Sleep and Academic Performance among Students

Introduction

Sleep is very important to all of us. The National Sleep Foundation in the US reports that insufficient sleep can bring damaging and even life-threatening outcomes (Orzech et al., 2011). According to researches, nearly 75% of students in university reported occasional sleep problems such as various sleep disturbances, difficulty falling asleep, excessive daytime sleepiness and delayed sleep phase syndrome (Altun et al., 2012). As sleep plays a facilitating role in students’ learning and memory process(Lemma et al., 2013), which is their primary learning cognitive needs, sleep does have a great impact on their academic performance directly and indirectly.

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Research focuses on OT students stated that the majority of them rated their current level of stress as ‘above average’ or ‘the highest in my life’ (Pfeifer et al., 2008). Besides, as international OT students, the transition to higher education, time management, language barriers, cultural shock and other factors do have an influence on their sleep, somehow result in unsatisfied academic performance.

There are a certain amount of studies focused on finding ways to help international students to achieve their academic goals and adapt to the new environment (Poyrazli, 2015). Some researches had revealed how cultural background difference, psychological factors such as loneliness and stress, social integration, environmental factors and biological factors related to academic performance among international students (Altun et al., 2012; Hershner & Chervin, 2014; Poyrazli, 2015).

And some researches specifically aiming at finding out how much stress OT students facing and how it leads to unsatisfied academic performance and outcome (Pfeifer et al., 2008). However, there are limited researches conducted about the relationship between ‘sleep’ and ‘academic performance’ among international students, and none of them focuses on international occupational therapy students.

So our aim, which is worth exploring, is to determine the effect of sleep quantity and quality on the academic performance among undergraduate international occupational therapy students at Monash University in Melbourne. The hypothesis was that a correlation would exist between the quantity and quality of sleep and academic performance among undergraduate international OT students.

The research is conducted by four international students from the Master of Occupational Therapy Practice 2015. 11 undergraduate OT students of Monash University were recruited to finish an online questionnaire and one follow-up interview.

Literature Review

All the researchers have searched a number of literatures from different perspectives. The part includes sleep problems and sleep habits among university students, behaviours that can impact on sleep, the relationship between sleep and academic performance, and the characteristic of international students in this particular issue.

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Sleep problems among university students

Sleep problems are common among university students. Poor sleep quality, insufficient sleep duration, and sleep disorders/disturbances have all been reported during the last few years. The prevalence of poor sleep quality in university students has been reported as ranging from 19.17% to 57.5% (Cheng et al., 2012). Kang and Chen (2009) reported that 33.8% of medical school students in Taiwan could be characterized as suffering from poor sleep quality as defined by a PSQI score higher than 5.

Most sleep specialists indicate that adult humans require approximately 8 hours of sleep per day (Carskadon, 2004). However, Gikunda et al. (2014) found that majority of university students slept between 4, 5 and 6 hours every night during weekdays and 6 and 7 hours per night over weekends and therefore had an irregular sleep-wake pattern, those who had Ds and Cs had lesser hours of sleep than the recommended. Researches also suggested that sleep disorders are now recognized as a public health concern with considerable psychiatric and societal consequences, specifically on the academic life of students (Choueiry et al., 2016).

Sleep habits among university students

University students tend to sleep quite late, but they usually need to get up early as they might have classes in the morning. Study in Korean university students found the average bedtime was 12:56 a.m. and over 25% of the students and at 2:00 a.m. or later over 26.4% of students. The average time students reported falling asleep was 1:16 a.m. (Yeung et al.,2008). During weekdays, the average student went to bed at 12:24 a.m. and awoke at 8:12 a.m. (Forquer et al., 2008).

