Insomnia in College Students: Causes and Effects

Between school work, hobbies, parties, and sometimes even work, most school students don’t get as much sleep as they need. Many don't even know that they're sleep deprived.

It can be fun for a while, but there are some serious consequences to poor sleep, especially for those who develop chronic insomnia.

I’m going to summarize research on college students and sleep so we can get to the bottom of sleep deprivation effects on students and how it should be treated.

How Common is Insomnia for Students?

A systematic review of studies on student sleeping habits found that approximately 18.5% of students meet the criteria for insomnia (1).

This may vary by school, major, and school year, as some studies have found insomnia rates as low as 9%, and others have found rates of up to 40%.

Insomnia is the most extreme case of poor sleep, but other studies show that approximately 60% of college students have poor sleep quality, which also has side effects (2).

Causes of Student Insomnia

The main causes of insomnia for students are poor sleep hygiene, mental health issues, and stress.

One large scale study of college students had 1,125 university students complete an online survey about their sleep habits (2). Responses were modelled against Pittsburgh Sleep Quality Index (PSQI) scores to see which factors predicted poorer sleep.

You can get your own PSQI score online here if you’d like.

Surprisingly, factors like alcohol and caffeine consumption were not significant variables. The variables that correlated to poor sleep were:

• Tension (anxiety)
• Stress
• Depression
• Anger

Note that this doesn’t mean that caffeine doesn’t cause insomnia, it just means that the average student in this study didn’t drink enough for it to be a significant factor for poor sleepers.

Other studies have found similar results. In particular, students with insomnia are approximately 2 times as likely to have clinically significant anxiety (3).

This could mean that sleep trouble causes anxiety (which it can), but since anxiety, depression, and insomnia are all bidirectionally related, one can lead to the other (4). So regardless of which one came first, both anxiety and insomnia can contribute to each other and cause side effects.

Student Sleep Hygiene

The most common sleep hygiene issues that appear to cause sleep problems in students are:

• One study of sleep hygiene in students found that poor sleep schedulingwas the best predictor of insomnia severity (5). In other words, students that had irregular sleep and wake times tended to have worse insomnia symptoms.
• Another study found that variable sleep schedules (same as above), going to bed dehydrated, and environmental noise were the sleep hygiene factors that significantly correlated with poor sleep quality (6).
• A study of medical students only found that watching TV in bed was significantly associated with poor sleep quality (7).

Research on student sleep hygiene and its impact is mixed, so take those results with some skepticism.

SummaryThe main causes of insomnia in students are stress, anxiety, depression, and certain sleep hygiene components like not having a consistent sleep schedule or sleeping in a noisy environment.

Effects of Sleep Deprivation on Students

Okay, so the majority of college students are sleep deprived to some degree, and we know what causes it.

Should we care?

Of course that’s rhetorical, as we know that there are serious short and long term side effects of insomnia.

For students, the consequences can end up having a major impact on the rest of their lives. Here’s what the research says:

• College students with poor sleep are more at risk of developing mental disorders (e.g. anxiety disorders, depression, etc.), which can lead to lower academic performance and higher rates of dropout and underemployment (8).
• Students with insomnia were more likely to experience excessive daytime sleepiness and clinically significant anxiety (9).
• Undergraduate students at a university with chronic insomnia had higher levels of anxiety, depression, and obsessive-compulsiveness, among other mental disorders (10). See the graph below, where PWI stands for Person with insomnia, and PWOI stands for Person without insomnia.

Students with insomnia basically had twice the odds of developing every serious mental health condition in that study.

Does Insomnia Affect Student Grades?

Research appears to show that a small level of sleep deprivation does not significantly affect grades compared to normal sleepers, but getting less than 5 hours of sleep regularly does.

The results of research on sleep quality and academic performance are a bit mixed, but it’s pretty clear that it’s a case of lacking sufficient research in this area.

