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Running head: SLEEP HEALTH IN COLLEGE STUDENTS

Sleep Health in College Students

Hannah Scott

Brigham Young University-Idaho

NURS433C; Section 01

Sister Parson

September 29, 2017

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SLEEP HEALTH IN COLLEGE STUDENTS

Sleep Health in College Students

PART 1: Defining the Population

Sleep is an essential restorative process that helps people maintain good health and find a

sense of well-being. In today’s increasingly busy society finding enough time in the day for all

the activities one needs to complete isn’t always possible. It isn’t uncommon for adults to forego

sleep in order to finish projects, get caught up at work, finish assigned homework, or finish other

unaccomplished tasks. Rather than slowing down and removing tasks from their to-do lists, some

people would rather finish their tasks and try to catch up on their sleep at a later time. This can

cause a perpetual decline in one’s hours of sleep per night and prevent one’s ability to cope with

life adequately. Sleep is a key determinant for how one functions during the day (Klewicki,

2017). Not getting enough sleep can place one in unfavorable conditions. According to the

National Institute of Health (2017), sleep is crucial for multiple facets of one’s lifestyle including

physical health, mental/emotional health, quality of life, and general safety.

When a person lays down to fall asleep at night their mind may not be awake but their

body is. This is an important time for the body to get to work on rejuvenating cells, tissues,

organs, and muscles which can help prevent development of many physical ailments as well as

heal the existing ones (Klewicki, 2017). When the body doesn’t get it’s needed restoration there

can be some serious effects. Studies have shown that those who are sleep deficient have an

increased risk for diseases like heart disease, kidney disease, diabetes, stroke, and obesity (NIH,

2017). The body craves sleep in order to perform many essential functions. The immune system

of the body needs sleep in order to work at full capacity. Those without sufficient sleep may

struggle fighting common infections that the immune system would otherwise be able to fend

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off. Physically, the body can’t function at its highest level without adequate sleep and rest each

night.

Mental and emotional capabilities are also affected by lack of sleep. One restorative

function sleep performs is within the brain itself. Sleep plays an important role in both learning

and remembering information by making connections and forming pathways within the brain.

Those who don’t get enough sleep at night might not have a full capacity of their mental abilities.

Sleep deficiency can cause difficultly in making decisions, controlling emotions and behavior,

finding a solution to problems, and one’s ability to cope with challenges (NIH, 2017). This may

cause a state of perpetual stress specifically for those in college. They may find they have a

harder time giving their full attention in class, getting good grades, and keeping their stress levels

down. Depending on the circumstances, lack of sleep has even been linked to depression, suicide

and other risky behaviors (NIH, 2017).

Although sleep can be harmful for one’s personal well-being, it can also be harmful on a

larger scale societal level. Many sleep deficient adults still go about their day to day business

regardless of their level of functioning. These same people drive their cars, operate machinery,

give care in the hospital, etc. The National Highway Traffic Safety Administration reported that

drowsy driving was the culprit of 72,000 crashes, 44,000 injuries, and 800 deaths in the year

2013. The margin for error is much greater for those who are sleep deficient. They take more

time to finish tasks, make more mistakes, and have slower reaction times (NIH, 2017). As a

matter of public safety, sleep health has to be taken as a serious issue.

Healthy People Goal

The Healthy people goal that coincides with this sleep health issue is SH-4, increase the

proportion of adults who get sufficient sleep (defined as 8 or more hours for those aged 18 to 21

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years and 7 or more hours for those aged 22 years and over, on average, during a 24-hour

period). This objective has a baseline of 69.6 percent of adults who go sufficient sleep in 2008

(Healthy People, 2013). This is the specific Healthy People 2020 data:

The target for this specific Healthy People goal is 70.8 percent. The most recent data

from 2013 shows that 65.3 percent of adults in Washington are getting enough sleep (Healthy

People, 2013). This number is below the national average and as such needs to be addressed and

taken seriously considering the physical, mental, and emotional ramifications.

Specific Population

The population that will be assessed are college students in the tri-cities, specifically the

ones attending Washington State University (WSU) Tri-Cities. WSU Tri-Cities is located at

2710 Crimson Way, Richland, WA 99354.

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The community of students that exist at WSU Tri-Cities are a hardworking one. There are

1,868 total students enrolled and of those students, 80 percent on campus are employed while

going to school. Enrollment has steadily gone up in the past twenty years making this campus on

WSU a viable option for many students.

