CHAPTER I

THE PROBLEM AND REVIEW OF RELATED LITERATURE

INTRODUCTION

Sleep is essential for a person’s health and wellbeing. National Sleep Foundation (2015).

It is also a critical part of maintaining the overall health, especially to college students as it plays

an important role in the cognitive learning of the student. The National Sleep Foundation

convened experts from sleep, anatomy and physiology, as well as paediatrics, neurology,

gerontology and gynecology to reach a consensus from the broadest range of scientific

disciplines. The panel revised the recommended sleep ranges. The recommended number of

hours of sleep for ages 18-25 which are mostly young adults or college students is at 8-9 hours

(Czeisler, 2015). Most of the students tend to stay up late into the night to accomplish their tasks,

whereby prioritizing tasks, commonly academics, rather than personal rest and sleep. Students

from all year levels, most especially college students, experience sleep deprivation. At an

alarming rate, sleep deprivation among nursing students has also become a major concern.

Nursing is a demanding profession with occupational stress which involves academics, and shift

duties all cramped up in four years.

Good quality sleep and enough amount of sleep are very important in order to have better

cognitive performance, good decision-making, and to avoid health problems as well as

psychiatric disorders. When students are sleep deprived, students are more prone to cognitive

problems and poor decision-making skills. A good quality sleep is one of the most important

things to become a good and active student nurse. Nowadays, student nurses face a lot of

problems due to heavy school works and balancing their time as a student nurse and a normal
 2

teenager. However, the most significant problem a student nurse faces is the sleep deprivation

they get due to demands by the academe, and community or hospital duty. This paper focused on

the incidence of sleep deprivation among level IV nursing students of Ateneo de Zamboanga

University. This topic was chosen after careful decision and the fact that sleep deprivation has

become a major concern among students of this course. Studying this topic on incidence of sleep

deprivation, knowing the number of sleep deprived students, how often these students are

deprived of sleep, and even possible commonalities for coping mechanism, after accurate

interpretation, helped the researchers understand the incidence of sleep deprivation and develop a

clearer view on the topic.

A research study conducted by Khin Thandar Aung, Mohammad Said Nurumal, and Siti

Nurhizwanybinti Zainal (2016) about sleep quality and performance of nursing students found

that the majority of college students experienced poor sleep quality. In addition, intense

academic demands among college students particularly nursing students because they had the

least amount of sleep. Another research study conducted by Cynthia Thomas, Constance

McIntosh, Ruth Ann Lamar, and Roberta Allen (2017) about Sleep Deprivation in nursing

students found that majority of the participants of the study needed 8 or more hours sleep to feel

rested. More alarming, more received 6 hours or less before a clinical experience. This

potentially places the students at risk for less than optimal learning in the classroom and more

significantly creates potential safety issues in the clinical environment.

Being deprived of sleep can become a cause for various types of sleeping disorders. A

study conducted by Jane F. Gaultney (2010), focused on the prevalence of sleep disorders in

college students, with sleep deprivation being the most common, and its impact on the academic

performance. The results showed that twenty-seven percent of students were at risk for at least
 3

one sleep disorder. African American and Asian students reported less risk for insomnia and

fewer poor sleep practices relative to white and Latino students. Students reported insufficient

sleep and a discrepancy between weekday and weekend amount of sleep. Students at risk for

sleep disorders were overrepresented among students in academic jeopardy. The data indicates

that a substantial number of college students may be at risk for sleep disorders or poor sleep

hygiene, and that sleep may impact academic success. Considering this, sleep deprivation is a

major concern among students, especially level IV nursing students of Ateneo de Zamboanga

University, knowing that this course demands both academic excellence, and related learning

experience duty.

REVIEW OF RELATED LITERATURE

Many people suffer from sleep deprivation especially the students who study every night,

long nights of not having sleeps because of requirements that need to be passed on the next day.

Students suffer a lot from sleep deprivation especially the one who is in college. Pressman, 1997

indicates that sleep deprivation has been shown to impact negatively on a wide range of

cognitive, behavioral, physiological, and emotional measures. For example, mood changes

including irritability, fatigue, difficulty in concentration, and disorientation to short-term

memory alterations due to decreased attention, concentration lapses, and decreased motivation.

Illusions, hallucinations, visual misperceptions, and paranoid ideation are also observed with

sleep loss.

