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Is sleep a luxury that college students cannot afford?

Published:January 14, 2015DOI:https://doi.org/10.1016/j.sleh.2014.12.006
      College students are notoriously sleep deprived and have poor sleep habits. Although this may be accepted as normal, it is hard to ignore the impact of the poor sleep health of students when such a student is sitting in front of you. I was recently interviewed about sleep patterns and daytime sleepiness among college students by Wendy, a University of Michigan student. As I discussed chronic sleep deprivation among college students, I noticed she looked tired, even a bit haggard. I relayed a number of sleep health facts to her, primarily that 70%-96% of students get less than 8 hours of sleep per night during the week
      • Bachman L.
      • Bachman C.
      Student perceptions of academic workload in architectural education.
      • Lund H.G.
      • Reider B.D.
      • Whiting A.B.
      • Prichard J.R.
      Sleep patterns and predictors of disturbed sleep in a large population of college students.
      ; some academic majors may sleep worse than others; in 1 study, only 4% of architect students slept at least 7 hours a night and most pulled at least 3 “all-nighters” a month.
      • Bachman L.
      • Bachman C.
      Student perceptions of academic workload in architectural education.
      College students are sleepier than either adults or teenagers and report more problems with memory and concentration.
      • Oginska H.
      • Pokorski J.
      Fatigue and mood correlates of sleep length in three aged social groups: school children, students, and employees.
      I asked, “Do you think sleep deprivation and sleepiness are a problem on campus?”“It is with me,” Wendy said, “I'm always sleepy. On a weeknight, I often get 4-5 hours of sleep. I finish studying at 1-2 am, and then go to sleep.” Her Epworth Sleepiness Scale was 15 of 24, indicating severe sleepiness—in the range of a person with narcolepsy. My goal shifted from not just relaying information about sleep among college students for her to use for her article but to try to encourage her to change her own sleep behaviors.
      Sleep deprivation has impacts on students that they may not recognize. There is an association with slowed reaction time, impaired immune function, increased risk of infection, even compromised memory, and learning.
      • Lange T.
      • Perras B.
      • Fehm H.L.
      • Born J.
      Sleep enhances the human antibody response to hepatitis A vaccination.
      • Hasler G.
      • Buysse D.J.
      • Klaghofer R.
      • et al.
      The association between short sleep duration and obesity in young adults: a 13-year prospective study.
      • Stickgold R.
      • James L.
      • Hobson J.A.
      Visual discrimination learning requires sleep after training.
      • Cohen S.
      • Doyle W.J.
      • Alper C.M.
      • Janicki-Deverts D.
      • Turner R.B.
      Sleep habits and susceptibility to the common cold.
      Certain types of learning and memory require sleep, and pulling an all-nighter may mean the student's performance may never catch up from that episode of sleep loss.
      • Stickgold R.
      • James L.
      • Hobson J.A.
      Visual discrimination learning requires sleep after training.
      • Walker M.P.
      • Brakefield T.
      • Morgan A.
      • Hobson J.A.
      • Stickgold R.
      Practice with sleep makes perfect: sleep-dependent motor skill learning.
      Unsurprisingly, an erratic sleep schedule can impair grade point average.
      • Eliasson A.H.
      • Lettieri C.J.
      • Eliasson A.H.
      Early to bed, early to rise! Sleep habits and academic performance in college students.
      Outside the classroom, there is the link between impaired driving, sleep deprivation, and alcohol. On a driving simulator, as minimal as 1-2 alcoholic drinks combined with only 4 hours of sleep resulted in car accident in 23%-33% of students.
      • Vakulin A.
      • Baulk S.D.
      • Catcheside P.G.
      • et al.
      Effects of moderate sleep deprivation and low-dose alcohol on driving simulator performance and perception in young men.
      “Could you sleep earlier?” I asked. Some students are “night owls” or have delayed sleep phase disorder and cannot fall asleep until late at night.
      • Crowley S.J.
      • Acebo C.
      • Carskadon M.A.
      Sleep, circadian rhythms, and delayed phase in adolescence.
      • American Academy of Sleep Medicine
      She said, “If I had the time, I could, but I can't get my work done earlier.” We broke down her schedule to see where we could squeeze in extra sleep. She is up at 6 am to go to the gym, working at the cafeteria by 7:30 am, in class from 9:30 am until the late afternoon, back at the cafeteria to work the dinner shift, and studying starts around 9 pm. “I work 30-37 hours a week, plus take 17-credit hours. My parents pay for my tuition, but I have to pay for room, board, and books.” I sat back, flummoxed, where could one fit sleep into that schedule?
