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Literature review

Introduction

Insomnia is the most prevalent sleep disorder. Studies have proven Lack of enough sleep

reduces a person’s immune response system leaving them susceptible to opportunistic infections.

The Third International Classification of Sleep Disorders (ICSD-3, AASM 2014) criteria defines

Insomnia as a disorder which causes a difficulty initiating sleep and maintaining sleep or waking

up earlier than desired with daytime impairment despite adequate opportunity and circumstances

to sleep. The Fifth Edition of the Manual of Mental Disorders (DSM-5, APA 2013) provides an

alternative definition for insomnia. They define insomnia to include persistent complaints with

quantity or quality of sleep. There are two types of Insomnia disorders acute insomnia which

lasts from one day to about a weak and chronic insomnia which last over extended periods.

This study places special focus on college and high school students since the effects of

insomnia are more pronounced within these groups. Sleep is essential in the maintaining of

cognitive functions including learning, memory consolidation, critical thinking and decision

making. The increasing number of insomnia cases a significant and a poses a threat to the

learning process. Sufficient sleep time for young adults is 7 to 9 hours. A recent study by hg

which included more than 1000 American college students found that out of the 1000 only 25%

slept for less than 6.5 hours. Another study by hg on more than 50000 students in Norway

colleges and universities established that 22% men and 34% met the criteria for insomnia.

Considering this worrying results-this literature will attempt to evaluate the significance of the

most notable causes of insomnia i.e., changes in sleep pattern and mental pressures in explaining

the growing numbers of recorded insomnia cases. The review also studies the implications of

insomnia on academic performance and health of college students.

Causes of Insomnia in college students

Changes in sleep patterns

Abrupt changes in sleep pattern affects circadian rhythm, which is a biological process that

regulates the wake-sleep cycle. The circadian process guides metabolism and body temperatures-

essential factors that induce sleep. Frequent change in sleeping times, travelling across multiple

time zones are the most known factors that affect circadian process. Most college students

especially those taking advanced causes such as nursing often suffer from the two types of

insomnia.

A study by Patrick Marshall indicate growing complaints by college students about school

workload. The study indicate that most students lack time for recreation and are often forced to

work on school assignments until late in the night to beat deadlines. In contrast school

proponents hold that school routine and schedules are not to blame for student burnouts they

argue students are now spending less studying and more time watching television, surfing on

their phones and working after school jobs. Nearly 90% of millennial (individuals between the

ages of 20–33) binge watch and the most common age group to binge watch are those enrolled in

colleges. Another study by hg found out that increasing numbers of low-income students and

high cost of living is exposing 20% to 50% of college students to food insecurity which causes

them to work almost full time. Divergence on the two studies leave room for further research on

the root causes of strain in college students between huge schoolwork loads and limited study

caused by factors not related to learning.

Mental pressures
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More studies show that parent and community’s expectation on children performance and their

desired profession is contributing to college students choosing courses they are not interested in

or are underqualified to pursue in the attempt to please the community. College students trying to

live to expectation (achieving high academic success/ high GPA) find themselves in acute

depressions, anxiety and other mental disorders. Goodhines et al., research on students’

performance established significant correlations between performance, anxiety cases, depression

and cases of insomnia; indicating and independence between the three variables performance,

insomnia and mental pressures. Güneş and Arslantaş study provided similar results only that the

study incorporated social-economic status as another significant factor influencing state of the

mind. Nevertheless, our literature review found limited information on the combined effect of

factors affecting state of the mind i.e., anxiety, depression and social-economic in predicting

Insomnia and consequently performance rates.

Personality traits

Although not related implicitly to schooling-student personality is a significant factor influencing

incidences of insomnia. Students with neuroticism and perfectionism personality are more likely

to suffer from insomnia. Hintsanen et al. (2014) Empirical research involving 1632 Finnish

student’s established strong associations between neuroticism and severity of insomnia. Brand et

al 2015 cross-sectional study and Longitudinal studies by Azevedo et al. 2010 and Lombardo et

al. 2013 show that perfectionist traits: error avoidance, doubts about actions and maintenance of

socially ascribed standards for excellence increased chances of anxiousness and insomnia.

Implications of Insomnia
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Several meta-analysis studies reveal insomnia impair cognitive functions. Fortier-Brochu et al.

(2012) which was based on 24 different types of studies and covering a sample of 639

individuals with insomnia and 558 normal sleepers revealed insomnia substantively impaired

working memory, critical thinking and decision making abilities. Similar other studies have

established similar results. When it comes to health related conditions- several pieces of

literature show high correlation between insomnia and incidences of in hypertension (Fernandez-

Mendoza et al. 2012); acute myocardial infarction (Laugsand et al. 2011) and incident heart

failure (Laugsand et al. 2013). However, all studies in these category have one systematic flaw-

they fail to include the effects delayed sleep–wake phase disorder (DSPD). There can be

overlaps between chronic and DSPD, especially given that prevalence of DSPD in young adults

ranges from 7% to 16%. Future studies in this line of thought need to include DSPD as a

confounding to eliminate chances of getting biased results.

Conclusion

The studies express high levels of association between changes in sleeping patterns, mental

pressures and personality traits with high incidences of insomnia cases in college students. And

also reveal high correlations between insomnia, lower academic performance and health

problems. However, the reliability of the studies concerning implications of insomnia on health

and performance cannot be substantiated since they did not control for DSPD which has similar

characteristics and effects as insomnia.

Hypothesis
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Following the findings from the literature review we hypothesize

H1: changes in sleep patterns, mental pressures and personality are significant predictors of

insomnia.

H2: there is a strong association between insomnia, lower academic performance and health

risks.

Reference
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Hintsanen M, Puttonen S, Smith K, Törnroos M, Jokela M, Pulkki-Råback L, Hintsa T,

Merjonen P, Dwyer T, Raitakari OT, et al. 2014. Five-factor personality traits and sleep:

evidence from two population-based cohort studies. Health Psychol. 33(10):1214–1223

Azevedo MH, Bos SC, Soares MJ, Marques M, Pereira AT, Maia B, Gomes AA, Macedo A.

2010. Longitudinal study on perfectionism and sleep disturbance. World J Biol Psychiatry.

11(2):476–485

Fortier-Brochu É, Beaulieu-Bonneau S, Ivers H, Morin CM. 2012. Insomnia and daytime

cognitive performance: a meta-analysis. Sleep Med Rev. 16(1):83–94

Fernandez-Mendoza J, Vgontzas AN, Liao D, Shaer ML, Vela-Bueno A, Basta M, Bixler EO.

2012. Insomnia with objective short sleep duration and incident hypertension: the Penn state

cohort * novelty and signicance. Hypertension 60(4):929–935.

Laugsand LE, Vatten LJ, Platou C, Janszky I. 2011. Insomnia and the risk of acute myocardial

infarction: a population study. Circulation 124(19):2073–2081