Effects of medical school on mental health and sleep habits

BACKGROUND and OBJECTIVES: This study aims to define changes in anxiety and depression among medical students while evaluating the association of sleep habits and other risk factors, including exercise habits and a diagnosis of chronic disease. The effect of the COVID-19 pandemic was also evaluated. DESIGN: A cohort of first- and second-year medical students was evaluated longitudinally using survey methods to quantify changes from pre-medical school and summer break to each semester in medical school throughout years one and two. METHODS: Data was analyzed using Generalized Linear Mixed Models (GLMMs) on the numeric responses of General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Pittsburg Sleep Quality Index. Additional assessments evaluated exercise habits, chronic disease, and impact of COVID-19 Pandemic. RESULTS: Depression, anxiety, and sleep habits displayed a cyclical change that was associated with the academic cycle. The COVID-19 pandemic was never significant. Medical students who had a chronic disease diagnosis had increased severity. Exercise did not play a role. CONCLUSION: The main driver for depression, anxiety, and poor sleep quality was the academic cycle, while the COVID-19 pandemic did not have an impact on mental health.

Sleep Medication in Older Adults: Identifying the Need for Support by a Community Pharmacist

Many older adults take benzodiazepines and sedative-hypnotics for the treatment of sleep disorders. With a view to considering the possible discontinuation of hypnotics, the objectives of the present study were to describe bedtime habits and sleep patterns in older adults and to identify the sleep medications taken. An expert group developed a structured interview guide for assessing the patients’ bedtime habits, sleep patterns, and medications. During an internship in a community pharmacy, 103 sixth-year pharmacy students conducted around 10 interviews each with older adults (aged 65 or over) complaining of sleep disorders and taking at least one of the following medications: benzodiazepines, benzodiazepine derivatives (“Z-drugs”), antihistamines, and melatonin. A prospective, observational study was carried out from 4 January to 30 June 2016. The pharmacy students performed 960 interviews (with 330 men and 630 women; mean ± standard deviation age: 75.1 ± 8.8). The most commonly taken hypnotics were the Z-drugs zolpidem (n = 465, 48%) and zopiclone (n = 259, 27%). The vast majority of patients (n = 768, 80%) had only ever taken a single hypnotic medication. The median [interquartile range] prescription duration was 120 (48–180) months. About 75% (n = 696) of the patients had at least 1 poor sleep habit, and over 41% (n = 374) had 2 or more poor sleep habits. A total of 742 of the patients (77%) reported getting up at night—mainly due to nycturia (n = 481, 51%). Further, 330 of the patients (35%) stated that they were keen to discontinue their medication, of which 96 (29%) authorized the pharmacist to contact their family physician and discuss discontinuation. In France, pharmacy students and supervising community pharmacists can identify problems related to sleep disorders by asking simple questions about the patient’s sleep patterns. Together with family physicians, community pharmacists can encourage patients to discuss their hypnotic medications.

Social Isolation and Sleep: Manifestation During COVID-19 Quarantines

Although researchers have investigated the impact of social isolation on well-being, the recent quarantines due to COVID-19 resulted in a social isolation environment that was unique to any examined in the past. Because sleep is one of the endogenous drives that impacts short and long-term health and well-being, it is important to consider how social isolation during the COVID-19 government-mandated quarantines affected sleep and sleep habits. A number of researchers have addressed this question during the last 2 years by examining several concepts related to possible changes in sleep during the quarantines. To best understand these recent results, the current mini review provides a background on the pre-pandemic literature on the effects of social isolation and loneliness with a focus on sleep and then summarizes the recent literature on sleep and sleep habits. In general, sleep was negatively impacted for many people during the pandemics but not all. One group that seemed to benefit from the pandemic in terms of sleep patterns, were younger people who could more easily adapt their sleep times to match their internal chronobiology. Given the potential broad impact of sleep on health and well-being, better understanding how social isolation impacts sleep is an important consideration for individuals, work organizations, and governments.

Sleep and circadian indices for planning post-pandemic university timetables

The aims of the present study were to obtain sleep quality and sleep timing information in a group of university students, and to evaluate the effects of a circadian hygiene education initiative. All students of the University of Padova (approximately 64,000) were contacted by e-mail (major campaigns in October 2019 and October 2020) and directed to an ad hoc website for collection of demographics and sleep quality/timing information. Participants (n=5740) received one of two sets of circadian hygiene advice ('A regular life' or 'Bright days and dark nights'). Every month, they were then asked how easy it had been to comply, and provided with the advice again. At any even month from joining, they completed the sleep quality/timing questionnaires again. Information on academic performance was obtained post hoc, together with representative samples of lecture (n=5972) and exam (n=1800) timings, plus lecture attendances (n=25,302). 52% of students had poor sleep quality and 82% showed signs of sleep deprivation. Those who joined in October 2020, after several months of lockdown and distance learning, had better sleep quality, less sleep deprivation and later sleep habits. The 'Bright days and dark nights' advice resulted in earlier get-up time/midsleep compared to the 'A regular life' advice. Significant changes in most sleep quality and sleep timing variables were observed in both advice groups over time, also in relation to pandemic-related events characterising 2020. Early-chronotype students had better academic performances compared to their later chronotype counterparts. In a multivariate model, sleep quality, chronotype and study subject were independent predictors of academic performance. Taken together, these results underlie the importance of designing circadian-friendly university timetables.

