Sleepy Students: How can we help?

Sleepy Students:

How can we help?



1. Identify keys factors which contribute to late bedtimes and

insufficient sleep among college students.



2. Discuss how sleep deprivation impairs academic

performance, memory, mood, and driving.



3. Explain how to use specific questions about a student’s

sleep patterns to develop tailored sleep recommendations

which help modify a student’s bedtime, wake time, and

wind-down time.



4. Outline how to create a student-led public health campaign

to promote healthy sleep using education of providers, health

and wellness websites, and social media.

1.

State of sleep among students

2.

Why does sleep deprivation occur

3.

Consequences of sleep deprivation



“

In one of our first studies we evaluated the

usefulness of the MSLT by comparing

narcoleptics and normal sleepers. The results

were fabulous. The MSLT distinguished

patients and normals, however some of the

normals were pathologically sleepy (1-5

minutes). This group tended to be college

students. For a while we thought these

were in the early stage of the narcoleptic sleep

disorder…But it was hard to imagine why

Stanford University would attract so many

budding narcoleptics…Nearly all the students

appeared pathologically sleepy! I should have

not been so surprised, because I have been

watching students fall asleep in class

0 10 20 30 40 50 60 70 80

8 hours of sleep Less than 8 hours

Lund, H. G., B. D. Reider, et al. (2010). "Sleep patterns and predictors of disturbed sleep in a large population of college students." The Journal of Adolescent Health 46(2): 124-132.

0

10

20

30

40

50

Percent

Students

Students

Bachman L, Bachman C. Student perceptions of academic workload in architectural education. J Archit 

High

School

College

High

School

Oginska, H. Fatigue and Mood Correlates of Sleep length in three Age-Social Groups: School Children, Students, and Employees. Chronobiology International 2006 1317-1328 0 10 20 30 40 50

Memory Sleepiness Concentration

Teens College Adults

Percent Students

82% report significant sleepiness

at University of Michigan

The

story

of

Hector



Red Bull (8.2 oz) 80.0

Jolt 71.2



Pepsi One55.5



Mountain Dew 55.0

Mountain Dew Code

Diet Coke 45.6

Normal sleep or SWS deprived

REM sleep deprived

Dependence on REM sleep of

overnight improvement of a

perceptual skill.

Improvement in visual discrimination

Testing at 5 pm on day of learning task: comparing no nap, +SWS/-REM, +SWS/+ REM sleep

Mednick, S. Sleep Dependent learning: a nap is as good as a night. Nature Neuroscience Vol 6, July 2003.

Arithmetic task

Michael W.L. Chee Functional imaging of working memory

following normal sleep and after 24 and 35 h of sleep deprivation: Correlations of fronto-parietal activation with performance

◦

_{Short sleepers < 6}

hours found to have

lower GPAs (2.74)

◦

_{Long sleepers > 9}

hours higher GPAs

(3.24)

Kelly WE, Kelley, Kathryn E., Clanton, Robert C. The relationship

between sleep length and grade point average among college students.

Weekday

1 Hour later

wake time

↓

.132 GPA

r=-.350

Weekend

1 hour later

wake time

↓

.115 GPA

r=-.321

“the relationship between sleep habits and higher GPA …provides strong support for the hypothesis that sleep habits account for some of the variance in first-year students GPA.”

Trockel, MS. Health-related variables and Academic Performance among First-Year College Students: Implications for Sleep and Other Behaviors. J of Amer Coll Health 2004

The all-nighter: dumb and doesn’t know it

.

All-nighter Normal Sleep

I rocked that test!

Perceived

better

Performance and

Effort

Pilchner, JJ. How Sleep Deprivation Affects Psychological Variables Related to College Students’ Cognitive Performance. J Amer Coll Health. Nov 1997



Anger



Confusion



Fatigue



Depression



Increased stress



Students more likely to use prescribed and

OTC stimulants, ETOH

Lund, H. G., B. D. Reider, et al. (2010). "Sleep patterns and predictors of disturbed sleep in a large population of college students." The Journal of Adolescent Health 46(2): 124-132.

Nightmares

Nadorff, M. R., S. Nazem, et al. (2011). "Insomnia symptoms, nightmares, and suicidal ideation in a college student sample." Sleep 34(1): 93-98.



Electronic CBT

◦

_{Breathe (stress reduction, coping}

skills)

◦

_{Refresh (sleep, sleep hygiene)}

◦

Refresh associated with

improved sleep and decreased

depressive symptoms

Trockel, M., R. Manber, et al. (2011). "An E-mail delivered CBT for sleep-health program for college students: Effects on sleep quality and depression symptoms." Journal of Clinical Sleep Medicine 7(3): 273-278.

