The Effectiveness of Sleep Hygiene Habits on Improving Sleep Quality in College Students
Abstract
Several research studies have reported decreased sleep and sleep issues negatively affecting the general population, with the college student population being highly affected. This literature review intended to answer the question of how effective sleep hygiene habits and technological sleep interventions are in improving the quality and amount of sleep in undergraduate students approximately 18 to 24 years of age. Various reputable databases were utilized to find recent peer-reviewed publications that followed the strict inclusion criteria of primary research on college students. The gathered results and data from each paper were organized and evaluated by constructing a research matrix and annotated bibliography. Each source was critically appraised based on the Joanna Briggs Institute (JBI) and Critical Appraisal Skills Programme (CASP) tools to check its credibility. The included sources used quantitative and qualitative methods to draw inferences and conclusions. It was found that sleep interventions overall provided positive benefits. Specifically, technological sleep interventions are beneficial as they generally lead to improved sleep, yet technology can become detrimental in some cases. Considering a more inclusive sample that ideally represents the general population along with well-thought-out methods would enhance the studies' generalizability and validity. This type of research is important in overcoming a prevalent public health challenge.
Introduction
Sleep health refers to the overall well-being and several aspects of sleep such as duration, amount, quality, and consistency. Problems and difficulties in sleep health are an essential public health issue because it is closely connected to not only physical health, but mental and emotional health as well. Different research efforts indicate that a lack of sleep and sleep issues impact populations of all ages and backgrounds. Certainly, college students are greatly impacted by these problems, because students may suffer from huge workloads, substance use, caffeine consumption, social and relationship changes, and personal difficulties. The overwhelming, and in some cases unhealthy, pressure placed on these individuals leads to insufficient and poor quality of sleep. As a result, these major consequences affect many aspects of college students’ lives, especially their well-being and overall physical function.
Even though sleep aids are available options for improving sleep, individuals may experience adverse side effects. These medications are also not intended for long-term use or as a permanent solution. That being said, it is essential to establish and research sleep hygiene habits that are effective in providing enough rest, while minimizing the tolls put on the body and the inconveniences or challenges in people’s everyday routines. Improving sleep for all is necessary, as it is a part of everyone’s physiological needs that can often be overlooked or sacrificed due to stress and lifestyle choices.
The purpose of this literature review is to examine the effects of sleep hygiene habits on both sleep quality and the amount of sleep in college students. Due to the increased prevalence of technology in younger generations, this paper elaborates more on technological sleep interventions. Technological sleep interventions refer to the strategies and approaches specifically designed to address sleep-related issues associated with technology use. This includes both the implementation of devices or platforms and screen usage boundaries. With this in mind, the specific question for this literature review is: How effective are technological sleep interventions in improving the quality of sleep in undergraduate students, who are approximately 18 to 24 years of age, compared to those who do not practice the interventions? This paper will outline the benefits and drawbacks of technological sleep interventions based on different researchers’ claims about college students’ sleep after testing each intervention involving technology, compared to a true control.
Methods
The study selection process was done by utilizing PubMed, PsycINFO, Biosis, and Google Scholar as databases for finding at least fifteen articles. Only five of these sources were used in the final draft, since they were the most focused on answering this paper’s research question. The keyword combinations that were used in each search query were “sleep”, “college students”, “sleep hygiene”, “sleep problems”, and “technology”.
This review mainly included quantitative publications that followed either a randomized controlled trial, cohort study, or qualitative study design implementing surveys. The inclusion criteria consisted of primary research on college students in general and with sleep disorders. This criterion included only published peer-reviewed literature in the English language from the most recent 5 years as well. All primary sleep research studies that gathered data on older adults, the elderly, adolescents, children, and infants were excluded since they did not help in providing clear and accurate statistical trends in college students. Additionally, after multiple searches and analyses, articles that connected sleep with information about mental health issues or the lifestyle during the COVID-19 pandemic in 2020-2021 were also not useful for the final review.
The data collection was done by organizing and evaluating each publication’s findings into a research matrix. Additionally, an annotated bibliography was developed to analyze each source further. The writer of this literature review applied critical appraisal for all sources by cross-checking with Joanna Briggs Institute (JBI) and Critical Appraisal Skills Programme (CASP) tools. This was done to determine each research article’s strengths and limitations, in order to ensure credibility, relevance, and limited bias in this literature review.
