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 Table of Contents  
Year : 2021  |  Volume : 12  |  Issue : 3  |  Page : 128-131

Change in sleep-wake cycle, use of digital media and emotional wellbeing amidst COVID-19 lockdown amongst dental students in India

Department of Periodontology and Implantology, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India

Date of Submission08-Jun-2021
Date of Decision12-Aug-2021
Date of Acceptance14-Aug-2021
Date of Web Publication17-Sep-2021

Correspondence Address:
Dr. Surekha Ramrao Rathod
104, Department of Periodontology and Implantology, VSPM Dental College and Research Centre, Nagpur, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/srmjrds.srmjrds_51_21

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Background: Maharashtra is one of the major hotspots affected with COVID-19 infection in India. By imposing lockdown to implement preventive and control strategies, entire world is trying to contain the spread of this potentially fatal pandemic. Lockdown has compelled people to stay at home, refrain from their day-to-day activity and lead to drastic lifestyle changes. Aim: The aim of the study was to assess the impact of COVID-19 pandemic lockdown on sleep-wake pattern and emotional status among Bachelor of Dental Surgery undergraduate students. Materials and Methods: This observational online survey was carried out among the undergraduate students of our dental college. The question on individual sleep cycle, wake up pattern, eating habits, working hours, screen time on T.V., mobile, and laptop were addressed before and during the lockdown. The results were tabulated and analyzed using the SPSS software version 17.0. If P < 0.001, the results were reported to be statistically significant. Results: Statistical difference was observed in the usage of digital media, change in their sleep wake pattern, and eating habits among dental students during the lockdown period after applying paired test with P < 0.001. Furthermore, these unpredictable changes in their working hour, sleeping pattern, eating habits, and concern about spending time build stressful situation among students. Conclusion: It can be concluded that the dental students have increased level of stress and disturbance in sleep-wake cycle and emotional well-being during this COVID-19 lockdown.

Keywords: COVID 19, emotional aspects, sleep

How to cite this article:
Rathod SR, Gonde NP, Pandurang Kolte AA, Jadhav AN. Change in sleep-wake cycle, use of digital media and emotional wellbeing amidst COVID-19 lockdown amongst dental students in India. SRM J Res Dent Sci 2021;12:128-31

How to cite this URL:
Rathod SR, Gonde NP, Pandurang Kolte AA, Jadhav AN. Change in sleep-wake cycle, use of digital media and emotional wellbeing amidst COVID-19 lockdown amongst dental students in India. SRM J Res Dent Sci [serial online] 2021 [cited 2023 Feb 4];12:128-31. Available from:

  Introduction Top

Cases of life-threatening pneumonia were recorded in Wuhan city, China, in December 2019. A novel coronavirus was identified as the source of the infection.[1] The number of reported cases in Wuhan, as well as other Chinese cities increased rapidly.[2] The World Health Organization on January 30, 2020, declared this disease as a “Public Health Emergency of International Concern.” In India, Maharashtra state was one of the major COVID-19 hotspot and the first case of COVID-19 pandemic in Maharashtra was confirmed on March 9, 2020 and then after the whole country was under total lockdown since March 22, 2020. Many countries are now following preventive and control measures to halt the spread of this dangerous virus and so began implementing regional and national containment or lockdown measures.[3],[4] Only necessary duties such as medical, basic necessities were allowed. Public were advised to stay at home, adults were asked to work from home and students were made to attend online teaching. As the public meeting and socialisation were restricted, people developed stress due to reduced gatherings.[5],[6]

The COVID-19 outburst threatens not only physical health but also psychological resources and adaptability. The outbreak has significantly altered the rhythm of human life and burdened many countries' health-care systems in recent months.[7] Individuals who have been quarantined are more likely to experience a wide range of negative emotions, including fear, anger, guilt, and low self-esteem. Due to these people are likely to feel less safe in their physical environments.[8] Since the outbreak, the social and economic effects have been obvious in more interconnected and globalized world.[9] It is very well identified that almost all bodily functions in the living person have a 24 h (daily) difference and that these rhythms are synchronized with sleep wake as well as the day-night cycle.[10] Staying home can reduce the physical activity, increased use of mobile phone, laptop, social media and this sudden change in the lifestyle affects the normal day-today routine of young generation which increases the risk of mental health problem. Increased use of digital and social media to spend time, on the other hand, is known to have a negative impact on sleep health, reducing sleep quality and increasing daytime sleepiness.[11] It would be interesting to know how youngster's lifestyle changed and had impact on their emotional behaviour during lockdown. Hence, the purpose of the study was to evaluate the impact of COVID-19 pandemic lockdown on sleep-wake pattern and emotional status among Bachelor of Dental Surgery (BDS) students.