(WSU Tri-Cities Fact Sheet, 2016)

The demography within the community of students is well spread. 58.5 percent of

students on campus identify as female and 38.4 percent of students identify as male. 33.5 percent

of students identify as a minority, making it WSU’s most diverse campus. The average age of

students attending is 25.7. There are 20 different undergraduate programs offered to the students

and 33 graduate degree programs as well. Some of these subjects one can study at this campus

can be shown below:

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There is a particular interest in Science, Technology, Engineering, and Mathematical

(STEM) jobs for the area due to the fact that there are national labs nearby as well as the location

of one of the biggest Department of Energy plants in the United States – the Hanford Project.

The Tri-Cities is ranked #7 in the nation for STEM jobs. Due to this pull STEM related jobs,

students on campus have earned over $160,000 in STEM scholarships for an investment in future

employment within the area. After the completion of their education at this WSU campus, 92

percent of students are able to find employment within 6 months of graduation, and 81 percent of

those graduates are retained in employment opportunities within the nearby Franklin and Benton

counties (WSU Tri-Cities Fact Sheet, 2016). WSU Tri-Cities is also involved with institutions in

the area including industrial, agricultural, and other community employers and groups. This

campus has a particular focus on the community and tries to set their students up for success

within the area.

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Community

The college students that attend WSU Tri-Cities live in the community of the Tri-City

area consisting of Kennewick, Pasco, Richland and West Richland. It is the 4th largest

metropolitan area in Washington state behind Seattle, Spokane, and Yakima. The different cities

are connected by the junction of the Yakima, Snake and Columbia Rivers which is what the area

gets its namesake from. The population is approximately 248,400 (Tri-City Regional Facts,

2010).

Tri-City Development council provides the following information about the area:

Population

(Fact Sheet, 2017)

Income

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Top 15 Employers

(Fact Sheet, 2017)

Although there is a decent amount of farming opportunities in the area through Lamb

Weston, Tyson Foods, Agri-Northwest, and so on the Tri-Cities is well known for being a hot

spot for Bechtel, Battelle and the Pacific Northwest National Laboratory. They employ

thousands of personnel within the area and are largely responsible for the growth of the area as

well as the STEM job seeking people that end up becoming inhabitants of the area. Typically

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these jobs require higher education which helps create more knowledgeable and informed

population in the Tri-Cities.

Most of the activities within the Tri-Cities are centered around families. Every summer

there is an annual conduction of the boat races which joins people together to root for their

favorite hydroplanes. Right before K-12 school starts the Benton-County fair is held and the

masses come out to ride the fair rides, watch the rodeo, and participate in livestock and other

competitions.

The various bridges between the cities represent not only the physical but also the

symbolic connection between Kennewick, Pasco, Richland and West Richland.

(Butner, 2008)

Plan:

In order to gather the assessment data for this project interviews will be conducted with

two key informants, one being a police officer, and another being a college professor. Three

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different college students will be interviewed about their sleeping habits and what effects their

sleeping habits have on their life. A windshield survey will be conducted at the nearby Dutch

Brothers coffee shops, Highway 240, and the WSU Tri-Cities campus. The sources of secondary

data will be from Healthy People 2020.

PART 2: Assessment

Primary Data

Each key informant was interviewed separately and asked the exact same questions. Those

questions were the following:

1. What concerns do you have for students that aren’t consistently getting enough sleep?

Police Officer College Professor

“When the students don’t sleep well their driving is impaired. Depending on how poorly the student’s sleep habits are it can be similar to driving under the influence of alcohol. Reflexes are slower which can lead to decreased reaction time, which can lead to more accidents.”

“I am concerned for others on the road. Some student travel from Grandview or Prosser and take the highway to get here. Consistently getting little sleep can make a drive like that unbearable. Especially as we move towards winter with less sunlight drivers are more susceptible to falling asleep at the wheel. Nothing is more terrible than having to tell loved one’s about a death that was completely preventable. Especially when the death was someone who had so much to live for.”

“Sleep has a large bearing on one’s emotional health. It can potentially make students less patient when they’re on the road. Road rage is a real danger to drivers on the road.”

“Some students will drink unsafe amounts of

“Academic performance suffers. I’ve known too many students that will stay up all night to study for one of my tests when what they really needed was to rest.”

“The student may be physically present but they’re so tired they fall asleep during lecture. This can also be a distraction for the other students in class.”

“It can be a safety concern during labs. Full attention and participation is needed when working with the various chemicals we have the chance to work with.”

“I’ve had students miss class because they aren’t sleeping well at night and are trying to catch up during the day. This can further put the student behind academically.”

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caffeine to keep them awake. From a safety perspective, these students are in danger – we’ve had two students in the area who have had serious health repercussions after drinking insane amounts of caffeine. It isn’t good for the heart.”

