While studies do appear to indicate a deterioration of mood, even after the relatively minor withdrawal associated with over- night caffeine deprivation, animal studies and well-controlled human studies involving high habitual and low habitual users tend to confirm a “net benefit” for caffeine use, particularly in relation to psychomotor performance. Further research, particularly with (necessarily rare) caffeine-naive populations, is required to elucidate the complexities of the relationship between caffeine, sleep, and daytimefunctioning. This would ideally involve an integrated double blind study, whereby a larger cohort with caffeine levels controlled and monitored through blood plasma samples were exposed to daytime and evening caffeine at various dosages to monitor impact on sleep and next-day performance. However, the convenience of accessing caffeine compared to ensuring adequate restorative sleep means that caffeine has applied advantages that are likely to see its use as a performance “enhancing” substance persist.
Moreover, they were engaged in several other activities that were potentially stimulating and delayed sleep. Subjects who slept the least also multitasked the most. Regardless of socioeconomic status, adolescents multi- tasked on average 4 activities late into the night. The subjects who multitasked the most had significant de- crease in hours of sleep, as well as significant sleep disturbance during school hours. One subject in partic- ular, who slept ⬍ 5 hours each night, reported falling asleep on average 8 times during a school day. In addi- tion, 37% took naps after school and 42% did so on the weekend, apparently trying to make up for lost sleep. With 33% on average falling asleep at least twice per day, these adolescents who multitask the most are at risk for changes in school performance, difficulties with ex- ecutive function, and degradation of neurobehavioral function. 25,27
However, a more therapy-oriented approach may be necessary to address specific sleep complaints as the main adverse effects of shift work. Historically, this was done with pharmacotherapy (18) but has gradually given way to behavioural sleep medicine, which is based on behaviourism and cognitive psychology and has been successful in treating sleep disorders (19, 20). Cognitive behavioural therapy for insomnia (CBT-I) uses various techniques such as sleep hygiene, sleep restriction, stimulus control therapy and relaxation (19, 21). The cognitive therapy component is about offering education about sleep to subsequently target dysfunctional beliefs and minimise worries. Sleep hygiene includes a number of practices to promote good sleepquality, such as avoiding stimulants like caffeine and nicotine close to bed time, exercising, and limiting daytime naps. Sleep restriction is another powerful tool to increase sleep pressure by reducing the amount of time spent in bed to more closely match the amount of time spent sleeping. It reduces the sleep onset latency and wake periods at night (22). Stimulus control therapy increases patient’s awareness of “going to bed” rituals and advises against bed use for activities other than sleeping (e.g. watching TV). Relaxation therapy such as hypnosis (23), self-hypnosis, autogenous training, and progressive muscle relaxation or biofeedback are also effective in reducing sleep onset latencies and improving sleepquality (24, 25). An approach combining these techniques is more effective than simply applying sleep hygiene or cognitive behaviour alone (26, 27). Röttger et al. (28) reported that a bundle of interventions called
Caffeine, a well-known adenosinergic receptor antagonist, is one of the most widely consumed psychoactive substance mostly taken to restore low levels of wakefulness, modulate the activities of brain and improve task performance. Our study reveals that caffeine consumption is prevalent among the undergraduate university students of Karachi. Majority of the poor sleepers are tea consumers, though it did not reach statistical significance, which corroborate with a similar study (Hindmarch et al., 2000). The study also revealed that 3 out of 10 respondents consumed energy drinks, which is found to be strongly associated with sleepquality. This is in general agreement with prior studies (Aslam et al., 2013; Lemma et al., 2012; Reissig, Strain, & Griffiths, 2009; Velez et al., 2013). Besides caffeine, which is the main stimulant of energy drink, it may also contain other stimulating ingredients. The amino acid, taurine, a frequent ingredient in energy drinks, is thought to increase the effects of caffeine (Rath, 2012).
