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College Students and Sleep

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College Students and Sleep

Written by Wei-Shin Lai, MD

Dr. Lai, the founder of SleepPhones, has been seeing students at Penn State's Student Health Center since 2007.

College students simply don't get enough of sleep. If I had to choose the biggest problem concerning sleep in college students, it's just that they choose to not sleep. There are many reasons for it. Going out to have fun with friends is often more important. Other students over-extend themselves with taking too many credits and participating in too many extracurricular activities. A growing percentage of students don't sleep enough because of their financial circumstances. They have to work 20-40 hours a week just to pay for school.

These young students have the stamina to stay up frequently, getting by on naps. However, they may not realize that just because they can do it, they shouldn't do it. Ultimately, daytime performance suffers. Over the next week, I will explore some sleep-related topics concerning college students.

1. All-nighters.

An occasional all-nighter is part of the college experience. It normally takes 3 days to recover from one. The first day after an all-nighter may actually be okay. Adrenaline is running high. The test or paper is done. It's time to celebrate! You might feel a little tired, but can usually stay awake all day long, especially with the help of caffeine and salty and sweet snacks.

The second day is the day you really drag. All day long, you can't focus, your eyes gloss over the page, and you feel like taking a nap in class. It's a wasted day where nothing gets done, or gets done poorly and you have to do it all over again later anyway. The third day, you feel a little bit better. By the fourth day, your body has finally recovered from the all-nighter.

The best way to avoid them is to plan better and to stick with the plan. That's easier said than done. Procrastination may be due to not knowing what to do, having perfectionist expectations, giving in to distractions, or lack of interest.

If you have to pull frequent all-nighters, then something needs to change. Analyze why they occur. Try to avoid getting into those situations. Perhaps it has to do with procrastination. Turn off the phone to focus. Seek help from your professor or teaching assistant. Ask questions. If it's a motivation problem, you may need to see an academic adviser.

2. Owl habits.

Teens and young adults are well known for their ability to sleep in until noon. A significant portion of 15-25 year olds are known to sleep scientists as "owls." Their internal clocks are longer than 24 hours. That means, if they were kept in a dark room for weeks, they would awaken and sleep in cycles of 26 hours, for example.

In the case of a 24 hour cycle, someone who wakes up at 8am would be sleepy by midnight. But if they have a 26 hour cycle, they wouldn't be sleepy until 2am. But in both cases, they would still have to wake up at 8am the next day. The owl suffers from sleep deprivation because they can't fall asleep and they still have to wake up 2 hours earlier than when their body is ready.

The best way for owls to deal with the faulty internal clock is to train it every day. Bright outdoor sunlight is the most powerful device for training the clock. Owls should get as much sun as possible early in the morning. Making sure that the dorm room window faces east and opening the blinds first thing in the morning are helpful. Once awake, plan an activity that involves being outside - like studying outside or walking to class. In the evening, avoid bright lights, including bright computer screens. Turn down the brightness setting on the computer screen and don't watch too much TV.

3. Substances use and abuse. Caffeine.

Teens and young adults like to push boundaries. They take risks. Some take bigger risks than others, and the types of risks vary. Alcohol is often abused, as is caffeine, by college students. Both decrease sleep quality. 8 hours of sleep many only be as restful as 6 hours after drinking alcohol or caffeine.

I am seeing an increase in caffeine abuse. The promotion of energy drinks among college students definitely work. In fact, there's a Red Bull car that drives around downtown. Admittedly, it's a pretty cool-looking car with a giant can of Red Bull on the roof.

In my opinion, occasional caffeine intake (a few times a week, in small quantities) is fine. So eating a chocolate cake, drinking a cappuccino with friends, having a cup of tea while studying for a test in the afternoon are all fine ways to enjoy and use caffeine. Someone who has a cup of coffee every morning is probably chemically dependent on that drug. Someone who uses coffee to fend off the effects of alcohol has a serious problem with both substances. If you can't stop drinking daily coffees without getting a headache, you know your body's dependent. If you use caffeine to get high and act crazy to impress friends, you're abusing it.

I've seen students jittery and shaky, not knowing what's going on with their body from ingesting too much caffeine in the form of energy drinks and caffeine pills. One student ended up missing the test she was up all night studying for because she was having severe physical effects.

The slightly older and highly-stressed graduate students develop high blood pressure through their indentured schooling. They don't have as many problems with alcohol, but they certainly love their caffeine. Most hang out at the coffee shops downtown all day long during dissertation writing. Despite a family history of high blood pressure, heart disease, and diabetes, and a steady trend to developing those diseases themselves, the grad students ignore their health in favor of a chemically-induced zombie-like constantly-wired state of being. What they don't realize is that when they stay up late trying to get an experiment done, they are probably making mistakes and will have to repeat the experiment again anyway when they are alert. It's hard to make the right decisions when tired, no matter how much caffeine is in the brain. (Trust me. Been there; done that.)

