
==== Front
Nurs Open
Nurs Open
10.1002/(ISSN)2054-1058
NOP2
Nursing Open
2054-1058
John Wiley and Sons Inc. Hoboken

10.1002/nop2.70013
NOP270013
NOP-2023-Aug-1656.R3
Empirical Research Quantitative
Empirical Research Quantitative
Impact of COVID‐19 lockdown on sleep patterns and the related problems among nursing students
Elbilgahy et al.
Elbilgahy Amal Ahmed https://orcid.org/0000-0002-0465-6061
1 2
Alanazi Areej Musaad 3 4
Alrawili Badriah Mefrh 5
Alenezi Rawan Mamdouh 3 6
Alanazi Rawan Fahad 3 4
Alanazi Amal Khulaif 3 4
Fawzy Manal S. https://orcid.org/0000-0003-1252-8403
7 8 manal2_khashana@ymail.com
manal_mohamed@med.suez.edu.eg

1 Department of Maternal and Child Health Nursing, Faculty of Nursing Northern Border University Arar Saudi Arabia
2 Department of Pediatric Nursing, Faculty of Nursing Mansoura University Mansoura Egypt
3 Faculty of Nursing Northern Border University Arar Saudi Arabia
4 Department of Neonatal Intensive Care Unit Maternity and Children Hospital, Ministry of Health Arar Saudi Arabia
5 Department of Pediatric Emergency, Maternity and Children's Hospital Arar Saudi Arabia
6 Department of Intensive Care Unite North Medical Tower Hospital, Ministry Of Health Arar Saudi Arabia
7 Department of Biochemistry, College of Medicine Northern Border University Arar Saudi Arabia
8 Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine Suez Canal University Ismailia Egypt
* Correspondence
Manal S. Fawzy, Department of Biochemistry, College of Medicine, Northern Border University, Arar, Saudi Arabia.
Email: manal2_khashana@ymail.com and manal_mohamed@med.suez.edu.eg

23 9 2024
9 2024
11 9 10.1002/nop2.v11.9 e7001302 7 2024
26 8 2023
04 8 2024
© 2024 The Author(s). Nursing Open published by John Wiley & Sons Ltd.
https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Abstract

Aim

To evaluate the impact of the COVID‐19 lockdown on sleep patterns and quality among nursing students in our college.

Design

A cross‐sectional study was carried out.

Methods

A total of 302 nursing students aged 18–25 years, representing both genders and various academic levels, participated in this study. A pre‐validated, self‐administered questionnaire was used to assess sleep quality during COVID‐19 and it was distributed through various social media platforms for data collection.

Results

Female students comprised the majority (92.1%) of participants. Of 332 nursing students, 302 completed the questionnaire, yielding a 91% response rate. Statistically significant differences were observed before and during the COVID‐19 lockdown regarding the need to sleep after waking, feeling refreshed upon waking, satisfaction with individual sleep patterns and experiencing restless and troubled sleep (p = 0.001). Additionally, approximately one‐third of nursing students (32.9%) reported poor sleep quality during the COVID‐19 pandemic, with minimal impact on the total sleep hours among the studied cohorts.

Public Contribution

The COVID‐19 pandemic has statistically significant impacted nursing students' sleep quality and levels. Acknowledging these challenges and planning for providing supporting measurements is essential to ensuring that nursing students can maintain their physical and mental health, which is critical for their ability to provide quality healthcare.

COVID‐19
nursing students
sleep
Sleep Quality Assessment Scale
Deanship of Scientific Research, Northern Border UniversityNBU‐FFR‐2024‐3039‐01 source-schema-version-number2.0
cover-dateSeptember 2024
details-of-publishers-convertorConverter:WILEY_ML3GV2_TO_JATSPMC version:6.4.8 mode:remove_FC converted:23.09.2024
Elbilgahy, A. A. , Alanazi, A. M. , Alrawili, B. M. , Alenezi, R. M. , Alanazi, R. F. , Alanazi, A. K. , & Fawzy, M. S. (2024). Impact of COVID‐19 lockdown on sleep patterns and the related problems among nursing students. Nursing Open, 11 , e70013. 10.1002/nop2.70013
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pmc1 INTRODUCTION

