0358 Sleep Among Transgender and Cisgender Adolescents

Abstract Introduction Sleep problems are germane to the majority of adolescents, but stigmatized youth may experience poorer sleep than those who have not experienced stigma. However, no prior studies have examined sleep among transgender adolescents (TGAs). Investigating these sleep disparities is critical, since low sleep duration and poor sleep quality are predictive of depressive symptoms and suicidality among adolescents, two mental health outcomes experienced disproportionately by TGAs. Using a nationwide survey of adolescents, we examined sleep duration, sleep quality, and rates of insufficient sleep among a sample of adolescents, and we compared those parameters between TGAs and cisgender adolescents (CGAs). Methods Adolescents (n=1784) ages 14-18 completed an anonymous survey including measures of sleep, sexual and gender identity, depressive symptoms, and demographic variables. Participants were grouped as TGA or CGA. Unadjusted associations between gender identity and sleep outcomes were examined, followed by multivariate regression models examining associations adjusted for demographics and depressive symptoms. Results TGAs reported sleeping fewer hours, higher odds of being a ‘poor sleeper’, and lower odds of getting the right amount of sleep and getting ‘enough sleep’ than CGAs. After adjusting for key demographic variables, TGAs were still more likely to report that they were poor sleepers and less likely to report getting enough sleep compared to CGAs. When adding depressive symptoms as a covariate, the finding that TGAs reported they got enough sleep less often than CGAs remained marginally significant. Conclusion Transgender adolescents reported receiving poorer sleep than cisgender adolescents. Future studies should focus on longitudinally examining the emergence of sleep problems among TGAs and CGAs, which may also serve to identify specific biopsychosocial pathways that contribute to heightened risk for sleep problems among TGAs. Sleep disparities may be a promising target for prevention and intervention programs to improve health outcomes among stigmatized youth. Support This study was funded by the University of Pittsburgh Central Research Development Fund through an award to Drs. Salk, Choukas-Bradley, and Thoma. Dr. Levenson was supported by grant K23HD087433. Dr. Thoma was supported by grants T32MH018951 and K01MH117142, Dr. Salk was supported by grant T32MH018269, and Dr. Hamilton was supported by grant T32HL082610.

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Anxiety and depressive symptoms are associated with poor sleep health during a period of COVID-19-induced nationwide lockdown: a cross-sectional analysis of adults in Jordan

BMJ Open ◽

10.1136/bmjopen-2020-041995 ◽

2020 ◽

Vol 10 (12) ◽

pp. e041995

Author(s):

Yazan A Al-Ajlouni ◽

Su Hyun Park ◽

Jude Alawa ◽

Ghaith Shamaileh ◽

Aziz Bawab ◽

...

Keyword(s):

Depressive Symptoms ◽

Sleep Quality ◽

Health Outcomes ◽

Sleep Duration ◽

Sleep Problem ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Short Sleep Duration ◽

Sleep Health ◽

Short Sleep

Background Jordan, a Middle Eastern country, declared a state of national emergency due to COVID-19 and a strict nationwide lockdown on 17 March 2020, banning all travel and movement around the country, potentially impacting mental health. This study sought to investigate the association between mental health (eg, anxiety and depressive symptoms) and sleep health among a sample of Jordanians living through a state of COVID-19-induced nationwide lockdown. Methods Using Facebook, participants (n=1240) in Jordan in March 2020 were recruited and direct to a web-based survey measuring anxiety (items from General Anxiety Disorder 7-item (GAD-7) scale instrument), depressive symptoms (items from Center for Epidemiologic Studies Depression Scale), sleep health (items from the Pittsburgh Sleep Quality Index) and sociodemographic. A modified Poisson regression model with robust error variance. Adjusted prevalence ratios (aPRs) and 95% CIs were estimated to examine how anxiety and depressive symptoms may affect different dimensions of sleep health: (1) poor sleep quality, (2) short sleep duration, (3) encountering sleep problems. Results The majority of participants reported having experienced mild (33.8%), moderate (12.9%) or severe (6.3%) levels of anxiety during lockdown, and nearly half of respondents reported depressive symptoms during lockdown. Similarly, over 60% of participants reported having experienced at least one sleep problem in the last week, and nearly half reported having had short sleep duration. Importantly, anxiety was associated with poor sleep health outcomes. For example, corresponding to the dose–response relationship between anxiety and sleep health outcomes, those reporting severe anxiety were the most likely to experience poor sleep quality (aPR =8.95; 95% CI=6.12 to 13.08), short sleep duration (aPR =2.23; 95% CI=1.91 to 2.61) and at least one problem sleep problem (aPR=1.73; 95% CI=1.54 to 1.95). Moreover, depressive symptoms were also associated with poor sleep health outcomes. As compared with scoring in the first quartile, scoring fourth quartile was associated with poor sleep quality (aPR=11.82; 95% CI=6.64 to 21.04), short sleep duration (aPR=1.87; 95% CI=1.58 to 2.22), and experiencing at least one sleep problem (aPR=1.90; 95% CI=1.66 to 2.18). Conclusions Increased levels of anxiety and depressive symptoms can negatively influence sleep health among a sample of Jordanian adults living in a state of COVID-19-induced nationwide lockdown.