2. What do you think keeps students from getting enough sleep at night?


“Students today seem to be pretty busy. Depending on the various roles they’re required to fulfill, they may be slightly overwhelmed.”

“Kids today are so dependent on technology – it wouldn’t surprise me if they have a difficult time disconnecting from their phones, tablets, televisions, preventing them from sleeping well at night.”

“Other students may be too dependent on their coffee and other caffeinated drinks and may overdo it in order to keep them awake during the day. This can carry over in the night and can keep students awake when they want to be sleeping.”

“Technology is a prime suspect – it can be difficult to put your phone down at night when you want to know what’s going on through social media like Facebook, Instagram, twitter, etc. It even can affect what time I go to bed.”

“Netflix and other streaming services keep students awake.”

“The light on their screens at night can keep them up as well.”

“Some students become too focused on the social aspect of school. I’m glad the students have a way to feel connected to each other but at the same time I worry that they are putting social opportunities above their homework, employment, and their sleep.”

“I would say the biggest culprit of sleep loss is having priorities out of order in the student’s life.”

3. What do you think would help students make sleep a priority?


“There has to be some personal accountability with our efforts. At the end of the day the student has to choose to do the right thing. However, we can make students more aware

“From my point of view, I try to demand an appropriate amount of school work from my students in order to not overwhelm them while still challenging them. It’s a difficult

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of the dangers they put themselves in as well as the dangers they put others in when they drive sleep deprived.”

“Showing an educational video about the dangers of drowsy driving.”

“Reminding students of safe limits for caffeine consumption. Many don’t know how much caffeine is too much.”

“Regular patrols watching for drowsy driving can help remind these students of its importance – monetary reminders can be unpleasant but they stay with a person.”

“Police force education for those struggling with drowsy driving is crucial.”

(R. Julian, personal communication, October 14, 2017)

thing to do. I was a student before. I know how hard it is to juggle everything, so I try to be a resource for my students.”

“I also try to remind them to avoid procrastination. Stress levels are already at an all-time high during school. There’s no need to add more stress, which can have a negative influence on school work. Getting homework done in increments can help ensure that the student doesn’t stay up all night working on assignments.”

“The school could hold an educational seminar about the benefits of sleep and the dangers of sleep deprivation.”

“Posters can be put up throughout the campus reminding students with statistics how sleep can improve academic performance.”

“A reminder for students to limit their screen time at night could be helpful. The screen light can keep students up later than they were originally intending.”

(S. Baker, personal communication, October 18, 2017)

Student Interview – Two males and one female were asked the following questions.

1. What keeps you from getting enough sleep at night?

Male, Age 22 Female, Age 19 Male, Age 27

“I’m going into engineering and I have to admit, my major is pretty demanding of me. I spend a lot of time doing homework, working on projects, and making sure I get good enough grades so that I can get into grad school.”

“I still live at my parents’ house while going to school here so making friends here has been difficult. So, I try to be more social and that can keep me from sleeping.”

“I work at the local Dutch Bros and the hours are kind of erratic. Sometimes I work

“I have school, work, and a family. I have two kids and another on the way. My time is so limited as it is that sometimes sleep slips away from me.”

“I like to relax before going to bed by getting on social media on my phone.”

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“I am working while going to school. It’s difficult to balance everything in my life.”“I have a girlfriend and I have to make sure there is time in my schedule to be with her. Sometimes that means I don’t go to sleep in time.”

“My phone.”

“My roommates can be kind of disruptive sometimes.”

until midnight but still have class the next day at 8. Those days are the hardest for me to get enough sleep.”“My cell phone will keep me up late.”

“Sometimes I drink too much caffeine while I’m at work.”

“I have a bad habit of waiting until the last minute to finish my assignments.”

“Television can keep me up at night. Sometimes I just want to go home after a long day and numb my mind with TV. And there are specific shows that I watch with my wife that allow us to be together while relaxing.”

2. How many hours of sleep do you get per night and what is your quality of the sleep?


“It depends on what is going on with my personal commitments but I get around 5-6 hours a night.”

“Typically, good quality of sleep if I use my earplugs. Otherwise, my roommates may wake me up.”

“If I’m stressed about homework or big assignments due the next day or if I just know I have a lot to do in general I don’t sleep as well.”

“7 hours per night on average.”

“If I drink too much caffeine/sugar I don’t sleep as well.”

“Consistently 5 hours on the weekdays and 6-7 hours on the weekends.”

“I have to wake up a few times at night to help with my children. It keeps me from feeling like I’m truly rested.”

3. Do your sleep habits affect your performance in other areas of your life such as school,

work, recreation, and driving in the car?