The National Sleep Foundation (NSF), along with a multi-disciplinary expert panel,

issued its new recommendations for appropriate sleep durations. The report recommends wider

appropriate sleep ranges for most age groups. The results are published in Sleep Health: The
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Journal of the National Sleep Foundation. The National Sleep Foundation convened experts from

sleep, anatomy and physiology, as well as pediatrics, neurology, gerontology and gynecology to

reach a consensus from the broadest range of scientific disciplines. The panel revised the

recommended sleep ranges for all six children and teen age groups. A summary of the new

recommendations includes: Newborns (0-3 months): Sleep range narrowed to 14-17 hours each

day (previously it was 12-18), Infants (4-11 months): Sleep range widened two hours to 12-15

hours (previously it was 14-15). Toddlers (1-2 years): Sleep range widened by one hour to 11-14

hours (previously it was 12-14). Preschoolers (3-5): Sleep range widened by one hour to 10-13

hours (previously it was 11-13). School age children (6-13): Sleep range widened by one hour to

9-11 hours (previously it was 10-11). Teenagers (14-17): Sleep range widened by one hour to 8-

10 hours (previously it was 8.5-9.5). Younger adults (18-25): Sleep range is 8-9 hours (new age

category). Adults (26-64): Sleep range did not change and remains 7-9 hours. Older adults (65+):

Sleep range is 7-8 hours (new age category), Czeisler (2015)

Sleep is a major aspect in our everyday lives; however, fewer people are getting enough

sleep each night and more are slowly becoming sleep deprived. Sleep deprivation is defined as a

condition that occurs when an individual does not get enough sleep each night (What Are Sleep

Deprivation, 2012). There is an immense amount of research being conducted in order to

determine how to overcome sleep deprivation, but in order to surpass any issue, it is important to

know who is at risk of being afflicted by it. It is important to understand that people of all ages,

and ethnicities are at risk of becoming sleep deprived. More specifically, individuals who have

limited time for sleep, such as students, people who work a lot of hours either at either one or

more jobs, as well as caregivers. Also, those who have schedules that conflict with circadian

rhythms such as; shift workers, first responders and individuals who travel for work can also be
 5

at risk of suffering from sleep deprivation. Other individuals that could be included would be

those whose life style choices do not allow them to receive adequate amounts of sleep such as;

individuals who take medication to stay awake, those who abuse alcohol and or drugs, or those

who don’t place sleep high on their priority list. Individuals who suffer from various medical

conditions such as heart failure, heart disease, obesity, high blood pressure, diabetes, stroke,

transit ischemic attack (mini stroke), attention-deficit hyperactivity disorder, and depression can

all suffer from sleep deprivation as well (Who is at Risk, 2014)

So many people fail to maintain a proper sleep schedule, but sleep is one of the most

important aspects of mankind’s everyday life. There are several important aspects to maintaining

an adequate The Effects of Sleep Deprivation on Memory, Problem Solving, and Critical

Thinking 13 amount of sleep on a nightly basis. These would include: committing new

information to memory, maintaining normal body processes such as proper carbohydrate storage

and maintaining proper hormone levels, reduced tendency for day time sleepiness, thereby

reducing human errors such as medical mistakes and traffic accidents, reduction in irritability

and patience, improves concentration and reduces moodiness and laziness. Sleep disorders have

been linked with hypertension, irregular heartbeat, and increased cortisol levels, while an

adequate amount of sleep assists in maintaining proper immune system function (Benefits of

Sleep, 2015)

According to the National Heart, Lung and Blood Institute, Sleep Deprivation is defined

as a condition that occurs if you don't get enough sleep. Sleep deficiency is a broader concept. It

occurs if you have one or more of the following: You don't get enough sleep (sleep deprivation).

You sleep at the wrong time of day (that is, you're out of sync with your body's natural clock).

You don't sleep well or get all of the different types of sleep that your body needs. You have a
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sleep disorder that prevents you from getting enough sleep or causes poor quality sleep. Sleep

deficiency can lead to physical and mental health problems, injuries, loss of productivity, and

even a greater risk of death.

To understand sleep deficiency, it helps to understand how sleep works and why it's

important. The two basic types of sleep are rapid eye movement (REM) and non-REM. Non-

REM sleep includes what is commonly known as deep sleep or slow wave sleep. Dreaming

typically occurs during REM sleep. Generally, non-REM and REM sleep occur in a regular

pattern of 3–5 cycles each night. Your ability to function and feel well while you're awake

depends on whether you're getting enough total sleep and enough of each type of sleep. It also

depends on whether you're sleeping at a time when your body is prepared and ready to sleep.

