Simon J. Williams and Rob Meadows
All our lives all are affected by the coronavirus crisis one way or another, whether we get it or not. Each day brings news of newly confirmed cases, the latest death tolls, the heroic efforts of key workers on the frontline, the stresses and strains of life on the home front, patients fighting for their lives in intensive care, and the wider social and economic effects of the pandemic.
But what about our sleep? What impact is the coronavirus crisis having on our sleep, good, bad or somewhere in between? This is an important question in more ways than one. Sleep after all is a critical public health and safety issue for us all, with poor sleep linked to a range of negative health outcomes. It is also closely associated with stress, anxiety and other mental health problems, and a safety critical issue too, not least for those on the front line who may be struggling to get the sleep they need and deserve, even when their heads do touch the pillow. So what do we know, and what can we guess the sleep impacts might be, both short and long term?
What we know so far
News is now starting to emerge from China on the sleep and mental health impacts of crisis, where insomnia and a rise in anxiety have emerged as big problems. Some early Chinese studies are also now reporting that increased social capital improved sleep quality during self-isolation by reducing anxiety and stress and that medical staff treating patients with Covid-19 during the months of January and February had levels of stress, anxiety and self-efficacy that were linked to sleep quality and social support.
Other findings suggest that people may be sleeping more than usual. Findings from the COVID-19 Pulse study, for example, found that people in the US were sleeping more. Fitbit too have used their data to examine sleep during lockdown. They report that: “For the most part, people are going to bed later but getting more sleep, as well as more quality rest. For those whose quality of sleep has improved, they have been spending more time in deep and REM sleep”.
These findings however contrast with a Kings’ College London Ipsos MORI survey of 2250 people in the UK between 1-3 April 2020 which found that almost half (49%) of those surveyed said they felt ‘more anxious and depressed’ than normal with over a third (38%) saying they have ‘slept less well’ and 19% drinking ‘more alcohol’. Social media discussion threads too have been circulating which suggest that people are feeling tired and weary from the lockdown already, regardless of much sleep they are getting.
Advice and recommendations meanwhile are starting to appear on how to manage our sleep problems during the crisis, including those staff on the frontline where sleep is in short supply. Of particular note, a task force of the European CBT-I Academy recently released comprehensive guidelines.
As for those patients in hospital with the virus, we know how desperately tired and exhausted the virus leaves those fighting it, not to mention the staff treating them, and how much sleep patients need when discharged, including the Prime Minster just out of hospital who has been told to rest. For those families sadly bereaved however, then sleep will doubtless be hard and in short supply.
All in all then a mixed picture so far depending on where you look, with some sources suggesting people are getting more sleep than usual and others highlighting the sleep problems associated with the lockdown and bereavement.
What’s missing here?
What’s missing however from these statistics and stories, responses and recommendations so far is any sustained consideration of the likely impacts of the crisis on existing and future sleep inequalities, both short and long-term. The closest we get to this so far indeed are the aforementioned Chinese studies which don’t address things like socio-economic status (SES), but which nevertheless underline the need for more research of this kind on sleep differentials both during and following confinement, including the role which sleep plays as a mediator of health inequalities.
As for socio-economic differentials in sleep, well previous research prior to the coronavirus crisis points to significant and enduring effects. Findings from the ESRC Understanding Society Survey for example, clearly suggest that the employed sleep better than the unemployed. Differing job types also affect sleep, with those in routine occupations reporting worse sleep than professionals. Job satisfaction likewise affects sleep quality, with 33% of those most dissatisfied reporting poor sleep quality compared to only 18% of the most satisfied.
A sizeable body of sociological research also now highlights important gender differences in sleep, with women more disadvantaged than men as a consequence of both their caring roles within and beyond the home and the sleep disruption of their partners. The adverse impacts of volatile relationships and domestic violence on women and their children’s sleep also weigh heavily on the balance sheet, as our previous research suggests. And yes, research also now points to significant ethnic sleep inequalities too. Research in the US, for example, reports a significant gap between black and white Americans.
These findings in turn are part of a wider corpus of research, both past and present, which points to persistent and in some cases widening health gaps according to factors such as material circumstances, education, occupation, income, gender and ethnicity. It’s shocking but hardly surprising on this count that news has just broken that the coronavirus ‘doesn’t discriminate’ mantra is far from the whole story. We know already, for example, that men are more at risk of mortality than women at any age. Statistics are also now appearing, as we write, that coronavirus is hitting those from black and minority ethnic backgrounds the hardest in American states such as Chicago, New York, Detroit and New Orleans.