Buboltz et al. (2001) reported that students went to bed later on weekends on average by 97 minutes and the weekend rise times were found by Forquer et al. (2008) to be more than two hours later than weekday rise times. However, a shift of the bedtime to later hours increased with age and present from the adolescent period, whereas the wake-up times were rather consistent across the ages, especially on weekdays (Thorleifsdottir et al., 2002). However, it doesn’t mean that delayed bedtime and shortened sleep duration wouldn’t cause a negative effect on both adolescents and young adults, who made up most of the university students.

Kabrita et al. (2014) also explored sleep quality and factors contributing to sleep and general health in a culture-specific context in Lebanon. The study was conducted among 540 students in both private and public university using PSQI. They found that the prevalence of poor sleep quality among Lebanese university students is associated with reduced sleep duration and shifts in sleep timing between weekdays and weekends, especially among evening types.

University students often have erratic schedules that cause irregular sleep patterns even though sleep durations remain relatively constant. And maintaining good physical and mental health without sound sleep and a regular sleep cycle is difficult, even if sleeping hours are kept constant (Matsumoto et al., 2012). Davidson et al. (2012) also suggested that average weekday sleep length was significantly correlated with mental wellbeing.

Behaviours that impact on sleep

The increased use of electronic media plays a very important role in the sleeping habits of university students. The use of computers, laptops, television, and the presence or availability of other media within a student’s room reduces the sleep duration and delay’s the bedtimes (Nuutinen et al., 2013).

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Kim et al. (2010) also suggested that heavy Internet use was correlated with multiple risk behaviours such as skipping meals and sleeping late as well as poorer health outcomes such as the higher likelihood of being overweight or having hypersomnia. Of students, 14.8% reported heavy Internet use (>4 h/day) and such use was associated with a lower likelihood of engaging in health-promoting activities such as exercising and seeking medical care.

As a consequence of using the smartphones, at least 43% had decreased sleeping hours and experienced a lack of energy the next day, 30% had a more unhealthy lifestyle (ate more fast food, gained weight, and exercised less), and 25% reported that their academic achievement been adversely affected (Alosaimi et al., 2016).

Gupta et al. (2016) did a study aim to examine the self-reported pattern of mobile phone usage among students of a medical university and to assess effects of mobile phones use on their psychological health in the form of their perceived stress, sleep quality, and academic performance. They recruited 1000 students of a medical university in India, both male and female of age between 17 to 24 years old.

The findings of this study suggest specific mobile usage patterns, various compulsions caused by mobile use, and a number of important relationships between mobile phone usage, health-related behaviours, and academic activities among college students. A highly significant correlation was found between night time use of mobile phone and difficulty in waking up, waking time tiredness, the decline in study habits and grades, decrease in concentration, increased frequency of missed classes, and being late for classes.

Sleep and Academic Performance

Eliasson et al. (2010) investigated the relative importance of total sleep time compared to the timing of sleep and wakefulness for academic performance. They conducted a questionnaire-based survey of 60,000 full- and part-time students (ethnically and culturally diverse) at the main campus of Montgomery College. A significant difference in the timing of sleep between high and low academic performers was found. Those with the highest GPA had earlier bedtimes (12.00am vs 12.38 am, p=0.05) and earlier wake time (7.13 am vs 8.02am, p=0.008) than those with the lowest GPA.

The academic performance of students was found to be negatively affected due to the decreased night sleep time, late bedtimes on weekdays and increased daytime sleepiness. However, students undergoing early bedtimes show excellent academic performances (BaHammam et al., 2012). Cheng et al. (2012) also suggested that poor sleep quantity and quality are related to lower academic performance among adolescents of all ages. Indeed, up to 70% of university students have regular sleep difficulties. Another thing is that Lund et al. (2010) reported that students overwhelmingly stated that emotional and academic stress negatively impacted sleep, which indicated that not only sleep has a huge influence on students’ academic performance, but it can also be the other way around.

