Let's talk about sleep: a systematic review of psychological interventions to improve sleep in college students

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The life of college students is filled with challenges in all areas. As emerging adults, they face changes in their living arrangements (e.g. flatmates), social life (e.g. new circle of friends, substance abuse), biological developments (e.g. chronotype) and financial situation (e.g. independence from parents, part‐time work). Academic demands such as examination periods, term papers and deadlines add further to these potential stressors. Considering these challenges, it is not surprising that sleep problems are a common occurrence in college students. Up to 60% report bad sleep quality (Lund et al., 2010); 14.9% indicate difficulties falling asleep, 25.9% report waking up frequently at night and 7.7% fulfil all general criteria for insomnia, according to the International Classification for Sleep Disorders (ICSD‐II), second edition (Schlarb et al., 2012). Nightmares are reported by 4.5% of undergraduate men and by 8.3% of undergraduate women (Abdel‐Khalek, 2010).
These relatively high prevalence rates are alarming, because sleep is related closely to academic success and general health in college students. Sleep habits, particularly wake‐up times, and sleep length predict the grade‐point average significantly in college students (Gaultney, 2010; Kelly et al., 2001; Lund et al., 2010; Trockel et al., 2000). In addition, an impaired sleep–wake cycle leads to lower academic performance (Medeiros et al., 2001). In detail, sleep loss in college students results in reduced learning capacity, poor declarative and procedural learning and general reduced neurocognitive functioning (Curcio et al., 2006). Correspondingly, bad sleep quality leads to more stimulant use (Lohsoonthorn et al., 2013). Besides academic concerns, bad sleep habits and impaired sleep quality are connected strongly with health risk behaviours such as fighting, suicide ideation, smoking and alcohol use (Trockel et al., 2000; Vail‐Smith et al., 2009). While Kelly found that sleep length is correlated positively with life satisfaction (Kelly, 2004), insomnia symptoms and nightmares increase the risk for suicidal ideation, mental health problems and lower self‐efficacy (Nadorff et al., 2011; Schlarb et al., 2012; Taylor et al., 2011). All in all, not only sleep disorders but even sleep problems and reduced sleep duration impair college students’ lives and their academic career significantly.
Several reviews have addressed the question of therapy in patients with sleep disorders. Smith and colleagues found that behaviour therapy (BT) and pharmacotherapy both improve sleep, although BT is superior in respect of sleep latency (Smith et al., 2002). Correspondingly, cognitive–behavioural therapy for insomnia (CBT‐I) improves sleep, as shown by several reviews (e.g. Koffel et al., 2015; Okajima et al., 2011), and is more efficient than pharmacotherapy (Mitchell et al., 2012). Montgomery compared three non‐pharmacological interventions (CBT, bright light, exercise) for sleep problems in later life and found that CBT has a positive effect on sleep maintenance, while exercise enhances sleep in general (Montgomery, 2004). Even though these reviews concern themselves with the non‐pharmacological treatment of sleep problems, they have several limitations. First, these reviews included only randomized controlled trials (RCT), which severely limited the variety of the included studies. Secondly, most of them focused on insomnia disorder and disregard other sleep disorders or impaired sleep quality. Lastly, none of the studies focused on students but rather on (older) adults.
A recent review examined the effects of sleep education programmes on sleep knowledge and sleep quality in college students (Dietrich et al., 2016). However, they focused only on sleep education and had a very narrow scope of only four included studies (three RCTs, one quasi‐experimental). These limitations lead to insufficient evidence to determine whether sleep education programmes improve sleep in college students.
There is a severe lack of broader reviews that examine the effectiveness of psychological interventions to improve sleep in college students.
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