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“I like to go to the gym in the mornings but if I don’t sleep enough I’ll skip.”

“It is harder to keep sharp attention to my professors if I’m tired but my classes right now are really important to excel in, especially for grad school. I can’t afford to not pay attention.”

“I have been drowsy at the wheel on a few occasions. I’ve never hurt anyone or caused any damage though.”

(N. Mounce, personal communication, October 15, 2017)

“If I’m sleep deprived my brain turns to mush at work. I don’t perform nearly quickly and tend to get more than a few drink orders wrong.”

“I will fall asleep during lecture if I don’t sleep well the night before.”

“Driving isn’t a problem when I’m tired. If I was driving long distances it might be but my commute to school and work is short.”

(B. Refiari, personal communication, October 15, 2017)

“When I don’t get enough sleep, it is difficult to focus during class.”

“I’m usually up on my feet at work so I can stay awake more easily there.”

“I’ll admit that I’m not always as patient as I can be when I haven’t slept. Especially with my children who need my patience the most.”

“I’m sure to stay alert in the car. My wife makes coffee before I leave in the mornings and that helps keep me alert.”

(D. Miller, personal communication, October 15, 2017)

These students were picked specifically for their varying perspectives and differing

lifestyles in order to get a better idea of the problem at hand. Each of the interviewees had

different living situations, different family configurations, different ages, and different majors

that allowed a greater portrayal of sleep health within this particular student body. A larger

number of interviews may have enabled a more thorough representation of the student body at

WSU Tri-Cities, however the interviews conducted provided a good glimpse of what college

students from different backgrounds felt about their own personal sleep habits. The key

informants were chosen due to their proximity to the issue of sleep deprivation and to the

students themselves.

Windshield Survey

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An observational survey was conducted during peak business hours at the following

locations: WSU Tri-Cities campus parking lot, Roasters Coffee Shop, and George Washington

Way (main street leading to campus). The identifiers for possible sleep deprivation for the

students were observed yawning, an unkempt appearance, and whether or not the student had

coffee in their possession. It should be noted that while some students appear unkempt when

sleep deprived, others may appear unkempt as a daily routine or habit. This delineation is not

made for the observation at the various sites.

WSU Tri-Cities Campus Parking LotDate: October 17, 2017Start Time: 8:00 amStop Time: 9:00 am

A. Observed Yawning B. Unkempt Appearance C. Coffee in hand22 66 31

Notes: There was little patience from drivers for students crossing through the parking lot making their way to campus, shown through aggressive driving and horn honking.

Roasters Coffee ShopDate: October 18, 2017Start Time: 7:00 amStop Time: 8:00 am


Notes: At this particular location, it was difficult to tell whether one was a student or not. The location also positively influenced the number of people with coffee in hand.

George Washington WayDate: October 19, 2017Start Time: 7:00 amStop Time: 8:00 am


Notes: This location is very busy at this time, so unfortunately not all drivers could be observed. Drivers were very aggressive during this time, and one minor car accident occurred on one side of the road.

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Data ResultsA. Total observed yawning 45B. Total observed with unkempt appearance 103C. Total observed with coffee in hand 78D. Total observed for windshield survey (A+B+C) 226E. Total sleep deprived observed (A+B/D) 65%F. Percentage of observed yawning (A/D) 19%G. Percentage of observed with unkempt appearance

(B/D)46%

H. Percentage of observed with coffee in hand (C/D) 35%

Secondary Data

Data retrieved from secondary sources included national data for drowsy driving and

outlined risk factors for sleep deprivation such as age, gender, socioeconomic status, and family

type. Data for the State of Washington and the Benton-Franklin county was unavailable.

National Data

The sleep foundation website released their quarterly report for the fourth quarter in 2016

and found some alarming information. In their study, they asked participants whether or not they

fell asleep behind the wheel in the past two weeks. Three percent of participants admitted to

dozing off in the specified time frame (Langer Research Associates, 2016). If these statistics

were applied nationwide that would equate to more than seven million drivers nodding off in the

last two weeks. In this same study, it was found that eight percent of drivers avoided driving in

the past two weeks due to being tired, and two percent of adults avoided taking a ride with

someone they thought may be too tired to drive safely (Langer Research Associates, 2016).

Those who drive drowsy may not be alert enough to react appropriately in traffic and could cause

fatal and non-fatal injuries. The United States National Highway Traffic Safety Administration

(NHTSA) reported that in the year 2014 drowsy driving killed 846 people (NHTSA, 2014).

Adults may feel that their sleep habits are inconsequential, but from this data we can learn that

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sleep health is a crucial factor to be considered in order to keep themselves and other drivers safe

on the road.