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Sleep among gender minority adolescents

SLEEP ◽

10.1093/sleep/zsaa185 ◽

2020 ◽

Author(s):

Jessica C Levenson ◽

Brian C Thoma ◽

Jessica L Hamilton ◽

Sophia Choukas-Bradley ◽

Rachel H Salk

Keyword(s):

Depressive Symptoms ◽

Sleep Quality ◽

Sleep Duration ◽

Online Survey ◽

Sleep Problems ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Gender Minority ◽

Minority Adolescents ◽

Inadequate Sleep

Abstract Study Objectives Stigmatized youth experience poorer sleep than those who have not experienced stigma. However, no studies have examined the sleep of gender minority adolescents (GMAs). Examining sleep disparities between GMAs and non-GMAs is critical because poor sleep is associated with mental health outcomes experienced disproportionately by GMAs. We examined sleep duration, sleep problems, and sleep quality among our sample and compared these parameters between GMAs and non-GMAs. Methods Adolescents aged 14–18 years (n = 1,027 GMA, n = 329 heterosexual non-GMA, n = 415 sexual minority non-GMA; mean age = 16 years; 83% female sex at birth) completed a cross-sectional online survey, reporting sex assigned at birth and current gender identity, sleep duration, sleep problems (too much/too little sleep and inadequate sleep), sleep quality, and depressive symptoms. Results Accounting for demographic covariates, GMAs were more likely to report inadequate sleep and shorter sleep duration and had higher odds of reporting poor sleep quality and getting too little/too much sleep than heterosexual non-GMAs. After also adjusting for depressive symptoms, the finding that GMAs more often reported poor sleep quality remained significant. Conclusions This first large, nationwide survey of sleep among GMAs suggests that GMAs may be more likely to have poor sleep than non-GMAs. The significance of our results was reduced when adjusting for depressive symptoms, suggesting that poorer sleep may occur in the context of depression for GMAs. Future work should include objective measures of sleep, examine the emergence of sleep disparities among GMAs and non-GMAs, and explore pathways that increase risk for poor sleep among GMAs.

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Left superior temporal sulcus morphometry mediates the impact of anxiety and depressive symptoms on sleep quality in healthy adults

Social Cognitive and Affective Neuroscience ◽

10.1093/scan/nsab012 ◽

2021 ◽

Author(s):

Yanlin Wang ◽

Ping Jiang ◽

Shi Tang ◽

Lu Lu ◽

Xuan Bu ◽

...

Keyword(s):

Depressive Symptoms ◽

Sleep Quality ◽

Sleep Problems ◽

Superior Temporal Sulcus ◽

Healthy Adults ◽

Poor Sleep ◽

Emotional Symptoms ◽

Neural Basis ◽

Poor Sleep Quality ◽

The Impact

Abstract Anxiety and depressive symptoms may predispose individuals to sleep disturbance. Understanding how these emotional symptoms affect sleep quality, especially the underlying neural basis, could support the development of effective treatment. The aims of the present study were therefore to investigate potential changes in brain morphometry associated with poor sleep quality and whether this structure played a mediating role between the emotional symptoms and sleep quality. One hundred and forty-one healthy adults (69 women, mean age = 26.06 years, SD = 6.36 years) were recruited. A structural magnetic resonance imaging investigation was performed, and self-reported measures of anxiety, depressive symptoms and sleep quality were obtained for each participant. Whole-brain regression analysis revealed that worse sleep quality was associated with thinner cortex in left superior temporal sulcus (STS). Furthermore, the thickness of left STS mediated the association between the emotional symptoms and sleep quality. A subsequent commonality analysis showed that physiological component of the depressive symptoms had the greatest influence on sleep quality. In conclusion, thinner cortex in left STS may represent a neural substrate for the association between anxiety and depressive symptoms and poor sleep quality and may thus serve as a potential target for neuromodulatory treatment of sleep problems.

