Republic of Iraq

Ministry of higher education

And Scientific research

University of Baghdad
College of medicine

The Prevalence Of Sleep Disorders Among a Sample of Iraqi Medical Students

Supervisor: Prof. Dr.Suhad Saeb Meejbil

Done by:

Hawraa Thair Farouq

Abbas Jassim Hassan

Zahraa Hassan Mohamed

 Research Project Part II (RP-II) Module
Year Four Medical Students
Semester Two

Research Project Completion Certificate

We certify that we worked together as a team under the supervision

of our supervisor to accomplish this research project as partial
fulfilment for Research Project Part II (RP-II) Module and we are
ready for discussing its content with the examining committee.

Students’ Names:
I certify that this research project was performed by the students
whose names are listed above under my supervision

Supervisor
Prof. Dr Suhad Saeb Meejbil
Subjects Page no.

Abstract 1

Result 2
Introduction 3
Sleep 5
Sleeping disorders 7
Medical study environment and sleep 9

Contents
disorders triggers
Results 11
Discussion 17
Conclusion 19
Recommendation 20
References 22
Questionnaire 25
 Abstract

Background:

Sleep problems are highly prevalent in the general population, with medical
students being particularly vulnerable. Research indicates that the prevalence of
sleep disturbances among medical students is significantly higher than that of their
non-medical peers (1). This can be attributed to multiple factors, including prolonged
study hours, emotional stress, lifestyle habits, and extensive use of stimulants(2).

Adequate, high-quality sleep is essential for long-term learning, optimal

neurocognitive and psychomotor performance, and maintaining physical and
mental health. Chronic sleep deprivation increases susceptibility to depressive and
anxiety disorders in medical students and decrease academic performance. For
instance, Curcio et al. emphasized a strong correlation between sleep quality and
academic performance, highlighting the impact of sleep on learning efficiency and
cognitive functioning (3).

Based on these observations, the current study aims to evaluate the intricate
relationships between sleep deprivation, sleep quality, and daytime sleepiness with
key factors such as quality of life, perceptions of the academic environment, and
symptoms of depression and anxiety.

Objective:
The objective of this study is to investigate the prevalence and types of sleep
disorders among medical students, as well as to examine the relationship between
sleep patterns, academic performance, and associated health outcomes within this
population.

Methods:
• Study Population: This study included medical students in the Medical
College of Baghdad University from the first grade to the sixth grade.
• Inclusion criteria: 6 grades during 2024
• Exclusion criteria: students from other non-medical universities.
• Study design: Convenient sampling technique

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• Operational definition: in this study, Sleep deprivation will be defined as
obtaining less than 5 hours of sleep per night on average, as measured by
students themselves.
• Sampling Technique: convenient sample
• Sample size: 432
• Data Collection: By using a research questionnaire through an online forum.
• Analysis Plan: A descriptive study. Tables, graphs, and calculations will be
done by IBM SPSS Statistics 20. Data were analyzed for the significance by
using Chi-Square test, when p-value below than 0.05 it is considered as
statistically significant.
• Human subject protection and Ethical approval: Anonymity and voluntary
participation would protect human subjects in this study. Only those who were
interested fill out the questionnaire at their convenience and in a private,
confidential setting. Also, the study didn't discuss issues which considered
ethically critical in our society.

Result:
432 medical students' were analyzed from Collages Of Medicine with highest
representation in the fourth stage (28.9%), they were aged 18-22 (70.8%) with a
gender distribution (63.9% female and 36.1% male). According to the SLEEP
questionnaire approximately 26.5% rated their sleep as poor, indicating
considerable dissatisfaction among a substantial portion of the sample.

Keywords: Sleep Disorders, Sleep Deprivation, Insomnia, Sleep Quality,

Circadian Rhythm, Academic Performance, Medical Students.

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Introduction:
Adequate sleep is essential for mental and physical well-being, yet chronic sleep
deprivation is strongly linked to impaired neurobehavioral functioning (1). Sleep
problems affect a significant portion of the general population, with approximately
one-third of adults reporting insomnia (2). A global survey conducted in 10 countries
revealed that 32.6% of primary care patients experience insomnia, a prevalence
consistent across diverse populations (3).