There are various risk factors that put one at a higher probability for driving drowsy.

Those who have shift work, such as truck drivers, pilots, police officers, doctors, nurses, and

other health care professionals are at a greater risk of driving home after work tired and

somewhat impaired. In addition, those with untreated sleep disorders like narcolepsy and

obstructive sleep apnea may suffer from day time sleepiness, causing drowsy driving.

Narcolepsy may also cause one to fall asleep suddenly at the wheel, putting themselves and other

drivers at risk. Adults may not be fully aware of their medication side effects either. If

medications are combined with certain ingested materials a reaction may result causing

drowsiness as well (American Academy of

Sleep Medicine, 2017).

Comparatively from other quarters,

the sleep foundation’s fourth quarter

information shows a drop on the sleep health

index indicating that there may be an

influence from the back-to-school season on

Americans and their sleep (Langer Research

Associates, 2016). School for adults and

children alike may have an influence on the

sleep that the American adult gets every

night. Sleep quality for adults is deficient.

Two-thirds of adults had difficulty falling or

(Langer Research Associates, 2016)

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staying asleep on at least one night in the previous week and only 30 percent of adults reported

always feeling well rested (Langer Research Associates, 2016). Quality of sleep has a large

bearing on how well rested a person may feel and can influence their performance in other areas

of their life.

Between genders it has been shown that men fall asleep much faster than women.

Comparatively, only 36 percent of women report falling asleep in less than 15 minutes while 45

percent of men report being able to fall asleep in less than 15 minutes (Langer Research

Associates, 2016). Age makes a difference in sleep habits as well. Almost half of older

Americans report being able to fall asleep in less than 15 minutes while only three in ten adults

that are younger than 30 years old report being able to fall asleep that quickly (Langer Research

Associates, 2016).

Socioeconomic status has a bearing on the amount of time it takes to fall asleep as well.

Those that identify as college graduates or higher income earners may be more likely to fall

asleep quickly. Over half of college graduates report being able to fall asleep within 15 minutes

while only 35 percent of non-graduates are able to do so. Similarly, 57 percent of those who are

making over $100,000 per year fall asleep in the specified time frame while only 30 percent of

those making less than $50,000 are able to do so (Langer Research Associates, 2016). This has

implications for college students that are in pursuit of their education and degrees, but may not

have fiscal security. Healthy people 2020 also confirmed that sleep can be affected by

educational attainment. When examining the percentages of adults getting enough sleep at night,

66 percent of those with a high school education under their belt reported being able to do so,

64.2 percent of those with some college, 63.7 percent with an Associates Degree, 69.7 percent

with a 4-year college degree, and 71.4 percent with an advanced degree (Langer Research

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Associates, 2016). As educational attainment rises within the first four years of college, amount

of sleep at night decreases. After completing a four-year degree, the amount of sleep rises

significantly, confirming the distress caused by college and the negative effect it has on sleep.

The type of immediate family that a person is a part of influences the amount and quality

of sleep they get. According to Healthy People 2020, out of those who are single, 65 percent of

adults report getting sufficient sleep. Out of those who are single parents with children, 53.5

percent report getting enough sleep. Out of those who are married or in a partnership, 73.1

percent report getting sufficient sleep. Out of those who are married with children, 64 percent

report getting enough sleep (Office of Disease Prevention and Health Promotion, 2008). It seems

that adults in committed relationships like marriage or other partnerships without children get

better sleep than any other demographic.

PART 3: Data Interpretation

Following a review of both primary and secondary data the importance of sleep health

has become alarmingly clear. There are various facets of one’s life that can be affected by lack of

sleep. While there are manifestations of lack of sleep such as lack of efficiency in the workplace,

decreased academic performance, poor attention none of these compare to the risk of falling

asleep while at the wheel. These two-ton vehicles, even with an awake and conscious driver on

the road, have the potential for lethal consequences. Drivers may believe they are more than

capable of driving well even while being slightly drowsy. They may be unaware of the dangers

of continuing to drive while being impaired by lack of sleep. This issue has to be taken more

seriously so that not only will people be more able to cope more efficiently with stressors in their

lives, but also to ensure that the rate of sleep related collisions and fatalities decrease.

