September 28, 2015

Losing Sleep Over Poor Performance

by Zak Cerminara, PharmD; PGY2 Oncology Pharmacy Resident, University of Maryland School of Pharmacy

I realize the irony of this essay as I write it with only five hours left until I have to wake up. Personally I struggle with the daily decision between staying up to work on a project or finishing homework or catching up on the emails and going to bed at a reasonable time. While I am sure that most people, me included, are aware that the lack of sleep is not healthy for your body or mind, does everyone really understand how detrimental sleep deprivation can be?

A lot of people are cognizant of the fact that young adults should get seven to eight hours of sleep every night, but how many people actually accomplish this? A Gallup survey in 2013 found that 59% of Americans get seven or more hours of sleep each night.  This means that over 40% get less!  And 14% of Americans say they get less than five hours of sleep per night. This is a substantial difference when compared to the original survey conducted in 1942. Back then 84% of Americans reported getting seven or more hours of sleep each night with the average person getting almost eight hours per night. While you might expect that people today willingly sleep fewer hours and are satisfied with the amount of sleep they get, 43% of people in the 2013 survey said they would be happier if they got more sleep.1

Knowing that there is this large gap between the amount of sleep we get compared to what we should be getting is one thing. But how does the lack of sleep impact our performance? Sleep is important for our bodies — it's the time when our bodies repair and grow. But sleep also important for our mental state, including memory and cognitive function. During sleep our brains consolidate the memories and experiences from the day — and this facilitates learning as we process the day’s events.  Students may think that staying up to study for a big exam will benefit them (e.g. spending additional time learning the material) but, in actuality, they are doing themselves a disservice.

Sleep loss not only causes fatigue and sleepiness but it also leads to neurocognitive and psychomotor performance impairments. One meta-analysis found that sleep-deprived individuals performed at a level comparable to the ninth percentile of those who had adequate sleep.2 Lack of sleep has been shown to impact the prefrontal cortex, which is responsible for higher brain functions including memory, reasoning, and language. One study found that shortening sleep duration lead to decreased memory encoding and knowledge retention, suggesting that the hippocampus may be affected.3

A study conducted with first-year college students found that for every hour delay in sleep, the predicted GPA decreased by 0.13 on a 4.0 scale. This study sought to determine favorable and negative health related variables and their relation to GPA. The study found that the variables that had the highest correlation to poor GPA were later weekday and weekend wake up time as well as later weekday and weekend bedtimes.4 Another study compared the sleep habits of the lowest and highest quintile of performers base on their GPA. They did not find any significant difference in total hours of sleep between the two groups, but they did find that students with the highest GPAs went to bed earlier and woke up earlier when compared to students who performed less well academically.5

I know that some of you might be saying: “I’m in [law / medical / pharmacy / graduate] school. There aren’t enough hours in the day to get everything done. Plus, I think I am smart enough to know if I were experiencing the detrimental effects of sleep deprivation on my academic performance.” Actually, you probably don’t.

In a slightly barbaric study, investigators examined the impact of sleep deprivation on performance.6 They found that after just one night of sleep deprivation, college students (n=44) scored significantly lower on a cognitive task when compared to a group of students who were not sleep deprived. Amazingly, the sleep deprived students ranked their concentration, effort, and estimated performance significantly higher than those students who were not sleep deprived.6 This suggests that while you feel like you are performing well, you lack an awareness of how detrimental sleep deprivation impacts your performance!

A recent study looked at the sleep patterns of pharmacy students.7 Not surprisingly, the investigators found that students who reported sleeping an average of 6 hours or less each night were statistically more likely to report feeling tired when waking up and throughout the day.  Those who got less sleep were also more likely to feel excessively sleepy during class and when studying course materials. When looking at actual academic outcomes, comparing the grades of those who slept more or less than an average number of hours during the week was not statistically different. This finding mirrors previous studies. However, it is important to note that most of the students in the study slept well under the recommended number of hours each night, averaging about six hours of sleep per night.  Thus most of the students were sleep deprived! The most compelling finding of this study was the relationship between the number of hours slept the night before an exam and academic performance. The authors found that those with a GPA less than 2.5 slept an average of 4.60 hours the night before a test, while those with GPAs above 3.5 slept an average of 5.53 hours before the test.7 There is one caveat. While one might assume that these students are studying when they stayed up late the night before an exam, the author’s acknowledge they don’t know with certainty what these students were actually doing.

So what can educators do to help learners get more sleep? The most obvious solution is to make certain the amount of work students are expected to do outside the classroom is reasonable. While homework and outside projects are certainly beneficial to learners, paying attention to the amount as well as the sequencing of assignments is key. Overburdening the learner with a bunch of assignments all due the same week is a recipe for disaster! Parsing out big assignments into small chunks helps learners stay on task. Furthermore, ensuring that concepts are taught well during class sessions (e.g. using active learning strategies) is another way educators can help. If learners spend hours of time outside the classroom trying to relearn or memorize concepts because they were poorly understood in class, it’s a waste of time. Using audience response questions and working through practice problems in class can help the teacher gauge student learning. Lastly, explicitly coaching students about how to manage their time is another strategy – including encouraging learners to get a good night’s sleep!

So the next time you are considering staying up late to finish work, consider a few things: Could it wait until tomorrow? What level of cognition does the work require? And is it worth staying up to finish if there is a strong likelihood that you won’t perform as well or may need to redo parts of it tomorrow? Maybe you should get a good night’s of sleep instead.

  1. Jones JM. In U.S., 40% Get Less Than Recommended Amount of Sleep. Gallup, Inc. December 13, 2013. [Internet]  Accessed September 20, 2015.
  2. Pilcher JJ, Huffcut AI. Effects of sleep deprivation on performance: a meta-analysis. Sleep 1996;19:318–26.
  3. Alhola P, Polo-Kantola P. Sleep deprivation: impact on cognitive performance. Neuropsychiatr Dis Treat. 2007;3:553-567.
  4. Trockel MT, Barnes MS, Egget DL. Health-related variables and academic performance among first-year college students: implications for sleep and other behaviors. J Am Coll Health 2000;49:125–30.
  5. Eliasson AH, Lettieri CJ, Eliasson AH. Early to bed, early to rise! Sleep habits and academic performance in college students. Sleep Breath. 2010;14:71-5.
  6. Pilcher JJ, Walters AS. How sleep deprivation affects psychological variables related to college students' cognitive performance. J Am Coll Health. 1997;46:121-6.
  7. Zeek ML, Savoie MJ, Song M, et al. Sleep duration and academic performance among student pharmacists. Am J Pharm Educ 79(5): Article 63.

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