and using the bedroom only for sleeping.

“Even though everyone likes to watch Netflix in bed, that’s probably not the best idea if you have trouble with sleep,” Guadagni said.

Other techniques that can help someone fall asleep faster include light stretching before getting into bed or engaging in otherwise calming activities to reduce brain stimulation. People should also try to be active during the day and get exposure to bright light, especially during the morning, in order to maintain circadian rhythms.

“If you wake up during the night and really cannot fall back asleep, get up,” Guadagni added. “Don’t try to stay in bed and stress too much about not sleeping. That’s been shown to be even worse for you.”

Guadagni also said that the survey used for this research remains open, and that the research team will continue to analyze what kind of impact the ongoing nature of the pandemic will have on sleep quality. The researchers are particularly interested to see whether the spikes in coronavirus cases that have resulted in new or more severe lockdown restrictions will have a specific effect on sleep quality and mental health, Guadagni said, and that “some other analysis and results will come out of this data.”

As for the initial results from the first few months of the pandemic, Guadagni said that they show that “women suffer the most” under the circumstances.

“We hope that this paper will increase the awareness in terms of partners, but also organizations and employers on the fact that probably the evaluation … of performance for women at this particular time in life needs to be slightly different,” Guadagni said. “We cannot think that this situation didn’t impact women, and it’s not fair to have the same evaluation criteria that you would have in non-pandemic times or for their male counterparts that don’t have the same shared load.”

The article, “Sleep Quality, Empathy, and Mood During the Isolation Period of the COVID-19 Pandemic in the Canadian Population: Females and Women Suffered the Most,” was published on Oct. 23, 2020 in Frontiers in Global Women’s Health. It was authored by Veronica Guadagni, Alberto Umilta, and Giuseppe Iaria, all of the University of Calgary.