Indian Journal of Health Social Work
Daytime Sleepiness, Sleep Quality and Sleep Habits Among Undergraduate Students
NANDHA KUMARA PUJAM. S
Assistant Director & Associate Professor of Clinical Psychology School of Criminology and Behavioral Sciences, Rashtriya Raksha University (An Institution of National Importance) At Lavad- Dehgam, Gandhinagar, GujaratCorrespondence: Nandha Kumara Pujam. S, e-mail id : firstname.lastname@example.org
Background: The growing level of stress on students, is affecting their psyche, sleep and life style. Sleep deprivation and symptoms related to sleep disorders have been ignored and inadequately understood. A Good quality and quantity sleep are important in order to have better academic performance and to avoid other health problems. Aim: To Study the day time sleepiness, sleep Quality and sleep habits between male and female undergraduate students of Amity University, Madhya Pradesh. Materials and Methods: Day time sleepiness, Sleep Quality and sleep habits were investigated using a stratified random sampling method from the student of Amity University, Gwalior, Madhya Pradesh, India. The study was carried out during June – September 2017 with 202 undergraduate students. The scales administered were Epworth Daytime Sleepiness scale, Sleep hygiene Index and Pittsburg Sleep Quality Index. Data was analyzed by using statistical Package of social sciences (SPSS) version 16.0. Results: The present study found that female students reported significantly higher day time sleepiness than male students. Besides that female student showed poor sleep hygiene and sleep quality than the male students. Furthermore on Pearson correlation it was found that significant positive correlation between day time sleepiness, sleep quality and sleep hygiene. Moreover, Out of 206 students 23.8% had abnormal level of daytime sleepiness, 14.1% had borderline level of daytime sleepiness and 62.1% had normal level of daytime sleepiness. Conclusion: Sleep disturbance are an important issue among university students. They should be taken for counseling in which sleep hygiene should be emphasized during the initial sessions of the counseling. Nightmare, snoring and irregular sleep patterns further complicates the condition which also should be addressed in the counseling sessions.
College is a place where many young adults acquire a degree of personal freedom which paves the way for change in their life style.Also due to academic and peer pressure their life style gradually changes which plays a pivotal role in modification of their sleep pattern. One of the life style habits that young people frequently alter upon entering college is sleep. Conceivably due to social and academic demands, many college students choose an irregular sleep wake pattern. In order
to compensate the night time sleep, research shows that there is significant increase in day time sleepiness among students (Pilcher, Ginter and Sadowsky 1996).Sleep deprived individuals show an increase in negative mood states along with increased fatigability, decrease in alertness and memory in daily activities (Kjellberg 1977).
Excessive daytime sleepiness has a significantassociation with motor accidents (Lyznicki et al. 1998).In a study by Tsai and Li (2004) assessed 237 college students and reported that the female students sleep earlier and wake up earlier with longer sleep latency, they showed sleep disturbance in the form of higher awakenings at night sleep, longer naptime and poor sleep quality than the male students.Similarly, Medeiros et al. (2001) reported female students went to sleep earlier than male students however they showed a poor sleep quality on Pittsburgh sleep quality index.
In another study by Mesquita and Reimao (2010) examined 710 university students and found 60.38% were poor sleepers this,reduced sleep times and increased disturbances were associated with media use.Likewise, Veldi, Alouja and Vasar (2005) studied sleep quality of medical students and found that 29%, 40% and 24% reported excellent, good and satisfactory sleep quality respectively.Interestingly, Salehi (2015)assessed 312 medical students and documented 81.1% were poor sleepers, 60.5% need sleep during the day and slept in the day time. Furthermore, Tsui and Wing (2009)examined 620 business students and reported the sleep duration during working days was shorter than the non-working days. The duration of sleep for Female students was longer than the male students in weekends. The hostel students slept more frequently than the day scholars and observed sleep disturbance in 58% business students. More poor sleepers were found in the students taking early morning lectures. Conversely, Nojomi, Bandi and Kaffashi (2009)evaluated 400 medical students and residents and showed 14% reported perfectly satisfied sleep, around 44% participants expressed good sleep, similarly 30% participants had fair sleep and remaining 1.5% conveyed a very poor sleep, the insomnia was more in females.There has been some controversy regarding the sleep duration.Harrison and Horne (1995) debated that over reporting of sleep deprivation due to the criteria of duration of sleep per night and therefore does not need to take more sleep than their current norm. Harrison accentuated on the point that average 7.5 hours of daily night sleep is sufficient, and showed is disagreement to the current opinion that increased night sleep might decrease the day
time sleepiness. suggested that whereas current opinion seems to moving towards take more sleep and be less sleepy when awake(Dement and Mitler 1993). Others argue that the average sleep length of 7.2 to 7.4 hours is deficient; it should be 8.5 hours per night (Bonnet and Arand 1995). In Addition to that Webb and Agnew (1975) debated, we are chronically sleep deprived based on their observation of 16 young male adult for 4 consecutive nights, and reported that the average sleep should be 10 hours of sleep, rather than the average 7 to 8 hours.Moreover, Taub (1977) examined two groups of 10 male university students and observed positive mood states such as cheerful, energetic, general activation, high activation were significantly higher and negative affects such as anger, hostility and depression significantly less in the long sleepers.
