Sleep problems, including insomnia, are prevalent and increasing among college students, new research out of Norway indicates.
Over an 8-year period, investigators analyzed weekday and weekend sleep parameters in more than 50,000 Norwegian college and university students (ages 18-35 years), including bedtime, rise time, sleep duration, sleep-onset latency, wake-after-sleep onset, sleep need, and sleep deficit.
Investigators found large weekday–weekend differences across most sleep parameters.
Moreover, the sleep duration of most students was at the lower end of normal (roughly 7.5 hours) during weekdays, but they made up for it on the weekends by meeting their sleep needs and sleep recommendations (roughly 8 hours).
Insomnia was higher in women than in men, and there was a substantial increase in sleep problems during the 8-year study period, especially in women.
"We found that sleep problems are both prevalent and increasing among students," lead author Børge Sivertsen, PhD, professor of psychology and sleep specialist, Norwegian Institute of Public Health, Oslo, told Medscape Medical News.
"I think both educational institutions and student welfare associations need to take a broad approach, in terms of the mental health crisis, which also includes insomnia, facing college students today," he said.
The study was published online December 4 in the Journal of Sleep Research.
Major Public Health Problem
"Short sleep duration and insomnia have been highlighted as major public health problems," the authors write.
For young adults, the recommended sleep duration is between 7 to 9 hours. International research has found that a "substantial proportion of students fail to reach these recommendations, and thus do not obtain the amount of sleep they need to function," the authors state.
"Our motivation to conduct this study in students was a combination of several growing concerns," said Sivertsen.
"The prevalence of insomnia in the general population is growing, and recently we have shown that older adolescents are particularly at risk of both too-short sleep and insomnia, but we know little about how this is after the transition into young adulthood," he said.
Sivertsen pointed out that this study helps fill a void about sleep-related data from the past 10 years.
"Very few trend studies about sleep exist, allowing us to answer questions about whether or not sleep problems have changed or remained stable in the last decade."
To investigate the question, the researchers surveyed full-time Norwegian students participating in the Students’ Health and Wellbeing Study (SHoT), a national student survey for higher education in Norway, with data collected in 2010, 2014, and 2018.
SHoT2010 and SHoT2014 sleep studies included 26,779 and 13,525 students, respectively, all younger than 35 years.
The SHoT2018 consisted of 50,054 students between the ages of 18 and 35 years.
Participants’ usual bedtime and rise time, time in bed (TIB), sleep-onset latency (SOL), and wake-after-sleep onset (WASO) were self-reported separately for weekdays and weekends.
Sleep duration was used as a categorical variable; sleep deficit, which consisted of subtracting total sleep duration from subjective sleep need, was calculated separately for weekends and weekdays.
In addition, participants indicated the number of nights per week that they experienced difficulties initiating sleep (DIS), difficulties maintaining sleep (DMS), and early morning awakenings (EMA), as well as daytime sleepiness and tiredness.
Students were asked about the duration of their problems, when relevant.
Insomnia disorder was defined by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria.
More Pronounced in Women
Compared with all invited students, the current sample included a larger proportion of women than of men (69.1% vs 30.9%, respectively; mean [SD] age, 23.2 [3.3]).
The majority of participants (63%) were between 21 and 25 years old.
The mean bedtime on weekdays was 11:15 PM, with men tending to go to bed significantly later than women (11:38 PM vs 11:05 PM, respectively).
Mean TIB for weekdays was 8 hours 28 minutes (8 hours 32 minutes for men, vs 8 hours 21 minutes for women).
By contrast, mean sleep duration was 7 hours 24 minutes for both sexes.
On average, bedtime during weekends was 1 hour 25 minutes later than on weekdays, while the corresponding rise time discrepancy was 2 hours 8 minutes, "reflecting that the students slept an average of 1 hour more during weekends than weekdays," the authors note.
Bedtime as well as rise time discrepancies between weekdays and weekends were similar for men and women.
Since the students’ subjective sleep need was 8 hours 1 minute, their sleep deficit was 27 minutes on weekdays, but their sleep duration was longer than subjectively needed on weekends.
On weekdays, mean SOL was 48 minutes, with most participants (66.6%) reporting SOL more than 30 minutes, and only 18.2% reporting SOL less than 15 minutes.
Moreover, SOL was significantly longer for women than men (P < .001).
Mean WASO on weekdays was 16 minutes, with 71% of the participants reporting less than 15 minutes WASO.
On the other hand, on weekends, mean SOL was 35 minutes, while mean WASO was 12 minutes.
Almost one third of participants (30.5%) reported insomnia, with a prevalence that was significantly higher among women than among men (34.2% and 22.2%, respectively).
However, age was "significantly and positively" associated with the prevalence of insomnia, especially among men (age × sex interaction: P = .018).
In women, the highest prevalence of insomnia was found in those between ages 26 to 28 years, followed by 29 to 35 years, 18 to 20 years, 23 to 25 years, and 21 to 22 years.
In men, on the other hand, the highest prevalence was in those ages 29 to 35 years, followed by those ages 26 to 28 years. The other groups were almost evenly tied.
Students with insomnia had significantly shorter average weekday sleep duration than did those without insomnia (6 hours 50 minutes vs 7 hours 39 minutes respectively, P < .001).
Moreover, a significantly larger proportion of students with insomnia slept <6 hours, compared with those without insomnia (21.2% vs 6.7%, respectively; P < .001) — a trend that was similar in men and women.
Difficult Transition
Sleep disturbances significantly increased between 2010 and 2018, with 22.6% of students reporting having difficulties initiating or maintaining sleep (DIMS) in 2010, 26.5% in 2014, and 30.5% in 2018 (χ2 [df = 2, n = 69,139] = 231.1, P < .001).
Although the increase was significant in both sexes, it was particularly pronounced in women, where the prevalence increased from 23.4% in 2010 to 28.2% in 2014 and 32.4% in 2018.
Although the prevalence of DIMS was "somewhat lower" in men, a similar increase was found.
"Both male and female students obtained an average weekday sleep duration in the lower end of the normal range — 7:24 hours," Sivertsen reported.
"More concerning was the high prevalence of insomnia, defined according to the DSM-5 diagnostic criteria," he continued.
"We also found a significant increase in the proportion of students reporting difficulties initiating and/or maintaining sleep, which was more pronounced in women," he noted.
Sivertsen suggested that the "increase in insomnia in our students parallels the similar and recent mental health problems observed in this population."
The bright screens of 21st-century electronics, Sivertsen said, also played a significant role. "In terms of sleep specifically, another important factor is likely the extensive use of electronic gadgets and social media, which we know accompanies our students 24/7."
He encouraged more of a focus on prevention, especially in younger college students.
"We must try harder to make the already difficult transition from adolescence to young adulthood easier," he said.
Three student welfare associations in Norway (SiO, Sammen and SiT) initiated and designed the SHoT study. SHoT2018 received funding from the Norwegian Ministry of Education and Research (2017), and the Norwegian Ministry of Health and Care Services (2016). Sivertsen and coauthors have disclosed no relevant financial relationships.
J Sleep Res. Published online December 10, 2018. Abstract
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Cite this: Insomnia, Other Sleep Problems Rising in College Students - Medscape - Dec 13, 2018.
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