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Prevalence of sleep disorders among medical students

Article  in  Research Journal of Pharmaceutical, Biological and Chemical Sciences · January 2015

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 ISSN: 0975-8585

Research Journal of Pharmaceutical, Biological and Chemical

Sciences

Prevalence of Sleep Disorders among Medical Students.

Farah Moayedi 1, Alireza Shahabjahanlu 2, Feysal Rasa 3, Payam Sadeghi3*.

1
Behavioral and Neurosciences Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
2
Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
3
Student Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.

ABSTRACT

Having a healthy behavior and physiology is impossible without normal sleep pattern. Between the
ages 18 and 25, people are prone to sleep disturbances. The aim of this study was to investigate the
prevalence of insomnia among medical students of Hormozgan University of Medical Sciences. This cross
sectional study was conducted on 400 medical students of Hormozgan University of Medical Sciences, Bandar
Abbas, Iran in 2013. Insomnia severity index was used to assess their sleep disorder. Also, demographic data
were collected by a checklist. Data were analyzed by SPSS v. 16 software using descriptive statistics such as
mean, standard deviation, percent, t- test and chi-square and a p-value below 0.05 was considered as
significant. The mean age of the participants was 22.42 ±1.74 and 157 of them (46.2%) were male and 183
(53.8%) were female. Also, 111 were in the Basic Sciences period, and 68 were passing their clerkships. Among
all the participants, 254 (74.7%) were in dormitories. Among all the participants 14 (4.1%) had no insomnia,
172 (50.6%) had below the threshold insomnia, 130 (38.2%) had moderate clinical insomnia and 24 (7.1%) had
severe insomnia.Due to the importance of this issue and its long term impacts on the general health, further
studies should be conducted to investigate this issue.
Keywords: sleep disorders; medical students; prevalence

*Corresponding author

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INTRODUCTION

Having a healthy behavior and physiology is impossible without normal sleep pattern. Between the
ages 18 and 25, people are prone to sleep disturbances [1, 2]. College life, which mostly occurs during this ages
also affects the sleep pattern [2]. Social and physical changes, entering adult life and having to make various
choices that affect the rest of their lives are several risk factors that affect sleep pattern [3].

Many sleep disorders remain undiagnosed. However, insomnia affects their quality of life and
decreases their productivity. Sleep disorders influence the nervous, endocrine and immune systems and make
the individual vulnerable to diabetes, psychosocial stress, cognitive dysfunction, learning disability, decreased
work efficacy, hypertension, obesity and increase the risk of cardiovascular diseases [4]. Studies have shown
that mood disorders, alcohol and medication abuse and misuse, and inactivity are related to sleep disorders
[5-9]. It can also be an early symptom of depression and anxiety [9].

Studies in Jordan, Palestine, Saudi Arabia and Lebanon have shown that a large number of college
students have poor sleep quality [4, 9-11]. Other studies have suggested that academic performance is highly
related to these disorders [10, 12, 13].

Pagel et al showed that 69.7% of students with poor academic records had problems falling asleep
[13]. Eller et al showed that difficulty falling and remaining asleep, morning fatigue, daytime drowsiness and
nightmares have high prevalence among students [14].

Even though it is important to assess sleep patterns and the prevalence of sleep disorders among
university students, few studies have been conducted on this group [4]. Medical students are one of the most
important groups and effort must be made to maintain their focus [9]. Factors that help them improve their
skills directly impact the general health. Therefore, we aimed to investigate the prevalence of insomnia among
medical students of Hormozgan University of Medical Sciences.

METHODS

This cross sectional study was conducted on 400 medical students of Hormozgan University of
Medical Sciences, Bandar Abbas, Iran in 2013. Participants were selected among all medical students by simple
randomization. All medical students who attended Hormozgan University of Medical Sciences were eligible for
the study. Those who were not willing to participate in the study, did not fill above 80% of the questionnaire or
were consuming medications that affect normal sleep were excluded from the study.

Data was collected by a checklist for demographic data such as age, gender, marital and occupational
status along with 14 questions that described their daily habits during the previous month; bed time, awake
time, daily sleep duration, number of night shifts, using sleep medications (milligrams per week), daily exercise
(hours per week), smoking, hukkah and alcohol usage (amount per week), avoiding sleep due to television or
computer usage (number of nights avoided) and consuming methylphenidate (milligrams per week).