You have an internal "body clock" that controls when you're awake and when your body is ready

for sleep. This clock typically follows a 24-hour repeating rhythm (called the circadian rhythm).

The rhythm affects every cell, tissue, and organ in your body and how they work. If you aren't

getting enough sleep, are sleeping at the wrong times, or have poor quality sleep, you'll likely

feel very tired during the day. You may not feel refreshed and alert when you wake up. Sleep

deficiency can interfere with work, school, driving, and social functioning. You might have

trouble learning, focusing, and reacting. Also, you might find it hard to judge other people's

emotions and reactions. Sleep deficiency also can make you feel frustrated, cranky, or worried in

social situations. The signs and symptoms of sleep deficiency may differ between children and

adults. Children who are sleep deficient might be overly active and have problems paying

attention. They also might misbehave, and their school performance can suffer.

According to Hershner and Chervin (2014). College is a time of intellectual growth and

development as young adults’ transition from adolescence to adulthood. Although the worth of
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college in terms of increased productivity and higher earning potential is rarely debated, there is

a significant personal and societal cost of college both in terms of time and money. For optimal

return on the investment of time, effort, and money, students need to maximize their learning,

academic, and personal growth. Sleepiness from any cause can compromise these goals, through

impact on learning, memory, grades, perception of effort, driving performance, and mood.

Although sleep deprivation has effects on many aspects of health, this article focused on areas

that may be particularly problematic for college students.

According to Hershner and Chervin (2014). Students with sleep disorders probably do

not achieve optimal academic performance, and up to 27% of students may be at risk for at least

one sleep disorder.57 Students at risk for academic failure (GPA <2.0) were at a

disproportionately high risk for sleep disorders. Among those who screened positive for

obstructive sleep apnea, 30% were at risk for academic failure. Medical students classified as

frequent snorers more frequently failed their Internal Medicine examination (47%) than did

occasional snorers (22.2%) or non-snorers (12.8%). After adjustment for age, BMI, and sex, the

relative risk for snorers to fail the examination was 1.26 (95% confidence interval: 1.01–1.57).65

Obstructive sleep apnea is suspected to have cognitive effects in both children and adults.66 A

higher percentage of students at risk for academic failure screened positive for other sleep

disorders including: periodic limb movement disorder/restless legs syndrome (21%),67 insomnia

(22%), circadian rhythm sleep disorders (26%), and hypersomnia (21%).57 As nearly one in four

students is at risk for a sleep disorder, screening for sleep disorders among students with poor

academic performance may well be advisable.

Many people suffering from routine sleep loss are not even aware of it, and many who do

realize they are not getting enough sleep are not aware of what it is costing them. Sleep loss
 8

creates sleepiness, which can be associated with decrements in vigilance, reaction time, memory,

psychomotor coordination, information processing, and decision-making. With increasing

sleepiness, individuals demonstrate poorer performance despite increased effort, and they may

report indifference regarding the outcome of their performance (Behavioral Medicine, 1996).

Behavior Medicine illustrates that not getting enough sleep affects the person in several ways:

1. Problem solving skills are impaired. Sleep loss noticeably impairs our ability to

comprehend rapidly changing situations, increases the likelihood of distraction, 8 makes us think

more rigidly and less flexibly, and reduces our ability to produce innovative solutions to

problems.

2. Communication skills suffer. Sleep loss reduces the words in vocabulary both verbally

and in writing.

3. Learning and memory suffer. Sleep loss diminishes scores on tests of memory, verbal

fluency and overall creativity.

4. Motor skills are impaired. Studies show there is a direct connection between sleepiness

and impaired hand-eye coordination. The degree of impairment has led researchers to compare it

in severity to drunkenness.

One thing is for certain, that chronic sleep loss may lead to deterioration of mood and

motivation; decrease in attention, energy, and concentration; and an increase in fatigue,

irritability, tension, anxiety, and depression. Individuals suffering from sleep deprivation may

have an increased incidence of psychophysical problems such as stomach problems, menstrual

irregularities, headaches, and increased muscle tension (National Sleep Foundation, 1999). Any
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one of these consequences of sleep deprivation can seriously affect productivity and

performance.

Causes of Sleep Deprivation

Just like other problems that humanity faces, there is not a single cause for sleep

deprivation. If a person suffers from a sleep disorder, it is very likely that the individual will

become sleep deprived, the issue is determining which disorder the person suffers from so that

help can be sought after to assist in receiving enough sleep. People have been known to suffer

from insomnia, sleep terror disorder, narcolepsy, sleep walking, and sleep apnea; these are just a

few of the many disorders that individuals can suffer from, which can prevent them from

achieving an optimum sleep regimen each night as witnessed by researchers Murphy and

Delanty (Murphy, & Delanty, 2007).

