Examining the relationship between sleep and health outcomes in students
New Michigan State University research analyzes stress effects on sleep quality and diet during the novel coronavirus pandemic.
When the novel coronavirus pandemic took hold in the U.S. in March 2020, college students were among the first groups affected. Schools across the country, including Michigan State University (MSU), swiftly sent students home, canceled in-person activities, and switched to fully remote instruction to reduce exposure to the virus.
Shortly afterwards, Robin Tucker, assistant professor in the MSU Department of Food Science and Human Nutrition (FSHN), and her research group began to study the effects of the pandemic on student health.
“Students are among those experiencing sleep problems, and those problems are associated with measures of stress, including financial stress and other stressors caused by the pandemic,” she said. “We wanted to characterize that in order to get a better understanding of what's going on, and hopefully be able to use that understanding to be able to deal with similar events in the future.”
Tucker notes there are studies that have suggested natural disasters are similar to pandemics in terms of the effects on health and health outcomes, particularly increased rates of anxiety and depression.
One key factor that can help students cope with stress is sufficient, high-quality sleep.
“Sleep (is) an under-appreciated public health threat,” Tucker said. “People not getting enough sleep or experiencing poor sleep quality are at risk for developing chronic diseases later in life. There are also more immediate effects of poor quality, insufficient sleep: Your immune system doesn't work as well, so that could mean you get an extra cold or miss class or work because you're sick.”
Sleep, stress and diet: A global concern
With many in-person lab studies put on pause, Tucker, along with colleagues from Bowling Green State University (BGSU), Indiana University of Pennsylvania (IUP), International Medical University in Malaysia, Institute of Technology Sligo in Ireland, Leiden University College in the Netherlands, and the University of Taipei in Taiwan, created an online survey and distributed it to undergraduate, graduate and professional students in all seven countries represented.
“There were not many differences in outcomes in students from the seven different countries,” said Tucker. “Sleep is a problem everywhere. It seems to be part of the universal student experience.”
This unique study takes a holistic look at how multiple factors, such as sleep duration, diet and stress, can simultaneously impact sleep quality, rather than analyzing a single-variable relationship. Chen Du, a doctoral student in Tucker’s lab, has been instrumental in this work.
“(Du) conducts analyses that allow us to explore how these relationships are affected by each other and look at multiple aspects of what's going on,” Tucker said. “Instead of this very binary, ‘if this, then this’ approach, we can look at a couple of different factors and how they're influencing each other.”
In addition to her research on the pandemic’s impact on sleep quality on college students, Tucker also conducted a separate online study examining the relationships between financial stress, dietary behaviors and sleep. Approximately 1,200 students from MSU, BGSU and IUP participated in an online survey for this research.
“We found that the relationship between increased financial stress and poor dietary outcomes is completely mediated by sleep problems,” she said. “In other words, when you get enough sleep and good quality sleep, the relationship between financial stress and poor dietary behaviors disappears.”
Tucker said future work will focus on how reducing sleep problems might help students avoid undesirable dietary behaviors, such as frequent consumption of junk food and not eating enough fruits and vegetables.
“Our previous work before COVID-19 indicated that students who had significantly reduced sleep quality at the end of the semester compared to the beginning were more likely to have gained weight during the semester compared to students who maintained their sleep quality,” she said.
Teaching techniques for better sleep
Tucker currently runs a sleep education program with MSU Extension geared toward helping older adults achieve better sleep with an emphasis on improving sleep hygiene. Principles from this program are also applicable students.
“Sleep hygiene are the practices that you need to do to protect and maintain your sleep,” Tucker said. “It’s just like when you think about dental hygiene; those practices that we need to do to protect our oral health, like brushing and flossing.”
Sleep hygiene practices include avoiding scrolling through your cell phone before bed, eliminating the TV from your bedroom and maintaining a consistent bedtime and wake time all seven days of the week.
Stimulus control therapy is another approach Tucker teaches. This involves only going to bed when you’re tired, so you’re not forcing yourself to go to sleep. If you don’t fall asleep within 10 minutes of going to bed, you should get up and do an activity that’s not stimulating or arousing, then go back to bed when you start to feel tired.
Meditation and relaxation techniques are other components of sleep education.
“Mediation and relaxation techniques help people avoid thinking about a to-do list that's a mile long or the exam they have the next day,” Tucker said. “We help participants consider how to set themselves up for success, mentally, when it comes to sleep.”
Challenges for students
It can be difficult for students to prioritize high-quality, sufficient sleep because their time is often limited.
“I think it's important to understand that carving time out for sleep is not wasted time. When we talk about reserving time for exercise or physical activity every day, we need to make sure that we're protecting time for sleep as well,” Tucker said.”If you start to understand that it's important for your mental health as well as your physical health, then maybe that will help you to prioritize sleep.”
Tucker believes that financial and sleep education peer groups could help improve health outcomes.
“I could see training undergraduate and graduate students to deliver a sleep education program, so that if you're a student, you're learning from somebody who understands the pressures that you face, who has adopted the recommendations from the program and has seen positive effects,” she said. “You're hearing the testimonial from somebody who looks like you and lives in the same environment that you do.”
Tucker said investing in resources, as well as implementing simple solutions — avoiding late-night scrolling on your phone, waking up and going to bed at the same time every day, wearing an eye mask to block out light, using ear plugs or a white noise machine to block out noise — can go a long way.
“Exploring common-sense, feasible, cost-effective ways that we can help people get better sleep— that's very exciting to me,” she said.