College students are particularly vulnerable to sleep disorders, often experiencing

inadequate sleep, difficulty falling or staying asleep, poor sleep quality, and
excessive daytime sleepiness. These issues are exacerbated by academic pressures,
lifestyle habits, and environmental factors such as noisy living conditions.
According to the National Sleep Foundation, 59% of adults aged 18 to 29 identify
as “night owls,” leading to insufficient rest when required to wake early (4). Social
obligations, academic stress, and shared living environments further contribute to
sleep disruptions.

Medical students, as a subset of college students, face unique challenges. Their

demanding schedules, emotionally taxing clinical duties, and high stress levels
contribute to a higher prevalence of sleep problems in this group. Poor sleep not
only affects academic performance but also exacerbates mental health issues,
creating a cycle of stress and poor sleep quality. Untreated sleep disorders may
result in long-term health consequences, including deficits in attention, increased
risk-taking behavior, depression, and strained relationships.(5)

The International Classification of Sleep Disorders (ICSD-3) categorizes sleep

disorders into groups such as:

Insomnia
Sleep-disordered breathing (e.g., sleep apnea)
Hypersomnolence (e.g., narcolepsy)
Circadian rhythm disorders (e.g., Delayed sleep phase syndrome)
Parasomnias
And Sleep-related movement disorders (6).
Notably, women are more likely than men to suffer from insomnia, with a
reported ratio of 4:1 (7).

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Management of sleep disorders involves both non-pharmacological and
pharmacological approaches.

Non-pharmacological strategies include relaxation techniques, sleep hygiene

education, and stimulus control therapy (8).

Pharmacological treatments, such as short- or intermediate-acting benzodiazepine

receptor agonists (BzRAs) or the melatonin agonist, may be used in specific cases.
Failure to address sleep disorders increases the risk of cardiovascular diseases,
cognitive impairments, and mood disorders (9).

Despite the significant impact of sleep disorders, their prevalence among college
students remains under-researched. Understanding the relationship between sleep
problems and factors like gender, race, and academic performance is crucial. (10)

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Sleep
Sleep, which is defined as a transitory state during which individuals are unable to
actively interact with their surroundings (11), plays a key role in people’s well-being.

Its macrostructure can be divided into the rapid eye movement (REM) phase and
three stages of non-REM.

(NREM) sleep: N1, N2, and N3. In the absence of any sleep disorders, N1 acts as a
transition between sleep and wake states, paving the way for N2 and, finally, N3,
as sleep deepens. In the final and most active phase of the sleep cycle, i.e., the
REM phase, bursts of rapid eye movements occur, along with distinct temporal
patterns and brain-wave interactions (12). This is referred to as sleep
architecture.(pic.1)

Unlike NREM stages, REM presents more sudden variations in measurable

physiological parameters, such as abrupt changes in arterial blood pressure, heart
rate, respiration, and a drop in body temperature. During this stage, healthy
subjects generally show complete muscle atonia, i.e., a type of muscular
immobility caused by the total relaxation of the muscles (13).

Pic.1. sleep architecture

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Sleep and wake states are generated by intrinsic neural networks and regulated by
circadian mechanisms. The initiation and maintenance of sleep require the
suppression of ascending arousal systems that promote wakefulness. Extracellular
adenosine increases throughout the awake period, and rising levels signal shifts
toward sleep. The adenosine activates inhibitory neurons of the ventrolateral pre-
optic area of the brain and serves as a sleep switch (14).
Circadian rhythms are the physical, mental, and behavioral changes an organism
experiences over a 24-hour cycle.
Light and dark have the biggest influence on circadian rhythms, but food intake,
stress, physical activity, social environment, and temperature also affect them.
Most living things have circadian rhythms, including animals, plants, and
microorganisms. In humans, nearly every tissue and organ has its own circadian
rhythm, and collectively they are tuned to the daily cycle of day and night.
Circadian rhythms influence important functions in the human body, such as: Sleep
patterns hormone release, appetite and digestion, and temperature.(15)

The system that regulates an organism’s innate sense of time and controls circadian
rhythms is called a biological clock.

It’s composed of proteins encoded by thousands of genes that switch on and off in
a specific order.(16) A master clock coordinates all the biological clocks in an
organism. In vertebrate animals, including humans, the master clock exists in the
brain. The human master clock is a large group of nerve cells that form a structure
called the suprachiasmatic nucleus (SCN).

Among other functions, the SCN controls production of the hormone melatonin
based on the amount of light the eyes receive. In the evening, a person’s master
clock tells their brain to make more melatonin, causing sleepiness. The SCN also
synchronizes the circadian rhythms in different organs and tissues across the body
(17).