Also, Insomnia Severity Index (ISI) which is a standard questionnaire that evaluates sleep disorders
during the past two weeks was used to assess insomnia. This questionnaire consisted of seven questions about
problems in falling asleep and staying asleep, sleeps satisfaction, daily activity interference caused by
insomnia, if the sleep disturbances are noticeable by housemates, having concerns about current sleep pattern
and anxiety related to sleep pattern. Each question had five options which were rated between 0 and 4 and
the final score was between 0 and 28. A total score below 7 indicates no insomnia, scores between 8 and 14
described insomnia that is below threshold, between 15 and 21 described clinical insomnia (moderate
insomnia) and scores of 22 and above indicated severe clinical insomnia. The ISI questionnaire was retrieved
from Kaplan and Sadock’s comprehensive Textbook of Psychiatry.

Since the sleep pattern of most students changes during the exams, the questionnaires were
distributed in other periods. All participants provided informed consent and data remained confidential.

Data were analyzed by SPSS v. 16 software using descriptive statistics such as mean, standard
deviation, percent, t- test and chi-square and a p-value below 0.05 was considered as significant.

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RESULTS

The mean age of the participants was 22.42 ±1.74 and 157 of them (46.2%) were male and 183
(53.8%) were female. Also, 111 were in the Basic Sciences period, and 68 were passing their clerkships. Among
all the participants, 254 (74.7%) were in dormitories.

Among all the participants 14 (4.1%) had no insomnia, 172 (50.6%) had below the threshold insomnia,
130 (38.2%) had moderate clinical insomnia and 24 (7.1%) had severe insomnia. As shown in table -1, 103
participants (30.3%) had no problems in falling asleep and few students (2.9%) had severe problems in falling
asleep. On the other hand, 144 out of 340 students (42.3%) had no problem in staying asleep.

Table 1: Prevalence of problems related to falling and staying asleep

Male Female Total

Number Percent Number Percent Number Percent
Problems in No problems 29 18.5 74 40.4 103 30.3
falling Mild 58 36.9 51 27.9 109 32
asleep Moderate 49 31.2 43 23.5 92 27
Severe 14 8.9 9 4.9 23 6.8
Very severe 7 4.5 6 3.3 13 3.9
Total 157 100 183 100 340 100
Problems in No problems 25 15.9 62 33.9 87 25.6
staying Mild 75 47.8 69 37.7 144 42.3
asleep Moderate 36 22.9 32 17.5 68 20
Severe 15 9.6 17 9.3 32 9.4
Very severe 6 3.8 3 1.6 9 2.7
Total 157 100 183 100 340 100

Among the participants, 39 (11.5%) reported that sleep disorders had no interference with their daily
activities, while 123 (36.3%), 128 (37.6%), 43 (12.6%) and 7 (2%) reported mild, moderate, high and very high
disturbances, respectively.

As shown in table -2, male gender, computer and internet, smoking, study period and alcohol use
might be related to sleep disorders.

Table 2: Prevalence of insomnia among different factors evaluated in this study

Below threshold Moderate clinical Severe clinical

No insomnia
insomnia insomnia insomnia
P-value
Numbe Percen Numbe Percen Numbe Percen Numbe Percen
r t r t r t r t
Male 3 19 72 45.8 67 42.6 15 9.5
Gender <0.0001
female 11 6 100 54.6 63 34.4 9 4.9
Dormitory Yes 9 3.5 129 50.7 94 37 22 8.6
0.127
Residents No 5 5.8 43 50 34 39.5 2 2.3
Never 7 4.1 93 55 55 32.5 14 8.2 0.459
Delayed
Below once 4 4.8 48 57.8 29 34.9 2 2.4
sleep due
1-2 times 3 5 22 36.6 31 51.6 4 6.7
to
television 3-5 times 0 0 5 31.2 11 68.8 0 0
per week Every night 0 0 4 50 0 0 4 50
Delayed
sleep due Never 3 2.9 59 55.1 41 38.3 4 3.7
to
computer Below once 9 9.7 48 51.6 32 34.4 4 4.3 0.042
and
1-2 times 0 0 43 53.8 27 33.7 10 12.5
internet
3-5 times 0 0 15 38.5 23 58.9 1 2.5
usage per
week Every night 2 10.6 7 36.8 5 26.3 5 26.3
Smoking Never 14 4.8 150 51.1 112 38.2 17 5.8 <0.0001

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per week Below once 0 0 6 35.3 9 52.9 2 11.7