The coronavirus disease 2019 (COVID‐19) has been declared an international emergency by the World Health Organization (WHO) (WHO, 2020). The rapid spread of the disease has caused unprecedented restrictions to be implemented to control its spread and mitigate its impact (Gildersleeve et al., 2022). These measures included social distancing and the closure of schools, universities, retirement homes and sports venues and restricting movement in heavily affected areas (Fawzy & AlSadrah, 2022). For university students, this resulted in statistically significant lifestyle changes, particularly concerning their academic routines. Many students experienced sleep quality disorders, which adversely affected their academic success and were often linked to mental health issues (Xie et al., 2020). Sleep quality is critical for physical and mental well‐being, happiness and vitality. Without sufficient restorative sleep, individuals cannot function, study, develop or interact effectively (Mahfouz et al., 2020). Therefore, understanding what determines perceived sleep quality is essential, as it can indicate sleep problems and other health consequences (Kohyama, 2021).

On March 9, 2021, the Ministry of Education in Saudi Arabia announced the closure of all schools and universities across the Kingdom, including both public and private educational institutions and technical and vocational training centers (Sayed, 2021). Despite Saudi Arabia being a forerunner in implementing initial precautions such as curfews and total restrictions during the COVID‐19 pandemic, these measures statistically significant disrupted various sectors, particularly the educational sector (Sayed, 2021). To address these challenges, the ‘Ministry of Education’ swiftly transitioned to online education (Al‐Khresheh, 2022).

Sleep is an active, functional, reversible and cyclical state characterized by specific behaviours like increased threshold reactions to outside stimuli and relative immobility. It affects both the body and the mind (Silva et al., 2016). Sleep is a vital physiological need that must be met to sustain life. It is essential for human health and well‐being, allowing the body to relax, restore itself physically and protect against the wear and tear of waking hours. Sleep also induces changes in brain waves that contribute to relaxation, memory consolidation, learning, critical thinking, decision‐making and academic performance (Diekelmann, 2014). University students, when transitioning to a new environment with greater responsibilities, increased pressure and more chaotic schedules, often experience changes that affect their sleep quality (Elbilgahy et al., 2021).

During sleep, the body cools down, the muscles relax profoundly, the eyes move and breathing rate, hormone levels and heartbeat rhythm alter. Common sleep disorders range from insufficient sleep duration to poor daytime functioning (Chattu et al., 2018). These sleep disturbances have a well‐documented impact on the entire population but have increased with the COVID‐19 pandemic lockdown, particularly among students (Marelli et al., 2021). According to recent study, undergraduate students in various disciplines, including nursing, experienced poor sleep quality as their sleep habits adjusted to align with virtual education (Semsarian et al., 2021). Nursing students are especially prone to unhealthy lifestyles due to high academic loads and poor time management skills (Quina Galdino et al., 2020), making them more susceptible to sleep disorders and their consequences (Copaja‐Corzo et al., 2022). College students often sleep for shorter periods during the week than on weekends due to sleep deprivation during academic or workdays, which might detrimentally affect their health (Salvi et al., 2020). The shortened sleep–wake cycle may result from anxiety related to achieving high academic performance, poor eating habits, irregular physical activity, substance use and demanding academic schedules (Salvi et al., 2020). Given the limited studies in our region addressing this issue, this study aims to explore the effect of the COVID‐19 lockdown on sleep patterns/quality before and during the lockdown among nursing students at our university using a validated questionnaire as the data collection tool.

2 SUBJECTS AND METHODS

2.1 Research design

A cross‐sectional research design was applied to fulfil the aim of the study.

2.2 Study setting

This research study was conducted in the Faculty of Nursing at our University during the academic year 2021–2022.