Will Sleep Gaps Widen?
Whether these sleep gaps are likely to widen during the crisis, after the crisis, or both, is of course unclear at the moment. Time and data will tell. What is needed for now however, is to think of the possibilities and plausible hypotheses to ensure that data are being collected which will enable us to do the future fine-gained analysis on these questions and issues. The data which gets collected will depend on what people think is important. And we would normally have user consultations on this count, but everything is moving so fast at the moment that important questions and issues may get missed out. The ONS, for example, are already adapting their surveys with covid-19 questions in mind.
So what might these possibilities and plausible hypotheses be?
One possibility, albeit unlikely, is that these sleep gaps reduce or cancel out as a consequence of the crisis, resulting in a flattening effect. A case, in other words, of the ‘Shared burdens of worry’ — or new burdens for those in higher SES groups to be precise.
A second possibility, and probably the most likely, is that these sleep gaps persist or widen as a consequence of the crisis, both short and long-term. A global recession after all is already predicted, with the World Economic Forum now claiming the 2008 crisis was simply a ‘dry run’ of what’s to come. And as we already know, the worst of these economic impacts tend to hit the poorest the hardest with knock on effects for sleep and health through stress, worry and associated health risking behaviours and lifestyles. Women too are more likely to be adversely affected on these counts than men, given women tend to be more economically disadvantaged and have more caring roles and responsibilities within and beyond the home. To the extent moreover that ethnic minority groups experience higher levels of social and economic disadvantage and discrimination, as well as disproportionate impacts of the virus as the latest news suggest, then again we can expect significant knock on impacts on sleep and health in both the short and long term.
A third possibility, which could equally well materialise, is that new sleep inequalities emerge as a consequence of the crisis, beyond existing or widening SES gender and ethnic differentials that is. It is difficult to know right now, for obvious reasons, what these might be but important all the same to keep an eye on in future as part and parcel of wider public health and social inequalities agendas.
Why’s sleep political – and what can be done to address these gaps?
Drawing attention to these relationships between sleep other social inequalities and health disparities also makes clear that sleep is not simply a personal or private matter but a political matter through and through. A question of social justice indeed, as Lauren Hale has cogently and tirelessly argued, and hence another prime example of what C. Wright Mills in The Sociological Imagination termed the link between private troubles and broader public issues of social structure.
As for what can be done about these sleep inequalities, well that of course depends on how things pan out sleep-wise in the short and longer term post-coronavirus. To the extent however that these sleep gaps are socially determined and persist or widen in the aftermath of the coronavirus crisis, then effectively tackling them requires upstream action. Not just a downstream individual matter of pills or psy-therapies of the CBTi kind, in other words, however helpful they may be for those struggling with their sleep here and now, but of political will and public policy to tackle the upstream social determinants of these sleep disparities, including the social, structural and societal roots and drivers of these problems in contemporary capitalism and neoliberal societies and a commitment on the part of government to reduce or remove inequalities and injustices of these kinds in future. Measures too, at an institutional level, to help tackle or prevent sleep problems across the social scale, from later school start times in some US states, to more flexible sleep-friendly work schedules, including shifts to better synchronise with our body clocks and chronotypes.
Sleep then, on these counts, becomes another useful way of thinking through what the world could and will look like post-coronavirus, including the differing possible futures at stake here.
What Now? An Invitation
Let us end therefore with an invitation of sorts to join the sleep and society debate by:
Adding sleep inequalities to current and subsequent debates about the costs and consequences of the coronavirus crisis and joining the dots in so doing.
Asking the right questions in current and future planned Covid-19 research which enable us to address potential sleep inequalities through more detailed fine-grained analysis of the kind discussed above.
Tracking sleep inequalities over time and tackling the socially determined gaps through upstream not just downstream solutions in the name of public health and social justice. A distant dream perhaps but one which is certainly feasible and far from fanciful.
Sociology and the social sciences then, to conclude, have a critical role to play in these developments and debates regarding sleep disparities both now and in future beyond the Coronavirus crisis. The politics of sleep indeed.
Simon J. Williams is Emeritus Professor of Sociology at the University of Warwick. Rob Meadows is Reader in Sociology at the University of Surrey.