Sleep Problems in College: Education Helps

Fran Lowry

September 14, 2011

September 14, 2011 — Not surprisingly, college students, especially those in their freshman year, have trouble sleeping. Many do not even realize just how bad their sleep problems are, but teaching them about ways to effectively manage sleep can improve their well-being, a new study suggests.

The study, led by Kathryn M. Orzech, PhD, from Brown University, Providence, Rhode Island, also showed that inviting students to discuss their sleep problems may be a gateway topic to get them to address sensitive health issues such as depression with healthcare professionals.

Dr. Kathryn M. Orzech

"Students who are feeling depressed or who may have physical health problems may not want to go to the counseling center or campus health center, so if someone asks them how they are sleeping, that might lead them to start opening up about something a little more stigmatized," Dr. Orzech told Medscape Medical News.

The study appears in the August-October issue of the Journal of American College Health.

Erratic Sleep Schedules

College students are well known for their erratic sleep schedules and late bedtimes. As many as 50% of college students report significant levels of daytime sleepiness, which may interfere with academic performance and daily tasks such as driving.

However, there are few studies to help student health professionals understand the determinants of sleep among college students, and education about sleep hygiene in this group is rare, Dr. Orzech said.

She and coinvestigators David B. Salafsky, MPH, and Lee Ann Hamilton, MA, from the University of Arizona, Tucson, collected data from an online survey of students' state of sleep on 4 occasions (2 fall semesters and 2 spring semesters) from October 2005 to April 2007.

All of the students lived on campus, most were freshmen, they were predominantly white, and their mean age at the start of the study was 18.5 years. Almost all had a roommate.

The online survey consisted of 34 questions, and the primary sleep measure was the Pittsburgh Sleep Quality Index (PSQI), a 19-item questionnaire designed to measure sleep quality and disturbance during the past month.

Of the 5500 students who were targeted for the fall 2005 survey, 1823 (33%) returned a response. Of these participants, 500 students responded that they would be willing to participate in a 30-minute in-person interview regarding their sleep habits. Of these, the researchers randomly selected 30 students.

In the fall of 2006, more than 250 students agreed to be interviewed, and a total of 18 students were chosen from this group for an in-person interview.

Disconnect Between Sleep Rating and Experience

The study found that the mean PSQI score for male students was 6.38, and for women, it was 6.69. A score greater than 5 denotes poor sleep. However, when the students were asked to rate the quality of their sleep, most (60%) reported that their sleep was "fairly good."

"There was a disconnect between their sleep rating on the PSQI and their actual sleep experience," Dr. Orzech said.

A typical student bedtime was around 12:40 am, and students routinely took 20 to 30 minutes to fall asleep. They often woke up between 8:00 and 8:30 am and, as a result, netted less than 7 hours sleep a night.

The students complained that their sleep was being hindered by noise from roommates, and many said they could not sleep because they were not prepared for the next day's schoolwork and lay awake worrying.

Dr. Orzech and her team also began to educate the students about good hygiene both through a sleep media campaign in the campus newspaper and through posters that were placed in dorms.

Sleep education poster used at Brown University

"We educated them about keeping their room dark and cool and making it conducive to sleep. Things like being prepared for school the next day helped, and so did relaxing and unwinding. Having exercise as part of their daily routine also helped. Sleep experts will tell you that you shouldn't exercise too close to bedtime, but for those college students, it didn't seem to matter," she said. "We encouraged them to have regular sleep and wake times, and that also helped."

Of the 971 students who responded to questions about the education campaign, 90 said it helped them sleep better. Their PSQI score dropped, they went to bed earlier, fell asleep faster, and stayed asleep longer, she added.

"The education campaign cost was minimal, costing less than $2500, and it helped nearly 10% of the students find ways to sleep better, so we learned from a practitioner standpoint that a relatively modest health campaign can yield results," Dr. Orzech said.

Poor Survey Response

For Ralph Manchester, MD, from the University of Rochester Medical Center in New York, this study, although it gives some additional information about sleep patterns in undergraduates, is flawed.

"We now have a little more information about the sleep habits in college students, mostly in their first or second year, but because of the way the study was designed, it is hard to draw too many firm conclusions beyond just some general observations," he told Medscape Medical News.

In his view, the response to the survey was poor. "They sent an invitation to everyone, but only about 30% responded. It's not the worst response rate in the world, but it's not great," he said.

"People who do studies have to decide what resources they have to support the study and do the best they can with those resources," Dr. Manchester, who is on the editorial board of the Journal of American College Health but did not review this particular manuscript, noted.

"This was basically an observational study done at 4 different points in time, with very limited ability to follow the same student over those 4 points," he said.

Dr. Orzech has disclosed no relevant financial relationships. Dr. Manchester reports that he is on the editorial board of the Journal of American College Health but was not involved in reviewing this manuscript.

J Am College Health. 2011;59.

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