2.3 Sampling and participant characteristics

We employed a non‐probability convenience sampling design to recruit 302 nursing students of various academic levels, including interns, from both genders. With a total population of 332 nursing students in the academic year, our response rate was nearly 91%. Our sample primarily consisted of students engaged in remote learning who also experienced statistically significant, albeit reduced, in‐person hospital training during the pandemic. Additionally, some students voluntarily participated in community initiatives such as COVID‐19 immunizations and screening programs. Although these volunteer activities were not part of the formal curriculum, they provided invaluable frontline exposure and highlighted the students' dedication to their professional responsibilities during a public health crisis.

2.4 Tools of data collection

The validated ‘Sleep Quality Assessment Scale’ was used to evaluate the sleep quality of nursing students during COVID‐19 (Supplementary file—Data S1) (Shahid et al., 2011). The scale comprises 28 items that assess six domains of sleep quality: daytime symptoms, restoration after sleep, problems initiating and maintaining sleep, difficulty waking and sleep satisfaction. The questionnaire included two sections: The first section gathers the socio‐demographic characteristics of the participants, including age, marital status, academic year, residence and the number of sleep hours during and after the lockdown. The second section focuses on sleep duration and quality before and after the pandemic. Participants were asked to indicate the frequency of certain sleep behaviours on a scale from 0 to 3 (0 = ‘few,’ 1 = ‘sometimes,’ 2 = ‘often,’ and 3 = ‘almost always’).

Responses for items related to factors 2 (restoration after sleep) and 5 (satisfaction with sleep) were reverse‐scored before being tallied. The total scores ranged from 0 to 84, with higher scores indicating more severe sleep quality disorders.

2.5 Reliability and validity

The validity of the adopted survey was verified and the researchers reviewed the translation to ensure accuracy. The test–retest reliability of the adopted scale was assessed using Cronbach's alpha, which yielded an alpha coefficient of 0.81, indicating good reliability.

2.6 Pilot study

A pilot study was conducted with 30 students (10% of the calculated study sample) to assess the feasibility, applicability and clarity of the tool within our specific context. Since this pilot study was solely to validate the questionnaire's applicability and did not involve any interventions, we included these participants in the total study sample. These students raised no concerns or issues regarding the questionnaire, which ensured that their responses remained unaffected by prior familiarity. Consequently, the researchers believe that their inclusion does not introduce bias or compromise the integrity of the data. Additionally, the relatively small size of the pilot study sample compared to the primary study sample further minimizes any potential impact on the overall results.

2.7 Ethical considerations

The study adhered to the principles outlined in the ‘Declaration of Helsinki.’ Research Ethics Committee approval was granted by the ‘Local Committee of Bioethics’ of the authors' institute. Administrative permission was also obtained from the dean of the Faculty of Nursing at Northern Border University. After explaining the purpose of the study, written consent was obtained from all participants. They were informed about their right to withdraw from the research at any stage and the confidentiality of their data was assured.

2.8 Method of data collection

As faculty members routinely teach students of various academic levels and genders, we developed an electronic Google form for data collection over 2 months. To recruit participants, we posted an announcement in the students' WhatsApp groups, Facebook and Twitter, outlining the study's objectives and providing a link to the questionnaire. We initially employed convenience sampling by directly inviting students through these groups. To broaden our outreach, we then utilized snowball sampling techniques, requesting leaders of each academic year to disseminate the study link within their respective groups, thereby facilitating wider questionnaire distribution.

To safeguard against bias, we randomly selected participants, targeting a diverse group of students to complete and evaluate the questionnaire. This approach helped mitigate selection bias and ensured a representative sample. Additionally, we monitored the responses to confirm that a broad demographic was represented, aligning with our goal of capturing a comprehensive perspective from the student body.

2.9 Statistical analysis

Data were analysed using the ‘Statistical Package for Social Science (SPSS), IBM SPSS Statistics for Windows, (Version 21.0. Armonk, New York, United States).’ Descriptive statistics, such as frequencies and percentages, were used to describe the primary variables. To compare the perceived data, Chi‐squared (χ 2) or Fisher exact tests were applied as appropriate. Statistical significance was set at a p‐value of less than 0.05.

