Let's Talk About One Of The Most Underappreciated Things Among Students; Sleep.

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People love to play video games, read a book, watch a few series on the television etc. Does anyone even feel the urge to sleep nowadays? People have been making quite a fuss about how a day should be extended to more than 24 hours so that many things can be done in a single day but I digress. Sleep is an important component of longevity and I have preached about it a couple of times in articles which I have written before but it seems to me that nowadays, most of the college students were sleep deprived. If sleeping is so important in keeping us healthy enough to make a contribution to the world, why is it in one review paper which was written by Shelley in 2014 documented that out of 115 college students, 50% experienced daytime somnolence and about 70% were reported to complain about feeling tired and sleep-deprived at least 3 times a week? It is such a significant number and without any of the statistic presented on any review journal, I think you can make an objective assessment that most of the time, people were sleep-deprived and there is no amount of sleep seems to be able to compensate for that.

There is seems to be a lot of contradicting explanation regarding how many hours should we spent a day sleeping for us to be healthy? Is the sleeping hours counted on a daily basis or can we record it at a weekly interval? For example, if humans are required to sleep for 60 hours per week (minimum), can we work our ass off on the weekday and sleep it off on the weekend? Is it healthy? Well, pretty much like obesity, your height and certain diseases, I would say that the thing that would determine whether or not you will be healthier than the other, sleeping for a specific number of hours is multifactorial. It can be influenced by a variety of factors that can result in a varying number of outcomes. Life can't be that simple if sleep is pretty much complicated. In May 23rd 2018, Torbjörn Åkerstedt (the lead author) has published an article which demonstrated the benefits of sleeping in the weekends (more hours than we should have slept) to compensate the sleeping debt that we have created during the weekdays (Source).

Sleep debt or sleep deficit is the cumulative effect of not getting enough sleep. A large sleep debt may lead to mental or physical fatigue.

Source

In 2015, the National Sleep Foundation has published a guideline which can be used by pretty much everyone regarding how many hours should (or shouldn't) we spend sleeping per day. Here some info about them:

• Newborns (0-3 months): Sleep range narrowed to 14-17 hours each day (previously it was 12-18)
• Infants (4-11 months): Sleep range widened two hours to 12-15 hours (previously it was 14-15)
• Toddlers (1-2 years): Sleep range widened by one hour to 11-14 hours (previously it was 12-14)
• Preschoolers (3-5): Sleep range widened by one hour to 10-13 hours (previously it was 11-13)
• School-age children (6-13): Sleep range widened by one hour to 9-11 hours (previously it was 10-11)
• Teenagers (14-17): Sleep range widened by one hour to 8-10 hours (previously it was 8.5-9.5)
• Younger adults (18-25): Sleep range is 7-9 hours (new age category)
• Adults (26-64): Sleep range did not change and remains 7-9 hours
• Older adults (65+): Sleep range is 7-8 hours (new age category)

Source

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Obviously, people who sleep less or more than the recommended hours are not necessarily sick, but it can be indications to an ageing process, diseases or fatal genetic problems which might have interfered with our sleep arrangement. As a doctor, I would say that sleeping for more than 6 hours can be a luxury. Even though I often give some advice to my patient to sleep for more than 6 hours a day, I myself were sleep deprived. I have to work for more than 36 hours twice a week while being paid peanuts for it. Man, being a doctor is tough but lucky for me, I'm passionate about it so it is relatively easier to live under those terms.

When I was a medical student, I ensured myself to sleep at least 8 hours so that I can recall and function better for days to come. Obviously, it is not consistent, some days I will sleep a pretty bit late, gaming with my buds and during the exam's week, my sleeping schedule goes haywire. Sometimes, I chugged a lot of caffeine to stay awake and revise things, and it is ridiculous because most of the times, most of the questions being asked were the topic which I didn't read or touched at all. There are a lot of studies which have found that sleep and mortality rate present itself as a U-shaped line on the graph which indicates that sleeping for less or more than the recommended hours can impose a negative consequence on an individual, specifically on their general well-being. So, today, we are going to discuss some benefits and why is it important for a college student to ensure they sleep adequately especially during the exam's week.

Why A Student Needs To Be Particular About Their Sleeping Habits?