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THE MODERATING EFFECT OF RAISING ONE’S GRANDCHILDREN ON THE RELATION BETWEEN SLEEP AND DEPRESSION

Innovation in Aging ◽

10.1093/geroni/igz038.2505 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S678-S678

Author(s):

Melanie Stearns ◽

Danielle K Nadorff

Keyword(s):

Older Adults ◽

Risk Factor ◽

Depressive Symptoms ◽

Sleep Quality ◽

Sleep Problems ◽

Depression Scale ◽

Poor Sleep ◽

Older Individuals ◽

Poor Sleep Quality ◽

Custodial Grandparents

Abstract Recent evidence has shown that poor quality sleep is associated with depression, particularly among older individuals (Bao et al., 2017; Nadorff, Fiske, Sperry, & Petts, 2012). Moreover, given the high prevalence of depressive symptoms among older adults, it is important to identify possible risk factors of poor sleep quality. One possible risk factor is being a custodial grandparent (raising one’s grandchildren), as increased caregiving responsivities are associated with increased depressive symptoms (Brand-Winterstein, Edelstein, & Bachner, 2018). Based upon these previous findings, the current study examines the effect of custodial status on the relation between sleep quality and depressive symptoms. The sample (N = 466) was a subset of individuals recruited in the second wave of the MIDUS biomarkers project completed in 2009 who answered the sleep, caregiving, and depressive symptoms variables of interest. Measures included the Center for Epidemiological Studies Depression Scale (CESD), the Pittsburgh Sleep Quality Index (PSQI), and a question regarding custodial grandparent status. The current study aimed to examine whether poor sleep quality might serve as a risk factor for experiencing depressive symptoms and how custodial grandparents might differ from other older adults. Moderation analyses were conducted using SPSS’ Process macro on the sample. The interaction between global sleep quality and custodial grandparent status was significant in predicting depressive symptoms, t (1, 465) = 3.90, p = .04, such that custodial grandparents reported a stronger positive correlation between greater global sleep problems and depressive symptoms than non-custodial grandparents. Implications, future directions, and limitations are discussed.

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Abstract 63: Relation between Poor Sleep Quality and Resistant Hypertension

Hypertension ◽

10.1161/hyp.60.suppl_1.a63 ◽

2012 ◽

Vol 60 (suppl_1) ◽

Author(s):

Rosa Maria Bruno ◽

Laura Palagini ◽

Alessia Di Giulio ◽

Angelo Gemignani ◽

Stefano Taddei ◽

...

Keyword(s):

Depressive Symptoms ◽

Sleep Quality ◽

Sleep Duration ◽

Resistant Hypertension ◽

Antihypertensive Drugs ◽

Multiple Logistic Regression Analysis ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Short Sleep Duration ◽