3 RESULTS

Table 1 represents the demographic characteristics of the participants (n = 302). The majority (n = 261) of the participants were female (86.4%). Approximately (n = 242, 80%) of the participants were aged 21–25 and most (n = 220) were single (72.8%).

TABLE 1 Socio‐demographic characteristics of participants (N = 302).

Variables	No. (302)	%	
Sex	
Male	41	13.6	
Female	261	86.4	
Age	
18–20	60	20	
21–25	242	80.1	
Academic year	
1st year	86	28.5	
2nd year	80	26.5	
3rd year	52	17.2	
4th year	43	14.2	
Internship	41	13.6	
Marital Status	
Single	220	72.8	
Married	76	25.2	
Divorced	6	2	
GPA	
2–3	14	4.6	
3.1–4	112	37.1	
4.1–5	176	58.3	
Note: Data were presented as numbers (No.) and percentages (%).

Abbreviation: GPA: grade point average.

Figures 1 and 2 show sleep hours and sleep patterns among nursing students before and during COVID‐19, respectively. About 25.8% (n = 78) of nursing students slept less than 6 h during COVID‐19 compared to 13.9% (n = 42) before COVID‐19 (p < 0.001). Although most participants tended to sleep more during the day than at night, this difference did not reach statistical significance (p = 0.153 before COVID‐19 and p = 0.719 during COVID‐19).

FIGURE 1 Percentage distribution of nursing students' response by sleep hours before and during COVID‐19. The y‐axis is represented as percentages. The significance was set at p‐value <0.05. The chi‐squared = 16.4, overall p‐value = 0.0009.

FIGURE 2 Percentage distribution of nursing students' response by sleep pattern before and during COVID‐19. The y‐axis is represented as percentages. The significance was set at p‐value <0.05. Overall p‐values >0.05 before and during COVID‐19.

Regarding sleeping quality, during the COVID‐19 lockdown, more than one‐third of nursing students (n = 99) reported poor sleep quality (Figure 3).

FIGURE 3 The differences between sleep levels among nursing students before and during the COVID‐19 pandemic. The chi‐squared = 34, overall p‐value <0.0001.

Table 2 illustrates the impact of the COVID‐19 lockdown on sleep patterns and quality among nursing students. There were statistically significant differences in certain aspects of sleep patterns before and during the COVID‐19 lockdown. These differences include feeling the need to sleep after waking up, feeling refreshed after waking up, satisfaction with their sleep regime and experiencing troubled sleep that makes students nervous and restless. Specifically, there were statistically significant differences in feeling the need to sleep after waking up (χ 2 = 1.99 p = 0.047), feeling refreshed after waking up (χ 2 = 4.56 p = 0.001), feeling satisfied with their sleep regime (χ 2 = 3.561, p = 0.001) and troubled sleep‐making the student nervous and restless (χ 2 = 1.97, p = 0.049). These findings indicate that the pandemic and associated lockdown measures noticeably impacted the sleep quality and patterns of nursing students.

TABLE 2 Impact of COVID‐19 lockdown on sleep pattern and related problems among nursing students (N = 302).

