{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T18:02:37Z","timestamp":1785175357108,"version":"3.55.0"},"reference-count":50,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int. J. Environ. Res. Public Health","IJERPH"],"abstract":"<jats:p>Major societal stressors such as pandemics and economic crises can significantly disrupt individual well-being through altered sleep patterns. This study uses a mixed-methods approach to explore the underlying causes and consumption expressions of sleep disturbance during the COVID-19 lockdown. Based on qualitative responses from 59 participants, the findings reveal three core disturbance patterns: delayed sleep schedules, increased sleep duration, and sleep restriction. These shifts were associated with a combination of emotional arousal, cognitive overload, and disrupted routines. Two dominant types of pre-sleep thought processes\u2014pressing and comforting\u2014appear to influence sleep outcomes. Despite the availability of mindfulness and guided-meditation technologies, most participants did not adopt these tools, citing either skepticism or inertia. The proposed model highlights the interplay between personal traits, pre-sleep behavior, and stress responses in shaping sleep. The study offers implications for public health initiatives, suggesting that targeted and accessible interventions are needed to support sleep health during a major stressor.<\/jats:p>","DOI":"10.3390\/ijerph23080969","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T17:16:34Z","timestamp":1785172594000},"page":"969","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Understanding Sleep Disturbance Due to Stressors: An Exploratory Mixed-Methods Study During the COVID-19 Pandemic"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7630-5260","authenticated-orcid":false,"given":"Muhammad","family":"Aljukhadar","sequence":"first","affiliation":[{"name":"Olayan School of Business, American University of Beirut, Bliss Street, Beirut 1107 2020, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"100916","DOI":"10.1016\/j.eclinm.2021.100916","article-title":"Sleep problems during COVID-19 pandemic and its\u2019 association to psychological distress: A systematic review and meta-analysis","volume":"36","author":"Alimoradi","year":"2021","journal-title":"EClinicalMedicine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"299","DOI":"10.5664\/jcsm.8930","article-title":"Sleep problems during the COVID-19 pandemic by population: A systematic review and meta-analysis","volume":"17","author":"Jahrami","year":"2021","journal-title":"J. Clin. Sleep Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"45","DOI":"10.5664\/jcsm.8800","article-title":"Escalation of sleep disturbances amid the COVID-19 pandemic: A cross-sectional international study","volume":"17","author":"Mandelkorn","year":"2021","journal-title":"J. Clin. Sleep Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1080\/07420528.2020.1786107","article-title":"COVID-19 pandemic and lockdown: Cause of sleep disruption, depression, somatic pain, and increased screen exposure of office workers and students of India","volume":"37","author":"Majumdar","year":"2020","journal-title":"Chronobiol. Int."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Gualano, M.R., Lo Moro, G., Voglino, G., Bert, F., and Siliquini, R. (2020). Effects of Covid-19 lockdown on mental health and sleep disturbances in Italy. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17134779"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1590\/1516-4446-2020-0008","article-title":"\u201cPandemic fear\u201d and COVID-19: Mental health burden and strategies","volume":"42","author":"Ornell","year":"2020","journal-title":"Braz. J. Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Franceschini, C., Musetti, A., Zenesini, C., Palagini, L., Scarpelli, S., Quattropani, M.C., Lenzo, V., Freda, M.F., Lemmo, D., and Vegni, E. (2020). Poor sleep quality and its consequences on mental health during the COVID-19 lockdown in Italy. Front. Psychol., 11.","DOI":"10.3389\/fpsyg.2020.574475"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.sleep.2020.05.011","article-title":"The enemy who sealed the world: Effects quarantine due to the COVID-19 on sleep quality, anxiety, and psychological distress in the Italian population","volume":"75","author":"Casagrande","year":"2020","journal-title":"Sleep Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"249","DOI":"10.31887\/DCNS.2003.5.3\/lstaner","article-title":"Sleep and anxiety disorders","volume":"5","author":"Staner","year":"2003","journal-title":"Dialogues Clin. Neurosci."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Li, D.J., Ko, N.Y., Chen, Y.L., Wang, P.W., Chang, Y.P., Yen, C.F., and Lu, W.H. (2020). COVID-19-related factors associated with sleep disturbance and suicidal thoughts among the Taiwanese public: A Facebook survey. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17124479"},{"key":"ref_11","first-page":"e923921-1","article-title":"Social capital and sleep quality in individuals who self-isolated for 14 days during the coronavirus disease 2019 (COVID-19) outbreak in January 2020 in China","volume":"26","author":"Xiao","year":"2020","journal-title":"Med. Sci. Monit. Int. Med. J. Exp. Clin. Res."