Short Sleep

Purpose: Insomnia and short sleep duration have been associated with increased incidence of hypertension. However, the relationship between sleep loss and resistant hypertension (RH), has not been ascertained yet. Methods: 270 patients at first access to our Hypertension Outpatient Unit were enrolled. RH was defined according as office BP values >140/90 mmHg with 3 or more antihypertensive drugs, or controlled BP with 4 or more drugs, including a diuretic. Pittsburgh Sleep Quality Index (PSQI), and Beck Depression Inventory (BDI) were assessed. Poor sleep quality was defined as PSQI>5, mild-to-severe depressive symptoms as BDI score >10. Patients with self-reported sleep apneas or snoring were excluded (n=21). Results: Complete data were available for 234 patients (males 51%, mean age 58±13 years, BMI 26±5 kg/mq, antihypertensive treatment 84%, previous CV events 12%, diabetes 8%, smoking 15%, hypercholesterolemia 60%). Mean sleep duration was 6.4±1.6 hours, with a 49% prevalence of short sleep duration (<6 hours) and similar in both sexes. Conversely, women had higher PSQI scores (5.2 vs 3.6, p=0.03) and prevalence of poor sleep quality (46% vs 30% in men, p=0.01). Women showed also higher BDI scores (4.5 vs 1.8, p=0.006) and prevalence of depressive symptoms than men (20% vs 7%, p=0.003). RH patients (15%) had higher PSQI (5.8 vs 4.1, p=0.03), a difference shown in women (6.8 vs 4.8, p=0.04) but not in men (4.7 vs 3.5, p=0.37). The association between BDI score and RH showed a similar behavior (overall 3.6 vs 2.8, p=0.02; women 5.1 vs 3.7, p=0.03; men: 2.0 vs 1.9, p=0.53). In a multiple logistic regression analysis (including age, sex, obesity, diabetes, previous CV events, sleep duration, use of hypnotic drugs) poor sleep quality was independently associated with RH (OR 2.2, CI95% 1.1-5.3). However this relationship lost significance when also depressive symptoms were included in the model (p=0.12). Conclusions: Short sleep duration is highly prevalent in hypertensive patients. This condition is accompanied by poor sleep quality and depressive symptoms in women. Poor sleep quality is associated with a 2-fold higher probability of having RH. This association could be mediated by the presence of depressive symptoms.

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Abstract MP073: Sleep Patterns and Depression in a Diverse Sample of Women from the AHA Go Red for Women Strategically Focused Research Network (SFRN)

Circulation ◽

10.1161/circ.135.suppl_1.mp073 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Brooke Aggarwal ◽

Ming Liao

Keyword(s):

Depressive Symptoms ◽

Sleep Quality ◽

Sleep Duration ◽

Minority Women ◽

Poor Sleep ◽

Sleep Patterns ◽

Short Sleep Duration ◽

Short Sleep ◽

Long Sleep ◽

Race Ethnicity

Background: Depression has been linked to increased risk of cardiovascular disease (CVD) through biological mechanisms and altered lifestyle behaviors, possibly including short and/or long sleep duration. However the relation between specific sleep components and depressive symptoms, and interaction by race/ethnicity has not been fully defined. The purpose of this study was to determine if sleep patterns including short sleep duration, poor sleep quality, and insomnia were associated with depressive symptoms in a free-living ethnically diverse population of adult women, and if they varied by racial/ethnic status. Methods: English or Spanish speaking females between the ages of 20-79 y, participating in an observational cohort study as part of the American Heart Association Go Red for Women SFRN, were included (n=50, 56% (28 of 50) non-white, mean age = 41 ±18y). Sleep patterns were assessed using the Pittsburgh Sleep Quality Index (PSQI), a validated instrument used to measure the quality and duration of sleep in adults. Presence of insomnia was measured using the Insomnia Severity Index (ISI). Depressive symptoms were assessed using the Beck Depression Inventory (BDI-II). Linear and logistic regression models were used to evaluate cross-sectional associations between sleep patterns and depression overall, and by race/ethnicity. Results: Overall, nearly one-fifth of participants had depressive symptoms (BDI II score ≤13), 18% (9 of 50) had short sleep duration (<6 hours per night), 38% (19 of 50) had poor quality sleep (PSQI score ≥5), and 40% (20 of 50) had some level of insomnia (ISI score ≥8). Mean BDI-II scores among women who slept <6 versus ≥6 hours were significantly greater (16 versus 5, p=.0003). Higher depression scores were associated with shorter sleep duration (p=.001), poorer sleep quality (p=.03), and higher insomnia severity (p<.0001) overall. There was no association between depression and long sleep (≥8 hours). When stratified by race/ethnicity, depression was significantly associated with poor sleep quality among minority women in multivariable models adjusted for demographic confounders (OR=1.42, 95% CI=1.03-1.95), but not among non-Hispanic white women. Depression was also significantly associated with insomnia severity (p<.001), and sleep duration (p=.03) among minority women only, in multivariable adjusted models stratified by race/ethnicity. Conclusions: In this diverse sample of women, sleep problems were highly prevalent. Poor sleep quality, insomnia, and short sleep duration (but not long sleep) were associated with greater depressive symptoms among minority women but not whites. These preliminary data suggest that minority women with short sleep duration may be at heightened CVD risk from depression. Future research should determine if interventions designed to improve sleep result in decreased depressive symptoms and reduced CVD risk.