      “Do you ever take naps?” I asked.“About twice a week I take 1-2 hour nap and I feel a lot better,” she said. I presented Wendy data showing students who napped more had higher GPAs and how a nap of 6 minutes improved memorization of a list of vocabulary words by 11%.
      • Eliasson A.H.
      • Lettieri C.J.
      • Eliasson A.H.
      Early to bed, early to rise! Sleep habits and academic performance in college students.
      • Lahl O.
      • Wispel C.
      • Willigens B.
      • Pietrowsky R.
      An ultra short episode of sleep is sufficient to promote declarative memory performance.
      Wendy's school, employment, and personal goals cause her to forfeit sleep to meet her responsibilities. Although she would like to sleep more, she does not appreciate the vital need for healthy and adequate sleep. To her, sleep is a luxury. Would she still consider sleep a luxury if she knew the association between sleep and academic performance? I told her some studies indicate students who sleep more have higher GPAs.
      • Kelly W.E.
      • Kelley K.E.
      • Clanton R.C.
      The relationship between sleep length and grade point average among college students.
      She said, “My GPA is not as good as I'd like, but I have a 3.6/4.0.” I sensed defeat but reiterated my arguments; most students are sleepy and do not get adequate sleep, which might increase the risk of obesity, poor grades, and compromise driving, especially when alcohol is consumed.
      • Gangwisch J.E.
      • Malaspina D.
      • Boden-Albala B.
      • Heymsfield S.B.
      Inadequate sleep as a risk factor for obesity: analyses of the NHANES I.
      • Howard M.E.
      • Jackson M.L.
      • Kennedy G.A.
      • Swann P.
      • Barnes M.
      • Pierce R.J.
      The interactive effects of extended wakefulness and low-dose alcohol on simulated driving and vigilance.
      • Arnedt J.T.
      • Wilde G.J.S.
      • Munt P.W.
      • Maclean A.W.
      Simulated driving performance following prolonged wakefulness and alcohol consumption: separate and combined contributions to impairment.
      She nodded in understanding; I had given her the knowledge, but every behavioral change was a compromise: “I have to work to pay for school, I need to exercise to be healthy, and if I don't take 17 credits, I won't get through college in 4 years.” Her final argument: “If I get through two more years, I will sleep then.”
      Wendy's perception of sleep as a luxury, not a necessity, is commonplace. Initiatives, such as Healthy People 2020 and Healthy Campus 2020, may help change this mentality and bring the importance of healthy, adequate sleep to the forefront of medicine and society. Nevertheless, there is more to be done, for all ages, but especially in this age group. Can we make class schedules and school policies more sleep friendly? The answer is “yes.” Literature shows a later start time in high school can improve grades and mood and decrease motor vehicle accidents.
      • Danner F.
      • Phillips B.
      Adolescent sleep, school start times, and teen motor vehicle crashes.
      • Vorona R.D.
      • Szklo-Coxe M.
      • Lamichhane R.
      • Ware J.C.
      • McNallen A.
      • Leszczyszyn D.
      Adolescent crash rates and school start times in two central Virginia counties, 2009-2011: a follow-up study to a Southeastern Virginia Study, 2007-2008.
      • Owens J.A.
      Impact of delaying school start time on adolescent sleep, mood, and behavior.
      • Lufi D.
      • Tzischinsky O.
      • Hadar S.
      Delaying school starting time by one hour: some effects on attention levels in adolescents.
      Apart from institutional changes, effective educational interventions can increase sleep duration and improve sleep habits from preschool to college students.
      • Blunden S.L.
      • Chapman J.
      • Rigney G.A.
      Are sleep education programs successful? The case for improved and consistent research efforts.
      • Quan S.F.
      • Anderson J.L.
      • Hodge G.K.
      Use of a supplementary internet based education program improves sleep literacy in college psychology students.
      • Wilson K.E.
      • Miller A.L.
      • Bonuck K.
      • Lumeng J.C.
      • Chervin R.D.
      Evaluation of a sleep education program for low-income preschool children and their families.
      Now is the time to translate this research into implementation. Schools, including colleges and universities, need sleep-friendly policies and start times, based on the best practices for our students. It is time to bring the significance of sleep to the forefront of education not just for the sake of learning and academics but also for the mental health, quality of life, and safety of students. Students should not be the only focus of these educational initiatives, as many adults also sacrifice sleep to meet their many responsibilities. Through education, public policy, and healthy discussion, we can encourage adequate sleep for all ages.

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