The Vicious Cycle of Sleep Deprivation, Decreased Academic Performance, and Poor Mental and Physical Health

by Kendall Kara, PharmD, PGY1 Pharmacy Practice Resident, G.V. Sonny Montgomery VA Medical Center

Inadequate amounts of sleep can have detrimental effects on test scores, GPA, mental health, and physical health.1,2,3 Adequate sleep is essential to physical and mental wellbeing. A lack of sleep leading to poor outcomes in all aspects of students’ lives can lead to a “vicious” cycle.2 According to the CDC, 1 in 3 adults do not get enough sleep per night. The suggested number of hours of sleep per night varies based on age. For adults 18-60 years old, at least 7 hours of sleep is recommended.¹ If you ask any college or graduate student if they consistently get 7 hours of sleep every night the answer is probably “no”.

A lack of sleep and a lack of daytime alertness has negative impacts on cognitive function and learning by disrupting the prefrontal cortex that helps control language, creativity, consolidation of memory, and reasoning skills. Studies have shown that slow-wave sleep can help consolidate fact-based learning whereas REM sleep can help consolidate procedural memory.⁶ Lack of sleep not only affects test performance and GPA but also causes daytime sleepiness, impaired concentration in class, and decreased memory capacity.3 The amount of time we have each day is finite.  So the longer students stay up to study, the less time they have for sleep. Thus “pulling all-nighters” and late-night study sessions can be detrimental to their success in school.

A lack of sleep has been shown to have a negative impact on academic performance in multiple clinical trials. Having recently graduated from pharmacy school, I found the study entitled “Sleep Duration and Academic Performance Among Student Pharmacists'' was very relatable.³ Professional school is very demanding, but it is a time when students get the least amount of sleep. In this study, students were asked to complete a questionnaire about their sleep patterns during a typical school week and the night before an examination, as well as the frequency of daytime sleepiness. More than half of the 364 students surveyed reported they do not get the recommended 7 hours of sleep per night (54.7%), went to bed later (52.2%) the night before, and woke up earlier (67.5%) the morning of an exam, and reported feeling tired almost every morning when waking up (54.4%). Students who reported shorter sleep durations the night prior to an exam had significantly lower test scores and lower semester GPAs.³  An increase in sleep by one hour was associated with an 11% increase in the course grade. This cycle of studying, lack of sleep, decreased concentration in class, daytime sleepiness, and poor test performance is a vicious cycle many students experience.

Another study titled “Test Anxiety and Poor Sleep: A Vicious Cycle” was designed to examine if test anxiety affects sleep quality and duration among undergraduate students taking a statistics class.² It is already well established that test anxiety has a negative impact on test performance but adding the element of poor sleep to this equation has not been well tested. The researchers used multiple tests to measure students' baseline sleep quality and quantity, depression, anxiety, and insomnia. The students were also sent a Sleep Mood Study Diary that they were asked to fill out every day for 6 days leading up to the exam. The questions from this diary assessed sleep onset latency, total sleep time, and sleep efficiency. Students were assessed for test anxiety the mornings before and after the exam. Study results revealed that students who had even minor amounts of anxiety had worse test scores. Anxiety was also associated with poor sleep quality. Poor sleep quality resulted in increased anxiety and caused further sleep disruption, again leading to a vicious cycle that ultimately had negative academic consequences. The combination of text anxiety and poor sleep resulted in lower test scores (up to 4.96 points) in many students.²  In this study it is unclear what starts the beginning of the cycle. Do anxious people sleep less, which causes anxiety and decreased test performance? Or, does sleep deprivation cause poor test performance that ultimately causes anxiety?

Inadequate sleep not only affects academic performance but also impacts mental and physical health.^3,4 Lack of sleep is associated with mental health issues such as irritability, hyperactivity, poor impulse control, impaired memory, depression, anxiety, mood swings, and increased perceived stress. Physically, lack of sleep is associated with an increased risk of infection, slowed metabolism, heart disease, high blood pressure, obesity, diabetes, and all-cause mortality.⁴

So how can we break these vicious cycles? It is important that teachers and faculty are aware of that many of their students are sleep deprived. Teachers and administrators have the opportunity to positively impact the overall well-being of students starting from the very beginning of their program.3 Educating students about healthy sleep habits, self-care, doing regular wellness checks, and scheduling tests at appropriate hours are ways teachers can positively impact the overall well-being of students.^3,5

There are many recommendations to ensure students (and their teachers!) are getting high-quality sleep, but here are 6 important “counseling points” to help students develop healthy sleep habits:⁵

1. Limit caffeine intake and other stimulants. I know this is hard for many students because they can become dependent on caffeine to get through the day and stay awake at night to study. Cutting back on caffeine intake, and not consuming caffeine 8 hours before bedtime can help students fall asleep easier.⁵
2. Reduce screen time. Putting away the phone, computer, and TV an hour or so before bedtime can help with falling asleep faster. Lights from devices can disrupt the secretion of melatonin which can make it harder to fall asleep.⁵
3. Plan ahead and create a study schedule in advance. Setting specific and regular times to study before tests rather than cramming the night before can help improve overall sleep quality and test performance.
4. Diet and exercise. It’s very easy to tell people about the importance of diet and exercise but it’s difficult to actually practice what you preach. Maintaining a healthy lifestyle can help with overall well-being including improved sleep.⁵
5. Prioritize your sleep just as much as you prioritize school and studying. Setting a bedtime that allows you to get 7 hours of sleep every night. Tracking your sleep can help increase accountability to yourself.⁵
6. Finally, know when to seek help. If sleep deprivation is negatively impacting academic performance or mental/physical health, it is important that students feel comfortable talking to teachers about their struggles. Teachers, faculty, and staff should be judgment-free resources for finding students the help they need to succeed.⁵

References

1. 1 in 3 adults don't get enough sleep [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2016 [cited 2021Oct27].
2. Hamilton N, Freche R, Zhang Y, Zeller G, Carroll I. Test anxiety and poor sleep: A vicious cycle. Int J Behav Med 2021;28(2):250–8.
3. Zeek ML, Savoie MJ, Song M, Kennemur LM, Qian J, Jungnickel PW, et al. Sleep duration and academic performance among student pharmacists. Am J Pharm Educ. 2015;79(5): Article 63.
4. Sleep health [Internet]. Sleep Health | Healthy People 2020. [cited 2021Oct27]. Available from: https://www.healthypeople.gov/2020/topics-objectives/topic/sleep-health?topicid=38
5. Sleeping to succeed [Internet]. Learning Center. 2020 [cited 2021Oct27].
6. Sleep clinic Seattle: Sleep doctor Kirkland, Washington (n.d.). Retrieved January 25, 2022, from https://www.soundsleephealth.com/