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The Impact of Sleep Timing, Sleep Duration, and Sleep Quality on Depressive Symptoms and Suicidal Ideation amongst Japanese Freshmen: The EQUSITE Study

Sleep Disorders ◽

10.1155/2016/8737654 ◽

2016 ◽

Vol 2016 ◽

pp. 1-10 ◽

Cited By ~ 17

Author(s):

Atin Supartini ◽

Takanori Honda ◽

Nadzirah A. Basri ◽

Yuka Haeuchi ◽

Sanmei Chen ◽

...

Keyword(s):

Depressive Symptoms ◽

Suicidal Ideation ◽

Sleep Quality ◽

Sleep Duration ◽

Sleep Onset ◽

Poor Sleep ◽

Sleep Onset Latency ◽

Onset Latency ◽

Poor Sleep Quality ◽

The Impact

Aim. The aim of this study was to identify the impact of bedtime, wake time, sleep duration, sleep-onset latency, and sleep quality on depressive symptoms and suicidal ideation amongst Japanese freshmen.Methods. This cross-sectional data was derived from the baseline survey of the Enhancement of Q-University Students Intelligence (EQUSITE) study conducted from May to June, 2010. A total of 2,631 participants were recruited and completed the following self-reported questionnaires: the Pittsburgh Sleep Quality Index (PSQI), the Center for Epidemiologic Studies Depression Scale (CES-D), and the original Health Support Questionnaires developed by the EQUSITE study research team.Results. Of 1,992 participants eligible for analysis, 25.5% (n=507) reported depressive symptoms (CES-D total score ≥ 16), and 5.8% (n=115) reported suicidal ideation. The present study showed that late bedtime (later than 01:30), sleep-onset latency (≥30 minutes), and poor sleep quality showed a marginally significant association with depressive symptoms. Poor sleep quality was seen to predict suicidal ideation even after adjusting for depressive symptoms.Conclusion. The current study has important implications for the role of bedtime in the prevention of depressive symptoms. Improving sleep quality may prevent the development of depressive symptoms and reduce the likelihood of suicidal ideation.

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Sleep disturbances in spousal caregivers of individuals with Alzheimer's disease

International Psychogeriatrics ◽

10.1017/s1041610207005339 ◽

2008 ◽

Vol 20 (1) ◽

pp. 149-161 ◽

Cited By ~ 60

Author(s):

Joy Creese ◽

Michel Bédard ◽

Kevin Brazil ◽

Lori Chambers

Keyword(s):

Depressive Symptoms ◽

Health Status ◽

Sleep Quality ◽

Health Outcomes ◽

Sleep Disturbances ◽

Sleep Problems ◽

Spousal Caregivers ◽

Care Recipient ◽

Dementia Caregivers ◽

Caregiver Role

ABSTRACTBackground: Although sleep problems are commonly reported among dementia caregivers, the nature and frequency of caregiver sleep disruptions, and their relationship to health status, has received little empirical attention to date.Methods: The current study investigated the sleep situations of a sample of 60 spousal caregivers currently residing with a Alzheimer disease care recipient, including the frequency of nocturnal disruptions by the care recipient, and the reasons for these disruptions. In addition, exploratory correlations were computed between caregiver sleep variables and health outcomes.Results: Some 63% of spousal caregivers reported sleep disruptions due to the nocturnal behavior of the recipients of their care. Poorer caregiver sleep quality was associated with higher frequency of nocturnal disruptions by the care recipient, the care recipient needing to use the bathroom, and wandering, higher caregiver depressive symptoms, and higher levels of caregiver role burden. The frequency of nocturnal disruptions was associated with poorer mental health status and a greater number of depressive symptoms.Conclusions: Results suggest that nocturnal disruptions by the care recipient may have adverse health consequences for spousal caregivers, and that further study of the determinants of caregiver sleep quality and health outcomes are warranted.