Along with officially diagnosable sleep disorders, it has been observed through empirical

studies such as Hershner and Chervin’s Causes and Consequences of Sleepiness Among College

Students that schedules set by colleges and public schools are partially responsible for students

being afflicted with sleep deprivation. With class times being set early in the morning and late in

the evening as well as work-loads being increased outside of the class room, individuals’

circadian rhythms can become discombobulated, causing them to have an inadequate sleep cycle

(Hershner, & Chervin, 2014).

The third major factor that can lead to an insufficient amount of sleep is when an

individual makes personal and professional commitments beyond that of what is reasonably

accomplished. Different careers can lead individuals to go extended periods of time without

adequate amounts of sleep each night, for example; medical professionals and shift workers.
 10

When said individuals do finally have the opportunity to go home and rest, they still have to deal

with the demands of their socioeconomic factors such as raising a family and environmental

noise pollution (Murphy, & Delanty, 2007).

Effects of Sleep Deprivation

By failing to obtain an efficient amount of sleep each night, there is an increased

possibility of there being one or more adverse effects on the individual’s cognitive capabilities.

The actual ability to store information is not completely hindered when a person is suffering

from total sleep deprivation; however, when a person is suffering from a lack of sleep, they may

tend to lose the ability to filter information; therefore, storing more irrelevant information into

their working memory, leaving less room for that which is relevant, making it appear that the

memory itself is being hindered. This was clearly observed through the empirical research study

titled: The Effects of Two Types of Sleep Deprivation on Visual Working Memory Capacity and

Filtering Efficiency, which was conducted by researchers Drummond, Anderson, Straus, Vogel,

& Perez (Drummond, Anderson, Straus, Vogel, & Perez, 2012).

Sleep loss has been shown to be inversely proportional to academic performance; when

one fails to receive an adequate amount of sleep on a nightly basis, the literature states that an

individual’s skills in learning capacity, such as memory, attention and problem solving skills are

effected the most. Sleep deprivation can also lead to daytime sleepiness. When these factors are

all being faced, students are likely to achieve lower test scores and lower grade point averages;

however, it has been shown that cognitive function is not hindered as drastically when the

individuals are working in groups as when working alone (Chiang, Arendt, Zheng, & Hanisch,

2014)
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An individual’s physical and mental health and abilities have been shown to have direct

correlation with sleep deprivation. Research has shown that people who suffer from sleep

deprivation, are more likely to have issues with their cognitive abilities, such as memory and

problem solving skills when the individual also suffers from hypertension, but the relationship

does not end there. The empirical research study Decreased Cognitive/CNS Function in Young

Adults at Risk for Hypertension: Effects of Sleep Deprivation, which was conducted by

researchers; McCubbin, Peach, Moore & Pilcher have also shown that individuals who do not

have hypertension are more likely to develop this issue when constantly depriving themselves of

sleep (McCubbin, Peach, Moore, & Pilcher, 2012). The brain is most effectively influenced by

the different chemicals that are naturally released by the body, but it is very possible to disorient

the brain by not releasing, or releasing too much of, a certain chemical. The empirical research

study Neurophysiological Effects of Sleep Deprivation in Healthy Adults, has shown that people

suffering from total sleep deprivation have an increase in dopamine output and a decrease in

cortisol, thereby requiring an increase in a combined effort of production from the prefrontal and

limbic cortical regions. Despite the increase of activity in the brain, individuals still suffer from

decreased cognitive performance (Klumpers, Veltman, van Tol, Kloet, Boellaard, Lammerrtsma,

& Hoodendijk, 2015)

A review of the relevant literature over the past 15 years reveals that insufficient sleep (or

partial sleep deprivation) has a variety of adverse effects. Despite the wide range of research

methodologies (e.g., qualitative studies, surveys and clinical trials, instruments) and settings

(e.g., field studies, and time-isolation laboratories, and sample sizes), the results are quite

similar: insufficient sleep has been associated with cognitive problems, mood alterations,

reduced job performance, reduced motivation, increased safety risks, and physiological changes.
 12

Results from laboratory studies of total sleep deprivation (one or more nights without sleep) were

not included in this review, since the focus of this section is on insufficient sleep (partial sleep

deprivation) and not on total sleep deprivation.