Three similarities in the data that was gathered were:

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1. Drowsy driving leads to the most serious consequences of sleep deprivation

2. Adults attending University or College get less sleep at night

3. Socioeconomic status has a large bearing on the amount of sleep adults get

Significant difference from credible website and observation:

There were three different factors that play into sleep health:

1. The increased use of electronic devices decreased amount of sleep

2. Caffeine’s stimulant effect can keep people awake in both positive and negative ways

3. Sleep amount decreases as life commitments increase

During the windshield survey, some other observations were made which have not already

been noted. While observing those in line at the coffee shop, there were a few drivers that

demonstrated being tired by leaning their heads against their arms on their doors or with their

forehead on their steering wheel. It was also noted that out of the individuals I talked with, there

were some that reported being sleep deprived even though they didn’t look sleep deprived. It is

possible that those who spend more time working on their physical appearance sleep less than

others. This makes some of the data gathered about certain individuals looking “unkempt” to be

somewhat inconclusive.

Strengths of the community:

1. Due to the large investment into STEM jobs, the students within the area are highly

motivated and hard working. This distinguishes students from other areas that try to

finish their education within the community at a branch of a University rather than a full-

fledged campus. The perception of students that stay within the community they were

raised in isn’t always great, but this community is different. There is a respect for

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students wanting to stay in the area, and scholarships are being offered to these students,

investing in the quality of the workforce here.

2. The Roasters coffee shop put up a sign on their drive thru window advising their

customers about how much caffeine is safe for adults to consume. The business itself is

trying to advocate for safe consumption of caffeine.

3. The professors try to regularly advocate for good sleep, specifically before important

tests in their classes.

4. The community cares about making sure that drowsy drivers stay off the road as

evidenced by the efforts of the various police departments of the area pulling drivers over

that demonstrate an inability to drive safely, sometimes caused by drowsiness. The state

has imposed a $550 fine for negligent driving to discourage adults from taking risks on

the road.

5. The Washington State Governor Jay Inslee proclaimed November 5th-12th 2017, as

Drowsy Driving Awareness and Prevention week.

Challenges of the population:

The common occurrence of sleep deprivation in the student population puts them at

higher risk for collisions and fatalities.

Students have more responsibilities, taking away opportunities to get adequate sleep.

Some students over compensate their lack of sleep with caffeinated drinks to keep them

awake during the day, which may in turn keep them awake at night interfering with the

body’s natural sleep-wake cycle.

Prioritization of homework and other responsibilities over sleep is not uncommon for

students.

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Students may over estimate their ability to drive safely while impaired by lack of sleep.

Some students may travel into town for early morning classes, putting them at risk for

driving when their natural sleep rhythm would have them asleep.

Students may be desperate for jobs and take positions during a time when the body’s

natural sleep rhythm would have them asleep.

Significant information which validates the health issue:

64 fatal collisions and 308 seriously injury collisions were investigated in the state of

Washington from 2011 – 2015.

8 percent of drivers in a national study avoided driving in the previous two weeks due to

being tired, and 2 percent of adults avoided taking a ride with someone they thought may

be too tired to drive safely.

40 percent of students felt rested no more than two days out of the week.

PART 4: Population Health Plan

Areas of Improvement:

1. Education: Students typically have to travel in order to get to school, occasionally in

the morning for early classes when they would otherwise be sleeping. This sets these students up

for possible drowsy driving, putting themselves and others at risk. There needs to be more

education on the effects of sleep deprivation especially concerning the dangerous side effects of

poor sleep health. Students need to understand the consequences of poor sleep health where it

effects their ability to drive lethal machines. These consequences include:

Inattentiveness at the wheel

Decreased reaction time

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Episodes of micro-sleeps, or brief losses of consciousness at the wheel (extremely

dangerous for highway driving)

Recommendations for this problem:

Teaching should be given to college students to increase awareness of possible

consequences listed above. A seminar could be held on campus for the students to learn more

about sleep health and the effects that it has on driving habits. Police officers or EMTs could

possibly come to campus to put on the seminar about drowsy driving. Driving while drowsy is

clearly unsafe. These students need to be taught about driving drowsy and the best ways to avoid

it including:

Getting enough sleep daily (7-8 hours for adults)

Sleeping adequately before long road trips

Avoiding alcohol to prevent increased drowsiness and impairment

Using public transportation if possible while drowsy

Becoming aware of medication side effects

Avoiding mixing medications

Avoiding driving during peak sleepiness hours, specifically from midnight to 6

AM and during the late afternoon

Becoming more aware of personal signs of drowsiness such as an inability to stay

within the roadway lines

Drinking coffee or energy drinks then taking a quick nap as a short-term solution

to drowsiness

2. Students have to become more aware of how their sleep health affects their academic

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performance. In an attempt to improve their grades or perform well on impending tests students

may stay up through the night for hours on end, unwittingly decreasing their chances of doing

well on their tests.