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Sleeping disorders
Sleep disorders are a group of conditions that disturb sleep architecture, affecting
both the quantity and quality of sleep (18). These disorders can occur during sleep
(e.g., parasomnias) or during the day. Several factors can disrupt the sleep cycle,
such as caffeine consumption, light exposure, noise, or an irregular sleep schedule.
Each factor can lead to a specific sleep disorder.

For instance, not adhering to a consistent sleep schedule can result in sleep-wake
disorders, which manifest as impaired evening function, excessive sleepiness, or
sleep-maintenance insomnia characterized by early morning awakenings. In
contrast, delayed sleep-wake phase disorder involves difficulty initiating sleep
before the early morning hours, leading to delayed wake-up times and symptoms
of severe sleep-onset insomnia accompanied by excessive daytime sleepiness
Investigators have characterized insomnia as a disorder of hyperarousal that
manifests as hypervigilance during the day and difficulty initiating and maintaining
sleep at night.(30)

This hyperarousal may result from chronic activation of the neuroendocrine

system’s stress response.

Caffeine consumption also impacts sleep quality. Regular intake can shift rapid eye
movement (REM) sleep to the early part of the night and stages 3 and 4 sleep to the
later part, reducing overall sleep quality. Additionally, caffeine consumption alters
subjective perceptions of sleep characteristics in a dose-dependent manner (20).

Each sleep phase is associated with specific disorders. For example, nightmare
disorder and recurrent isolated sleep paralysis are REM parasomnias that cause
significant distress. Nightmare disorder involves repeated nightmares with vivid
and distressing dream content remembered upon awakening. This can lead to a fear
of returning to sleep, particularly in individuals with psychiatric or stress-related
disorders (21). Non-REM disorders, such as sleepwalking and sleep terrors, range in
cause from developmental phenomena in children to aggressive or injurious motor
behaviors in individuals of all ages (21).

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Circadian Rhythm Disorders

Circadian rhythms can become misaligned with environmental light-dark cycles,

leading to disorders characterized by non-restorative sleep, excessive sleepiness,
and difficulties in falling or staying asleep (22).

Key endogenous circadian rhythm sleep-wake disorders (CRSWDs) include:

• Delayed Sleep–Wake Phase Disorder (DSWPD): A delayed sleep-wake cycle

relative to desired sleep times.

• Advanced Sleep–Wake Phase Disorder (ASWPD): An advanced sleep-wake

cycle relative to desired sleep times.

• Irregular Sleep–Wake Rhythm Disorder (ISWRD): A chronic, chaotic pattern of

sleep-wake behaviors.

• Non-24-Hour Sleep–Wake Rhythm Disorder (Non-24): A daily drift in the sleep-

wake period, leading to increasingly delayed or advanced sleep-wake times.(23)

Exogenous circadian rhythm disorders, such as shift work disorder (SWD), occur
when the circadian system becomes misaligned with work schedules. Short-term
effects of circadian rhythm misalignment include drowsiness, poor coordination,
and difficulty concentrating. Long-term misalignment can lead to serious health
issues, including obesity, diabetes, mood disorders, cardiovascular problems, and
even cancer, as well as exacerbating pre-existing conditions.(24)

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Medical study environment and sleep disorders triggers

The social status acquired during academic studies plays a crucial role in shaping a
person’s career trajectory (25). University life, particularly for medical students, is
often described as one of the most stressful periods due to the immense
psychological and academic demands. The stress levels among medical students
are significantly higher than those experienced by students in other disciplines,
primarily due to the rigorous nature of medical education.

Categories of Stressors:
Stressors encountered by medical students can generally be divided into three
categories:

1. Frustrations: These arise when efforts to achieve a goal are blocked by external
or internal obstacles, or when the goal itself becomes unattainable.

2. Conflicts: These occur when contradictory motivations or needs arise

simultaneously, forcing an individual to make challenging choices. Conflicts can
be classified into:

• Situations involving both the desire to approach and avoid a goal.

• Choices between two equally important yet conflicting goals.

• Decisions between two or more unpleasant actions.

The type of stress and the coping strategies adopted largely depend on the nature of
these conflicts.

3. Pressure: Refers to tensions caused by internal or external forces that demand

an increase in effort, a faster pace, or a complete change in strategy to achieve a
goal (26).