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Depressive Symptoms, Subjective Cognitive Decline, and Subjective Sleep Quality Are Associated with Slips and Falls: Data from the Community Health Survey in Korean Adults

Gerontology ◽

10.1159/000518007 ◽

2021 ◽

pp. 1-11

Author(s):

Ji Hee Kim ◽

Joon Ho Song ◽

Jee Hye Wee ◽

Jung Woo Lee ◽

Hyo Geun Choi

Keyword(s):

Risk Factors ◽

Depressive Symptoms ◽

Sleep Quality ◽

Cognitive Decline ◽

Sleep Problems ◽

Subjective Cognitive Decline ◽

Poor Sleep ◽

Subjective Sleep Quality ◽

Subjective Sleep ◽

Risk Factors For Falls

Background: Identifying the risk factors for falls among the elderly population is arguably one of the most imperative public health issues in the current aging society. Objectives: This study aimed to determine the associations between depressive symptoms, subjective cognitive decline (SCD), and poor subjective sleep quality and the risk of slips/falls in a Korean older population. Methods: This cross-sectional study involved 228,340 elderly individuals living in Korea. Measurements included self-reported depressive symptoms, SCD, and self-reported sleep quality. The risk of slips/falls was dichotomized depending on whether slips/falls had occurred during the past year, and the associations between different risk factors and slips/falls were explored. Multiple logistic regression was used to obtain the odds ratios (ORs) and 95% confidence intervals (CIs). Complex sampling methods were used to estimate the weighted value of each participant. Results: The risk of slips/falls was significantly associated with high levels of depressive symptoms (adjusted OR 1.06, 95% CI: 1.05–1.07) and SCD (adjusted OR 1.33, 95% CI: 1.19–1.50). Regarding each sleep quality component, the adjusted ORs for slips/falls were 1.85 for very poor sleep quality, 1.49 for long sleep latency, 1.04 for <5 h of sleep duration, 1.32 for low sleep efficiency, 2.78 for high sleep disturbance, 1.52 for the use of sleep medication ≥3 times a week, and 1.82 for high daytime dysfunction due to sleep problems compared to the respective good sleep conditions. Conclusions: Our results demonstrated that depressive symptoms, SCD, and poor subjective sleep quality are independent factors affecting the occurrence of slips/falls. Thus, efforts to manage depressive symptoms and cognitive decline early and to improve sleep quality can be an alternative strategy to decrease the likelihood of falls.

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Persistence of the Effects of the COVID-19 Lockdown on Sleep: A Longitudinal Study

Brain Sciences ◽

10.3390/brainsci11111520 ◽

2021 ◽

Vol 11 (11) ◽

pp. 1520

Author(s):

Maurizio Gorgoni ◽

Serena Scarpelli ◽

Anastasia Mangiaruga ◽

Valentina Alfonsi ◽

Maria R. Bonsignore ◽

...

Keyword(s):

Depressive Symptoms ◽

Sleep Quality ◽

Online Survey ◽

Sleep Problems ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Final Sample ◽

Sleep Arousal ◽

Related Stress ◽

Restrictive Measures

The effects of the COVID-19 pandemic on sleep have been widely documented, but longitudinal evaluations during different phases of the “COVID-19 era” are needed to disentangle the specific consequences of the r145estrictive measures on sleep variables. The aim of this study was to assess the immediate effect of the lockdown’s end on sleep and sleep-related dimensions in an Italian sample, also considering the stress and depressive symptoms. We used an online survey to longitudinally collect data on sociodemographic, environmental, clinical, sleep, and sleep-related variables in two time points: during and immediately after the lockdown. The final sample included 102 participants. The large prevalence of poor sleep quality, clinically relevant pre-sleep arousal, and depressive symptoms, as well as poor sleep quality and pre-sleep arousal score observed during the lockdown, remained stable after its end. On the other hand, the prevalence of moderate-to-severe event-related stress and intrusive symptom scores exhibited a drastic reduction after the end of home confinement. Both bedtime and rise time were anticipated after the lockdown, while sleep quality exhibited only a trend of post-lockdown sleep disturbance reduction. Our findings point to a reduced stress level (specific for the intrusive symptomatology) after the end of the lockdown and persistence of sleep problems, suggesting two non-mutually exclusive hypotheses: (a) the strict restrictive measures are not the main cause of sleep problems during the pandemic and (b) home confinement induces long-lasting effects on sleep observable after its end, and a longer period of time might be needed to observe an improvement.

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