It is important to note that none of the several hundred studies reviewed for this paper

showed any positive effects from sleep restriction in healthy adults. While it is true that one night

of sleep deprivation can temporarily elevate mood in depressed patients, it has adverse effects on

mood in healthy individuals of all ages, including nurses. Depression increases, irritability

increases, and people report feeling more stressed when sleep is restricted. Extended sleep times,

however, are not associated with improved mood or health and may be associated with poor

health. Mortality rates were highest among subjects ages 30 to 100 years who slept 8 or more

hours, and lowest among those who slept 7 hours sleep, findings that were identical to those

obtained a year later from a prospective study of 82,975 registered nurses (Nurses Health Study).

Health Consequences of Sleep Deprivation: memory & cognitive impairment

Students think that when they purposely lose sleep by pulling all-nighters, that they are

preparing themselves for more success. This is far from the truth, and students are not

performing better. Doing all-nighters and losing sleep is not worth beneficial. A study by Curcio,

Otenyo- 12 Ferrara, and De Gennaro (2006) explored the idea that sleep plays an essential role in

learning and memory. The study observed that there is a corresponding relationship between

sleep and memory and synaptic plasticity (Curcio, Ferrara, and De Gennaro, 2006). To test the

ideas behind memory retention and sleep loss, researchers Pilcher and Walters (1997) conducted

a series of cognitive tasks that had participants complete 2 questionnaires that mainly tested

concentration and estimated performance. Students were also able to self-report on the amount of
 13

effort they perceived to use on the tests. As anticipated, sleep deprived participants performed

tasks significantly worse than non-sleep deprived participants on cognitive tasks (Pilcher and

Walters, 1997). Surprisingly, participants who were sleep deprived rated their concentration and

effort level higher than non-deprived participants (Pilcher and Walters, 1997). Students who

were sleep deprived also rated their estimated performance significantly higher than non-

deprived participants (Pilcher and Walters, 1997). Although sleep deprived students had the

selfperceived notion that they were more concentrated and more likely to perform well compared

to non-deprived students, these finding are contrary to the actual facts which show that sleep

deprived students will perform worse. The Pilcher and Walters (1997) study shows that college

students are unaware to what extent their sleep deprivation has on their ability to complete

cognitive tasks and retain memory.

Overcoming Sleep Deprivation

There are multiple ways in which individuals can work to overcome their sleep

deprivation and return to functioning at an appropriate efficiency. Insomnia has been shown to

be a lead cause in sleep deprivation, causing individuals to lie awake at night, unable to achieve

sleep, or constantly waking throughout the night, there are multiple treatments that have been

tested and of these, one seems to stand out. With all the different drugs being used to aid with

sleep, acupuncture is actually proving to be an effective aid and more research is going into

discovering the true potential of this treatment (YuanFang, Jian-Hua, Neng-Gui, Zhao-Hui,

Zhen-Hua, Shu-Jun, & Wen-Bin, 2013).

Another aid in the fight against sleep deprivation is natural sleep aids. It is remarkable

how many natural aids there are, most of which come from leaves, roots and tree bark. Some of
 14

these aids include: kava-kava, which is an herbal remedy that relaxes the body and enhances

dreaming. Valerian root, which eases nerve and muscle tension as well as relieves anxiety and

chamomile, which is a flower that is most often drunk as a tea, aids in reducing restlessness and

digestion. There are a plethora of natural remedies that help with releasing Melatonin and

Tryptophan, which are natural chemicals in the body that aid in healthy sleep. One should always

choose a natural remedy over its synthetic counterpart when available (Kopparapu, Puranik,

Nargund, Samuel, Shahapurkar, & Mathew, 2012).

A full night of sleep is not always an option with people’s nonstop lives, so the majority

of people turn to different stimulants in order to keep them going during the day. Studies have

shown that when 20mg of d-amphetamines are ingested orally, the individual returns to a

cognitive state that was present prior to being sleep deprived, allowing for an improvement in

addition and subtraction as well as logical reasoning tasks. Amphetamines also reduce a person’s

response bias by increasing their confidence in their actions and decisions. It has long been

believed that nicotine has the ability to aid in the retention and enhancement of cognitive

functions, when the individual is sleep deprived, due to the fact that it is a stimulant, but research

has actually shown it has no positive effect on the brain’s cognitive capabilities, due to its

inability to improve sleep latency. L-deprenyl, like nicotine, fails to improve sleep latency in

sleep-deprived individuals thereby negating any improvements on cognitive performance during

the sleep deprivation period. These findings were discovered in the empirical research of

Stimulant Drug Effects on Performance and Behavior After Prolonged Sleep Deprivation: A

Comparison of Amphetamine, Nicotine, and Deprenyl (Newhouse, Penetar, Fertig, Thorne, Sing,

Thomas, & Belenky, 1992).

