Sleep (or at least a physiological period of quiescence) is a highly conserved behavior that occurs in animals ranging from fruit flies to humans.1 So a result, a substantial fraction of humans’ life is spent in this mysterious state. In the twentieth century, there was a revolution in understanding of the physiology of sleep, the importance of role of sleep and its quality influencing various other medical conditions. Sleep disruptions can be passing problem or sign of more serious underlying medical condition.2 A periodic state of rest accompanied by varying degrees of unconsciousness and relative inactivity is referred as sleep, in another way is a state in which an individual lacks conscious awareness of environment surroundings, but can be easily aroused.2,3Sleep is vital to human health and serves critically in neurobehavioral,4 cognitive5,6 and safety-related performance,7 memory consolidation,8,9 nociception10 as well appetite regulation,11 immune 12and hormonal functions.13
The American Academy of Sleep Medicine (AASM) and Sleep Research society released the recommended amount of sleep that it should be 7 or more hours per night on a regular basis to promote optimal health in adult. Sleeping less than 7hours per night on a regular basis is associated with adverse health outcomes, where as sleeping more than 9-hours per night is associated with health risk.14–16 There is strong correlation between quality of sleep and indices like occupational activities, physical and psychological well being and even death.17Feeling energetic and fit after sleeping is described as the quality sleep.18 Simply put together, sleep quality refers to how well you sleep. Panel of experts established the key indicators of good sleep quality and released by the National Sleep Foundation (NSF) actual sleeping time should be more (i.e.85%), falling asleep in less than 30 min, waking up no more than once per night and being awake for 20 minutes or less after initially falling asleep.15
Insufficient sleep is a serious problem with health consequences.2 In a survey prevalence of insomnia in Indian population, it was found to be 9% while, 30% of population reported occasional insomnia.19Insomnia is characterized by difficulty falling asleep, difficulty staying asleep, waking up too early or complaints of waking up feeling unrefreshed.2 COVID-19 pandemic has gripped and halted the world. Nepal is a country between China (the epicenter of COVID-19) and India (a recent hotspot nation for COVID-19). The exponential rise in numbers of infected cases in Nepal has lingered the lockdown, so has increased joblessness, mental stress and so on and so forth. Survey on COVID-19 impact, lockdown that disrupted sleep patterns among 1,500 respondents in India reported that 67% respondents that worked from home had altered sleep schedule, 50% believed that their sleep pattern had disrupted, 81% felt their sleep schedule will get better after lockdown.20 There are clear reciprocal dependencies between sleep duration, quality and the immune responses against viral, bacterial, and parasitic pathogens, the latter altering in turn sleep patterns, the improved sleep quality and duration in the population may mitigate the propagation and severity of disease induced by SASRS-Cov-2 infection.21
Although medical science has occupied the optimum level of success in the field of health a new challenge named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged to face, was first identified in December 2019 in Wuhan City in central China.22,23 As of May12, 2020, World Health Organization has reported that Globally confirmed cases were 4,006,257 and deaths rate were 278,892 among them 88,891 new cases and 4531 deaths in last 24 hours and unfortunately, the number is only increasing. Similarly in Regions of the Americas: 1,702,451 confirmed cases and 10,1874 deaths rate, in Western Pacific Region: 160,910 confirmed and 6,493 death rate, Eastern Mediterranean Region: 265,164 confirmed and 9013 death rate, South East Asia Region: 100,881 confirmed and 3481 death rate, African Region: 44,533 confirmed and 1415 death rate has been reported till 12th May, 2020.24 As per Ministry of Health and population of Nepal, more than 400 confirmed COVID-19 positive cases has been reported till 20th May, 2020 and it will rise up sharply.25The government of Nepal had announced nationwide total lockdown on March 24,2020 in a bid to stop the covid-19 from spreading out of control. The lockdown has totally clamped down the movement of people and shutdown of industries, schools and all other institutions except few.
Infectious disease epidemics not only affect the physical health of patients but also affect the psychological health and wellbeing of the non-infected population.26 Previous studies have shown that the prevalence of novel infectious diseases, such as severe acute respiratory syndrome (SARS), can increase anxiety, depression, and stress levels in the general population, these negative emotions directly affect sleep.27,28 During the pandemic and lockdown period, reduced physical activity and disrupted routines of people are few among the main threats to sleep patterns amid the global outbreak.29 Thinking about the COVID-19 crisis and watching news about the crisis, death of people causes stress among people, which is one of the primary causes of insomnia. Reducing TV time, increasing levels of physical activity and adhering to the same pre-lockdown work-hour routine and positive attitude towards life will improve the quality of sleep.20
A survey on changes in sleep pattern, sense of time, and digital media use during COVID-19 lockdown in Italy stated that during home confinement sleep timing markedly changed, with people going to bed and waking up later, spending more time in bed but, paradoxically, also reporting a lower sleep quality. The increase in sleep difficulties was stronger for people with a higher level of depression, anxiety, and stress symptomatology, and was associated with the feeling of time dilatation.30 A team of Chinese investigators found more than one-third of frontline health care workers responding to the coronavirus outbreak reported symptoms of insomnia. A survey on COVID-19 Health care workers and risk of insomnia presented that 36% people had symptoms of insomnia. Those patients with insomnia also reported higher levels of other health issues, for instance, 87.1% of patients with insomnia symptoms reported depression.31
Based on the previous research evidence, we have reason to speculate that the psychological condition as well sleep quality of the public may also be affected during COVID-19 outbreak in Nepal. Therefore, using a web-based cross-sectional study, we aimed to assess the impact of COVID-19 pandemic over the quality of sleep of Nepalese population. We hope that our study findings will provide data support for the targeted interventions on psychological and mental health in Nepalese public during the outbreak.