7.2: Sleep Habits and Disruptors

Sleep Disrupters and Sleep Disorders

Although sleep is a natural and essential biological process, it is easily influenced by a range of internal and external factors. For college students, disruptions to sleep are especially common due to demanding academic schedules, high stress levels, and irregular routines. These disruptions may stem from environmental conditions, lifestyle habits, emotional health, or underlying medical conditions. In many cases, multiple factors interact to interfere with the quality and timing of sleep. Understanding these disrupters is a critical first step in recognizing and addressing barriers to healthy sleep.

Circadian Rhythms and Why They Matter

The body’s circadian rhythm, an internal clock that regulates physiological processes over a roughly 24-hour period, regulates sleep. This rhythm influences not only when sleep occurs, but also hormone secretion, body temperature, digestion, and alertness. It is governed primarily by the suprachiasmatic nucleus in the brain, which uses environmental light cues to synchronize the body’s systems with the day-night cycle.

Light exposure plays a central role in circadian regulation. When natural light decreases in the evening, the SCN signals the pineal gland to release melatonin, the hormone that facilitates drowsiness and sleep. Exposure to bright light in the morning inhibits melatonin and promotes wakefulness. Disruptions to this system, such as late-night screen use, inconsistent bedtimes, or irregular wake times, can shift the circadian rhythm and lead to circadian misalignment, where the internal clock no longer matches environmental cues.

For students, this misalignment often takes the form of "social jet lag," a mismatch between weekday and weekend sleep patterns. Over time, such irregularity can result in difficulty falling asleep, reduced sleep quality, impaired daytime functioning, and increased vulnerability to sleep disorders.

Environmental and Lifestyle Disrupters

Sleep quality is affected by the sleep environment and personal behaviors. One of the most potent disrupters is artificial light, particularly blue light from phones, laptops, and tablets. This type of light suppresses melatonin production and can delay the onset of sleep. Other environmental factors, such as noise and room temperature, can lead to fragmented or non-restorative sleep, even if total sleep time appears sufficient.

Lifestyle choices also play a significant role. Caffeine can remain active in the body for up to six hours or more, delaying sleep onset and reducing deep sleep. Alcohol, although it may promote initial drowsiness, disrupts REM sleep and contributes to more frequent awakenings. Nicotine is another stimulant that can increase sleep latency and contribute to lighter, less restorative sleep.

Sleep timing matters, too. Irregular sleep schedules, late-night studying, shift work, or social commitments can push bedtime later and make it harder to fall asleep at a consistent hour. Other habits, such as late-night eating or intense exercise just before bed, can interfere with the body's ability to transition into a restful state.

Psychological and Emotional Factors

Emotional and psychological well-being are deeply interconnected with sleep. Stress, anxiety, and depression are among the most common psychological factors that disrupt sleep. Stress activates the body’s arousal systems and increases cortisol, a hormone that promotes alertness. Persistent worry about academics, relationships, or finances can delay sleep onset or cause repeated awakenings during the night.

Anxiety-related symptoms, such as muscle tension and rapid breathing, can make it physically uncomfortable to fall asleep. Anticipatory anxiety, such as worrying about the next day’s obligations, often intensifies at night when distractions are fewer. Meanwhile, depression can cause both insomnia and hypersomnia (excessive sleepiness). It is linked to disruptions in REM and deep sleep, leading to fatigue and low mood even after extended sleep periods.

Coping behaviors during times of emotional distress may also worsen sleep. Increased screen time, substance use, social withdrawal, or erratic routines are common responses to stress or low mood, and they often interfere with the body’s natural signals for rest.

Health Assessment: Pittsburgh Sleep Quality Index

The Pittsburgh Sleep Quality Index (PSQI) is a widely used self-report questionnaire that assesses sleep quality and disturbances over a 1-month interval. It helps individuals understand how well they are sleeping and whether their sleep habits may be contributing to fatigue, mood changes, or other health concerns.