Why are College Students Sleep Deprived?

 15

Poor sleep hygiene is a common factor that increases sleep loss. Sleep hygiene is the

promotion of regular sleep (CDC, 2012). Without adequate sleep hygiene, students may find

themselves with worse health consequences that encourage sleep deprivation. A study

implemented with college students showed that 33% of sleep deprived students took longer than

30 minutes to fall asleep, and 43% of the students studied also reported prematurely waking up

more than once on a nightly basis (Forquer et al, 2008). Some people may have the belief that

college students have different sleep hygiene depending on their class standing and majors.

Although it may be true that some majors have different amount of work load, Forquer et al.

(2008) found that there is no differences between freshman, sophomores, juniors, seniors, and

graduate students for the time to fall asleep, number of premature waking per night, and total

hours of sleep per night.

Poor sleep hygiene is a common cause of sleep deprivation among college students;

however, other causes such as alcohol consumption also affect students. According to Hershner&

Chervin (2014), approximately four out of five college students drink alcohol. Alcohol is known

to shorten sleep latency; however, it promotes fragmented sleep in the latter half of the night

(Hershner& Chervin, 2014). A study conducted about sleep and alcohol consumption found that

11.6% of students who drank alcohol used it as a sleep aid (Hershner& Chervin, 2014). The use

of alcohol for sleep is a dangerous practice that has negative health consequences. In fact,

alcohol may increase the risk for obstructive sleep apnea (Hershner& Chervin, 2014). In addition

to alcohol consumption, college students are also sleep deprived due to other drugs such as

caffeine and energy drinks.

Caffeine consumption is commonly used in the college lifestyle as a remedy for

preserving alertness and most importantly, preventing sleep in times when there is an urgency for
 16

studying. Students depend on caffeine products such as coffee and energy drinks for their source

of caffeine. The body’s response to highly caffeinated drinks is detrimental to sleep hygiene; for

example, intake of 2 to 4 cups of coffee taken at night can increase sleep latency on average from

6.3 to 12.1 minutes, reduce sleepiness, and improve the ability to sustain wakefulness

(Hershner& Chervin, 2014). Students who plan to study for long periods of time seek caffeinated

dirnks because they are readily available products. Students gravitate to the effectiveness of

caffeine consumption, because the effects of caffeine can last 5.5–7.5 hours (Hershner& Chervin,

2014). This suggests that caffeine consumed in the afternoon could impair one’s ability to fall

asleep (Hershner& Chervin, 2014). Energy drinks are another form of caffeinated drinks that are

popular among college students. Approximately 34% of 18–24 year Otenyo- 8 olds consume

them regularly (Hershner& Chervin, 2014). In 2006, it was reported that Americans spent more

than $3.2 billion on energy drinks , and the majority (67%) of consumers bought energy drinks to

help alleviate the symptoms linked to insufficient sleep (Hershner& Chervin, 2014). Like coffee,

the main sources of stimulus in energy drinks is caffeine, which has similar effects on the body.

The amount of caffeine in energy drinks varies from 45–500 mg, which explains the potency of

these products (Hershner& Chervin, 2014). Students view the effect of caffeine as a benefit to

their health; nevertheless, many do not consider the dangerous side effects associated with

depriving themselves from sleep.

Suggestions for How Students Can Improve Sleep

When students are pulling all fighters to study, and or using distracting technology prior to

bedtime, it a form of self-sabotage. It is self-sabotage in a sense that students are preventing

 17

themselves from performing in school to the best of their ability. As mentioned in the Pilcher and

Walters (1997) study, students are unaware that their choice to deprive themselves from sleep in

deterring them from academic achievement. People can improve sleep hygiene by following a

few strategies to increase sleep quality. The first strategy is to go to bed and wake up at the same

time each day (CDC, 2012). Notre Dame College (2007) suggests that getting on Otenyo- 14 a

schedule, will help the body get used to a regular sleep cycle. The second tip is to make sure the

one’s bedroom is conducive to a distraction free sleep by making sure the room is quiet, dark,

comfortable in temperature, and it is a general relaxing environment (CDC, 2012). The third

suggestion is to make sure that one’s bed is comfortable and is used only for sleeping and not for

other activities such as reading, or watching TV (CDC, 2012). It is highly recommended that

students use common areas and the library instead, because using the bed to complete stress

related activity such as schoolwork can be destructive to effective sleep (Notre Dame College,

2007).The fourth recommendation is to avoid large meals before bedtime (CDC, 2012). It is

suggested that if one plans to eat before bed to do it about 2 hours prior to bedtime (Notre Dame

College, 2007). These tips are based on the CDC’s general assessment of good sleep hygiene so

that people can avoid sleep deprivation or other disordered sleep patterns. Students can benefit

from these suggestions; however, the college student environment sometimes does not support

good sleep.

