The importance of improving college students' sleep-wake patterns is supported by numerous studies that have described the negative consequences of poor sleep in this population. These consequences range from weight gain to depression and anxiety and suicidal ideations and attempts. Undergraduate college students are emerging adults who experience significant lifestyle changes during their undergraduate college careers. Many of these changes are rooted in their ‘new found freedom’ of living away from home. For many this is the first time they are in charge of making decisions about their sleep-wake cycles. As a result, college students most often engage in irregular and ineffective sleep-wake patterns and are notoriously bad sleepers. Many factors contribute to poor sleep in college students. Some of which are non-modifiable (being away from home, class time, course assignments), while the majority are behavior based (sleep schedule, screen time, exercise and diet). However, it is very difficult to motivate college students to change their behavior. One great motivator of college students is their grade (GPA). We have seized upon this motivation. The purpose of this project was to develop and test the acceptability of a graded lifestyle change assignment that focuses on improving sleep. This presentation will discuss the findings from over 600 students over the course of 4 years of implementation.
Methods:
Participants were undergraduate students (primarily first semester freshmen) at a large public research-one University in the southern United States who were enrolled in a freshman signature course (Sleep: Are We Getting Enough?). The students attended twice weekly (Tuesday & Thursday) lectures that presented scientific findings related to sleep science and the application of these findings to human experiences. The students completed a number of assignments in this course; however, one was specifically focused on guiding them to make a lifestyle change to improve their sleep quality. During the month of November, students selected a specific sleep related behavior (e.g. caffeine intake, electronic use) that they would change during the assignment period (1 month). November was purposefully chosen because it encompasses a time that many students have major educational stressors (e.g., mid-term exams, major paper and project assignments), environmental stressors (e.g., cold & flu season), and visits home for Thanksgiving. These challenges provided an opportunity to practice a lifestyle change during stressful times. Students completed an initial lifestyle change plan, three ongoing progress reports, and one final reflection for this assignment. Goal attainment scaling was used to assist students to structure their lifestyle change goals and to evaluate their progress.
Results:
650 students completed this assignment over the course of four years (2014-2017). Just over half were female students (56%) and they represented nine majors (business, communications, education, engineering, fine arts, geosciences, liberal arts, natural sciences, nursing, and undeclared). Student goals encompassed a variety of behaviors; however most can be grouped into four lifestyle foci (Exercise, Screen time, Sleep Schedule, Diet). During the progress reports, students identified barriers and facilitators to achieving their lifestyle change goals and discussed approaches to address the barriers while reinforcing the facilitators. The most common barriers were: a) lack of time and b)competing interests; while the most common facilitators included: a) use of friends/family as an accountability partner, b) setting/posting reminders of the goal, and c) feeling good about meeting goal. Additionally, students offered plans to maintain/improve their performance toward their goal in each progress report. The most common plans included: a) time management, b) goal modification, or c) substituting a sleep promoting activity for the behavior being modified (e.g. read a paper novel in the 30 minutes before bed rather than scrolling through social media on the phone). At the end of the assignment, students submitted a final report that evaluated their overall performance as well as the major takeaways they gained from the experience of completing the assignment. A majority of students self-reported a significant improvement in their sleep quality over the course of the assignment. Qualitative perceptions and quantitative outcomes will be presented in detail. Additionally, discussions of unanticipated outcomes and suggestions for how and why to incorporate similar assignments into existing courses will be presented.
Conclusion:
College students can learn to make positive changes to improve their sleep and overall quality of life. Guiding them to identify and address the facilitators and barriers to these changes is an important part of the process to create and sustain these changes. Finally, we must acknowledge that the motivations to make these changes are different for emerging adults than they are for older populations. It may be that the most effective way to improve sleep quality in college students is to ‘attach a grade’ to the activity.