Results
Broad Outcomes
A systematic review compared psychological interventions divided into four categories: sleep hygiene, cognitive-based therapy (CBT), relaxation, and other psychotherapeutic interventions (Friedrich and Schlarb, 2018). Sleep hygiene is defined as adjustable healthy habits, behaviors, and environmental factors aimed to provide a good night’s sleep. Meanwhile, CBT is a psycho-social treatment designed to reduce mental health condition symptoms in various contexts and it can be applied for treating sleep challenges. The CBT approach allows individuals to utilize their confidence and problem-solving skills in overcoming their internal challenges related to their sleep. The authors searched for randomized controlled trials, quasi-experimental studies, and college/university students as part of their inclusion criteria. They excluded breathing-related sleep disorders for the reason that they needed to be addressed with solutions besides psychological interventions and studies that focused on correlations or prevalence rates due to their broad interpretations. The authors observed varying effects for the following intervention categories: sleep hygiene (small to medium), CBT (large), relaxation (very small to very large), and other psychotherapeutic interventions (medium). Even though sleep hygiene has somewhat of a favorable impact on sleep quality, the authors implied that CBT and relaxation techniques should be combined to improve both sleep and mental health in college students. These strategies would address underlying psychological factors contributing to sleep difficulties and promote overall well-being.
This systematic review provided an insightful analysis of different interventions with quantitative data as evidence. While this publication can be used to provide a general overview of the significance of sleep interventions in enhancing sleep quality, this perspective may slightly differ from findings in other studies that claim the substantial benefits of sleep hygiene habits. Moreover, Cohen’s d values for sleep hygiene interventions (0.35-0.50) indicate a relatively smaller impact on sleep quality, sleep rhythm, daytime sleepiness, and sleep problems. Furthermore, the authors mentioned the challenges of reducing bias, addressing a more inclusive sample, varying outcome measures, clarifying overlapping categories, and having the potential of contrasting findings. Nevertheless, the authors still established their credibility by clearly communicating their search strategy for obtaining an acceptable quality of evidence and limitations.
Digital Communication Interventions
One study about email interventions utilized an experimental group design to investigate the effects of an email communication intervention on college students with insomnia. The intervention involved delivering an email specifically focused on cognitive behavioral therapy for insomnia (CBT-I) to the experimental group. On the other hand, the control group did not receive any emails throughout the study (Chang et al., 2021). Despite the fact that this article focused more on CBT as an intervention, it still analyzed the correlations associated with sleep hygiene, and the email outlined sleep hygiene habits that the participants were asked to follow. Each participant in the experimental group was requested to follow healthier sleep hygiene habits to enhance their sleep quality. The researchers utilized the insomnia severity index, 16-item dysfunctional beliefs and attitudes about sleep index (DBAS-16), Pittsburgh sleep quality index, Epworth sleepiness scale, sleep hygiene index, and alcohol use disorders identification test for their measures. As a result, the researchers generally found that the intervention group demonstrated a significant improvement in sleep and positive outcomes compared to the control group throughout the whole study, thus suggesting that the sleep intervention was helpful. Despite the acknowledged challenges in consistently delivering emails and ensuring intervention adherence, the paper brought an interesting, intriguing perspective on the impact of email-delivered sleep interventions on sleep quality, particularly among college students experiencing sleep difficulties. The paper shed light on the potential benefits or limitations of utilizing email as a means to improve sleep quality in this specific population.
Similarly, the paper on the text message communication intervention followed an experimental group design and measured the following variables: sleep knowledge, sleep hygiene index, self-efficacy time management, self-efficacy sleep influences, self-efficacy disruptive influences, and sleep quality (Gipson et al., 2019). Biweekly text messages presented brief sleep hygiene recommendations suggested by the National Sleep Foundation (NSF) and guidelines from the Center for Disease Control and Prevention (CDC). The researchers demonstrated that sleep quality, sleep hygiene, and sleep knowledge improved in the experimental group. Even though the control groups were designed to only get text messages about improving healthy behaviors in general, their overall sleep improved for them as well. It was concluded that text messaging is a feasible approach to delivering an intervention to promote healthy behaviors among young adults, especially in sleep health. The authors mentioned the limitations of some instruments not demonstrating reliability with their sample, the participants’ extraneous activities affecting their sleep patterns, measures reflecting a false high despite the low attrition rate, disproportionate representation, and potential subjectivity.
Turning Off and Plugging Away from Technology
While technology can be helpful, extensive usage can become obsessive and detrimental to college students’ health. One quantitative cross-sectional study evaluated the effect of computer game-playing habits on university students and how that impacted their sleep states (Akçay and Akçay, 2020). The authors designed a survey to gather their data and findings. They utilized the sociodemographic and descriptive questionnaire form, Pittsburgh sleep quality index, and Epworth sleepiness scale. The game addiction scale for adolescents (short form) was utilized too, for assessing how the level of game addiction relates to sleep quality. Their experimental observations determined that as the level of game addiction increased, sleep quality decreased. As a result, the participants’ daytime sleepiness got more severe, and their wake-up time shifted to later times. The authors proposed a solution in which effective sleep hygiene intervention strategies need to be developed for college students. Even though the authors mentioned the limitations of generalizability from disproportionate sample representation and potential subjectivity, this particular paper is one of few publications that evaluated how video games affected sleep quality in college students.