Professors at the University or individuals in administration could set up an educational

seminar, perhaps in conjunction with the drowsy driving seminar in order to teach the students

about the educational benefits of getting enough sleep. They could teach the students that studies

show that those who go to bed with a regular schedule, and get an adequate amount of sleep each

night do better on tests and consequently maintain a higher GPA than those with inadequate and

irregular sleep patterns.

Education should be provided on the circadian rhythm and that those who have an

irregular sleep cycle have a more difficult time falling asleep, causing sleep times to get later and

later. Students should also be encouraged to establish a regular sleep cycle to also keep the rest

of the body healthy. Sleep provides restorative functions, and when that restoration isn’t

completed the body can become susceptible to all sorts of maladies like weight gain, catching a

cold, or development of Type II Diabetes. These health problems can further perpetuate the

academic inadequacy of students, and should be a reminder that sleep is an essential function.

3. Education: Students may be overcompensating with caffeine to combat their

drowsiness. 85 percent of adults in the U.S. consume caffeine in one of its’ many forms each

day. One Grande Starbucks coffee represents three quarters of the recommended caffeine

consumption in a day. Some students will drink multiple energy drinks in a day if they feel tired

enough, which can be dangerous for one’s heart health. High levels of caffeine can increase

24


blood pressure thereby increasing one’s risk for

heart disease as well as one’s heart attack and

stroke risk.


Students need help knowing the

limits for caffeine consumption can help

them understand what is and is not safe for

them, even if their drowsiness persists.

Recommendations for caffeine

consumption for adults is 400 mg daily.

In order to help students become more

aware of how much caffeine they should have in a

day, there should be signs displayed on campus

like the picture on the left, displaying different

levels of caffeine in mg for common beverage

products. Students may not be aware that certain

beverages like a Grande (16 oz) cup of Starbucks

coffee contains 75 percent of the daily recommended caffeine amount. This will help students

make more educated decisions. While the sign giving examples of caffeine amounts should be

utilized there should be additional reminders

on campus about the acceptable 400 mg limit

of caffeine that an adult should have in a day.

(Gore, 2013)

25


The sign on the right could also be displayed in order to reinforce the thought process with the

students on campus.

Encouragement of local coffee shops to post signs about the recommended daily dosage

of caffeine should be considered as well. The source of these caffeinated beverages should have

a warning to those consuming. These signs would be best placed on vending machines within the

school and on coffee shops windows and check-out stands.

4. There may be students with undiagnosed sleep disorders, decreasing quality of sleep

and predisposing some to dangerous situations. Some students may unknowingly have

Obstructive Sleep Apnea, decreasing their quality of sleep. Others may have undiagnosed

narcolepsy, and could fall asleep during inopportune times such as while driving a car, operating

machine, and so on.


Although there may be a small percentage of people that qualify under this category,

these students need some sort of screening program to help them identify whether or not they’re

having sleep problems so that they can more fully succeed in gaining an education. Perhaps the

student health center could increase access to pamphlets about sleep health, provide increased

training for health care professionals working with these particular students, and treating those

with these sleep disorders as needed. Professors and administrative staff may also be able to

screen for these problems as they work with the students more closely than student health center

professionals.

Evaluation

These various goals would be measured in different ways according to the concern, and

would be evaluated as following:

26


Drowsy Driving Education: Attendance of seminars held at the university by the cops

and the EMTs could potentially indicate the success of the program. Those conducting the

seminar could also ask participants to fill out a pledge to avoid drowsy driving and come up with

a plan in order to follow through with that commitment. Success would be measured based on

the number of pledges filled out by those in attendance. An audit of students would also be

performed before and after the seminar to see whether or not the education provided had any

bearing on these students’ actual driving habits.

Sleep Health Bearing on Academics: This effort would be measured by surveying a

class of students about their sleep habits and asking them what their GPA is and their current

grade in the class. The education would be provided in the classroom and then a survey of the

same students could be re-administered at the end of the class to see if there was a change in

testing scores or not for those that changed their sleeping habits. For those receiving the

education in a seminar put on by the professor and administration success in the program would

be monitored by surveying those in attendance about whether or not the information they learned

would encourage them to take sleep health more seriously. The results of these surveys would

help determine whether or not the education was effective.

Safe Caffeine Consumption: Measured by number of caffeine related health problems,

including overstimulation leading to heart problems and otherwise. A random survey of students

on campus would be completed asking them about whether or not they know how much caffeine

is safe for adults. Based on their responses, public health measures could be re-evaluated in order

to help keep students safe.

27


These students would also benefit from education concerning the right times to drink

caffeine in order to make sure they’re able to fall asleep at night, saving them from possible sleep

deprivation.

