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Pandemic Worry Keeping Americans Up at Night

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April 21, 2021 -- The rate of insomnia in the United States has more than doubled since the COVID-19 pandemic began, new research shows.

A national survey conducted by the American Academy of Sleep Medicine (AASM) reveals that almost 60% of Americans are now experiencing COVID-19 related insomnia.

The rate of insomnia in the general population is normally about 10% to 30%, Fariha Abbasi-Feinberg, MD, a sleep medicine doctor in Fort Meyers, FL, and member of the AASM's board of directors, said.

"So it is definitely double what it's been in the past. Some people are worried about getting sick from the virus, but there are a lot of economic anxieties, a lot of societal anxieties now. I feel like the stress level of the country in general has just been elevated over the last year," she added.

The research also shows that a growing number of people are turning to medication, supplements, or other substances to improve their sleep.

Commissioned by the AASM, the online survey of 2006 adults across the United States. It was conducted from March 11 to 15, 2021.

Sleep-Aid Use

Over half of survey respondents (56%) reported an increase in sleep problems since the pandemic began. Men were more likely than women to report such disturbances (59% vs 54%). The highest rate, at 70%, was among those age 35 to 44 . People in this age group were also most likely to use a sleep aid.

It makes sense that people in this age group are especially hard-hit by the pandemic, said Abbasi-Feinberg.

"These are people who are in the workforce and dealing with their work schedule and job stresses. They're parents of young children or at least children of school age and may be home-schooling their kids. And lots of them are in that sandwich generation and are caretakers to their parents. So they have been really squeezed," she said.

The most commonly reported sleep problem was insomnia or trouble falling and staying asleep (57%). More women (67%) than men (47%) experienced this problem, and those 55 and older were most likely to report it.

Other problems reported included sleeping less (46%), having lower quality sleep (45%), and having more disturbing dreams (36%).

The survey also showed that the struggle for a good night's sleep has led to an increase in the use of sleep aids. Over half (51%) of those surveyed said they used a medication, an over-the-counter supplement, or other substances to help them fall asleep.

Men were more likely than women to use a sleep aid (58% vs 44%). Results by age group showed that almost two thirds (65%) of those 35 to 44 are using a sleep aid.

Most sleep-aid users reported taking them often (53%). Those aged 65 years and older were more likely to report regular use (67%).

About 68% of respondents who regularly use sleep aids said they are taking them more often during the pandemic. This rate was much higher among men (75%) than women (60%). The largest increase in sleep-aid use, at 81%, was among those age 35 to 44.

Abbasi-Feinberg noted that a wide variety of over-the-counter sleep aids are available at pharmacies and that in some places, CBD and other cannabis products can be legally purchased.

"So people are trying a lot of things before they come to talk to a physician" about their sleep problems, she said.

A Key Pillar of Health

Doctors are often hesitant to prescribe sleep medications to older patients "unless there's a real reason for it," Abbasi-Feinberg said. Typically, such medications are prescribed only after "a more in-depth evaluation and discussion about the benefits and risks."

For older patients, who may be taking other medications, possible side effects of sleep aids, such as loss of balance, "are more worrisome," she said.

In general, the survey results were consistent across the various regions of the United States.

While tens of millions of Americans have been vaccinated against COVID-19, there continues to be concern about a fourth wave of the virus and an increase in more contagious variants, said Abbasi-Feinberg.

It's important for doctors to routinely ask patients about sleep and how they're dealing with anxiety and to refer patients to a sleep specialist when necessary, said Abbasi-Feinberg. Patients, too, should raise the subject with their doctors.

"Sufficient sleep is one of the three pillars of a healthy lifestyle along with good nutrition and regular exercise," she said.

Doctors should remind patients about healthy sleep habits, including avoiding caffeine before bed.

"That might seem obvious, but believe it or not, I see people every single day who come in for sleep issues and they're drinking iced tea or Coke before they go to bed," she said.

Adults should try to get about 7 hours of sleep a night, although some need more and others can get away with less, she added.

Despite the survey's concerning results, Abbasi-Feinberg remains optimistic that as more people are vaccinated and the economy improves, people's lives and sleep patterns will return to normal.

Commenting on the survey findings, Yue Leng, MD, assistant professor in the Department of Psychiatry and Behavioral Sciences at the University of California, San Francisco, noted that in general, older people experience more sleep disturbances and take more sleep medications than younger people. However, among survey respondents, seniors "seemed to be much less affected by COVID-related sleep disturbances and took fewer sleep-aids than other age groups."

Leng, whose research focuses on the link between sleep and nervous system diseases, said it "makes sense" that those age 35 to 44 were most affected by the pandemic. "This might be the age group whose life has the most changes as a result of COVID lockdown."

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