Variable	Before COVID‐19 outbreak	During COVID‐19 outbreak	χ 2	p‐value	
Rarely	Sometimes	Often	Almost always	Rarely	Sometimes	Often	Almost always	
N	%	N	%	N	%	N	%	N	%	N	%	N	%	N	%	
Difficulty falling asleep	84	27.8	96	31.8	60	19.9	62	20.5	78	25.8	92	30.5	60	19.9	70	23.2	2.11	0.035*	
Sleep deeply	68	22.5	86	28.5	72	23.8	76	25.2	68	22.5	98	32.5	78	25.8	58	19.2	1.65	0.099	
Waking up during sleep	70	23.2	78	25.8	80	26.5	74	24.5	58	19.2	102	33.8	68	22.5	74	24.5	1.06	0.287	
Difficulty to go back to sleep once walking in midnight	56	18.5	84	27.8	72	23.8	90	29.8	52	17.2	92	30.5	78	25.8	80	26.5	2.07	0.039*	
Wake up easily by noises	82	27.2	80	26.5	50	16.6	90	29.8	56	18.5	78	25.8	86	28.5	82	27.2	0.72	0.474	
Excessive movement during sleep	52	17.2	98	32.5	70	23.2	82	27.2	56	18.5	80	26.5	94	31.1	72	23.8	1.82	0.069	
If I wake up, I never go back to sleep	90	29.8	74	24.5	78	25.8	60	19.9	70	23.2	106	35.1	76	25.2	50	16.6	1.23	0.220	
Feel refreshed after sleep	10	36.4	90	29.8	50	16.6	52	17.2	62	20.5	106	35.1	72	23.8	62	20.5	4.56	0.000**	
I feel unlikely to sleep after sleep	106	35.1	88	29.1	66	21.9	42	13.9	72	23.8	94	31.1	82	27.2	104	17.9	3.07	0.002**	
Troubled sleep gives me headaches	48	15.9	48	15.9	70	23.2	136	45.0	44	14.6	64	21.2	82	27.2	112	37.1	0.89	0.370	
Troubled sleep makes me nervous and restless	48	15.9	60	19.9	58	19.2	136	45.0	36	11.9	74	24.5	96	31.8	96	31.8	1.97	0.049*	
I want to sleep more after waking up	54	17.9	84	27.8	70	23.2	94	31.1	44	14.6	84	27.8	102	33.8	72	23.8	1.99	0.047*	
My sleeping hours are enough	90	29.8	72	23.8	74	24.5	66	21.9	60	19.9	94	31.1	90	29.8	58	19.2	0.67	0.498	
Troubled sleep is causing me to lose my appetite	74	24.5	72	23.8	68	22.5	88	29.1	48	15.9	80	26.5	96	31.8	78	25.8	0.49	0.0.619	
Troubled sleep makes it difficult to think	60	19.9	60	19.9	72	23.8	110	36.4	44	14.6	96	31.8	80	26.5	82	27.2	2.67	0.008**	
Feel strong and energetic when you wake up	92	30.5	86	28.5	72	24.5	50	16.6	62	20.5	88	29.1	86	28.5	66	21.9	3.32	0.001**	
Disturbed sleep causes loss of interest in work or others	56	18.5	72	23.8	68	22.5	106	35.1	50	16.6	90	29.8	62	20.5	100	33.1	2.067	0.039*	
I feel tired after sleeping	38	19.2	90	29.8	80	26.5	74	24.5	52	17.2	88	29.1	92	30.5	140	23.2	0.91	0.362	
Disturbed sleep causes mistakes while working	46	15.2	88	29.1	70	23.2	98	32.5	52	17.2	76	25.2	70	23.2	104	34.4	1.28	0.200	
I feel satisfied with my sleep regime	96	31.8	102	33.8	62	20.5	42	13.9	76	25.2	96	31.8	78	25.8	52	17.2	3.561	0.000**	
Troubled sleep makes me forget things more	96	18.5	60	19.9	84	27.8	102	33.8	44	14.6	80	26.5	90	29.8	88	29.1	1.42	0.155	
Troubled sleep makes me lose focus at work	54	17.9	60	19.9	86	28.5	102	33.8	44	14.6	82	27.2	80	26.5	96	31.8	0.86	0.388	
Drowsiness causes daily struggle	50	16.6	70	23.2	90	29.8	92	30.5	48	15.9	56	25.2	78	25.8	100	33.1	0.57	0.564	
Troubled sleep makes me lose interest in all things in general	66	21.9	60	19.9	82	27.2	94	31.1	46	15.2	72	23.8	70	23.2	114	37.7	0.90	0.367	
I find it hard to get out of bed in the morning	64	21.2	64	21.2	88	29.1	86	28.5	56	18.5	84	27.8	84	27.8	78	25.8	1.06	0.286	
Troubled sleep makes me tired easily at work	58	19.2	68	22.5	88	29.1	88	29.1	40	13.2	98	32.5	66	21.9	98	32.5	0.76	0.443	
Usually, my mind is clear after sleep	64	21.2	90	29.8	92	30.5	56	18.5	48	15.9	92	30.5	82	27.2	80	26.5	1.64	0.101	
Troubled sleep makes my life painful	54	17.9	80	26.5	88	29.1	80	26.5	50	16.6	41	27.2	80	26.5	90	29.8	0.79	0.429	
Note: Data presented as number (No.) and percent (%). χ 2: The chi‐squared test.