Higher Tablet Use Is Associated With Better Sustained Attention Performance but Poorer Sleep Quality in School-Aged Children

There are growing concerns that increased screen device usage may have a detrimental impact on classroom behaviour and attentional focus. The consequences of screen use on child cognitive functioning have been relatively under-studied, and results remain largely inconsistent. Screen usage may displace the time usually spent asleep. The aim of this study was to examine associations between screen use, behavioural inattention and sustained attention control, and the potential modifying role of sleep. The relations between screen use, behavioural inattention, sustained attention and sleep were investigated in 162 6- to 8-year-old children, using parent-reported daily screen use, the SWAN ADHD behaviour rating scale, The sustained attention to response task and the children’s sleep habits questionnaire. Tablet use was associated with better sustained attention performance but was not associated with classroom behavioural inattention. Shorter sleep duration was associated with poorer behavioural inattention and sustained attention. Sleep quality and duration did not act as mediators between screen usage and behavioural inattention nor sustained attention control. These findings suggest that careful management of the amount of time spent on electronic screen devices could have a beneficial cognitive impact on young children. The results also highlight the critical role of sleep in enhancing both behavioural attention and sustained attention, which are essential for supporting cognitive development and learning.

Surf or sleep?

Poor sleep habits may cause serious problems of mind and body, and it is a commonly observed issue for college students due to study workload as well as peer and social influence. Understanding its impact and identifying students with poor sleep habits matters a lot in educational management. Most of the current researches is either based on self-reports and questionnaires, suffering from small sample size and social desirability bias, or the methods used are not suitable for the education system. In this paper, we develop a general data-driven method for identifying students' sleep patterns according to their Internet access pattern stored in the education management system and explore its influence from various aspects. First, we design a Possion-based probabilistic mixture model to cluster students according to the distribution of bedtime and identify students who are used to stay up late. Second, we profile students from five aspects (including eight dimensions) based on campusbehavior data and build Bayesian networks to explore the relationship between behavioral characteristics and sleeping habits. Finally, we test the predictability of sleeping habits. This paper not only contributes to the understanding of student sleep from a cognitive and behavioral perspective but also presents a new approach that provides an effective framework for various educational institutions to detect the sleeping patterns of students.

Questionnaire-Derived Sleep Habits and Academic Achievement in First Year University Students

This study aimed to determine the effect of sleep quantity and quality via the Pittsburgh Sleep Quality Index (PSQI) on students’ academic achievement in their first year of university study. In this cross-sectional study, 193 students (102 female, 91 male, mean ± SD; age = 19.3 ± 2.9 y) from an undergraduate Health degree in New Zealand completed the PSQI four weeks prior to the end of the semester in their first year of university study. Results from three core subjects in the first semester were averaged and correlations between the PSQI and academic success were evaluated using Spearman’s rho (ρ). The group were also trichotomized using a PSQI global score of ≤5 as the threshold for “good” sleepers (n = 62, 32%), a score of 5–8 for “moderate” sleepers (n = 63, 33%) and a score ≥8 to characterize “poor” sleepers (n = 68, 35%). Overall, students averaged 7 h 37 min of self-reported sleep duration with an average bedtime of 22:55 p.m. and wake time of 8:01 a.m. There was a significant, small inverse relationship between academic performance and bedtime (p = 0.03, ρ = −0.14), with those going to bed earlier having superior academic success. The trichotomized data demonstrated no significant differences in academic performance between students with poor, moderate and good sleep quality (p = 0.92). Later bedtimes were associated with lower academic performance in a group of first year university students. However, there were no other relationships observed between academic success and self-reported sleep quality or quantity as determined by the PSQI. Enhancing awareness of the impact of sleep timing on academic success should be prioritized and strategies to improve sleep hygiene should be promoted to university students.

Effect of Physical Activity, Smoking, and Sleep on Telomere Length: A Systematic Review of Observational and Intervention Studies

Aging is a risk factor for several pathologies, restricting one’s health span, and promoting chronic diseases (e.g., cardiovascular and neurodegenerative diseases), as well as cancer. Telomeres are regions of repetitive DNA located at chromosomal ends. Telomere length has been inversely associated with chronological age and has been considered, for a long time, a good biomarker of aging. Several lifestyle factors have been linked with telomere shortening or maintenance. However, the consistency of results is hampered by some methodological issues, including study design, sample size, measurement approaches, and population characteristics, among others. Therefore, we aimed to systematically review the current literature on the effects of three relevant lifestyle factors on telomere length in human adults: physical activity, smoking, and sleep. We conducted a qualitative systematic review of observational and intervention studies using the Preferred Reporting Item for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The systematic literature search covered articles published in MEDLINE and EMBASE databases (from 2010 to 2020). A total of 1400 studies were identified; 83 were included after quality control. Although fewer sedentary activities, optimal sleep habits, and non- or ex-smoker status have been associated with less telomere shortening, several methodological issues were detected, including the need for more targeted interventions and standardized protocols to better understand how physical activity and sleep can impact telomere length and aging. We discuss the main findings and current limitations to gain more insights into the influence of these lifestyle factors on the healthy aging process.

SCREENING OF PSYCHOLOGICAL DISTRESS AMONG COLLEGE STUDENTS DURING THE COVID-19 LOCKDOWN PERIOD: A CROSS-SECTIONAL STUDY

The uncertainty and dread linked with COVID-19 has contributed to a rise in mental health disorders among the general population showing high rates of anxiety, depression, posttraumatic stress disorder, and psychological discomfort. The current study aims to assess the prevalence of psychological distress among undergraduate students of an Arts college in rural Tamilnadu. A cross-sectional study was carried out among 100 undergraduate students of an arts college selected by convenient sampling technique using GHQ-12 questionnaire via online platforms. Among the 100 medical students who participated in the study, 78% were found have severe problems with psychological distress. Leisure time activity like smartphone usage was found to have a signicant association with psychological distress (p<0.05) while other factors like gender, socio-economic status, physical activity, dietary preferences, junk food consumption and sleep habits were not associated statistically. Early recognition of students under stress and counselling will go a long way in helping students adjust to the demands of the educational curriculum.