Table 4.

Themes, subthemes, and example quotes from the open-ended comments (n=310).

Theme		Subthemes	n (%)	Example quote
Sleep disruptions not due to the pandemic
	Children and family (n=59)	Child care (1-18 years)	27 (46)	“6 year old who wakes 2-3 times per night (some secondary to COVID related anxiety for him), 2.5 year old who wakes about 2-3 nights per week”
		Infant care	18 (31)	“Both COVID and my usual sleep disturbances plus my infant daughter”
		Concerns about family affecting sleep	8 (17)	“COVID plus home stress plus stress over my kids, my job, my marriage”
		Pregnancy affecting sleep	6 (10)	“I was pregnant with twins and carried to term. COVID increased my anxiety and work-related stress. I had to lay off employees and reduce my salary, right before maternity leave.”
	Work demands affecting sleep (n=48)	Shift work	18 (38)	“Mostly schedule fluctuations each week - late evening shifts followed by early morning shifts”
		Work-life interference	18 (38)	“Extra work at home [charting] due to increased patient volumes”
		Residency training	6 (13)	“Switching schedules with residency (days/nights and 28-hour calls), overall sleep debt, and fatigue”
		Volume of calls/pages	6 (13)	“The volume of calls and messages from my patient and caregiver population is through the roof…sleeping 4-5 hours [per night].”
	Personal health conditions (n=41)	Poor sleep prior to the pandemic	18 (44)	“I have never been a great sleeper.”
		Chronic medical issue	12 (29)	“Possibly COVID-19 related.... I had an onset of Obsessive-Compulsive Disorder this summer and have been adjusting to antipsychotic medication, intervention, and prescription sleep aids.”
		Formal sleep disorder	8 (20)	“Insomnia pre-dating COVID, but [it] worsened with COVID”
		Female hormones	3 (7)	“In vitro fertilization side effects”
Sleep disruptions due to the pandemic
	Pandemic-related sleep disturbances (n=48)	Pandemic affecting sleep	17 (35)	“I never had sleep issues prior to the COVID-19 pandemic. Suddenly I had issues with sleep initiation.”
		Nightmares about the pandemic	8 (17)	“The only thing that has changed with my sleep is an increase in nightmares and night terrors primarily regarding work situations.”
		Pandemic-related exhaustion	8 (17)	“In the last 1-2 months, I am EXHAUSTED and fall asleep easily, often on the couch right after dinner.”
		Medication/substance use to cope with the pandemic	7 (15)	“Alcohol plays a role in my sleep deprivation and ‘coping’ during COVID.”
		Worry about pandemic response	4 (8)	“I worry about how COVID is being managed by the President of the United States and I don't believe he is doing a good job; I worry things will get even worse if he is elected to a second term. This does keep me awake at night.”