Why do we need sleep that much? Can we function better without sleep? Can we do good on certain activities or uses a certain degree of pathological anxiety developed by sleeping less to make something beneficial for our health? Well, not likely. There are a lot of misleading facts about how little geniuses in the history of mankind sleep which resulted in a great achievement as they can function better and much longer spending less time a day, sleep. Nikola Tesla, for example, might have taken a short nap instead of sleeping for a long duration of hours but bear in mind that he did it for a few times a day which could have accumulated to the number of hours recommended by the National Sleep Foundation. It is therefore important for us to not only focus on how many times we sleep a day but the quality of the sleep. People who are affected by the Fatal Familial Insomnia (FFI), for example, can sleep up to 6 hours but their brain waves don't indicate they were actually sleeping so in a way, they were not sleeping; just closing their eyes, floating in the darkness. What happened to them in the end? People who have been diagnosed with FFI usually died between 12 to 18 months after the onset of insomnia.

As one of the most important things for a student is academic performances, sleeping adequately can be thought as a necessary tool which must be wielded as it is as much as important with eating the right food to keep you healthy. In a review journal written by Curcio G et al in 2006, they found that people who possessed healthy physical, mental functioning and emotional state would have a good sleeping pattern measured in 24 hours, not a week. It is therefore unreasonable for people to assume that sleeping in the weekend for more hours than the one recommended by a standardised guideline should be fine as long as it is intended for covering a specific number of hours of sleeping debt. Depositing hours of sleep debt like spending money by using a credit card, is pretty much popular among people nowadays, especially among students. I get it we are trying to enjoy our life in the university before working our ass off towards graduation day a few weeks before exam days but the majority of them don't realise that it's eating them, slowly and painfully.

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A part of the brain called the prefrontal cortex which performs a few executive functions which are important for a higher level of learning are significantly affected by a lack of sleep. This can cause several impacts on the capability of the brain to encode new memories or even being creative on certain things as it is impaired from sleep deprivation, this observation was documented by a study conducted by Yoo et al in 2007 (Source). Honestly, I can list out a few more benefits of sleep but people seem to take it as something that we shouldn't make so much fuss about. Students who are sleep deprived are motivated to sleep which affect most of their daily activities particularly if it involves learning; you need a lot of energies to operate a heavy machinery (the brain). Even Sheldon in the TV Series "The Big Bang Theory" is portrayed as someone who needs to sleep at 9 pm and he woke up usually at 6 am which gives him a total of 9 hours of Zs. Honestly, I can't seem to think a better way other than incorporating all of this quality in a popular TV series so that people would learn it.

In a study conducted by Megan L. Zeek et al in 2015, she found that students who sleep for more than 7 hours achieved better academic performances compared to people who sleep less. It is speculated that increasing 1 hour of sleep from 7 hours up to 9 hours, increase academic performances by 11%. However, it should be noted that almost as high as 54% of the students are sleep deprived which they complained of feeling lethargic after waking up (they sleep for less than 7 hours). The effect is profound especially during the exam week whereby students usually sleep for 5 hours on average. I mean why do we have exams at all if it will affect our health in negative ways, right? We have anxiety, depression and now sleep deprived. Kidding aside, as it is important for students to get a good grade in order to score a better job, it makes them desperate and confused which one is the best choice for them to take; sleep it off or stay up longer to study more. I would probably sleep but different people have different views on what to do when they want to achieve something.

Second Wind Phenomenon

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I have covered this topic in my previous article but like any teacher, it is always good to reinform so that all readers would be benefited from said, topic. Ever wonder why you have a surge of energy past 10 pm onwards even though you were tired from the daytime activities? This is a popular reason why people have been complaining they were having insomnia whereas they were not. Insomnia is a pathological condition which would either cause you to have some difficulty in sleep initiation or stay asleep which would result in an early awakening. The latter is not necessarily pathological as it can be a part of a normal process of ageing usually, mistakenly diagnosed as having depression (elderly people would have less than normal production rate of melatonin which would cause them to have problems in maintaining a good night sleep). Factors like exposure to light-emitting devices such as computers and mobile phones before your daily Zs would cause you to experience a condition which I would like to call "sleep delay" attributable to the level of melatonin, which is a protein with an anti-oxidant property that would aid in the sleeping initiation and maintenance process.

