“The woods are lovely, dark, and deep. But I have promises to keep and miles to go before I sleep.”
When Robert Frost penned these words, he could have been talking about today’s college students. They have many commitments in terms of school, clubs, jobs, and friends. It may be many hours before they get to bed. Sleep is not their top priority. And why should it be, when internal and external pressures to succeed have only increased in the last 30 years?
Currently, college students are more sleep-deprived than adults as a whole. According to the CDC, one-third of adults aged 18-60 get fewer than seven hours of sleep per night, versus half of college students
Ana’s story illustrates the perils and pitfalls of sleep deprivation.
I first see Ana in the spring semester of her freshman year.
“I feel more depressed and anxious. I probably need to increase my sertraline to improve my mood. School is harder than I thought it would be.”
Evaluating her symptoms of depression and anxiety, I ask her how she is sleeping.
“I can fall asleep fine, but I’ve been going to bed late and I have to get up early for classes. I sleep about five hours per night.”
I explain, “For your medication to be fully effective for depression and anxiety, you need at least seven hours of sleep per night. If you don’t have enough time, you can aim for six hours of sleep. Do you think that is doable?”
“I don’t know. I also am involved with clubs and I have a girlfriend.”
As we continue to review her history and the electronic health record, I see Ana has been sick every few months with colds and then the flu.
I say to Ana, “I know you’ve been sick a lot this year, which happens with freshmen, but I also know that sleep deprivation could hurt your immune system and lead to more viral illnesses. Do you think if you get more sleep you’ll be healthier?”
Ana is not convinced lack of sleep is negatively impacting her health. We raise her sertraline and her mood improves but she still has some symptoms of depression and anxiety. She continues to get more viral illnesses and her grades are slipping. She hopes she will feel better when she returns home over the summer.
When she returns to my office in the fall, she says, “My mood and health were good this summer since I got a job and kept a regular sleep schedule. I’m going to make sleep a priority this year. I broke up with my girlfriend because our relationship was taking up too much time. I’ll focus on school and a few clubs, and also spend time with my friends.” Ana made time for sleep and has had a good year academically, socially, and in overall health. She stays depression and anxiety free. We are able to lower and eventually stop her sertraline.
Ana learns the harm of lack of sleep through experience. There are many studies that show the academic, psychological, and physical benefits of consistent, high-quality, and good quantity sleep.
The Benefits of Good Sleep
- Academic impacts: A 2019 study of college students showed that better sleep quality, quantity, and consistency over the last month correlated with better grades. On the other hand, poor sleep the night before an exam did not impact the test grade. Long-term sleep has a greater impact on grades than sleep the night before an exam. If your student sleeps poorly the night before an exam, there should not be a great impact, as long as they have slipped well that month and studied adequately.
- Mental health effects: Good sleep decreases the risk of anxiety and depressive symptoms, as occurred with Ana. It can also decrease the risk of suicidal thinking.
- Physical effects: Good sleep improves the functioning of the immune system, and decreases the risk of heart disease, diabetes, and dementia.
- Physiologic effects: Sleep is essential for clearing out waste products in the brain. While we are asleep, the glymphatic system gets activated and bathes our brain in cerebrospinal fluid, removing toxins. Sleep also consolidates memories by strengthening neuronal connections.
How Your College Student Can Improve Their Quality and Quantity of Sleep
If your college is not getting enough sleep, how do you convince them to get the seven to nine hours per night that will improve their health and school performance?
- Explore causes of sleep problems: Do they have a noisy roommate? An overly warm room? Are they too busy to get adequate sleep? Is depression or anxiety making it hard to sleep?
- Discuss solutions to sleep problems: If they have some depression falling asleep, they can try the apps Calm or Headspace. If their roommate is noisy, suggest they talk with the roommate or RA. If they are having mental health issues, encourage them to go to the counseling center.
- Highlight negative impacts of insomnia: You can express concern if they are not sleeping enough. Ask them if they see any negative impacts. Gently point out what you see, “I wonder if your frequent colds might be related to your not getting enough sleep.”
- Encourage small steps: In my practice, it is hard to get the sleep-deprived student to make a big change. See if they can add a half hour or hour of sleep each night. Let them know you understand there might be a busy week where they cannot get enough sleep, but the following week they can do a sleep reset.
- Promote good sleep hygiene: Keep their room cool, go to bed and get up at the same time daily, exercise, avoid energy drinks or highly caffeinated beverages, and get outdoors during the day.
- Prioritize your own sleep: Be a role model. When they see you making changes, they might change, too.
Sleep is as essential to our well-being as the food we eat. As Shakespeare wrote in Hamlet, “Sleep that soothes away all our worries. Sleep that puts each day to rest. Sleep relieves the weary laborer and heals hurt minds. Sleep, the main course in life’s feast, and the most nourishing.”
©2022 Marcia Morris, all rights reserved.
Details have been altered to protect patient privacy.