A few studies show a clear connection between insomnia and poor academic performance:

• Insomnia symptoms were associated with poorer school performance, particularly in concentration and attention scores (11).
• Medical and paramedic students in Jordan who had low risk of insomnia had higher GPAs (12).
• Norwegian college and university students were much more likely to fail examinations if they slept less than 6 hours or more than 10 hours (13)

Those are the common sense results that most people would expect, but there are also studies that show the opposite of what we’d expect:

• A study that followed 1,074 college students for a year found no correlation between chronic insomnia and grade point average (14)
• A study in Ethiopian students found that 60% of students had insomnia, but “no significant association between insomnia and academic performance” (15).

These studies had limitations, and most importantly they are all correlational.

The most likely explanation for the study that showed that insomniacs had the same average GPA would be that students who get really stressed about school typically care a lot, which leads to poor sleep but also extra studying. To really conclude anything, we’d need an interventional study to see if fixing sleep issues in those students improved their GPAs further.

SummaryWhile more research is needed to quantify the impact of sleep deprivation on students, insomnia will affect energy levels, motivation, concentration, and other factors that will lead to poorer academic and social performance.

Treatment Options for Students With Sleep Trouble

Unfortunately, many students turn to over the counter medication (i.e. Tylenol PM) to try and treat insomnia, or even worse - alcohol at night and caffeine during the day (16).

These might be effective as crutches in the short term, but ultimately don’t fix sleep issues and there will be other side effects.

Treating insomnia in students isn’t very different from treating it in the general population. The most effective treatments are (17):

• Cognitive-behavioral therapy of insomnia (CBT-I)
• Sleep hygiene improvement
• Noise blocking technique (e.g. white noise)

While some types of therapies take a long time to have an effect, CBT-I often improves insomnia symptoms within weeks by decreasing stress and sleep anxiety levels.

Note that insomnia treatment should be guided by a doctor, as there could be other causes that need to be addressed (like a nutritional deficiency or comorbidity). They can also prescribe proper sleep medication if appropriate for your situation.

There’s some evidence that relaxation therapy (sort of like a guided meditation) can help improve sleep quality, but it’s far less effective than the solution above (18).

SummaryStudents with insomnia should see a doctor, who will check for any other obvious causes. For students with high levels of stress or mental disorders, a combination of CBT-I and sleep hygiene improvement is typically the best treatment plan.

Summary: College Students and Insomnia

The majority of college and university students are poor sleepers.

And while getting an hour or two of sleep is better than none, this not only affects their academic and social lives during school, but those results can impact their career and personal life for decades to come.

Most students with insomnia should start by fixing their sleep hygiene and seeing a doctor to see whether CBT-I or another treatment option is best for their situation.

References

1. A systematic review of studies on the prevalence of Insomnia in university students
2. Sleep patterns and predictors of disturbed sleep in a large population of college students
3. Insomnia and Relationship with Anxiety in University Students
4. A bidirectional relationship between anxiety and depression, and insomnia
5. Associations Between Sleep Hygiene and Insomnia Severity in College Students
6. Relationship of Sleep Hygiene Awareness, Sleep Hygiene Practices, and Sleep Quality in University Students
7. Association Between Sleep Hygiene and Sleep Quality in Medical Students
8. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication
9. Insomnia and Relationship with Anxiety in University Students
10. Insomnia and Mental Health in College Students
11. The relationship between insomnia symptoms and school performance among 4966 adolescents
12. Insomnia among Medical and Paramedical Students in Jordan
13. Insomnia, sleep duration and academic performance
14. Epidemiology of Insomnia in College Students: Relationship With Mental Health, Quality of Life, and Substance Use Difficulties
15. Insomnia and Its Temporal Association with Academic Performance among University Students
16. Over-the-counter medication and herbal or dietary supplement use in college
17. A Pilot Randomized Controlled Trial of the Effects of Cognitive-Behavioral Therapy for Insomnia on Sleep and Daytime Functioning in College Students
18. Relaxation therapy for insomnia