  Methodology Top

Study design

This observational online survey was carried out among the undergraduate students of our institute. The study was approved by the Institutional Ethics Committee VSPM Dental College and Research Center on September 18, 2020 (ECR/885/Inst/MH/2017). All procedures performed in the study were conducted in accordance with the ethical standards given in 1964 declaration of Helsinki, as revised in 2013. Online informed consent was obtained from the study participants. Convenience sampling was used in the survey. The questionnaire was prepared and validated by experts in the field. The questionnaire was mailed as Google Form link to the participants. A total of 22 questions [Figure 1] on individual sleep cycle, wake up pattern, eating habits, working hours, screen time on T.V, mobile, laptop were assessed before and during the lockdown. The questionnaire was distributed among 500 undergraduate students between May and June 2020 after the declaration of nationwide lockdown and the responses were noted. The primary outcome of the survey was to study the impact of COVID-19 pandemic lockdown on sleep-wake habit, and the secondary outcome was to study the impact of COVID-19 pandemic lockdown on emotional status of BDS undergraduate students.
Figure 1: Online questionnaire format

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Statistical analysis

Statistical analysis was performed using the SPSS software version 17.0, SPSS Inc., Chicago, IL, USA using paired t-test. P <0.001 was considered statistically significant.

  Results Top

Out of 500 undergraduates, 425 participants responded to the survey 98.3% of study participants were residing in States under Lockdown. 20.8% were having sleep/mental issues, out of which 2.6% participant were on medication for the same. 41.5% participants had disturbed sleeping pattern during lockdown.

On asking upon the average screening time (TV/laptop/mobile) before and during lockdown, it was found that average screen time duration before lockdown was less than average screen time duration during lockdown with P = 0.001 [Table 1].
Table 1: Comparison of sleeping time and screen time before and during the lockdown

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Physical activity was decreased in 60% of the individuals during lockdown. General mood status was low in 54.6% during lockdown. Eating and snacking were increased in 59.3% of individuals and appetite was increased in 43.8%. Similarly, personal relationship of individual with other family members or closed ones improved in 52% individuals however in 2.1% individuals the relationship also got worsened during this lockdown. No change was observed when asked about their quality of life in 39.1%, but the day dreaming was observed in 55.3% [Table 2].
Table 2: Comparison of lifestyle changes before and during lockdown

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  Discussion Top

In the present study, we observed that screen time was increased which was in accordance with a study done by Koeze and Popper which reported that in the USA the use of devices such as smartphones, tablets, and laptop computers increased by nearly 20% during the lockdown period.[12] It might be due to the fact that people in their homes generally rely on cyber resources for academic and professional activities during the lockdown period.

The general mood status in 60% individuals was found to be significantly low, their concern about how to spend time was increased which had an impact on their quality of life. It was in accordance with the study done by Hamaideh et al. in which the university students experienced depression, anxiety, and stress during the COVID-19 outbreak's “home-quarantine” period.[13] Alyami et al. evidenced that losing a job during the pandemic leads to a higher level of anxiety and depression among non-Saudi residents.[14] Loss of a job during a pandemic can significantly increase the vulnerability to poor quality of life. However, on contrary in an online survey by Mazza et al., among general population in Italy, reported increased levels of anxiety and stress among young people who had to work outside their residence. People employed in workplaces requiring increased contact with others, such as health-care canter's and travel stations, were likely to have higher stress levels due to fear of catching COVID-19.[15]

In our study, we have found that in some students, the personal relationship with their family got worsen during the lockdown. The economic difficulties and diminished opportunities to visit their families during the lockdown are likely to have a negative effect on their relationships with family members as reported by Kim and Park.[16] Previous studies have shown that the impact on mental health lasts longer and occurs more frequently than the disease itself, and that the psychological and economic effects can be incalculable if we grasp their quality in different contexts.[17] In past, increased indirect mortality from the other cause than Ebola itself was more significant during the Ebola outbreak, which may be due to epidemiological impacts associated with anxiety, stress, and psychological symptoms which have been increased in each point of the event, both individually and collectively.[18] Intense emotional and behavioral reactions, such as fear, boredom, loneliness and anxiety, or sleeplessness, as reported in the past have been reported in the similar situations for patients infected with COVID-19 (or suspected of being infected).[18] These conditions can lead to disorder, like feeling of depression, anxiety, psychotic, or frightening occurrences (including panic and posttraumatic stress) and even suicidal tendency. These illnesses are more common among quarantined patients, who have a higher level of psychological discomfort.[19],[20]

Uncertainty about infection and death, as well as the risk of infecting family and friends, can exacerbate dysphonic mental states in some people. Suicidal thoughts appear to have increased as a result of the pandemic and fear of infection, with tiredness having a significant impact: the more severe the sleeplessness, the greater the effect on these types of thoughts was observed in insomic individuals.[21] The social and natural environment has a great effect on one's well-being.[22]

There are several limitations to our study that ought to be noted. First, it is an observational study in which all study respondents actively participated in the questionnaire and there were no grounds for exclusion, implying that there may be bias in the selection process. Second, we were unable to determine whether COVID-19 exposure had an impact on the study participants' sleep quality.