PVT and 4h, 6h, 8h sleep

restriction

Van Dongen, HPA. The cumulative Cost of Additional Wakefulness:

Dose-Response Effects on Neurobehavioral Functions and Sleep Physiology from Chronic Sleep Restriction and Total Sleep Deprivation. Sleep. 2003

Subjects perception of sleepiness was not progressive (Stanford Sleepiness Scale)

0 5 10 15 20 25 30 35 GPA<2 GPA>2

Gaultney JF. The prevalence of sleep disorders in college

students: Impact on academic performance. J Am Coll Health.



Snoring



Apneas



Overweight

Academics

Erratic

sleep

schedule

Inadequate

sleep

Perceived

effort

Sleep

Disorders

Short sleep duration and

obesity

Average BMI by Sleep

Duration

Gangwisch, JE. Inadequate Sleep as a Risk Factor for Obesity: Analysis of the NHANES1 Sleep 2005 1289-1296

Sleep duration and risk of obesity 4 hours OR 2.35

5 hours OR 1.60

% of 

drivers

Howard, ME.et al., The interactive effects of extended wakefulness and  low‐dose alcohol on simulated driving and vigilance.   Sleep 2007.

Wake up at the same time each day.

Stop drinking coffee by noon.

Turn off the dang laptop and get off your phone.

Sleep

Education

_Policies

School

Naps

Individual

Age Number of studies Number of students Junior High 9.5-12.5 3 108 (26, 27,55) High School 14-18 4 1332 (25, 1200, 22, 58) College 19.5 3 1030 (19, 122, 889) Secondary (International schools) 14-16 4 638 (28, 81, 104, 425)

Blunden, S. L., J. Chapman, et al. (2012). "Are sleep education programs successful? The case for improved and consistent research efforts." Sleep Medicine Reviews 16(4): 355-370.

Trockel, M., R. Manber, et al. (2011). "An E-mail delivered CBT for sleep-health program for college students: Effects on sleep quality and depression symptoms." Journal of Clinical Sleep M di i 7(3) 273 278



_{Classroom lectures, power point presentations, surveys,}

hand-on activities, sleep pamphlets, group discussions,



_Sessions:

◦

30 minutes

◦

60 minutes

◦

3 forty-five minute sessions

Knowledge- tested in 6

programs



Increase in sleep knowledge

Behavior -tested in 6 programs

0 5 10 15 20 25 30

Pre Test First Test Sleep Test Post Test

Complete modules Partial Modules

Standard Instruction

*

Quan, SF. Use of Supplementary Internet Based Education Programs Improves Sleep Literacy in College Psychology Students, J Clin Sleep Med 2013:9(2):155-160

0 10 20 30 40 50 60

Sleep Hygiene More Consitent Wake Time

More Sleep

Sleep Module

Standard Instruction

Quan, SF. Use of Supplementary Internet Based Education Programs Improves Sleep Literacy in College Psychology Students, J Clin Sleep Med 2013:9(2):155-160

Brown FC, et al. Relationship of sleep hygiene awareness, sleep hygiene practices, and sleep quality in university students.

Behavior Med 2002:2833-8

Good Sleep

Knowledge

Good Sleep

_Behavior

Yes No Decrease in Sleep Latency 2 4 Naps 2 Less Irregular Sleep Schedule 3 1 Less

Sleepiness 1 (weekends only) Increased

Sleep

“

For nearly four decades, researchers have

found that knowledge is generally

unrelated to health behavior and that simple

information transmission

fails to change health-related behaviors. Yet

the concept of the pamphlet rack outside of

the doctor’s office, even in electronic form,

endures”.

Strecher, V. Internet Methods for Delivering Behavioral and Health-Related Interventions (eHealth), Annu Rev Clinical Psychol



Time



Personnel



Effectiveness



Cost

Chang

e

Knowledge

Intention

Attitude

Importance

The

“Norm”

Behavior

Control or

Self-efficacy

Parks et al. The stages of physical activity and exercise behavior: an integrated approach to the theory of planned behavior. Asia Pac J Public Health 2009



Everybody is doing it.



Addressing the individual student

◦

Key sleep behaviors:

1.

Sleep schedule

2.

Bedtime behaviors

Average sleep amount per night:

4.5 to 8 hours

“How long does it take you to fall asleep?” 15 to 60 min



Broad categories:

Further evaluation or

Sleep Clinic Referral

Establish a dialog about increasing sleep which might

encourage behavior change. Discussing grades and sleep,

health, and mood might have an impact

Earliest Class Time Compromise wake _time Later Class Time Compromise wake _time 8 AM 7:30 AM 9 AM 8:30 AM 9 AM 8:30 AM 10 AM 9:00 AM 10 AM 9:30 AM 11 AM 9:30 AM 11 AM 11 AM 12 PM or later 10:30 to 11 AM 12 PM or later 11 AM



_{Focus on wake time!}



If possible a consistent wake time is best, but most students

won’t/can’t

do this. So find a compromise wake time.



