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NSS-62907-causes-and-consequences-of-sleepiness-among-college-students © 2014 Hershner and Chervin. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Nature and Science of Sleep 2014:6 73–84 Nature and Science of Sleep Dovepress submit your manuscript | www.dovepress.com Dovepress 73 R e v i e w open access to scientific and medical research Open Access Full Text Article http://dx.doi.org/10.2147/NSS.S62907 Causes and consequences of sleepiness among college students Shelley D Hershner Ronald D Chervin Department of Neurology, University of Michigan, Ann Arbor, Mi, USA Correspondence: Shelley D Hershner Department of Neurology, University of Michigan, Med inn C728, 1500 east Medical Center Drive, Ann Arbor, Mi, USA Tel +1 734 936 6295 Fax +1 734 647 9065 email
[email protected] Abstract: Daytime sleepiness, sleep deprivation, and irregular sleep schedules are highly prevalent among college students, as 50% report daytime sleepiness and 70% attain insufficient sleep. The consequences of sleep deprivation and daytime sleepiness are especially problematic to college students and can result in lower grade point averages, increased risk of academic failure, compromised learning, impaired mood, and increased risk of motor vehicle accidents. This article reviews the current prevalence of sleepiness and sleep deprivation among college students, contributing factors for sleep deprivation, and the role of sleep in learning and memory. The impact of sleep and sleep disorders on academics, grade point average, driving, and mood will be examined. Most importantly, effective and viable interventions to decrease sleepiness and sleep deprivation through sleep education classes, online programs, encouragement of naps, and adjustment of class time will be reviewed. This paper highlights that addressing sleep issues, which are not often considered as a risk factor for depression and academic failure, should be encouraged. Promotion of university and college policies and class schedules that encourage healthy and adequate sleep could have a significant impact on the sleep, learning, and health of college students. Future research to investigate effective and feasible interventions, which dis- seminate both sleep knowledge and encouragement of healthy sleep habits to college students in a time and cost effective manner, is a priority. Keywords: grade point average, GPA, sleep deprivation, academic performance, adolescence, sleep education programs Introduction The college experience is of great value in providing emerging adults with a structured environment in which they can gain the knowledge, skills, and independence to chart their own path, become successfully employed, and contribute to society. However, this experience comes at great cost given rising tuition fees and ballooning student debt, and thus, it is vital that the college years be as efficacious as possible. A potential obstacle to maximizing success in college is the high prevalence of daytime sleepiness, sleep deprivation, and irregular sleep schedules among college students. Daytime sleepiness is a major problem, exhibited by 50% of college students compared to 36% of adolescents and adults.1 At least 3 days a week, 60% of students report that they are dragging, tired, or sleepy.2 Sleepiness is defined as the inability or difficulty in maintaining alertness during the major wake period of the day, resulting in unintended lapses into drowsiness or sleep.3 It is important to note that sleepiness is often circumstance-dependent, with many aspects of the students’ learning envi- ronment exacerbating sleepiness.4 For example, a lecture that does not require active http://www.dovepress.com/permissions.php http://creativecommons.org/licenses/by-nc/3.0/ www.dovepress.com www.dovepress.com www.dovepress.com http://dx.doi.org/10.2147/NSS.S62907 mailto:
[email protected] Julisa Carbajal Nature and Science of Sleep 2014:6submit your manuscript | www.dovepress.com Dovepress Dovepress 74 Hershner and Chervin participation and may be in a dark, warm lecture hall can unmask underlying sleepiness. Sleep deprivation is defined as obtaining inadequate sleep to support adequate daytime alertness.4 How much sleep a young adult needs is not clearly known, but is thought to be 8 hours.5,6 Most college students are sleep deprived, as 70.6% of students report obtaining less than 8 hours of sleep.7 The impact of educational major on sleepiness and sleep duration is not well studied, but the effect may be substantial. As reported at an Architecture School in the Midwest, only 4% of students obtained at least 7 hours of sleep at night; the average sleep duration was 5.7 hours, with 2.7 “all-nighters” per month.8 Eighty-two percent of college students believe that inadequate sleep and sleepiness impact their school performance.9 Students rank sleep prob- lems second only to stress in factors that negatively impact academic performance.10 Sleep deprivation and sleepiness are caused by a host of reasons and have numerous negative consequences. In the literature, sleep deprivation is often termed either acute sleep deprivation or chronic partial sleep deprivation. Colloquially for students, acute sleep deprivation is termed “pulling an all-nighter”, meaning that a person stays up for 24 hours or