Zailinawati et al. (2009) examined 799 Malaysian medical students and reported daytime sleepiness occurred in 35.5% and 16.1% showed bad sleep quality. Furthermore, knowledge about sleep hygiene does not necessarily influence sleep quality, whereas practicing proper sleep practice is strongly related to good overall sleep quality(Brown, Buboltz, and Soper 2002).Additionally, four fundamental sleep prototypes are related with academic achievement: sleep quantity, sleep quality, sleep regularity and sleep phase schedules (Gomes, Tavares and Azevedo 2011). One sleep related area that has not gained attention in non-medical college students is the relationship between sleep quality, sleep habits and daytime sleepiness. Therefore the present study intended to study the sleep quality, sleep habits and daytime sleepiness in university students.
MATERIALS AND METHODS
Participants and procedure
This cross sectional study was carried out during June 2017 to September 2017 at Amity University, Gwalior, Madhya Pradesh and collected data on daytime sleepiness, sleep hygiene and sleep quality. The participants were selected randomly and the sample consists of 206 undergraduate students which include both male (n=121) and female students (n=85). The participating students were informed about the objective of the study and written informed consent was taken from each student separately. Subsequently socio demographic data sheet, Epworth Daytime Sleepiness scale, Sleep hygiene Index and Pittsburg Sleep Quality Indexwere administered to all students in the present study.
Data was analyzed using the statistical package for social science (SPSS) 16.0 versions. Descriptive statistics were done for socio demographic data and to analyze the percentage of sleep latency and distribution of daytime sleepiness. Pearson correlation was used to analyze the relationship among daytime sleepiness, sleep hygiene and sleep quality. Furthermore independent sample “t” test was used to determine the difference between male and female students in terms of daytime sleepiness, sleep hygiene and sleep quality.
Table 1: shows the comparison of daytime sleepiness, sleep hygiene and sleep quality based on gender. There is a significant difference in daytime sleepiness (p<.01), female students (9.87±3.57) reported higher day time sleepiness than male students (8.11±4.34). Similarly there is a significant difference in sleep hygiene (p<.05) female students (21.89±6.31) reported poor sleep hygiene than male students (20.13±6.11). Likewise there is a significant difference in sleep quality (p<.05) female students reported poor sleep quality (6.61±2.64) than male students (5.67±2.33).
Table 2: shows the distribution of Epworth daytime sleepiness scale. Out of 206 students 23.8% had abnormal level of daytime sleepiness, 14.1% had borderline level of daytime sleepiness and 62.1% had normal level of daytime sleepiness.
Table 3: shows the distribution of bad dreams and snoring. Out of 206 students 126/61.2% reported bad dreams, of which75/62% were males and 51/ 60% were females.Similarly,out of 206 students, 54/26.2% reported snoring of which 35/28.9% were males and 19/22.4% were females.
Table 4: shows the distribution of sleep duration among the students. Out of 206 students, 4-5 hours of sleep were reported by 23/11.2% students of which 13/10.7% were males and 10/11.8% were females, 5-6 hours were reported by 29/14.1% students of which 16/13.2% were males and 13/ 15.3% were females, 6-7 hours were reported by 91/44.2% students of which55/45.5% were males and 36/42.4% were females, 7-8 hours were reported by 48/23.3% students of which 30/24.8% were males and 18/21.2% were females, 8-9 hours were reported by 15/17.3% students of which 7/5.8% were males and 8/9.4% were females.
Table 5: shows the distribution of sleep latency among the students. Out of 206 students, 94/ 45.6% students reported sleep latency was within 15 minutes of which 57/47.1% were males and 37/ 43.5% were females. Similarly, 35/ 17.0%students reported sleep latency was between 16-30 minutes, of which 20/16.5% were males and 15/17.6% were females. Likewise,39/ 18.9% students reported sleep latency was between 31-45 minutes, of which 23/19% were males and 16/18.8% were females. 20/9.7% students reported sleep latency was between 46- 60 minutes of which 12/9.9% were males and 8/ 9.4% were females. 18/8.7% students reported sleep latency above 60 minutes of which 9/7.4% were males and 9/10.6% were females.