The difference among international students

Culture plays a very important role in terms of the effect and role the extracurricular activities play on sleep and mental health in students. Different cultural shifts and socio-economic pressures also affect the lives of students and working adults, especially in terms of the quality of good night sleep (Kabrita et al., 2014). A number of studies, mainly from Asian, noted that the international students slept approximately six hours every night. A similar trend has been found in the Taiwanese students (Yang et al., 2003) and Korean whereas sleep length was five hours and 54 minutes among Hong Kong medical students (Yeung et al., 2008).

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However, there is currently no literature found on the relationship between sleep and academic performance among international students. Therefore it’s an opportunity to investigate on this topic as the number of international students is increasing in every profession in the university during past few years, and they are one of the important components in Australian universities.

Methodology

Design

This study was a cross-sectional study of a mixed method of combining quantitative and qualitative. It was designed and conducted as part of a learning-based study in the master’s program of occupational therapy in Monash university in Australia.

The study aimed to investigate whether sleep quantity and quality has an impact on the academic performance of international students in the undergraduate occupational therapy program at Monash University. Therefore, four questions were formed to address the purpose.

  1. Is there any relationship between sleep quality, quantity and academic performance in international students in the undergraduate occupational therapy program?
  2. How sleep quantity of international students in the undergraduate program at Monash University is?
  3. Is there any difference in their sleep quantity between semester time and break time?
  4. How sleep quality of international students in the undergraduate program at Monash University is?
  5. What is their level of satisfaction with their academic performance during last semester?

Based on the research questions and literature review, a questionnaire was designed into four sections. See the appendix (.reminder to add number..). The theme of interest was initially established by considering the research problem of sleep quantity and quality on academic performance using already in the literature review. The specific structure was outlined for each theme, and these are discussed further below.

The survey consists of nine questions in total, and each section involves two quantitative questions followed by one open-ended qualitative question. The qualitative question was sequentially designed to explore further reasons or meanings associated with the participant’s responses for that section. The questions and the order were highly selective due to the time, resources and instructions constrained.

The strategy of clear heading was used to structure and help the respondents to navigate the survey as follow:

Demographical section

The first section is consist of 13 demographic questions, which was designed based on previously published survey instruments to assess socio-demographic characteristics using interval, nominal, and categorical data. This was include, age, gender, which determine how much sleep the body needs (Bonnet & Arand, 2010), nationality, first language, year of studying and GPA. These data will provide baseline information that would be used for comparison and descriptive analysis.

Furthermore, In order to answer the second research question about the sleep quantity, additional questions were considered in this demographical part due to the constraints of this survey design. This was including collecting interval data about the total sleep hours per day since the evidence has been shown that limited amount of sleep leads to decrease performance, cognition and short-term memory, and attention span (Bonnet & Arand, 2010), which influence the performing grades (Entwistle and Ramsden, P. 2015). Moreover, the studies have found a significant difference in the sleep bed timing between high and low academic performers ( Eliasson, L.ettieri, & Eliasson, 2010), therefore a question about the usual bedtime was used.

In addition, Preference time for study was consider based on the …. Still i did not look to evidence.

The undergraduate international students moving from living with their families during high school to be a residence of their own with change in the social activities, roommates, and stress ,which were found to change the daily routine such as the sleep(Gaultney, 2010;Carter, 2013), and therefore, this study consider the multiple choice question about the environmental factors that may affect sleep. The last question in this part was about the medical condition, where the literature indicate its affecting on the sleep and on the academic performance (Lund, Reider, Whiting, & Prichard, 2010). (BaHammam,Alaseem., Alzakri, Almeneessier, & Sharif,2012)

Sleep quality

the Second section was designed to answer the third and fourth research question about Sleep quality. Five – likert scale was used for self -rating the sleep quality during the last semester and the sleep quality during the holiday. This tool is appropriate for measuring people’s attitudes, feelings and opinions (Liamputtong, ProQuest, & Ebooks Corporation 2013). Followed by Open-ended question about sleep disturbance. The questions on the sleep quality were based on The Pittsburgh Sleep Quality Index (PSQI), which is an effective instrument used to measure the quality and patterns of sleep in adults ( Buysse, Reynolds, Monk, Berman, & Kupfer, 1989).