There is also evidence that higher doses of caffeine (>6 – 9 mg·kg -1 ) can cause negative side effects in some people. Graham and Spriet (1995) found that some subjects complained of “mental confusion”, and Ahrens et al. (2007) initially included a 9 mg·kg -1 dose in their study on exercise performance on untrained women, but this elicited tremors, dizziness and vomiting in seven out of the ten women. Further to these ergolytic effects, research has demonstrated that caffeine can have an adverse effect on sleepquality. Drapeau et al. (2006) found that a caffeine dose of 200 mg given 3 h prior to bedtime, compared to a placebo, significantly decreased sleep duration and sleep efficiency, while lengthening the time it took to fall asleep. Therefore, because caffeine elimination has been shown to be impaired in women taking OCS, this may mean that women will be exposed to higher concentrations of caffeine for longer, which increases the risk of adverse effects occurring, not to mention the likelihood of reduced sleepquality.
Nearly 16% of the students in our sample classified their sleepquality bad, however Corrêa et al found that 40% of the study subjects reported their life. 26 Poor sleepquality is associated with excessive daytime sleepiness. 27,28 In the present study, daytime dysfunction was reported by 70% of the participants, who had difficulty staying awake during the day at least once a week. This is consistent with the literature, although there are variations across studies in the proportion of medical students reporting daytime sleepiness: 31%; 42.1% ; and 63%. 27,29,30 Therefore, medical students experienced greater deleterious effects on subjective sleepquality and daytime dysfunction than non-medical students. This can be explained by the fact that attending a medical course requires a high level of dedication and selflessness, signifying harmful lifestyle changes, such as sleep deprivation and poor sleep hygiene habits. 31-34
It is possible that both caffeine feeding and mechanical perturbation could have broad effects on the general physiology of the fly. Therefore, we used a third method (genetic) whereby sleep reduction was transient and measured egg output following neural-circuit-driven sleep loss. We used the GAL4 – UAS system to express a temperature-sensitive cation channel Drosophila Transient Receptor Potential 1 (dTRPA1, which opens above temperatures of 27°C and causes hyper-excitation; Hamada et al., 2008), in dopaminergic neurons that have previously been shown to be wake promoting (Liu et al., 2012; Shang et al., 2011; Ueno et al., 2012). We recorded the sleep levels of flies in tubes and egg output in vials exposed to the following regime: two days at 21°C, followed by 3 days at 28°C, followed by 1 day at 21°C under a 12 h:12 h light: dark photoperiod. As expected, at the higher temperature, sleep was reduced both during daytime and night-time when dopaminergic neurons were activated, whereas the baseline sleep levels of these experimental flies were not different from that of the parental controls at the lower temperature (Fig. 3A,B). The number of eggs laid by the experimental flies was significantly lower than that of the controls (Fig. 3Ci,Cii). Indeed, these differences in egg output between experimental and control flies were not seen at the lower temperature of 21°C (Fig. 3Ci,Cii) when sleep levels were not Table 1. Sleep loss and rebound characteristics of night-time sleep
Some recent studies have indicated that the blue light emitted by the mobile screens is the major culprit behind the PSQ in late night mobile users. As most of the mobile screens emit blue light in wave length between 400 − 495 nm and blue light in the range of 460 – 480 nm can cause a phase-shifting in human circadian clock by decreasing the production of melatonin. 31,32 Reduced melatonin levels have been linked to prolonged sleep latency and sleep disturbances. 16 Moreover, exposure to blue light increases brain alertness and stimulates cognitive functions, result- ing in PSQ. 17,18 Our study ﬁ ndings were also supportive of the above-mentioned facts, we observed that participants who “ used the mobile for at least 30 minutes after the lights have been turned off (without a blue light ﬁ lter), ” showed strong positive correlation with poor sleepquality, daytime sleepiness, sleep disturbances and increased sleep latency. Moreover, a comparative study of Mortazavi et al found that using amber blue light ﬁ lter in the mobiles, signi ﬁ cantly improves the sleepquality, but this study used a small sample size of 43 participants only. 33 We therefore recommend further case control and experimental studies with larger sample size to con ﬁ rm these ﬁ ndings.