THEORETICAL FRAMEWORK
 18

Below is the theoretical framework of the study (refer to Figure 1). This research utilized

the theory of Oswald which is the Restoration Theory, conceptualized in 1996, and the theory of

Nightingale which is the Environmental Theory, conceptualized during the 19th Century.

Restoration Theory Environmental Theory

(Oswald,1996) (Nightingale, 19th
century)

Figure 1: The Theoretical Framework of the study.

The Environment Theory of nursing is a patient-care theory. That is, it focuses on the

care of the patient rather than the nursing process, the relationship between patient and nurse, or

the individual nurse. In this way, the model was adapted to fit the needs of individual patients.

The environmental factors affect different patients unique to their situations and illnesses, and

the nurse must address these factors on a case-by-case basis in order to make sure the factors are

altered in a way that best cares for an individual patient and his or her needs. (Petepirin, 2016)

The focus Environmental theory is to alter the patient's environment in order to affect

change in his or her health. The environmental factors that affect health, as identified in the

theory, are: fresh air, pure water, sufficient food supplies, efficient drainage, cleanliness of the

patient and environment, and light (particularly direct sunlight). If any of these areas is lacking,

the patient may experience diminished health. A nurse's role in a patient's recovery is to alter the

environment in order to gradually create the optimal conditions for the patient's body to heal
 19

itself. In some cases, this would mean minimal noise and in other cases could mean a specific

diet. All of these areas can be manipulated to help the patient meet his or her health goals and get

healthy. (Petepirin,2016)

Nightingales environmental theory is an act of utilizing the environment of the patient to

assist him in his recovery. In this study, the researchers aims to know the different

environmental, external, and internal factors that causes the nursing students of Ateneo de

Zamboanga University to be sleep deprived. Knowing the different causes is not only the goal of

the researchers to find out but also the incidence of sleep deprivation among nursing students.

Some environmental factors and different causes of sleep deprivation also affects the rate of

occurrence of sleep deprivation among nursing students and in this study what the researchers

want to know is not the environmental factors that affects the incidence of sleep deprivation but

mainly the incidence of sleep deprivation.

Another theory, the Restoration Theory, was conceptualized by Oswald in 1996,

According to Oswald, the function of sleep is to restore the body during periods of inactivity so

that adequate biological functioning is ensured. The tissues of the brain and body are repaired

and the chemicals needed for proper functioning are replenished. Specifically, Oswald claims

that Non Rapid Eye Movement (NREM) sleep restores biological processes that have

deteriorated during the day. Rapid Eye Movement (REM) sleep replenishes and renews brain

processes through the process of protein synthesis. A student nurse is expected to function well

in classroom or in the clinical areas when amount of sleep is sufficient. Sleep is really important

and is essential to everyone, but when one is studying occurrence of sleep deprivation cannot

really be avoided and this increases the incidence as to why almost all college student are sleep
 20

deprived. The restoration theory is necessary for this research because this study involves sleep

deprivation.

The Environmental theory by Nightingale and Restoration theory by Oswald were chosen

to provide knowledge on the possible causes for sleep deprivation of nursing students. These

causes led to the goal of the study: to identify the incidence of sleep deprivation among level IV

nursing students. The correlation of the restoration theory of Oswald and the Environmental

theory of Nightingale is a useful theory to find out the different causes of sleep deprivation

which would affect the incidence of sleep deprivation among level IV nursing students. The

theoretical framework is formulated to identify certain factors or commonalities what causes the

students to be sleep deprived and also this theoretical framework also serves as a guide to

formulate the conceptual framework needed in order to gather variables that can be tested to

determine the incidence of sleep deprivation among nursing students of Ateneo de Zamboanga

University.
 21

CONCEPTUAL FRAMEWORK

The following diagram is the Conceptual Framework of the study (refer to Figure 2).