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Additionally, situations involving material or emotional losses can amplify stress
levels. Such losses often evoke feelings of helplessness or irretrievability, leading
to prolonged negative emotional states. These states are frequently triggered by
stimuli reminiscent of the original cause and demand passive coping
mechanisms.(27)

Impact on Sleep: The high levels of stress in medical school are further
exacerbated by excessive caffeine and stimulant consumption, as well as sleep-
wake inversion (i.e., staying active at night and sleeping during the day) in an
effort to meet academic demands. Stress, caffeine abuse, and circadian rhythm
disruptions are recognized as significant contributors to sleep disorders.
Given these factors, medical students represent one of the most vulnerable groups
to sleep disorders, making it essential to address these triggers to improve their
overall well-being and academic performance.(28)

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Results

Table 1: Demographic Distribution

Variable Category Frequency Percent (%)

Stage First 31 7.2
Second 67 15.5
Third 111 25.7
Fourth 125 28.9
Fifth 42 9.7
Sixth 56 13
Gender Female 276 63.9
Male 156 36.1
Age Less than 18 0 0
18-22 352 81.49
Above 22 80 18.51

As detailed in Table 1, the majority of participants were aged 18-22 (70.8%), with
a gender distribution (63.9% female and 36.1% male). The distribution across
academic stages showed the highest representation in the fourth stage (28.9%).

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Figure 1: On a scale of 1 to 5, overall quality of sleep over the past month
Sleep-Related Impacts

Sleep Quality Assessment

Figure 1 illustrates participants' self-reported overall sleep quality over the past
month, with a notable concentration at a neutral rating of 3 (45.3%).
Approximately 26.5% rated their sleep as poor (1 or 2), indicating considerable
dissatisfaction among a substantial portion of the sample.

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Table 2: Frequency of Sleep-Related Impacts on Various Aspects

Aspect Always Often Sometimes Rarely Never

Affects Concentration 135 157 102 34 4
(31.3%) (36.3%) (23.6%) (7.9%) (0.9%)
Skips Classes/Study 36 111 118 108 59
(8.3%) (25.7%) (27.3%) (25.0%) (13.7%)
Irritability/Moodiness 86 150 135 45 16
(19.9%) (34.7%) (31.3%) (10.4%) (3.7%)
Impacts Interaction with 67 142 135 72 16
People (15.5%) (32.9%) (31.3%) (16.7%) (3.7%)
Uses Stimulants 93 96 103 76 64
(21.5%) (22.2%) (23.8%) (17.6%) (14.8%)
Episodes of Insomnia (lasting more than a month)
No 184 42.6%
Yes 247 57.2%
Total 432 100.0%

Sleep-Related Impacts

Table 2 highlights various sleep-related impacts on daily activities. A significant

percentage reported that sleep affects their concentration (67.6% often or always),
with ( 54.6)% indicating it contributes to irritability and moodiness. Additionally,
(27.3%) sometimes skip classes or study due to sleep issues, emphasizing the
academic repercussions of poor sleep quality.

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Table 3: Sleep Duration, Schedule Regularity, and Insomnia Experiences

Aspect Frequency Percent

Average Hours of Sleep
5-6 hours 84 19.4%
6-7 hours 105 24.3%
7-8 hours 116 26.9%
Less than 5 hours 37 8.6%
More than 8 hours 89 20.6%
Total 432 100.0%
Regular Sleep Schedule
No 179 41.4%
Sometimes 164 38.0%
Yes 88 20.4%
Total 432 100.0%

Sleep Duration and Schedule Regularity

Table 3 presents data on sleep duration, with the most common range being 7-8
hours (26.9%). However, a considerable (38%) of participants reported irregular
sleep schedules, which could exacerbate sleep quality issues. Notably,( 57.2%)
experienced insomnia lasting more than a month, further complicating their sleep
health.

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Table 4: Sleep Quality and Regular Sleep Schedule Analysis

Variable and Category Regular Sleep Schedule p-value

No Sometimes Yes
Insomnia Episodes
Yes 111 (62%) 89 (54.3%) 47 (53.4%) 0.437
No 68 (38%) 75 (45.7%) 41 (46.6%)
Nightmare Frequency
Always 13 (8.6%) 11 (8.1%) 11 (14.7%) 0.172
Often 46 (25.7%) 49 (26.6%) 16 (21.3%)
Sometimes 64 (35.8%) 46 (28%) 34 (38.6%)
Rarely 26 (14..5%) 37 (22.6%) 12 (13.6%)
Never 9 (5%) 5 (3%) 7 (8.0%)
Physical Symptoms
Always 13 (7.2%) 13 (7.2%) 11 (12.5%) 0.064
Often 47 (26.3%) 27 (16.5%) 19 (21.6%)
Sometimes 65 (36.3%) 59 (36%) 27 (30.7%)
Rarely 49(27.4%) 59 (36%) 23 (26.1%)
Never 5 (2.8%) 7 (4.2%) 8 (9.1%)