Strong reliability have been found in the seven global scores (Cronbach’s α=.83). It differentiates “poor” from “good” sleep quality by measuring seven areas (components). However, in this study we only focused on subjective sleep quality and sleep disturbances due to the restrictions of the number of the questions by the assignment instructions and these components are more likely to answer the qulity research question.

Academic performance

Third section was designed to answer the fifth research question about academic performance. Grade point average (GPA) satisfaction, and the attendance, concentration level were utilized to determine the participant’s academic performance.(Carter, Cole, Sara, Cunliff, & Fent, Darla. 2013). Visual analogue scale (1-10) points have been used to collect ordinal data via rating the GPA satisfaction in last semester and the overall performance, attendance and concentration.

This scale has an advantage of providing the interval data , which can be analysis by a wider range of statistical test (Liamputtong et., al 2013). Followed by open-ended question about strategy to improve the academic performance.This question was to investigate what the international do to maximize their effort as well as gives some indication of what might student sacrifiy in their daily occupation in order to gain better academic achievement.

Sleep and academic performance

Finally, the fourth section was also, to answer the fifth research question about sleep & academic performance relationship. Categorial data was collected about the change in the sleep during exam and assignment due date and the consequence of decreased sleep on the academic performance.Open-ended question about if they think there is any relationship between sleep & achieve academic goals. These questions was based on summary of previous literature (Eliasson et al. 2010; Cheng et al. 2012; BaHammam et al., 2012)

One stage of piloting was undertaken before finalization, to elicit feedback on how the participants experienced the survey’s wording, phrasing, clarity, content, mode of answering items and overall user-friendliness. The first version of the questionnaire was e-mailed by to a small sample of three students who studied at Monash university and were able to give constructive feedback. The participants filled in the online survey on their own time. Then, appointments were given to conduct the interview on their suitable time. The re-field test was not achievable due to time constraints of the research project and due to late starting of the new semester to the undergraduate students.

The overall comment was, that most of the questions were clear and straightforward, no ambiguity. Furthermore, the positive comment was about the survey design and format as it was clear and easy to complete. Also, it was presented in a clear divided and logical order, which enhance the smooth transition from one sections to another. However there were some suggestions to added an introductory statement for each section not only for the first sections.

In addition, the environmental factors options have been seen covered many possibilities. Also, for all open-ended questions it was noticed only very few answers were given and some of the question were left blank and skipped. Then, during the interview , it was found that there is a common attitude among the participants ,which is to spend less time and effort on the survey even when there is many things to provide..

Moreover, more specificity was suggested in regard the question number eight which ask about the day time feel more efficient. Additionally, In the (in academic section) question about if there is any change of sleep during final exam week/assignment due week, have found overlapping with another similar one in the demographic question number 11 and that make confusing. Some grammar and spelling mistakes was identified. Finally, after conducting the Google form online, it was noticed difficulty to add the interview for the corresponding participants, as there were no name on the survey online.

Then researchers revise and refine the questionnaire based on the responses and feedback from the participants in order to generate the final version of the questionnaire. The authors consider changes include grammar, and spelling that needed. Also, in order to specify question about the day time more efficient?” additional word ( to study ) was added. The question number 11 from demographic has removed.

For the online survey, email address was included to facilitate added the interviews part accurately to the corresponding respondents. In terms of open-ended questions, the researchers emphasis and agree on the necessity to review these questions before the interview and make sure that all answers were filled in and ask for more clarification during the interview. Moreover, “ please list 2-3 examples “ was added to question number 16 to encourage them to enhance the rate of response. Finally, the introductory statement for each section were added.