  Conclusion Top

According to the findings of the study, mental health is an important component of overall well-being. It was observed that the dental students have increased level disturbance in sleep wake schedule and also have a impact on lifestyle-related behavior during this COVID-19 lockdown.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

She J, Jiang J, Ye L, Hu L, Bai C, Song Y. 2019 novel coronavirus of pneumonia in Wuhan, China: Emerging attack and management strategies. Clin Transl Med 2020;9:19.  Back to cited text no. 1
The Washington Post. China's Reopened Stock Markets Plunge as Coronavirus Outbreak Set to Become Pandemic. Available from: [Last accessed on 2020 Feb 03].  Back to cited text no. 2
Lu H. Drug treatment options for the 2019-new coronavirus (2019-nCoV). Biosci Trends 2020;14:69-71.  Back to cited text no. 3
Pillaiyar T, Meenakshisundaram S, Manickam M. Recent discovery and development of inhibitors targeting coronaviruses. Drug Discov Today 2020;25:668-88.  Back to cited text no. 4
World Health Organization. Mental Health and Psychosocial Considerations during the COVID-19 Outbreak. Available from: [Last accessed on 2020 Mar 18].  Back to cited text no. 5
Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health 2020;17:E1729.  Back to cited text no. 6
Sinha M, Pande B, Sinha R. Impact of COVID-19 lockdown on sleep-wake schedule and associated lifestyle related behavior: A national survey. Journal of Public Health Research 2020;9:239-45.  Back to cited text no. 7
Harper CA, Satchell LP, Fido D, Latzman RD. Functional fear predicts public health compliance in the COVID-19 pandemic. Int J Ment Health Addict 2020:1-14.  Back to cited text no. 8
McKibbin WJ, Fernando R. The global macroeconomic impacts of COVID-19: Seven scenarios. SSRN Electron J 2020;CAMA Working Paper No. 19/2020  Back to cited text no. 9
Chandrashekaran MK, Marimuthu G, Subbaraj R, Kumarasamy P, Ramkumar MS, Sripathi K. Direct correlation between the circadian sleep-wakefulness rhythm and time estimation in humans under social and temporal isolation. J Biosci 1991;16:97-101.  Back to cited text no. 10
Nag C, Pradhan RK. Impact of television on sleep habits. Biol Rhythm Res 2011;43:423-30.  Back to cited text no. 11
Koeze E, Popper N. The Virus Changed the Way We Internet. New York, NY, USA: New York Times; 2020.  Back to cited text no. 12
Hamaideh SH, Al-Modallal H, Tanash M, Hamdan-Mansour A. Depression, anxiety and stress among undergraduate students during COVID-19 outbreak and “home-quarantine”. Nurs Open 2021;00:1-9. [doi: 10.1002/nop2.918].  Back to cited text no. 13
Alyami HS, Naser AY, Dahmash EZ, Alyami MH, Al Meanazel OT, Al-Meanazel AT, et al. Depression and anxiety during 2019 coronavirus disease pandemic in Saudi Arabia: A cross-sectional study. Int J Clin Pract 2021;75:e14244.  Back to cited text no. 14
Mazza C, Ricci E, Biondi S, Colasanti M, Ferracuti S, Napoli C, et al. A nationwide survey of psychological distress among Italian people during the COVID-19 pandemic: Immediate psychological responses and associated factors. Int J Environ Res Public Health 2020;17:E3165.  Back to cited text no. 15
Kim JH, Park EC. Impact of socioeconomic status and subjective social class on overall and health-related quality of life. BMC Public Health 2015;15:1-15.  Back to cited text no. 16
Shigemura J, Ursano RJ, Morganstein JC, Kurosawa M, Benedek DM. Public responses to the novel 2019 coronavirus (2019-nCoV) in Japan: Mental health consequences and target populations. Psychiatry Clin Neurosci 2020;74:281-2.  Back to cited text no. 17
Shultz JM, Cooper JL, Baingana F, Oquendo MA, Espinel Z, Althouse BM, et al. The role of fear-related behaviors in the 2013-2016 West Africa Ebola virus disease outbreak. Curr Psychiatry Rep 2016;18:104.  Back to cited text no. 18
Xiang YT, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry 2020;7:228-9.  Back to cited text no. 19
Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ 2003;168:1245-51.  Back to cited text no. 20
Killgore WD, Cloonan SA, Taylor EC, Fernandez F, Grandner MA, Dailey NS. Suicidal ideation during the COVID-19 pandemic: The role of insomnia. Psychiatry Res 2020;290:1131-4.  Back to cited text no. 21
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  [Figure 1]

  [Table 1], [Table 2]


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