longer. More typically, sleep deprivation consists of chronic partial sleep deprivation, where a student obtains some, but not adequate sleep. Sleepiness can be an obvious conse- quence of sleep deprivation, but sleepiness can be caused by other circumstances, most commonly sleep disorders. To understand the consequences of sleepiness and sleep deprivation, knowledge of normal sleep and its impact on learning, memory, and performance are necessary. Equally important are potential interventions, as these may offer an opportunity to improve health and educational outcomes for this demographic. This article reviews the prevalence of sleepiness and sleep deprivation among college students, the impact of sleep on memory, contributing factors for sleep deprivation, potential consequences with a focus on those particularly applicable to college students, and available interventions to improve sleep among college students. Regulation of normal sleep: the circadian rhythm and homeostatic sleep drive Many college students are sleep deprived because they go to sleep late and wake up for classes or employment before adequate sleep is obtained. Two primary processes govern how much sleep is obtained, the homeostatic sleep drive and the circadian rhythm. The circadian system (internal clock) helps to regulate sleep/wake cycles and hormonal secretions while the homeostatic sleep drive increases the need for sleep as the period of wakefulness lengthens. The interaction of these two systems is described by the Two-Process Model of Sleep Regulation.11 Physiologically, adolescents and young adults tend to have a delayed circadian preference, and are “night owls”.12 This change occurs in association with puberty; more physically mature adolescents have a preference for later bedtimes and may have a lower homeostatic sleep drive, and consequently, are less sleepy at night.13–15 The typical adult circadian period is 24.1 hours, compared to an adolescent’s circadian period of 24.27 hours; this longer period makes it easier for the bedtime to shift later.15,16 A cardinal sign of a delayed circadian system is an irregular sleep schedule, where students have catch-up sleep on the weekend. Both high school and college students demonstrate a 1–3 hour sleep deficit on school nights, with a much longer sleep duration and often a later wake time on the weekends.7,17,18 How the circadian rhythm and homeostatic sleep drive change with puberty is not well understood, but the cumula- tive effect is that adolescents and young adults feel more awake in the evening, have a difficult time falling asleep until later, and consequently, have insufficient sleep during the school week and catch-up on sleep on the weekend. Exactly when this nocturnal preference or “night owl” tendency diminishes, remains unclear. When evaluated longitudinally, weekday bedtimes continued to delay until around 19 years of age, with weekend bedtimes remaining later until the early 20s, although other studies have shown this delay persisting until the junior year.19 The transition from high school to college also has an impact; college students go to bed 75 minutes later than high school students.7 In this study, freshman students’ bedtime was 12.22 am and 1.58 am with a rise time of 8.08 am and 10.26 am on weekdays and the weekend, respectively. Learning, memory, and sleep cycles Sleepiness and irregular sleep schedules have many unin- tended consequences, one of which is to negatively impact learning, memory, and performance. The precise details of the relationship between sleep and memory formation are not yet completely understood. The dual process theory maintains that certain types of memory are dependent on specific sleep states, such that procedural memory (know- ing how) may be dependent on REM (rapid eye movement) sleep and declarative memory (knowing what) on NREM (non-REM) sleep. The sequential processing theory suggests that memories require an orderly succession of sleep stages, www.dovepress.com www.dovepress.com www.dovepress.com Julisa Carbajal Julisa Carbajal Julisa Carbajal Julisa Carbajal Julisa Carbajal Julisa Carbajal Nature and Science of Sleep 2014:6 submit your manuscript | www.dovepress.com Dovepress Dovepress 75 Sleep deprivation, sleepiness during college ie, memory formation may be prompted by slow-wave sleep and consolidated by REM sleep (see Figure 1).20 Both theories may help to explain how a student’s sleep pattern could impact learning.21 In one study, REM sleep deprivation eliminated sleep-induced improvement on a visual perceptual learning (procedural) task; the same effect was not found with selective slow-wave sleep deprivation.22 REM sleep normally occurs every 90–120 minutes, approximately 4–5 times in a typical night, with each REM sleep period growing progressively longer, with the last episode near rise time.23 Therefore, college students with early morning classes may not attain the last 1–2 REM sleep periods, thus adversely affecting procedural memory. However, other studies suggest that NREM rather than REM sleep enhances procedural memories, while other studies correlated improvement with slow-wave sleep followed by REM sleep.24–26 Both of these theories support that sleep deprivation may limit the amount of REM sleep and/or slow- wave sleep that students obtain, which may compromise