Association Between Sleep Quality and Schedule

Table 4 examines the relationship between sleep schedule regularity and insomnia
episodes, finding no significant association (p=0.437). Additionally, the frequency
of nightmares and physical symptoms showed trends but did not reach statistical
significance (p=0.172 and p=0.064, respectively).

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Discussion:

Among 432 participants, the majority were females, with (63.9%( female
compared to (36.1%) males, as females filled out the questionnaire more than
males. The most participating grade was the fourth stage (28.9%).

A notable percentage of participants (31.3%) reported that concentration was

always affected, and 36.3% said it was affected very often. This indicates that
concentration difficulties are a common issue among the participants, potentially
impacting academic or professional performance. The relatively low percentage
(0.9%) of participants who reported never experiencing concentration problems
highlights the widespread nature of this concern.

Skipping classes or study sessions is another significant issue, with 8.3% of

participants stating they always skip, while 25.7% and 27.3% said they skip very
often or sometimes. This suggests a tendency to avoid academic responsibilities,
which may stem from issues such as lack of motivation, stress, or poor mental
health. A considerable portion of participants (13.7%) reported never skipping
classes or studying, indicating that this behavior isn’t universal.

Irritability and mood swings were reported by 19.9% of participants as occurring

always, and 34.7% reported it happening very often. These mood issues can
significantly affect social interactions and overall well-being. The fact that only a
small portion of participants (3.7%) reported never experiencing irritability or
moodiness suggests that these emotional issues are prevalent within the sample
population.

About 15.5% of participants reported that their interactions with people were
always impacted, with 32.9% indicating a very frequent impact. This suggests that
mental and emotional difficulties are not only affecting individual well-being but
also social relationships. A relatively small number (3.7%) reported no impact,
which again points to the broad reach of these challenges.

The use of stimulants was reported by 21.5% of participants as happening always,

and 22.2% as occurring very often. Stimulant use could be related to attempts to
cope with concentration problems or fatigue. A significant percentage (14.8%)

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reported never using stimulants, which suggests that for many, other coping
mechanisms are used or stimulant use is not perceived as necessary.

Regarding insomnia, 57.2% of participants reported experiencing insomnia

episodes lasting more than a month. This high prevalence of sleep disturbances can
contribute to a variety of other issues, including difficulty concentrating,
irritability, and overall diminished quality of life. It is concerning that such a large
proportion of the sample suffers from sleep-related problems, emphasizing the
need for addressing sleep hygiene and related factors.

Regarding sleep duration, the largest group (26.9%) reported sleeping 7-8 hours,
while 24.3% slept 6-7 hours, which is generally considered within a healthy range.
However, a considerable number of participants (8.6%) reported sleeping less than
5 hours, which is insufficient for optimal health. The findings on sleep schedules
indicate that 41.4% of participants do not have a regular sleep schedule, which
could be contributing to the insomnia and concentration issues observed.

• Regular Sleep Schedule: The data on sleep schedules shows that a majority
(41.4%) do not follow a regular sleep pattern. The lack of a regular sleep schedule
may exacerbate insomnia symptoms and contribute to difficulties in maintaining
focus during the day.(29) And in research from the Department of Basic Medical
Sciences, College of Medicine, Ajman University, they found that irregular sleep
schedules are highly prevalent among university students, aligning with global
findings. Two-thirds of participants reported sleeping less than 7 hours, while a
systematic review across 26 countries showed that 40% of students sleep 6 hours
or less.

Gender was not significantly associated with sleep irregularity, consistent with
studies from Taiwan and the USA. However, female students had poorer sleep
quality, lower sleep efficiency, and were more likely to use sleep medication,
similar to findings in Saudi Arabian medical students. The study also revealed that
students with irregular sleep schedules had higher PSQI scores, indicating poor
sleep hygiene.

