Pre‐pandemic sleep reactivity prospectively predicts distress during the COVID ‐19 pandemic: The protective effect of insomnia treatment
Open accessAbstract
The COVID-19 pandemic is a rare stressor that has precipitated an accompanying mental health crisis. Prospective studies traversing the pandemic's onset can elucidate how pre-existing disease vulnerabilities augured risk for later stress-related morbidity. We examined how pre-pandemic sleep reactivity predicted maladaptive stress reactions and depressive symptoms in response to, and during, the pandemic. This study is a secondary analysis of a randomised controlled trial from 2016 to 2017 comparing digital cognitive behavioural therapy for insomnia (dCBT-I) against sleep education (N = 208). Thus, we also assessed whether dCBT-I moderated the association between pre-pandemic sleep reactivity and pandemic-related distress. Pre-pandemic sleep reactivity was measured at baseline using the Ford Insomnia Response to Stress Test. In April 2020, participants were recontacted to report pandemic-related distress (stress reactions and depression). Controlling for the treatment condition and the degree of COVID-19 impact, higher pre-pandemic sleep reactivity predicted more stress reactions (β = 0.13, ± 0.07 SE, p = 0.045) and depression (β = 0.22, ± 0.07 SE, p = 0.001) during the pandemic. Further, the odds of reporting clinically significant stress reactions and depression during the pandemic were over twice as high in those with high pre-pandemic sleep reactivity. Notably, receiving dCBT-I in 2016-2017 mitigated the relationship between pre-pandemic sleep reactivity and later stress reactions (but not depression). Pre-pandemic sleep reactivity predicted psychological distress 3-4 years later during the COVID-19 pandemic, and dCBT-I attenuated its association with stress reactions, specifically. Sleep reactivity may inform prevention and treatment efforts by identifying individuals at risk of impairment following stressful events.
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Recent research suggests sleep reactivity may be amenable to behavioral treatment.
“Recent research suggests sleep reactivity may be amenable to behavioral treatment [27, 37, 54, 55]”
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Reffi, A. N., Kalmbach, D. A., Cheng, P., & Drake, C. L. (2023) · Journal of Sleep Research · doi:10.1111/jsr.13892 · Cited by 25 · see citing works
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“…with high trait sleep reactivity (i.e. a predisposition to experience sleep disturbance during or after a stressful event) are more likely to experience insomnia during a period of acute stress, with insomnia more likely to persist for these individuals if the stress becomes chronic [27, 36, 37].”
Background
- Authors
- Reffi, A. N., Drake, C. L., Kalmbach, D. A., Jovanovic, T., Norrholm, S. D., Roth, T., Casement, M. D., & Cheng, P.
- Affiliations
- Henry Ford Health (US)
- Neuroscience Center for Anxiety, Stress, and Trauma (NeuroCAST), Department of Psychiatry and Behavioral Neurosciences Wayne State University School of Medicine Detroit Michigan USA
- Wayne State University (US)
- University of Oregon (US)
- Corresponding author
- Reffi, Anthony N.
- ORCID
- Venue
- Journal of Sleep Research
- Publisher
- Wiley
- Published
- 2022-08-29
- Volume
- 32
- Issue
- 1
- Pages
- e13709-e13709
- ISSN
- 0962-1105 (ISSN-L)
- 1365-2869
- PMC
- PMC9537903
- OpenAlex
- W4293660745
- Cited by
- 10
- References
- 50
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 3
- FWCI
- 2.07
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Sleep Research (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (K23HL138166)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- sleep reactivity, COVID-19 pandemic, psychological distress, stress reactions, depression, cognitive behavioral therapy for insomnia, sleep education, risk prediction
- MeSH terms
- COVID-19, Humans, Sleep Initiation and Maintenance Disorders, Prospective Studies, Sleep, Pandemics
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