Ever wonder how do we ever wake up in the morning and why some people with depression would have a few onsets of early awakening while others would exhibit hypersomnia (sleeping more than the hours recommended by the guideline). Some articles suggested that waking up can be due to several factors but the main mechanism that I would like to stick with is the role of a stress hormone called cortisol. It is normal for people to have a high cortisol level when we wake up in the morning, that level of cortisols are required to put you in a state of alertness which would result in waking up. For those who don't know, out sleeping cycle is regulated by various organs which are lead by a small structure in a brain called the suprachiasmatic nucleus and a pineal gland. These organs will trigger the secretion of a protein called melatonin which is light-dependent that would exert various effects which include sleepiness.

Obviously, both of these organs are regulated by the stimuli sent by other organs that would indicate it is time to sleep; most of us knew the eyes as the primary organ that is responsible for such task. The light information would be relayed through the optic nerve, received and interpreted in the brain which would allow certain structures to act accordingly. Melatonin would then be secreted in a significant level and would eventually initiate sleep. Good news for us, melatonin would exert some sort of anti-oxidant property that would allow us to stay young and healthy but bad news for us, the concentration produced would decline as the time approaching midnight and would be at its lowest at approximately 2 am. Sleep would then be regulated by other factors that would allow it to be maintained and the level of a hormone called cortisol would start to rise, eventually reaching a point that you would wake up from your sleep. People who have been diagnosed with depression can either have some sort of problems with keeping certain hormone up or cortisols down. If they were the latter, then they would have some problems in maintaining their sleep, often wake up at 1 am or earlier after sleeping for like 2-3 hours.

What about second wind phenomenon? Well, it simple. It is a condition whereby you felt energetic despite being lethargic earlier as a result of melatonin reduction. You would have realised this by now if you felt sleepy between 8 to 10 pm but felt a surge of energy if you weren't sleeping by 12 am. It is simply explained by the reduction of melatonin because of the natural properties that it would reduce until it stays at the lowest level possible at a certain time. The timing varies according to where you were in the world, I'm not keeping track with the time in any place other than my country, Malaysia, but yeah, you get the gist; as long as its dark, you will feel sleepy but as the time goes on, you will start to feel energetic. It is physiological insomnia, not a pathological cause. If you want to learn more about stages of sleep and second wind phenomenon, you can refer to my previous article by clicking here.

Loneliness And Sleeping Problems

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There is an interesting study conducted in 2018 which concluded that people who are sleep deprived tend to be socially withdrawn and feeling lonely, leading to self-isolation and this particular outcome could have made people who encountered them felt lonely as well. I mean if loneliness could be contagious, then sleep-deprived can be an important medical symptom that needs to be controlled as it can affect others in a long run (Source). We have witnessed what loneliness can do to an individual. People who were living alone are prone to be affected by chronic diseases hence an increase in morbidity and mortality rate compared to people who were socially active; I can say that the most bizarre effect of loneliness took place in people who just lost their beloved in a condition we called as the widowhood effect. Feeling loneliness can stem from a few reasons, it is either:

• You tried to distance yourself from others for some reasons
• You felt lonely even though you were socially active, can be because you were dissatisfied with some components of your social life
• You were distanced by others

In case of sleep deprivation, usually, it is caused by the first one. You become disinterested in involving with others for a necessary healthy communication and interaction. Do you think college students nowadays are socially active or withdrawn? I'm talking about them in general and students who were sleep deprived since to have a degree of reluctance in engaging with others (whether it is executed or not is irrelevant). Sure, some people need to be pushed in order for them to do anything but people who were sleep deprived only seek sometimes for them to replace their sleeping hours hence the isolation. Nevertheless, it is just a speculation from my side based on the literature and my personal viewpoint; more studies are needed to establish such a conclusion and as feeling lonely can be subjective, it is pretty difficult to quantify the amount of feeling needed for us to categorise people as being lonely. Complicated, isn't it?

Sources

• Sleep Duration and Academic Performance Among Student Pharmacists
• Can You Make Up for Lost Sleep on the Weekend?
• NameOfSource
• Pilot Study of a Sleep Health Promotion Program for College Students
• Sleep duration and mortality – Does weekend sleep matter?
• 'Contagious' Loneliness Could Follow Poor Sleep
• Causes and consequences of sleepiness among college students

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