* p < 0.05.

** p < 0.01.

Additionally, a notable finding from the table is the statistically significant decrease in feeling strong and energetic upon waking up during the COVID‐19 outbreak. This indicates that nursing students experienced declining energy levels when waking up. Furthermore, there was a statistically significant increase in the desire to sleep more after waking up during the COVID‐19 outbreak, suggesting that nursing students felt a greater need for additional sleep upon waking.

Table 3 demonstrates no statistically significant associations between demographic characteristics and sleep levels before and during COVID‐19 at the 0.05 significance level.

TABLE 3 Relationship between demographic characteristics of nursing students and sleep levels before and after COVID‐19.

		Before COVID‐19 outbreak	Total	χ 2	p‐value	After COVID‐19 outbreak	Total	χ 2	p‐value	
Good	Average	Poor	Good	Average	Poor	
N	%	N	%	N	%	N	%	N	%	N	%	
Sex	Male	10	3.3	28	9.3	1	0.3	39	4.714	0.095	1	0.3	31	10.3	7	2.3	39	6.146	0.056	
Female	94	31.2	143	47.5	25	8.3	262	16	5.3	154	51.2	92	30.6	262	
Total	104	34.6	171	56.8	26	8.6	301	17	5.6	185	61.5	99	32.9	301	
Age	17–19 years	35	11.6	59	19.6	6	2.0	100	1.988	0.738	3	1.0	68	22.6	29	9.6	100	4.204	0.379	
20–22 years	54	17.9	93	30.9	16	5.3	163	12	4.0	96	31.9	55	18.3	163	
23 years and more	15	5.0	19	6.3	4	1.3	38	2	0.7	21	7.0	15	5.0	38	
Total	104	34.6	171	56.8	26	8.6	301	17	5.6	185	61.5	99	32.9	301	
Marital status	Unmarried	68	22.6	147	48.8	23	7.6	238	8.844	0.091	14	4.7	155	51.5	69	22.9	238	9.068	0.059	
Married	32	10.6	22	7.3	3	1.0	57	3	1.0	28	9.3	26	8.6	57	
Divorced	4	1.3	2	0.7	0	0.0	6	0	0.0	2	0.7	4	1.3	6	
Total	104	34.6	171	56.8	26	8.6	301	17	5.6	185	61.5	99	32.9	301	
Academic year	First	9	3.0	24	8.0	4	1.3	37	4.374	0.075	2	0.7	24	8.0	11	3.7	37	7.778	0.063	
Second	14	4.7	47	15.6	2	0.7	63	3	1.0	49	16.3	11	3.7	63	
Third	13	4.3	33	11.0	4	1.3	50	3	1.0	33	11.0	14	4.7	50	
Fourth	47	15.6	47	15.6	14	4.7	108	9	3.0	55	18.3	44	14.6	108	
Internship	21	7.0	20	6.6	2	0.7	43	0	0.0	24	8.0	19	6.3	43	
Total	104	34.6	171	56.8	26	8.6	301	17	5.6	185	61.5	99	32.9	301	
GPA	2–3	18	6.0	19	6.3	5	1.7	42	5.610	0.230	0	0.0	28	9.3	14	4.7	42	5.494	0.240	
3.1–4	47	15.6	78	25.9	15	5.0	140	10	3.3	90	29.9	40	13.3	140	
4.1–5	39	13.0	74	24.6	6	2.0	119	7	2.3	67	22.3	45	15.0	119	
Total	104	34.6	171	56.8	26	8.6	301	17	5.6	185	61.5	99	32.9	301	
Note: Data are presented as numbers (No.) and percentages (%). χ2: The chi‐squared test; statistical significance at p < 0.05.