Sample

Convenience sampling was used because it is easy, fast and inexpensive, yet it has some potential bias. The sampling supplemented by purposive sampling to allow for more deliberation that could provide the most insight into these findings (Liamputtong et., al 2013) also, to achieve variation in gender, years of study, and to determine if these factors would influence ……… This sampling strategy provided information-rich cases and encompassed the varying needs of a homogeneous group (Liamputtong et., al 2013)… I here i might just delete details and make it simple

The sample of 11 students 3 male and 8 female. The sample size was small due to limitation of the master’s program time. Participants were recruited from undergraduate occupational therapy students in Monash university, Peninsula campus in Melbourne in Australia (first, second and third year). students were eligible to participate if they were

  1. (a) undergraduate international students
  2. (b) complete at least one semester
  3. (c) study in occupational therapy full time field.

Students were excluded if they did not meet the inclusion criteria, or not contact the researcher team within one week from the announcement.

Recruiting

Before recruiting participants, the researchers acquired the permission of Dr. Nikos Thomas and Dr. Primrose Letin, to allow the researchers to come to their classrooms to recruit participants. The recruitment was carried out by two researchers, through announcement in the first, second and the third year class.

Participants who were interested in the study were asked to register their name, email, and numbers to contact them. Ethical consideration was monitored by ensure autonomy, beneficence, non-maleficence,and justice (Liamputtong, et., al 2013). Consent form was provided for the participants via e-mail and the verbal and written consent was obtained prior to each interview. Participant was informed that they can withdraw at any time of this study.

Also, each participant have received the explanatory statement, which explain the purpose of the study, potential benefits, from this study in terms of contributing to increase awareness and knowledge of sleep quantity, quality habit for the international students and academic performance which may benefit future researchers and inform Department of Occupational Therapy to take into account the need of international students, and there were no harm from this research. In addition, Confidentiality was maintained throughout the data collection and analysis process.Participants labelled with a code P. The collected data was de-identifiable and stored in a secure computer and in a locked cupboard during the project. Only researcher conducting the interview had access to the audio recordings of the interview.

Then, questionnaires were e-mailed to subjects to fill out all questions online.This method, helped to protect the anonymity and reduce the effect of the interviewer impact and social desire response as the participant will not feel that they had to give the desirable answers (Liamputtong et., al 2013).

After complete the survey the participants was asked to come for the interview of the qualitative part in their preference time. The interviews were conducted in the quiet environment either in discussion room at the Monash library or at the cafe after working hours. To minimize the power differential effect, some strategies were used such as sitting at eye level with the respondents, and spending time prior to the start of the interview in order to ‘‘get to know’’ the students to ensure they were comfortable (Liamputtong, et., al 2013). All interviews were audio-taped, and field notes were made during or immediately following the interviews to record.

This triangulation strategy by the source of gathering data helped to enhance the accuracy (Letts, Wilkins, Law,Bosch, & Westmorland,2007). The length of the interview was from 5 to 10 minutes. The interviews were conducted by the four researchers due to time constraints and pre existing relationship bias was avoided by conduct the interview with the unfamiliar researcher to the participants.

Then, the authers transcribed their verbatim.To increase trustworthiness and maximize rigors of the transcription and decreased bias, multistep process of member checking and triangulation by researchers was usedfor other transcript that completed by colleague researcher. Also, prior to analysis, participants were provided with transcripts of their interviews to review and check whether it reflected what they had discussed to approved (Letts et., al,2007; Liamputtong, et., al 2013). No incentive were given.

Statistical analysis

Quantitative data

Descriptive data were used to present demographic information and their reports about sleep quantity, sleep quality and academic performance. This includes frequency, percentage for categorical variables (gender, nationality, usual bed time, satisfaction with sleep quality) and Median, Inter-Quartile Range (IQR) for interval data with skewed distributions (age, hours of sleep per day) (Pallant, 2016). Spearman Rho coefficient were used to examine relationship between the average sleep hours per day and satisfaction with measurements of academic performance. A Fisher’s exact test for independence was used to explore the association between satisfaction with sleep quality during semester time and GPA score. Significance level was set at 0.05. Statistical analyses were conducted using SPSS version 23.