Background: Edentulism and sleep disturbance are chronic conditions that are common in older people and have serious adverse consequences for their functioning and quality of life. Edentulism can disturb sleep through the alteration of the craniofacial structure and surrounding soft tissue. However, the effect of prosthetic rehabilitation of edentulism on sleepquality is still not well understood. The objectives of this study are to test whether nocturnal denture wear affects sleepquality, daytime sleepiness, and the oral health related quality of life of edentate older people with moderate to severe sleep apnea, and to identify modifiers of effect of nocturnal denture wear. Methods/design: We will carry out a single-blind randomized cross-over trial. Seventy edentate older people with moderate to severe obstructive sleep apnea will be enrolled. The study participants will be assigned to wear and not wear their dentures on alternate periods of 30 days. The outcome measures will be sleepquality (assessed by portable polysomnography), daytime sleepiness (assessed by the Epworth Sleepiness Scale), and oral health related quality of life (assessed by validated questionnaire). A number of characteristics (sociodemographic, oropharyngeal morphology, oral and prosthesis characteristics, and perceived general health quality of life) will be assessed by means of clinical examination, 3D imaging of the craniofacial structure, and validated questionnaires at baseline. Linear mixed effects regression models for repeated measures will be fitted to test the study hypotheses. The main analyses will be based on the intention-to-treat principle. To assess the robustness of the findings to potential incomplete adherence, sensitivity analyses will be conducted while applying the per-protocol principle.
METHODS: Objectively measured total sleep time, sleep efﬁciency, and fragmentation, subjectively reported numbers of nocturnal awaken- ings, total nocturnal wake time, and sleepquality, and sleepiness/ fatigue measured by using the fatigue visual analog scale, the Stanford Sleepiness Scale, or the Epworth Sleepiness Scale were assessed. RESULTS: We did not ﬁnd differences between women who were exclu- sively breastfeeding, exclusively formula feeding, or using a combina- tion of the 2 methods, with respect to the assessed parameters. CONCLUSIONS: Efforts to encourage women to breastfeed should in- clude information about sleep. Speciﬁcally, women should be told that choosing to formula feed does not equate with improved sleep. The risks of not breastfeeding should be weighed against the cumulative lack of evidence indicating any beneﬁt of formula feeding on maternal sleep. Pediatrics 2010;126:e1562–e1568
and impaired daytimefunctioning. Women have the highest prevalence of insomnia. After a conditioning period, the aerobic activity group exercised for two 20 minutes sessions four times per week or one 30 to 40 minute session four times per week, both for 16 weeks. Participants worked at 75% percent of their maximum heart rate on at least two activities including walking or using stationary bicycle or treadmill. Participants in the non-physical activity group participated in recreational or educational activities such as cooking class or a museum lecture, which met for about 45 minutes three to five times per week for 16 weeks. Both groups received education about good sleep hygiene, which includes sleeping in a cool, dark & quiet room, going to bed the same time every night and not staying in bed too long if you can’t fall asleep. Exercise improved the participants self-reported sleepquality, elevating them from a poor sleeper to good sleeper. They also reported feeling better, their moods improved and had more vitality and less daytime sleepiness.
Numerous studies in the general population have demon- strated that poor or reduced amounts of nocturnal sleep and excessive daytime sleepiness adversely affect a variety of quality of life and functional health status indicators [15,46-50]. Both problems have also recently been associ- ated with cardiovascular disease [46-49], the most com- mon cause of death in the HD population . However, although sleep disorders and excessive daytime sleepiness  are very prevalent in the HD population, limited information is available with regard to the extent to which these problems affect life quality. Previous reports suggest that poor subjective sleep[52,53] and sleep-related breathing disorders  have adverse effects, but the scope of these studies with regard to sleep measures is lim- ited. Thus, we examined how quality of life is related to both subjective and objective measures of nocturnal sleep and daytime sleepiness in a sample of stable HD patients. Perhaps the most important finding of this study is that selected indicators of poor nocturnal sleep and increased daytime sleepiness are associated with reduced quality of life. Sleep complaints that characterize insomnia [52,55], including difficulty initiating sleep, early morning awak- enings, and feeling unrefreshed in the morning, are partic- ularly important. A recent study by Williams et al. , also noted that complaints of insomnia were associated with pain, depression, and decreased physical functioning. These findings suggest that the assessment and treatment of insomnia-related complaints should be included in any overall plan of care designed to optimize quality of life as well as other important clinical out- comes. Numerous pharmacological and/or cognitive behavioral techniques are efficacious for treatment of insomnia but controlled clinical trials designed to evalu- ate their effectiveness in HD patients remain to be con- ducted [56-59].