1-2 times 0 0 10 66.7 3 20 2 13.3
3 times or more 0 0 6 40 6 40 3 20
Never 8 4 106 52.2 67 33 22 10.8
Below once 4 4.2 47 48.9 43 44.7 2 2
Exercise
1-2 times 2 5.6 17 47.2 17 47.2 0 0 0.741
per week
3-5 times 0 0 1 33.4 2 66.6 0 0
Every day 0 0 1 50 1 50 0 0
Basic Sciences 1 1 59 53.1 40 36 11 9.9
Physiopatholog
Study 0 0 43 57.3 29 38.7 3 4
y 0.0001
period
Clerkship 9 11.5 36 46.1 23 29.5 10 12.8
Internship 4 5.3 34 44.7 38 50 0 0
Stimulant Yes 2 11.1 2 11.1 14 77.8 0 0
0.632
usage No 12 3.7 170 52.8 116 36 24 7.5
Never 14 4.7 155 51.8 113 37.7 17 5.6
Alcohol
Below once 0 0 13 50 9 34.6 4 15.4
Drinking 0.001
1-2 times 0 0 4 36.4 4 36.4 3 27.2
per week
3 times or more 0 0 0 0 4 100 0 0
Never 1 1.1 42 48.4 36 41.3 8 9.2
Studying Below once 3 4.2 31 43.7 30 42.2 7 9.9
0.472
before 1-2 times 6 4.8 78 62.9 35 28.2 5 40.1
sleep 3-5 times 4 9.5 16 38 20 47.6 2 4.9
Every night 0 0 5 31.2 9 56.2 2 12.6

DISCUSSION

This study was conducted in Iran in order to assess the prevalence of insomnia among medical
students. Most participants had below threshold insomnia (50.2%). Also, 7.1% of participants suffered from
severe clinical insomnia. Mousavi et al conducted a similar study and reported that 2% of the students
participated in their study had severe sleep disorders. Marlit et al also conducted a study in 2004 in Estonia
and reported that about 1% of students had severe insomnia.

Araste et al also conducted a study on 244 medical students and reported a prevalence of 57.4%.
Nojumi et al also reported that 56.3% of their participants had sleep disorders. In another study conducted by
Abdolghani et al in Saudi Arabia, 36.8% of medical students had poor sleep patterns. Kaffashi et al showed that
the sleep pattern of 14% of students was desirable.

In our study, male students showed higher rates of insomnia which was consistent with a study
conducted in India. However, Ghalebandi et al, Canellas et al and Abdulghani et al reported inconsistent
results.

Some studies have shown that the situation of dormitories is associated with students’ sleep pattern.
However, this relation was not confirmed by our study. A number of studies have shown that television is can
worsen the sleep pattern. This result was also inconsistent with our study. However, internet had negative
effects on their sleep pattern. Other studies have also shown similar results.

In our study, the prevalence of hukkah, alcohol consumption, and smoking was low and therefore,
their relationship with insomnia could not be assessed. Other studies reported that substance abuse can
decrease sleep quality. As shown in this study, in Iran, due to cultural situation and social stigma, the
prevalence of smoking and alcohol usage is very low, thus it is not cost effective to intervene on this issue in
order to improve the sleep quality.

Our study showed that exercise was not relevant to insomnia and its severity. On the other hand,
other studies reported that exercise can improve the quality of sleep. In our study, few students exercised
regularly. Therefore, the results cannot be reliable and further studies should be conducted to investigate this
relationship.

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By comparing our results to other studies, it can be found out that sleep disorders are more prevalent
among medical students compared with the general population. Many factors may be responsible for this
issue; being distant from family, lack of social, economical and emotional support of their family, having to
study more in order to keep up with their courses, consecutive exams in short periods of time and night time
shifts may result in sleep disturbance.

The diagnosis of insomnia was based on participants’ self report. Therefore, it is not completely
reliable. On the other hand, this was a cross sectional study and could not accurately determine whether these
factors have absolute relationship with insomnia or not.

According to the results of our study, about 45% of the participants had moderate or severe clinical
insomnia. This issue can decrease their quality of life and educational status, especially during internship. Our
results suggested that alcohol, smoking, internet, computer, and gender can affect the quality of sleep. Also,
interns have the worse sleep pattern and since they are directly involved with patient care, interventions must
be made to cure their insomnia.

Thus, due to the importance of this issue and its long term impacts on the general health, further
studies should be conducted to investigate this issue.

ACKNOWLEDGEMENTS

This article was the result of a medical student’s thesis. We would like to thank all participants and
medical students of Hormozgan University for their help and support during this study.
Conflicts of interests:
The authors of this article declare that they have no conflicts of interest.

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