Cover: Changes in Sleep-Wake Patterns and Disturbances Before and During COVID-19 in Urban American Indian/Alaska Native Adolescents

Changes in Sleep-Wake Patterns and Disturbances Before and During COVID-19 in Urban American Indian/Alaska Native Adolescents

Published in: Behavioral Sleep Medicine, Volume 20, Issue 3, pages 343-356 (2022). doi: 10.1080/15402002.2021.2022679

Posted on Oct 9, 2023

by Wendy M. Troxel, Alina I. Palimaru, David J. Klein, Lu Dong, Daniel Dickerson, Ryan Andrew Brown, Carrie L. Johnson, Elizabeth J. D'Amico


COVID-19 has profoundly affected sleep, although little research has focused on high-risk populations for poor sleep health, including American Indian/Alaska Native (AI/AN) adolescents.


This is the first longitudinal study to examine changes in sleep with surveys completed before the pandemic and during the early months of COVID-19 in a sample of urban AI/AN adolescents (N = 118; mean age = 14 years at baseline; 63% female). We use a mixed-methods approach to explore how COVID-19 affected urban AI/AN adolescents' sleep, daily routines, and interactions with family and culture. Quantitative analysis examined whether pandemic-related sleep changes were significant and potential moderators of COVID-19's effect on sleep, including family and community cohesion and engagement in traditional practices.


Findings demonstrate changes in sleep, including increases in sleep duration, delays in bedtimes and waketimes, and increases in sleep-wake disturbances (p's <.001). Higher levels of family cohesion and higher levels of engagement in traditional practices moderated pandemic-related increases in weekday sleep duration. Qualitative analyses revealed changes in adolescents' sleep and daily behaviors, as well as strategies adolescents used to cope with pandemic-related disruptions in sleep and routines.


Findings demonstrate positive and negative changes in sleep during COVID-19 stay-at-home orders, including simultaneous increases in sleep duration and sleep-wake disturbances. Results highlight the importance of considering multi-level influences on adolescent sleep, such as early school start times, family dynamics, and cultural factors. A multi-level approach may help guide prevention and intervention efforts to improve adolescent sleep health.

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