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Li, Y., Gu, S., Wang, Z., Li, H., Xu, X., Zhu, H., Deng, S., Ma, X., Feng, G., and Wang, F. (2019). Relationship between stressful life events and sleep quality: Rumination as a mediator and resilience as a moderator. Front. Psychiatry, 10.","DOI":"10.3389\/fpsyt.2019.00348"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"110371","DOI":"10.1016\/j.paid.2020.110371","article-title":"COVID-19 related loneliness and sleep problems in older adults: Worries and resilience as potential moderators","volume":"168","author":"Grossman","year":"2021","journal-title":"Personal. Individ. Differ."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Du, C., Zan, M.C.H., Cho, M.J., Fenton, J.I., Hsiao, P.Y., Hsiao, R., Keaver, L., Lai, C.-C., Lee, H., and Ludy, M.-J. (2021). The Effects of Sleep Quality and Resilience on Perceived Stress, Dietary Behaviors, and Alcohol Misuse: A Mediation-Moderation Analysis of Higher Education Students from Asia, Europe and North America during the COVID-19 Pandemic. Nutrients, 13.","DOI":"10.3390\/nu13020442"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.smrv.2014.08.002","article-title":"Protective and risk factors for adolescent sleep: A meta-analytic review","volume":"21","author":"Bartel","year":"2015","journal-title":"Sleep Med. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"zsaa179","DOI":"10.1093\/sleep\/zsaa179","article-title":"COVID-19-related mobility reduction: Heterogenous effects on sleep and physical activity rhythms","volume":"44","author":"Ong","year":"2021","journal-title":"Sleep"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Stanton, R., To, Q.G., Khalesi, S., Williams, S.L., Alley, S.J., Thwaite, T.L., Fenning, A.S., and Vandelanotte, C. (2020). Depression, anxiety and stress during COVID-19: Associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17114065"},{"key":"ref_18","unstructured":"Kemp, S. (2025, September 01). Report: Most Important Data on Digital Audiences During Coronavirus. Available online: https:\/\/thenextweb.com\/news\/report-most-important-data-on-digital-audiences-during-coronavirus."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Ingram, J., Maciejewski, G., and Hand, C.J. (2020). Changes in diet, sleep, and physical activity are associated with differences in negative mood during COVID-19 lockdown. Front. Psychol., 11.","DOI":"10.3389\/fpsyg.2020.588604"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Sa\u00f1udo, B., Fennell, C., and S\u00e1nchez-Oliver, A.J. (2020). Objectively-assessed physical activity, sedentary behavior, smartphone use, and sleep patterns pre- and during-COVID-19 quarantine in young adults from Spain. Sustainability, 12.","DOI":"10.3390\/su12155890"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"R930","DOI":"10.1016\/j.cub.2020.07.015","article-title":"Effects of lockdown on human sleep and chronotype during the COVID-19 pandemic","volume":"30","author":"Leone","year":"2020","journal-title":"Curr. Biol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e13074","DOI":"10.1111\/jsr.13074","article-title":"Changes in sleep pattern, sense of time and digital media use during COVID-19 lockdown in Italy","volume":"29","author":"Cellini","year":"2020","journal-title":"J. Sleep Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"R795","DOI":"10.1016\/j.cub.2020.06.021","article-title":"Effects of the COVID-19 lockdown on human sleep and rest-activity rhythms","volume":"30","author":"Blume","year":"2020","journal-title":"Curr. Biol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1080\/14427591.2023.2271485","article-title":"Pre-sleep routines in adult typical sleepers","volume":"31","author":"Koketsu","year":"2024","journal-title":"J. Occup. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.jpsychires.2017.10.015","article-title":"Blocking nocturnal blue light for insomnia: A randomized controlled trial","volume":"96","author":"Shechter","year":"2018","journal-title":"J. Psychiatr. Res."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Gringras, P., Middleton, B., Skene, D.J., and Revell, V.L. (2015). Bigger, brighter, bluer-better? Current light-emitting devices\u2013Adverse sleep properties and preventative strategies. Front. Public Health, 3.","DOI":"10.3389\/fpubh.2015.00233"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1080\/10410236.2017.1422099","article-title":"Altering adolescents\u2019 pre-bedtime phone use to achieve better sleep health","volume":"34","author":"Bartel","year":"2019","journal-title":"Health Commun."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.smrv.2014.07.007","article-title":"Screen time and sleep among school-aged children and adolescents: A systematic literature review","volume":"21","author":"Hale","year":"2015","journal-title":"Sleep Med. Rev."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.5664\/jcsm.6704","article-title":"Binge viewing, sleep, and the role of pre-sleep arousal","volume":"13","author":"Exelmans","year":"2017","journal-title":"J. Clin. Sleep Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"112954","DOI":"10.1016\/j.psychres.2020.112954","article-title":"Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: A web-based cross-sectional survey","volume":"288","author":"Huang","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.1177\/00332941221079723","article-title":"Generalized Anxiety Mediates the Relationship Between Loneliness and Sleep Quality Amongst Young Adults During the COVID-19 Pandemic","volume":"126","author":"Grey","year":"2023","journal-title":"Psychol. Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1177\/1359105314540014","article-title":"Bedtime procrastination: A self-regulation perspective on sleep insufficiency in the general population","volume":"21","author":"Kroese","year":"2016","journal-title":"J. Health Psychol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"231","DOI":"10.3200\/JACH.54.4.231-237","article-title":"Development and evaluation of the Sleep Treatment and Education Program for Students (STEPS)","volume":"54","author":"Brown","year":"2006","journal-title":"J. Am. Coll. Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e13052","DOI":"10.1111\/jsr.13052","article-title":"Dealing with sleep problems during home confinement due to the COVID-19 outbreak: Practical recommendations from a task force of the European CBT-I Academy","volume":"29","author":"Altena","year":"2020","journal-title":"J. Sleep Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1038\/s41398-020-00913-3","article-title":"Psychological health, sleep quality, and coping styles to stress facing the COVID-19 in Wuhan, China","volume":"10","author":"Fu","year":"2020","journal-title":"Transl. Psychiatry"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1007\/s00415-020-10056-6","article-title":"Impact of COVID-19 lockdown on sleep quality in university students and administration staff","volume":"268","author":"Marelli","year":"2021","journal-title":"J. Neurol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"R797","DOI":"10.1016\/j.cub.2020.06.022","article-title":"Sleep in university students prior to and during COVID-19 stay-at-home orders","volume":"30","author":"Wright","year":"2020","journal-title":"Curr. Biol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e13439","DOI":"10.1111\/jsr.13439","article-title":"Nightmare Content During the COVID-19 Pandemic: Influence of COVID-Related Stress and Sleep Disruption","volume":"31","author":"Kennedy","year":"2022","journal-title":"Sleep"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e13300","DOI":"10.1111\/jsr.13300","article-title":"Pandemic nightmares: Effects on dream activity of the COVID-19 lockdown in Italy","volume":"30","author":"Scarpelli","year":"2021","journal-title":"J. Sleep Res."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Musse, F.C.C., de Siqueira Castro, L., Sousa, K.M.M., Mestre, T.F., Teixeira, C.D.M., Pelloso, S.M., Poyares, D., and de Barros Carvalho, M.D. (2020). Mental violence: The COVID-19 nightmare. Front. Psychiatry, 11.","DOI":"10.3389\/fpsyt.2020.579289"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Huberty, J.L., Green, J., Puzia, M.E., Larkey, L., Laird, B., Vranceanu, A.M., Vlisides-Henry, R., and Irwin, M.R. (2021). Testing a mindfulness meditation mobile app for the treatment of sleep-related symptoms in adults with sleep disturbance: A randomized controlled trial. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0244717"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e299","DOI":"10.1002\/smi.1370","article-title":"The effects of a mindfulness-based stress reduction programme on pre-sleep cognitive arousal and insomnia symptoms: A pilot study","volume":"27","author":"Cincotta","year":"2011","journal-title":"Stress Health"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Daud\u00e9n Roquet, C., and Sas, C. (2018). Evaluating mindfulness meditation apps. Extended Abstracts of the 2018 CHI Conference on Human Factors in Computing Systems, ACM.","DOI":"10.1145\/3170427.3188616"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"163","DOI":"10.5664\/jcsm.7598","article-title":"Consumer sleep technologies: How to balance the promises of new technology with evidence-based medicine and clinical guidelines","volume":"15","author":"Khosla","year":"2019","journal-title":"J. Clin. Sleep Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1111\/j.1365-2869.2008.00732.x","article-title":"Sleep duration and mortality: A systematic review and meta-analysis","volume":"18","author":"Gallicchio","year":"2009","journal-title":"J. Sleep Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1080\/10543409108835014","article-title":"One-sided and two-sided tests and \u03c1 values","volume":"1","author":"Koch","year":"1991","journal-title":"J. Biopharm. Stat."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Semertzidis, N.A., Sargeant, B., Dwyer, J., Mueller, F.F., and Zambetta, F. (2019, January 4\u20139). Towards understanding the design of positive pre-sleep through a neurofeedback artistic experience. Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems, Scotland, UK.","DOI":"10.1145\/3290605.3300804"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1002\/smi.2468","article-title":"Are better sleepers more engaged workers? A self-regulatory approach to sleep hygiene and work engagement","volume":"29","author":"Barber","year":"2013","journal-title":"Stress Health"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/j.sleep.2015.02.001","article-title":"High-frequency heart rate variability during worry predicts stress-related increases in sleep disturbances","volume":"16","author":"Gouin","year":"2015","journal-title":"Sleep Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1007\/s12160-013-9503-9","article-title":"Using mental imagery to deliver self-regulation techniques to improve sleep behaviors","volume":"46","author":"Loft","year":"2013","journal-title":"Ann. Behav. Med."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/8\/969\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T17:17:49Z","timestamp":1785172669000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/8\/969"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,27]]},"references-count":50,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["ijerph23080969"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23080969","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,27]]}}}