It is clear from this review of baseline clinical study data that untreated primary insomnia, specifically poor sleepquality and reduced daytimefunctioning, is associated with substantial costs to both society as a whole and to individuals. Costs can be associated directly through reduced QOL, impairment of cognitive and physical functioning, and the subsequent increase in health care resource utilization associated with these problems, and indirectly as a result of reduced work productivity/presenteeism, lost income/ absenteeism, and other sources of indirect burden on society such as an increased risk of vehicle crashes. However, data on the impact of primary insomnia on absenteeism are incon- sistent; in the absence of depression, a common comorbidity in insomnia, absenteeism rates may be no higher than in those without insomnia.
Significant correlations were found between ESP scores and scores on insomnia (r= 0.117, P= 0.005), sleep apnea (r= 0.118, P= 0.004) daytimefunctioning (r= 0.225, P,0.0001), and sleepquality (r=- 0.104, P= 0.012), but not for CRD (r= 0.066, P= 0.112). Correlations between day- time functioning and insomnia (r= 0.415, P= 0.0001), CRD (r= 0.451, P= 0.0001), sleep apnea (r= 0.289, P,0.0001), and sleepquality (r=- 0.435, P,0.0001) were also signifi- cant, and were stronger than those observed between ESP and sleep disorders. When controlling for scores on the SLEEP-50 subscales of insomnia, sleep apnea, and CRD, the partial correlation between ESP and daytime function- ing scores was somewhat less pronounced, but remained significant (r= 0.188, P#0.0001). ESP scores and total sleep time were negatively correlated (r=- 0.092, P= 0.028). Total sleep time was significantly shorter in those who screened positive for having EDs (7.3 versus 7.6 hours, P= 0.034). Also, a clear difference in sleep disorder scores was found between those who screened positive and negative for ED (Table 2).
The harmful effects of technological devices, including smart phones have been increa- singly suspected among university students; bedtimes have become increasingly later at night, and leisure activities often extend through the night. Likewise, availability and need of increasing part-time job hours have been considered. The purpose of this re- search was to determine the relationship among lifestyles, quality of sleep, and daytime drowsiness of nursing students of University A. The research was conducted in June 2015, when student life rhythms were considered stable after two months of lectures. Responses with missing values or with inappropriate answers were excluded. Of the data collected from 96 respondents, only 71 were acceptable. The survey focused on lifestyle, daytime sleepiness (using ESS: Epworth Sleepiness Scale) and quality of sub- jective sleep (using the PSQI: Pittsburgh SleepQuality Index). Approval was obtained from the Research Ethics Committee of Shikoku University. While in this study, more than half (63.4%) of the students had poor quality of sleep, however, there was no rela- tionship between their quality of sleep and daytime drowsiness, or between their life- styles and the quality of sleep. These findings suggest that while university students’ use of technological devices is suspected to influence on sleep deprivation and consequent daytime drowsiness, the findings did not provide the evidence.