Table 6: shows the Pearson correlation between Daytime sleepiness, sleep hygiene and sleep quality and found to have positive correlation between daytime sleepiness and sleep hygiene (r=0.252, p<0.01) which indicates higher day time sleepiness is associated with poor sleep hygiene. Similarly there is a positive correlation between sleep hygiene and sleep quality (r=0.297, p<0.01) which indicates poor sleep hygiene is associated with poor sleep quality.
The present study found that female students reported higher day time sleepiness than male students. Similarly, female students reported poor sleep hygiene than male students.Likewise female students reported poor sleep quality than male students.This finding is in agreement with the previous research (Nojomi, Bandi and Kaffashi 2009). In contrast in a study by Baviskar and Phalke (2013) reported better sleep quality in females than males.Furthermore, Deepa and Rupa (2017) assessed 200 medical students and reported 76.0% showed poor sleep quality. In contrast Afandi et al. (2012) examined 290 university students and reportedno significant difference between male and female students in their sleep quality. However the overall sleep quality in their study was poor.
The present study also found that 23.8% had abnormal level of daytime sleepiness, 14.1% had borderline level of daytime sleepiness and 62.1% had normal level of daytime sleepiness. This finding is in accord with the previous study by Prashant et al. (2015) examined 503 medical students for day time sleepiness and reported 15.1% were in borderline, 11.33% students has serious daytime sleepiness. Similarly, Giri, Baviskar and Phalke (2013) evaluated 150 medical students and reported that 17.3% had abnormal levels of daytime sleepiness while 13.3% were borderline.
Additionally, the present study observed that 126/ 61.2% reported bad dreams, of which 75/62% were males and 51/60% were females.Likewise, 54/26.2% reported snoring of which 35/28.9% were males and 19/22.4% were females. Snoring was also reported to affect the sleep quality of the students (Veldi Aluoja and Vasar 2005).
Furthermore, 4-5 hours of sleep were reported by 23/11.2% students of which 13/10.7% were males and 10/11.8% were females, 5-6 hours were reported by 29/14.1% students of which 16/ 13.2% were males and 13/15.3% were females, 6-7 hours were reported by 91/44.2% students of which 55/45.5% were males and 36/42.4% were females, 7-8 hours were reported by 48/23.3% students of which 30/24.8% were males and 18/ 21.2% were females, 8-9 hours were reported by 15/17.3% students of which 7/5.8% were males and 8/9.4% were females. In a similar study byGiri, Baviskar and Phalke (2013) showed 2% students reported less than 5 hours of sleep duration, 17.3% students reported by 5-6 hours of sleep duration, whilst 61.3% students reported 6-7 hours of sleep duration, with more than 7 hours of sleep duration reported by 19.3% out of 150 students. Some research considers 7.5 hours as average sleep duration (Dement and Mitler 1993). Whilst others suggest 8.5 hours as average sleep length at night (Bonnet and Arand 1995).Moreover, 94/45.6% students reported sleep latency was within 15 minutes of which 57/47.1% were males and 37/ 43.5% were females. Similarly, 35/17.0% students reported sleep latency was between 16-30 minutes, of which 20/16.5% were males and 15/ 17.6% were females. Likewise, 39/18.9% students reported sleep latency was between 31-45 minutes, of which 23/19% were males and 16/ 18.8% were females. 20/9.7% students reported sleep latency was between 46-60 minutes of which 12/9.9% were males and 8/9.4% were females. 18/8.7% students reported sleep latency above 60 minutes of which 9/7.4% were males and 9/ 10.6% were females.
The present study observed that higher day time sleepiness is associated with poor sleep hygiene. This finding is concurrent with previous research (Mastin, Bryson and Corwyn 2006). Similarly, we found thatpoor sleep hygiene is associated with poor sleep quality.This finding is in agreement with previous research (Mastin, Bryson and Corwyn 2006).However, knowledge about sleep hygiene does not necessarily influence sleep quality, whereas practicing proper sleep practice is strongly related to good overall sleep quality(Brown, Buboltz and Soper 2002).
Sleep disturbance are an important issue among university students. They should be taken for counseling in which sleep hygiene should be emphasized during the initial sessions of the counseling. It is advisable that sleep education in university students may help them be aware of their own sleep problems and thereby willing to choose activity schedulesand sleep habits that enhances good sleep. Nightmare, snoring and irregular sleep wake pattern further complicates the condition which also should be addressed in the counseling sessions. This study has few limitations that need to be mentioned, this study was done in a private university and therefore the result cannot be generalized to Government University.Further we didn’t look for any particular factors for sleep disturbances such as role of media, internet and video games which can be taken up for future studies.
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Conflict of interest: None
Role of funding source: None