Abbreviation: GPA: grade point average.

4 DISCUSSION

The COVID‐19 pandemic has brought about unprecedented changes in our lives, including disruptions in sleep patterns and quality. Nursing students have been particularly affected, as they are on the front lines of the pandemic, dealing with increased stress and anxiety and long working hours (Arnetz et al., 2020; Gupta & Sahoo, 2020; Hosseini Moghaddam et al., 2022).

Studies have shown that university students, including nursing cohorts, have experienced a decline in sleep quality and duration since the onset of the pandemic worldwide (Alfawaz et al., 2021; Dongol et al., 2022; Marelli et al., 2021; Romero‐Blanco et al., 2020; Wathelet et al., 2020). This decline can be attributed to various factors, such as increased workload, fear of infection and changes in daily routine. Moreover, personal protective equipment has been found to cause discomfort and physical strain, leading to sleep disturbances (Kosendiak et al., 2023; Mahalingam et al., 2022). The lack of social support and isolation due to social distancing measures have also negatively impacted sleep patterns (Escobar‐Córdoba et al., 2021; O'Regan et al., 2021; Pilcher et al., 2021).

Our study shows that during the COVID‐19 pandemic, there were notable changes in sleeping hours, sleep quality and the physical and emotional effects of altered sleep quality. Before the pandemic, students' sleeping hours were sometimes as long as 12 h. However, during the pandemic, sleep duration ranged from 6 to 8 h, with more frequent daytime sleep than nighttime sleep.

Nearly one‐third of nursing students reported experiencing difficulties with their sleep patterns, resulting in lower sleep scores. These students noted that disturbed sleep patterns led to headaches, nervousness, restlessness, loss of appetite, daily drowsiness and decreased interest in work, potentially increasing the likelihood of making mistakes. They also reported losing focus, forgetting things and losing interest in their activities. These findings align with other studies that confirm that changes in sleep patterns can negatively affect performance, dietary and behavioural changes and even aggressive behaviour (Alimoradi et al., 2021; Romero‐Blanco et al., 2020).

Similarly, Kaçan et al. found that about 54% of their study students had adversely affected sleep patterns, with 31.8% having difficulty falling asleep and 17.4% frequently waking up at night due to the pandemic. These findings highlight that the pandemic and associated lockdown measures significantly affected students' sleep quality (Kaçan et al., 2021).

In contrast, Alkalash and colleagues reported a higher percentage of medical students (53%) sleeping less than 6 h per night compared to 26.5% in our study. Though both nursing and medical students face demanding academic schedules, requiring long study hours, lectures, clinical rotations and assignments/exams, studies have shown nursing students have poorer sleep quality compared to medical students (Gallego‐Gómez et al., 2021). This may be due to nursing students often having more clinical hours and less time for studying compared to medical students. Additionally, nursing students may face more stress and emotional demands due to their direct interaction with patients. On the other hand, medical students have been found to have irregular sleep patterns, which are associated with increased stress levels and decreased academic performance (Paudel et al., 2022). Both nursing and medical students need to prioritize sleep and take steps to improve their sleep patterns. This can include making time for relaxation and stress‐reducing activities, creating a sleep‐friendly environment and practicing good sleep hygiene habits, such as avoiding caffeine and electronic devices before bed (Albakri et al., 2021).

The statistically significant changes caused by the COVID‐19 pandemic have had notable collateral effects on nursing students' lifestyles, particularly impacting their sleep patterns. The shift to online education and reduced clinical practice hours due to the pandemic led many students to sleep more during the day. Exams conducted in the evenings further encouraged this shift from night sleep to today's sleep. These findings are consistent with several studies that found the pandemic affected nursing students' sleep patterns (Bodys‐Cupak et al., 2021; Mulè et al., 2022; Romero‐Blanco et al., 2020; Valenzuela et al., 2023).