On school days wake time: Latest should be 11 AM

Wake at 1 pm, may not be sleepy until 7 am

Wake at 11 am, may not be sleepy until 4 am



Bedtime Routine:

◦

Off electronics for a minimum of 30 minutes

◦

Stop caffeine 8 hours before bed

◦

Read (a book –no electronics) until drowsy

At the brightest setting measured from the same distance from a user's face, the iPhone 4 measured 275 lux, the iPad 1 measured 124 lux, and the iPad 3 measured 248 lux — all far above the melatonin-disrupting limit.

When held 14 inches away at the brightest setting, the iPhone 4

measured 8 lux and the iPad 1 measured 21 lux. The iPad 3, however, measured 32 lux — just above the threshold.



Helpful:



_{Small and realistic}

changes



_{Discuss the why}



_{Focus on academics}



_{“catch-up” sleep on the}

weekends



_{Ask “what keeps you}

from trying this?”



_{If appropriate (sleepy or}

won’t sleep group)

discuss naps



Not so Helpful



_{The term “sleep hygiene”}



_{Same weekend schedule}



_{Not acknowledging}

students’ challenging

schedule

N=63 Yes No

Did SASS help you understand the student’s sleep

issues? 72% 28%

Was the student receptive to the sleep

recommendations? 69% 31%

Would you use SASS regularly to address



“most of the time when people talk about sleep, they

talk about getting 8 hours of sleep- there is no way

that I can do that. I didn’t know small changes could

make a difference”



“School’s should teach more about sleep”



“I thought watching videos would relax me, I didn’t



Naps



Public Health Campaign



Education of counselors and providers



School start time



Electronic CBT

◦

_{Breathe (stress reduction, coping}

skills)

◦

_{Refresh (sleep, sleep hygiene)}

◦

Refresh associated with

improved sleep and decreased

depressive symptoms

Trockel, M., R. Manber, et al. (2011). "An E-mail delivered CBT for sleep-health program for college students: Effects on sleep quality and depression symptoms." Journal of Clinical Sleep Medicine 7(3): 273-278.

52 28 0 10 20 30 40 50 60 GPA >3.5 GPA<2.7

%

Eliasson et al. Early to bed, early to rise! Sleep habits

and academic performance in college students

Lahl, et al. An ultra short episode of sleep is sufficient to promote declarative memory performance, Journal of Sleep Research, 2008 Eliasson, et al. Early to bed, early to rise! Sleep Habits and Academic Performance in College Students. Sleep Breath 2010

26 university students with no daytime

0 10 20 30 40 50 60 70 80 90 100 Sleepiness hurts academics Naps would help Would you take more naps Yes No Not sure

0 20 40 60 80 No need

No time Home is too far away No place on campus concern for safety Concern for belongings



Students are not so picky:

◦

Comfortable couch

◦

Place to lock belongings



Women also want:

◦

Privacy screen

◦

Close to classes



_{Not worried about:}

◦

A separate room, identified as a nap location, an alarm, close to

studying.

0 10 20 30 40 50 60 70

No Time No Space Concern belongings

Undergraduate Graduate

 Orzech KM. The state of sleep among college students at a large public university. J Am Coll Health. 2011;59(7):612-619

.

Small, but measurable

change in sleep behavior

9% reported:

1. earlier bedtime,

2. shorter sleep latency

3. longer sleep duration

4. improved sleep quality

0 20 40 60 80 100 Sleepiness Sleepiness in Class Falling Asleep in Class Before After

Owens JA. Impact of delaying school start time on adolescent sleep, mood, and behavior. Archives of pediatrics & adolescent medicine. 2010;164(7):608-614

0 20 40 60 80 100 Somewhat depressed Irritated or annoyed Earlier start Later start

Owens JA. Impact of delaying school start time on adolescent sleep, mood, and behavior. Archives of pediatrics & adolescent medicine. 2010;164(7):608-614

0 50 100 150 200 250 300 State County Before Change After Change

Danner, F., & Phillips, B. (2008). Adolescent sleep, school start times, and teen motor vehicle crashes. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 4(6), 533 535



1. Reasonable deadline for assignments



2. Stop 8 AM classes



3. Improve sleep environments in the dorms

◦

_{Dim the lights}

◦

_{Enforce quiet hours}



4. Educate professors, advisors, counselors

on the impact of sleep

A sleepy night owl (MEQ 16-30)

Morning rock,

but you’re still sleepy (MEQ 59-69)

Morning rock! (MEQ 70-86 A night owl

(MEQ 31-41) You like days and nights



Technology and Sleep



GPA



Don’t Sleep, Don’t Drive:

Sleep deprivation



Impaired learning, memory, grades,

drowsy driving

Does education change behavior?



Behavior change Tailored feedback,

address barriers to change



Other interventions-nap locations, sleep

information available to students,

Future Directions- Sleep friendly school

policies