Reopening after COVID-19 lockdown triggers shifts in sleep patterns, mental health

Reopening workplaces and establishments after the lifting of coronavirus disease 2019 (COVID-19) lockdowns leads to an increase in physical activity as well as notable shifts in sleep patterns and mental wellbeing, according to a recent Singapore study.

“The COVID-19 pandemic disrupted daily lives worldwide, impacting sleep, physical activity, and mental wellbeing. Although lockdowns were imposed suddenly, the process of reopening has often been more gradual with partial mobility restrictions still in place,” the researchers said.

“As hybrid work arrangements and expanded use of electronic communication are likely to persist through the protracted pandemic and its aftermath, our findings could inform strategies to adapt to new societal norms,” they added.

Using wearable sleep and activity trackers, 198 participants were longitudinally assessed throughout the lockdown in Singapore and the subsequent reopening period. Passive smartphone tracking was also performed to assess usage and mobility. Reopening was accompanied by an increase in average step count from 5,819 daily steps during lockdown to 7,055 daily steps after reopening (mean change, 1,135.7 steps per day; p<0.001). [Sleep 2021;doi:10.1093/sleep/zsab250]

Other significant lifestyle changes were recorded, with average bedtime and waketime shifting by 14.1 and 27.1 minutes earlier, respectively (p<0.001 for both). As a result, average time-in-bed and total sleep time decreased by 14.4 and 11.4 minutes, respectively, (p<0.001 for both) after reopening.

Nevertheless, participants saw a slight but significant increase in sleep quality, with scores increasing from 2.56 to 2.64 points (p<0.001).

Such changes in lifestyle occurred concurrently with worse self-reported stress such that scores increased by 4.13 points during daytime (p<0.001) and by 3.64 points during the evening (p<0.001). Evening mood also worsened after reopening (p=0.008), while no significant change in loneliness was documented.

Notably, despite marked changes in lifestyle and wellbeing, total daily smartphone use was unaffected by the reopening, with each participant reporting around 6 hours of total screen unlock time per day. However, bedtime use grew slightly from 27.51 to 28.32 minutes (p=0.036).

Moreover, regression analysis showed that smartphone use remained a strong correlate of sleep behaviours. For example, participants with low vs high phone use during evenings had earlier wake times both during and after the lockdown. Physical activity also tended to be higher among those with low usage profiles.

“From these findings it seems that heavy smartphone use is indeed associated with unfavourable health behaviours. When looking at self-rated wellbeing indicators, however, more phone usage was not necessarily associated with stronger negative outcomes,” the researchers said, pointing to the absence of excess self-reported stress among participants with high phone use.

“Furthermore, some indications were found that individuals with intermediate levels of prebedtime phone usage reported slightly better mood and lesser loneliness compared to light phone users,” they added.

“The current data shows a complex pattern of changes in lifestyle and wellbeing after lockdown measures were lifted involving shorter and earlier sleep, increased physical activity but also increased stress,” the researchers said.