Although our study, to the best of our knowledge, is among the first to explore the frequency of sleep disturbances before and during the lockdown in our region, it has some limitations. First, the cross‐sectional study design limits the ability to conclude causal relationships between the variables and the outcomes. Second, the data were collected online via a Google form, which may increase social desirability and self‐reported bias. Third, we relied on self‐reported sleep‐quality scale instead of objective measurements (e.g., actigraphy). Fourth, we did not adjust for other covariates that could impact sleep patterns due to the limited scope of our study. In this sense, future research could utilize a mixed‐methods approach, including qualitative interviews, to explore the personal experiences of nursing students regarding their lifestyle and academic workload and incorporate objective measures of sleep, such as actigraphy, to complement self‐reported sleep quality assessments. In addition, employ robust analytical methods to determine causative factors and correlate them with lifestyle/academic stress changes and finally consider longitudinal studies to delve deeper into the potential factors influencing sleep quality and adjusting for covariates to provide a comprehensive analysis.

4.1 Nursing implications

The COVID‐19 pandemic does not simply impair university students; it also serves as a valuable lesson in adaptability and resilience. Nursing students and other university students can use this experience to learn how to better cope with changes in their lifestyle, whether they are physical or mental challenges. They need to adapt to and embrace these changes. ‘Strategies are required to manage nursing students' teaching/learning during the COVID‐19 pandemic or similar future situations,’ as concluded by Mulyadi et al. meta‐analysis (Mulyadi et al., 2021).

Senior nurses can be crucial in supporting university students with lifestyle adjustments, providing psychological support to the most susceptible groups and offering personalized psycho‐educational online programs and interventions on sleep to help maintain regular sleep–wake patterns and daily routines during lockdowns, as evidenced by the successful previous experiences (Hershner & O'Brien, 2018; Sovold et al., 2021). Nursing administration, deans and professors also have a statistically significant role in providing psychological and emotional support, offering resources and creating an environment that fosters resilience. By employing a proposed framework that unifies the efforts of leaders and faculty, Halat and colleagues concluded some strategies to promote work‐life balance among academics, along with recommendations for effective interventions to enhance their mental health outcomes (Hammoudi Halat et al., 2023).

5 CONCLUSIONS

The study concludes that the COVID‐19 outbreak negatively affected sleep patterns and quality among students, which highlights the need for comprehensive communication, staff protection and social/emotional support for university students during such challenging times. The findings underscore the importance of prioritizing sleep and mental health for nursing students, especially during public health crises, to enhance students' academic performance and overall well‐being.

AUTHOR CONTRIBUTIONS

Amal Ahmed Elbilgahy: Conceived and designed the experiments; analysed and interpreted the data; contributed materials and analysis tools/data; wrote the paper. Areej Musaad Alanazi: Performed the experiments; analysed and interpreted the data; participated in writing the paper. Badriah Mefrh Alrawili, Rawan Mamdouh Alenezi, Rawan Fahad Alanazi and Amal Khulaif Alanazi: Performed the experiments; analysed and interpreted the data; contributed materials and analysis tools. Manal S. Fawzy: Analysed and interpreted the data; participated in writing the paper and critically reviewed/edited the text.

FUNDING INFORMATION

The Deanship of Scientific Research at Northern Border University, Arar, KSA, funded this research work through the project number ‘NBU‐FFR‐2024‐3039‐01.’

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

ETHICS STATEMENT

This study has Research Ethics Committee approval (No. 61/44/H) from the ‘Local Committee of Bioethics’, Northern Border University, Arar, Saudi Arabia.

PATIENT CONSENT STATEMENT

Not applicable.

PERMISSION TO REPRODUCE MATERIAL FROM OTHER SOURCES

Not applicable.

CLINICAL TRIAL REGISTRY

Not applicable.

Supporting information

Data S1.

ACKNOWLEDGEMENTS

The authors thank all the nursing students who participated in the study.

DATA AVAILABILITY STATEMENT

All generated data were included in this article.
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