Another quantitative study examined the influence of cell phones on sleep quality among college students and the prevalence of sleep texting (Dowdell and Clayton, 2019). The authors measured the type of sleeper, sleep quality, and whether participants texted while they were supposed to be in a sleep state (and the number of occurrences). As a result, a quarter of the sample reported sleep texting behavior along with poor sleep quality from their cell phones influencing their sleep. Students who sleep texted were more likely to report sleep interruption, place their phone in bed with them, and have no memory of texting or what they texted. From their gathered results, the authors concluded that sleep texting and its influence on poor sleeping habits is a growing trend in the college student population.
The authors communicated several limitations in the study’s methodology. Relying solely on retrospective self-reports tends to result in subjective representations and underestimations of participants’ sleep-related behaviors. Moreover, the study lacked specific data on the frequency of sleep texting or the timing of these texts within the students’ sleep patterns. The guidelines regarding whether sleep texting should be counted during college students’ naps or nighttime sleep were also vague, which introduced ambiguity into the analysis and interpretation of results.
Discussion
From interpreting each source’s viewpoints and findings, it can be inferred that technology can improve sleep in college students, with effects ranging from small and medium to significant. However, the technology sleep intervention has to be implemented in an intentional way that is beneficial and not compulsive. Thus, a balance needs to be achieved between utilizing technology as an asset and at the same time limiting technology use. This is not to say that healthier sleep hygiene habits are limited to utilizing technology; rather, technology can be a strongly recommended tool. Depending on each individual’s practicality and accessibility, using other methods or even no method at all may work as well.
The general strengths of the sources were that they provided insightful perspectives and justification on how technology can either bring positive or negative impacts on college students’ sleep quality and amount of sleep. Specifically, the publication about the sleep hygiene intervention mentioned its approval of the Institutional Review Board (IRB), which further establishes its research ethics. The same paper clearly communicated its statistics and power analysis too, which further establishes its rationale. Yet, each paper had its limitations, whether they were mentioned or not. The main limitations had to do with gathering and retaining an accurate population sample, designing an effective and valid methodology for measuring variables, and relying on objective data rather than subjective self-reports. More importantly, many of these papers communicated their limitation in reducing and minimizing biases. Some of these papers also cautioned the readers against generalizing results as they may not be applicable to a majority of college student populations.
Considering these limitations, some recommendations to minimize possible research gaps could be designing quantitative experiments and randomized controlled trials to examine sleep hygiene habits and the effects on specific racial or ethnic demographics, especially in marginalized or underserved communities that do not have equitable access to resources. It is also important to consider nontraditional, transfer, and older undergraduate students since they would have different experiences than average college students.
Conclusion
Altogether, this literature review analyzed the advantages and disadvantages of using technology for sleep hygiene habits to improve the quality of sleep in undergraduate students. The main digital communication interventions so far such as email and text are beneficial for college students to a certain degree. Although, extended exposure and usage of devices will detrimentally affect their overall ability to get essential rest. To expand on the utilization of technology for sleep hygiene habits, future research can explore various aspects. This includes investigating the impacts of different types of apps designed for sleep tracking, meditation, breathing exercises, or yoga. The effects of technology accessories such as noise-canceling headphones, electronic readers, and smartwatches can be examined as well. Additionally, valuable insights can be gathered from studying the influence of listening to calming music, nighttime sleep podcasts, or nature sounds from technology. These suggestions represent potential avenues for future research in the field of technology and sleep hygiene habits. Implementing more effective strategies for solving this public health issue will lessen the likelihood of individuals experiencing serious health problems from sleep deprivation and enable many people to better meet their basic needs for an enhanced quality of life.
Acknowledgments
I would like to thank Dr. Brendan Johnston and Erik Fausak for providing resources and guidance in writing this literature review. I would also like to acknowledge my peers in my UWP 104FY course for their feedback and suggestions.
References
Akçay, D., & Akçay, B. D. (2020). The effect of computer game playing habits of university students on their sleep states. Perspectives in Psychiatric Care, 56(4).
Chang, Y. P., Pereira, T., Salinas, A., Or, H. Y., Morales, M., & Le, M. L. (2021). Effects of an email delivered cognitive behavioral therapy for insomnia in college students. Perspectives in Psychiatric Care, 57(4), 1685-1692.
Dowdell, E. B., & Clayton, B. Q. (2019). Interrupted sleep: College students sleeping with technology. Journal of American College Health, 67(7), 640-646.
Friedrich, A., & Schlarb, A. A. (2018). Let's talk about sleep: A systematic review of psychological interventions to improve sleep in college students. Journal of Sleep Research, 27(1), 4-22.
Gipson, C. S., Chilton, J. M., Dickerson, S. S., Alfred, D., & Haas, B. K. (2019). Effects of a sleep hygiene text message intervention on sleep in college students. Journal of American College Health, 67(1), 32-41.