Discussion

The present study collected qualitative and quantitative data from the students in reference to their sleep patterns and academic performance. The quantitative part of this research focused on the presentation of the collected data by means of grouping it into several categories such as demographic characteristics of the respondents (age, academic performance level, nationality, and language), their quantity of sleep on average and during the exam period, the average time at which they usually study and go to sleep, the environmental factors that affect their sleep, and the quality of their sleep during holiday and semester times.

Based on the quantitative date, it is possible to states that the vast majority of the study participants reported a significant change in their sleep patterns during the semester time when compared to that of the holiday and break time. Namely, most respondents admitted that during the semester time they tend to sleep less and go to bed later; none of the participants said that their sleep quality was very good during the semester, while about 30% said their sleep was very good during holidays.

Also, most of the participants named some factors that contribute to the loss of the sleep quality during the semester, many states that the environmental factors were not an issue for them. At the same time, almost all of the respondents reported a high percentage of negative effects on their studies caused by the loss of sleep – being tired during the class, losing focus, and coming in late.

The findings of this research match those of Mirghani, Mohammed, Yahia Almurtadha, and Ahmed (2015), who researched the academic performance of the medical students in Sudan and found that better sleep was one of the main determinants of better results in class. The reports of the participants of this research can be explained by the findings of Ahrberg, Dresler, Niedermaier, Steiger, and Genzel (2012), who explained that the lack of sleep causes a decrease in cognitive performance, and that impacts the academic success of the students during the semester time.

In addition, Gilbert and Weaver (2010) emphasised that in the American society the lack of sleep among the student populations is a frequent phenomenon that is associated with the poor academic performance primarily and also as a contributor to such disorders as depression and burnout due to the increase in the levels of stress in the affected persons. The strong relation between the quantity of sleep and the academic success of the learners was also established in the study by Lowry, Dean, and Manders (2010) that demonstrated that there is a correlation between the hours of sleep students get and their GPA.

In terms of the quality of sleep and the factors that determine it among the research participants, the characteristics that were names included the inability to fall asleep due to exhaustion, stress, worrying, and overthinking, delayed or broken up sleep cycle, noise, and lack of physical wellness. These factors have been connected to the poor academic performance in both young adults and adolescents in several previous studies (Becker, Adams, Orr, & Quilter, 2008; Carter, 2010). As found by Chiang (2013), academic and professional performance of the individuals with poor sleep quality are affected heavily and regularly.

Interestingly, in terms of quality of sleep, Lemma, Berhane, Worku, Gelaye, and Williams (2013) concluded that the length of sleep is not as important a factor as its quality meaning that the students who have a longer sleep on a daily basis by of poor quality, tend to show weaker performance than the individuals with fewer sleep hours of higher quality.

Basically, similar pattern can be observed in the present study where multiple participants have reported an observation that the higher levels of stress during the exam period are the factors that contribute to the students’ loss of quality of sleep because they tend to have exhausting dreams, disturbed sleep with a lot of waking during the night and nervous thinking that prevents them from having calm and relaxed sleep at night. Moreover, the sleep cycle that is delayed results in students skipping classes because due to going to bed later they tend to wake up late.

All in all, the primary factors that contribute to the reduced quantity of sleep are the delayed sleep cycle and the environmental influences such as noise or having to get up earlier due to the accommodation situated far away from the university. At the same time, the factors that can be associated with the quality of sleep are the levels of stress that make the students wake up multiple times per night, have worrying and nervous thoughts about exams, and emotional pressure that causes high levels of exhaustion that may cause insomnia.

The management strategies applied by the students to address these issues are more careful time management that allows them to organise their schedule and have more time to rest, study in teams and groups, ask for help, or adjust their environments and get rid of the impacts that contribute to their reduced quality and quantity of sleep.

References

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References for the method

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