Sleep Disorders: This effort would be measured by the number of students screened for

sleep related disorders at the student health clinic and also the number of students diagnosed.

Watching and subsequently catching signs of disordered sleep can make all the difference in the

safety of individuals on the University’s campus.

Conclusion

From the information learned about the hardworking students at WSU Tri-Cities, it is not

difficult to tell that they are a promising group. They will make quite an impact within the

community as they reach for their Science, Technology, Engineering, and Mathematical related

degrees. Students, especially at the collegiate level, are at great risk for poor sleep health and

need support from the community in order to become more aware of what can be done to help

them succeed in reaching their goals. Increasing the knowledge base of these individuals would

help us reach the Healthy People 2020 goal of increasing the proportion of adults who get

sufficient sleep (defined as 8 or more hours for those aged 18 to 21 years and 7 or more hours for

those aged 22 years and over, on average, during a 24-hour period). Safety has to be taken

seriously, especially when it comes to drowsy driving. These students are at higher risks of

overestimating their abilities to stay awake on the road while tired. College students have more

commitments than most adults, trying to manage their educational commitments, employment,

volunteer opportunities, and friends and social opportunities. Sleep can sometimes be the last

thing on their mind when they have so many other obligations. Teaching these students that sleep

28


is crucial to their success in various facets of their like can help empower them to make better

choices that will affect them profoundly.

Reflection

During this process, I really enjoyed the chance I had to speak with the students attending

school locally and understand their perspectives as students attending school close to home. I

found that I was easily able to identify with their struggles, as one who would qualify for the risk

category specified in this paper. I found myself becoming more and more motivated to ensure

that I take my own sleep health seriously as I was coming up with a plan to encourage other

students to do the same. I want to use my voice to help these students understand safe sleep

habits that can help them in their daily lives. I am motivated to make sure that my family knows

the various benefits of sleep health and I am committed to keeping myself and others safe in the

car by not participating in drowsy driving. I am using my newfound education to safely consume

caffeine. I am staying vigilant and educated to make sure that those that I interact with who have

sleep disorders aren’t flying under the radar. I am grateful for this opportunity to more fully

understand others and help protect them from harm and well as encourage them to succeed in

their endeavors.

29


References

American Academy of Sleep Medicine. (2017). Drowsy Driving. Retrieved from Sleep

Education: http://www.sleepeducation.org/sleep-topics/drowsy-driving

Butner, S. (2008). Pasco/Kennewick Cable Bridge. Retrieved from Flickr:

https://www.flickr.com/photos/rs_butner/2191951074

Drowsy Driving. (2013). Retrieved from National Highway Traffic Safety Administration:

https://www.nhtsa.gov/risky-driving/drowsy-driving

Fact Sheet. (2017). Retrieved from Tri-City Development Council: https://www.tridec.org/fact-

sheet/

Gore, A. (2013, February 6). How much caffeine is too much? The Starbucks coffee with 'three

quarters of he safe daily dose' in one cup. Retrieved from Daily Mail:

http://www.dailymail.co.uk/news/article-2274679/How-caffeine-caffeine-The-Starbucks-

coffee-quarters-safe-daily-dose-cup.html

Heyhoe, K. (2013). Caffeine Toxicity: Dosage Risks. Retrieved from

http://caffeineandyou.com/caffeine-toxicity/.

Klewicki, L. (2017). Getting Quality Sleep. Retrieved from Catholic Digest.

Langer Research Associates. (2016). Sleep Health Index Quarterly Report Q4 2016. Retrieved

from Sleep Foundation:

https://sleepfoundation.org/sites/default/files/NSF_SHI2016Report.pdf

National Highway Traffic Safety Administration. (2014). Drowsy Driving. Retrieved from

United States Department of Transportation:

https://www.nhtsa.gov/risky-driving/drowsy-driving#topic-crashes-and-fatalities

30


National Institutes of Health. (2017, June 7). Why is Sleep Important? Retrieved from National

Heart, Lung, and Blood Institute:

https://www.nhlbi.nih.gov/health/health-topics/topics/sdd/why

Office of Disease Prevention and Health Promotion. (2008). Sleep Health. Retrieved from

Healthy People: https://www.healthypeople.gov/2020/topics-objectives/topic/sleep-

health/objectives

Tri-City Regional Facts. (2010). Retrieved from Tri-City Regional Chamber:

http://www.tricityregionalchamber.com/tri-cities-regional-facts.html

WSU Tri-Cities Fact Sheet. (2016). Retrieved from Washington State University Tri-Cities:

https://tricities.wsu.edu/documents/2016/11/fall-2016-fact-sheet.pdf

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