prevalence of 18% among this group, which is higher than its rate of occurrence in the general population. Byrd et al 6 found that the prevalence of insomnia among college stu- dents in Ethiopia was as high as 61%, while another study found it to be 44.7%. 7 Insomnia symptoms are not only widespread, but they can also impact life adjustment. Sleep disturbances are known to affect both academic and work- place performance. 8 Additionally, sleep plays a vital role in cognitive functions such as judgment, as well as memory consolidation and recall, factors which are vital for academic performance. 9,10 Insomnia in college students is associated with psychological conditions such as depression and anxi- ety, as well as with certain behaviors such as substance abuse and poor sleep habits. 6,11 Substance abuse has been found to affect many aspects of sleep health. 11 Anxiety is one of the most commonly reported general mental disorders in univer- sity students. Anxiety disorders can arise from or can be exacerbated by various psychological issues or challenging situations in life. Among college or university students in particular these can include fears or concerns about academic performance, thoughts about the future, and other social pressures. 12 Poor sleep hygiene practices can affect both sleepquality and quantity, which in turn can affect daytimefunctioning. 13 While these life adjustment challenges fre- quently occur among college students, they often go unac- knowledged by the students themselves, and the broader health implications of inadequate sleep are frequently devalued.
Investigating the relationship between both the students’ excessive daytime sleepiness (ESS score) and quality of sleep (PSQI score), respectively, with the decrease of their academic performance and adjusting on the factors collected by the questionnaire (age, sex and level of psychological distress); The linear regression analysis suggested, in uni- variate model, the high level of psychological distress (K6 score) as factor of increased academic performance ( b= 0.04; 95% CI = 0.005–0.07; P < 0.024) and showed that factors associated to low academic performance were the old age ( b= −0.22; 95% CI = −0.35 to −0.09; P < 0.001) and the poor sleep ( b= −0.07; 95% CI = −0.14 to −0.002; P = 0.04). However, regarding daytime sleepiness, we found that in our study it was not statistically associated with academic performance (Tables 3 and 4).
only 3.8% of the variance in sleep duration (F(20,3934) ⫽ 7.85; P ⬍ .001). Of these, the only significant explanatory variable was age, with younger respondents sleeping longer than older ones (t ⫽ ⫺ 3.456; P ⫽ .001). According to the model, mean sleep duration decreased from 507.5 minutes at 12 years to 489.3 minutes at age 15. When the same model was limited to main effects, sleep duration was found to be shorter in boys (t ⫽ ⫺ 3.992; P ⬍ .001). It was also shorter in subjects who made greater use of caffeine (t ⫽ ⫺ 3.336; P ⫽ .001), as already noted, and it was shorter in subjects whose naps were of shorter duration (t ⫽ 3.388; P ⫽ .001). Nighttime sleep durations also varied significantly by day of week (t ⫽ ⫺ 7.79; P ⬍ .001). The longest durations occurred on Saturdays (mean: 518.0 min- utes) and Sundays (mean: 528.8 minutes), and the shortest were on Mondays (448.5 minutes; Fig 2).
A large Korean longitudinal study showed a bidirectional association between sleep and relationship quality. Low marriage quality led to a higher risk of a clinically relevant sleep disorder. Vice versa, a low sleepquality in the early stages predicted lower marriage satisfaction four years later . Sleep duration seemed to be influ- enced by relationship status, as singles and divorced people sleep less than married participants . Furthermore, unmarried people were more at risk of sleep disturbances compared to married adults . Haslers and Troxel assessed couples about sleep and relationship functioning . In men, higher sleep efficiency (measured by sleep diary) had a predictive value on less negative interaction with the partner. Vice versa, positive interactions reported by women seemed to influence men’s sleep efficiency positively.
impairment of studied cognitive function, quality of life, mood disturbance as depressed or anxious mood, and more affection of SDQ and ESS in patients with OSA than control group. These results could be attributed to multiple mechanisms, thought to contribute to sleepiness in patients with OSA. These include sleep fragmentation , hypoxia , partial chronic sleep deprivation from sleep time lost due to arousals , cytokine dysregulation , and interactions with individual adaptations . Other studies had proposed the hypothesis that both daytime somnolence and hypoxemia may contribute to cognitive dysfunction in OSA patients. In particular, the impairment of executive functions, motor and visuo-constructive abilities (such as language, fluency, drawing) may be related to severity of hypoxemia. Also, attention and memory deficits may be due to excessive daytime somnolence associated with sleep fragmentation [27-29]. Other studies suggested the importance of REM sleep for memory consolidation [30,31], particularly for those individuals with insomnia .