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Academic year and study program did not significantly influence sleep patterns,
though Ethiopian research found that second- and third-year students, especially
females, had a higher likelihood of poor sleep quality. Differences in academic
demands, sociocultural factors, and sample sizes may explain these
variations.Additionally, 57.2% of participants reported experiencing insomnia
lasting over a month, contributing to concentration difficulties, irritability, and
lower quality of life. The study also found that 52.9% of students experienced
excessive daytime sleepiness, a rate higher than in India, Malaysia, and Saudi
Arabia but lower than in Brazil and Colombia.The strong correlation between
irregular bedtime frequency and higher Epworth Sleepiness Scale (ESS) scores
suggests that inconsistent sleep schedules worsen sleep quality and increase
daytime drowsiness. These findings highlight the importance of promoting better
sleep hygiene among university students to improve overall well-being and
academic performance.

Conclusion:
1. Prevalence of Sleeping Disorders: The data indicates a high prevalence of
sleep disorders among students. Over 57% of participants reported experiencing
insomnia, and a significant portion of students (41.4%) do not maintain a regular

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sleep schedule. These findings suggest that sleep disturbances are a widespread
issue within this population.

2. Impact of Sleeping Disorders on Students: Sleeping disorders, particularly

insomnia, have a noticeable impact on students’ daily lives. Many participants
reported difficulties with concentration (31.3%), skipping classes or study sessions
(27.3%), mood disturbances (34.7%), and social interaction (32.9%). These issues
suggest that poor sleep is directly affecting students’ academic performance and
social relationships.

3. The Most Common Sleeping Disorder: The most common sleep disorder
reported is insomnia, with 57.2% of participants experiencing chronic episodes.
Additionally, irregular sleep schedules were found to be common among students,
contributing to overall poor sleep quality. These issues highlight the need for
interventions to improve sleep hygiene and address insomnia in this population.

Recommendations:

1. Improve Sleep Hygiene Practices: Encourage medical students to establish a

regular sleep schedule and maintain consistent sleep and wake times.

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2. Stress
Management and Mental Health Support: Since sleep disturbances like
insomnia are often linked to high stress levels, especially in medical studends.

3. Encourage Time Management and Academic Support.

4. Provide Education on the Consequences of Sleep Deprivation: Medical

students may not fully understand the long-term consequences of poor sleep on
cognitive function, memory retention, and overall health.

5. Encourage Healthy Coping Mechanisms: Since stimulant use was reported as

a common coping strategy for fatigue, it’s essential to promote healthier
alternatives, such as physical activity, adequate hydration, and proper nutrition.

6. Monitor and Address Insomnia Early.

7. Promote the Use of Sleep Apps and Technology: Incorporating sleep-tracking

apps and devices into students’ routines could help them better understand their
sleep patterns .

By addressing these key areas, medical schools can help alleviate sleep-related
issues among students, improving both their academic performance and overall
well-being.

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Questionnaire

1-Age:

-less than 18 -18-22 -above 22

2-stage:

-1st -2nd -3rd -4th -5th -6th

3-Gender:

-male -female

4-On average, how many hours of sleep do you get per night?

-less than 5 -5-6 -6-7 -7-8 -more than 8

5-Do you have a regular sleep schedule, going to bed and waking up at same time
everyday?

-yes -no -sometimes

6-have you ever experienced episodes of insomnia (lasting for more than a
month)?

-yes -no

7-how often do you experience nightmares or disturbing dreams?

-always -often -sometimes -rarely -never

8-how often do you experience physical symptoms such as headache or muscle

tension due to poor sleep?

-always -often -sometimes -rarely -never

9-on scale of 1-5 how would you rate the overall quality of your sleep over the past
month?

-1 -2 -3 -4 -5

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10-how often do you feel that bad sleep affects your ability to concentrate during
lectures or study sessions?

-always -often -sometimes -rarely -never

11-how often do you skip classes because of poor sleep or feeling too tired?

-always -often -sometimes -rarely -never

12-how often do you feel irritable or moody due to lack of sleep?

-always -often –sometimes –rarely -never

13-how often do u find yourself using stimulants (caffeine, energy drinks) to stay
awake?

-always -often -sometimes -rarely -never

14-How often do you feel that sleep problems contribute to stress or anxiety about
your academic performance?

-Always -Often -Sometimes -Rarely -Never

15-How often do your sleep problems affects your memory and mental state?

-Always -Often -Sometimes -Rarely -Never

16-How often do you wake up during the night and have trouble going back to
sleep?

-Always -Often -Sometimes -Rarely -Never

17-How often do you experience daytime sleepiness?

-Always -Often -Sometimes -Rarely -Never

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