Instructions

1. Access the Questionnaire: 
   • Download the PSQI Questionnaire or use the direct link provided in your course materials.
   • Pittsburgh Sleep Quality Index (PSQI) Instrument – PDF
2. Complete the Questionnaire:
   • Answer all questions honestly based on your sleep habits over the past month.
   • Be sure to answer every item to the best of your ability to ensure an accurate result.
3. Scoring and Interpretation:
   • After completing the questionnaire, use the official scoring guide to calculate your Global PSQI Score. PSQI Scoring Instructions – PDF
   • The PSQI consists of 7 components: 
     1. Subjective Sleep Quality
     2. Sleep Latency (how long it takes to fall asleep)
     3. Sleep Duration
     4. Habitual Sleep Efficiency
     5. Sleep Disturbances
     6. Use of Sleep Medication
     7. Daytime Dysfunction
   • Each component yields a score from 0 to 3. The 7 component scores are summed to create a Global PSQI Score ranging from 0 to 21.
   • Interpretation
     • 0–5: Good sleep quality
     • 6–10: Poor sleep quality
     • >10: Indicates significant sleep difficulties that may require professional attention
4. Reflect on Your Results:
   • Summarize Your Score: Note your Global PSQI Score and identify your strengths and weaknesses.
   • Describe Your Feelings: Reflect on your emotional response to your score. Were you surprised by your scores? Why or why not?

5. Identify Next Steps:

   • If your score indicates poor or problematic sleep, consider exploring lifestyle changes or discussing your sleep patterns with a healthcare provider.

   • If your sleep quality is good, reflect on what habits support your rest and how to maintain them.

6. Set a SMART Goal for Sleep Health:
   • Based on your reflection, create a SMART goal (Specific, Measurable, Achievable, Relevant, and Time-bound) to support or improve your sleep. For example: “I will turn off all screens and begin a wind-down routine by 10:00 p.m. every night for the next two weeks to help improve my sleep latency and overall sleep quality.”

This assessment is designed to increase awareness of your sleep health and provide a starting point for evaluating and improving your sleep habits. It is not meant to be used as a diagnostic tool. 

Common Sleep Disorders

When sleep problems persist despite efforts to address environmental or emotional factors, an underlying sleep disorder may be present. Sleep disorders are medical conditions that interfere with the ability to initiate or maintain sleep and often require clinical diagnosis and treatment.

• Insomnia is the most common sleep disorder and is characterized by persistent difficulty falling asleep, staying asleep, or waking too early. It may be short-term, or chronic, lasting three months or longer.
• Obstructive sleep apnea (OSA) involves repeated pauses in breathing during sleep due to airway obstruction. Individuals with OSA may snore loudly, gasp for air during the night, or feel excessively tired during the day despite long sleep durations.
• Restless legs syndrome (RLS) causes uncomfortable sensations in the legs, often described as tingling or crawling, which create a strong urge to move them. Symptoms typically worsen in the evening and interfere with sleep onset.
• Delayed sleep-wake phase disorder is a circadian rhythm disorder in which an individual’s biological sleep window is significantly shifted later than societal norms. Falling asleep and waking up at conventional times becomes difficult, even when sleep duration is adequate.

Conclusion

Sleep is influenced by a complex interplay of biological rhythms, environmental factors, behavioral habits, and emotional states. While some sleep challenges are temporary and easily corrected, others stem from deeper disruptions to the circadian system or the presence of medical conditions. Recognizing the variety of factors that can interfere with sleep is an essential step toward improving it. The next section explores evidence-based strategies for promoting more restorative and consistent sleep, helping to realign the body’s rhythms and support overall well-being.

References:

• 1: Sleep Wellness by Sheryl Shook is shared under a CC BY 4.0 license.
• 3: Circadian Rhythm by Sheryl Shook is shared under a CC BY 4.0 license.
• 6: Sleep Disorders by Sheryl Shook is shared under a CC BY 4.0 license.