Caffeine as a drug is underrated. Abusing it is not as shameful as alcohol, and in some circles, is even promoted. Yet, it has harmful effects like high blood pressure, palpitations (racing heart beats), and insomnia. Addiction rates are high. If someone is concerned about sleep quality, caffeine use must be minimized.

4. Substances use and abuse. Alcohol.

Alcohol causes most people to feel sleepy. There is a paradoxical reaction in some people, and it causes them to be more rowdy. Even in those who fall asleep more easily, the sleep quality is not as good for a variety of reasons.

The withdrawal from the chemical effects often occur in the middle of the night. Withdrawal effects are the opposite of the initial effects. So that means your blood pressure increases, heart rate increases, and you're tossing and turning more, whether or not you realize it.

Alcohol is a diuretic, so you end up going to the bathroom in the middle of the night/early morning. If you're living in a dorm, you may have to climb out of the loft bed, find your room keys and slippers, sneak out of the room without disturbing roommates, walk down the hall to the bathroom, turn on the bright fluorescent lights in there, use the bathroom, come back, and climb back up into the loft bed as quietly as possible in dim light. Going to the bathroom is a big production that severely interrupts sleep!

To break down alcohol, the liver has to change the chemical several times before it becomes harmless. Some of the intermediary stages make people feel poorly. If there are enough intermediary stages hanging around the next morning from binge drinking, then you get the sensation of a hangover.

Some people drink to help them relax. That's a dangerous justification for the use of alcohol. It's basically self-medicating with a very addictive drug. It is very likely that tolerance will build, and you'll need to use more and more alcohol to achieve the same effects. If anxiety is preventing sleep, talk to either a doctor or a counselor about the problem.

(I must admit that I didn't take my own advice just now. I decided to invent SleepPhones instead so that I could just listen to a hypnosis track whenever I had too many thoughts keeping me awake. Using headphones to listen to someone talking me into relaxing was a great natural cure for my insomnia.)

It is common knowledge that alcohol help people relax. But hopefully I've made it clear why alcohol use only reduces sleep quality and can potentially be problematic. Since most drinking in college is underage drinking (illegal), it's by definition, alcohol abuse.

5. Sleeping too much.

Sleeping too much may actually be a symptom of depression. At least one in five people suffer from depression at some point in their life. Depression and anxiety often go together as stress increases. Being away from home, having to make new friends, working hard in school, discovering intimate relationships, and worrying about grades are all stressful. Add financial instability, having to work a job, family situations, health problems, family history, and it becomes a set up for mood disorders.

Depression reduces sleep quality. Some college students experience insomnia while others sleep too much due to fatigue from decreased sleep quality. The neurotransmitters within the brain don't recover the way they should with sleep because they are imbalanced when a person is sad for an extended period of time.

College students may not understand their own feelings sometimes. A lack of motivation in school may be due to not liking their major or not liking life in general. While it's normal to feel poorly after a break up or poor performance, the student should feel better in a few weeks. It's when they don't feel better for more than a few weeks and start to spiral downwards that depression starts. The sooner they seek help to sort out what is going on, the sooner they will feel better.

Occasionally, sleeping too much is due to a medical condition like mono, thyroid disease, or anemia. Rarely, it's something more serious. The most common medical reason for sleeping too much is a mood problem like dysthymia, a mild form of depression. The Student Health Center at Penn State will have a small pilot study in which all of one doctor's patients will all be screened for depression at every visit. Suicide is the third most common cause of death in adolescents and young adults, so we are very aware of the risks of depression. College students who sleep too much, sleep more than usual, or just feel tired all of the time need to seek medical or psychological care.

6. How much sleep is right?

So now, there are problems with most college students not getting enough sleep. And then there are problems with a some college students getting too much sleep. Just how much sleep is right?

The short answer is 7-9 hours.

Women who are done with growing and maturation, having started their growth spurt at age 10-12, will be fine with an average of 7.5-8 hours of sleep. If a woman is still possibly growing, 8-9 hours is recommended. Men who are still in their growth spurt which started at age 16-17 should have 9 hours of sleep. You may suspect continued late growth if your parents matured later than their peers.

While college students are legally defined as adults at age 18, many are still growing into physical adulthood. For women, if your breasts are still getting bigger (out of proportion to weight gain), the darkened area around the nipples are still darkening, and you keep getting more hair in the armpits and pubic area, then you're still growing. For men, if you're growing taller, your voice is deepening, your testicle are still getting bigger, the scrotum is getting darker, and more body hair is still showing up, then you're still growing.

Growth hormone is released during sleep, as well as many other hormones, some of which have not yet been discovered. It's clear that sleep is critical to growth and maturation. Most men want to be tall, and getting adequate sleep (9 hours) will help ensure maximal height.

Once a college student is fully grown, then the typical adult rules follow. Most adults need 7-8 hours of sleep a night. For the long answer of how much sleep is optimal, please see my previous article, How Much Sleep You Are Supposed to Get.