Causes of Sleep
Deprivation

Level IV BSN
student nurses of Sleep Deprivation Incidence of
ADZU Sleep
Deprivation

Coping with
Sleep
Deprivation

Figure 2: The Conceptual Framework of the Study

The conceptual framework of the study mainly focused on the Incidence of sleep

deprivation among nursing students of Ateneo de Zamboanga Univeristy. Causes of sleep

deprivation and also how students handle sleep deprivation was included in this research study in

order for the researchers to know the commonalities of the causes why a student becomes sleep

deprived and how does these causes affect the incidence of sleep deprivation. Coping with sleep

deprivation and knowing how sleep deprivation affects the level IV nursing students personally

was also included in the study in order for the researchers to be aware and overcome sleep

deprivation in order for them to make it through the day of tiring school works and duties.
 22

There are five variables in the study; First variable which is an independent variable is the

variable “sleep deprivation” since it can stand alone and doesn’t need the support of other

variable for it to be defined and elaborated. Second variable is the causes of sleep deprivation,

third variable is the incidence of sleep deprivation fourth variable is to how nursing students

cope with sleep deprivation which are also dependent variables since they depend to the variable

“Sleep Deprivation”. Last variable is the level IV nursing students of Ateneo de Zamboanga

University which is also a dependent variable. Sleep deprivation which is the first variable

happens when a certain person did not complete the number of hours sleep needed. Sleep

deprivation is on the top of the conceptual framework since sleep deprivation is the main reason

why this study is created, sleep deprivation is also the main reason why some incidences of sleep

deprivation happen, why causes of sleep deprivation arises, and lastly, why most of the students

are able to handle or overcome sleep deprivation. Sleep deprivation is further extended into the

three branches of variables, these are the, causes of sleep deprivation, incidence of sleep

deprivation, and coping with sleep deprivation. It was further extended into three branches since

the researchers knew that sleep deprivation was a very broad term. The researchers identified 3

more variables that further elaborated sleep deprivation and it was causes of sleep deprivation,

incidence of sleep deprivation, and coping with sleep deprivation. All of these variable comes

down to the last variable of the study which is the Level IV nursing students of Ateneo de

Zamboanga University. The last variable is intentionally placed in the first part of conceptual

framework because it is the students who are greatly affected by sleep deprivation, it is through

the students why causes and incidence of sleep deprivation happens, and it is the duty of the

students to handle sleep deprivation in order for them to make it through the day of loads of

requirements, quizzes, duties and etc.

 23

STATEMENT OF THE PROBLEM

This research sought to determine the Incidence of sleep deprivation among nursing

students of Ateneo de Zamboanga University. Specifically, the study sought answer the following

questions:

1. What are the average number of hours of sleep of the level IV nursing students on a

regular day?

2. What is the incidence of sleep deprivation among the level IV nursing students?

3. What are the common causes of sleep deprivation among level IV nursing students?

4. How often are the level IV nursing students sleep deprived on a regular week?

5. How do the level IV nursing students cope with sleep deprivation?

SIGNIFICANCE OF THE STUDY

This study can be a learning paradigm for all the colleges in Ateneo de Zamboanga

University as well as high school and grade school department to enhance the students’

knowledge about the sleep deprivation. The researcher has focused on the incidence rate of sleep

deprivation among the nursing students thus this paper gave a more or less accurate number of

students who are sleep deprived. Included in this research is the quantitative value of sleep that

the nursing students could have every night.

Since sleep plays an important role in memory and learning process this study was a

significant endeavour in promoting normal sleep pattern. This paper promoted awareness to the
 24

nursing students that sleep deprivation is very detrimental to health; this would decrease their

ability to concentrate and complete complex task especially in the area of duty and in the

classroom as well.

Although there may be obvious negative consequences as a result of sleep deprivation

and though it remains a struggle to find the motivation to modify the behaviours; this study can

be a wake-up call for the all the colleges and other academic organizations that sleep deprivation

do exist among students. Through this research there was a valid evidences about the causes of

sleep deprivation and how it affects students’ performance. From this research action took place

and a plan of solution to modify administrative staff in terms of strategic management for the

students who are sleep deprived.

Sleep deprivation is and largely under-recognized health issue which may require a multi-

dimensional approach to be able to transform previous behaviour. This study therefore paved the

way for other researchers in the academe to investigate deeply about the incidence of sleep

deprivation of the students from other departments and to further gather data about the causes

effects of sleep deprivation and how students cope up from this problem.

SCOPE AND LIMITATION OF THE STUDY

The problem of this study solely focused only in the Incidence rate of sleep deprivation

among level IV nursing students of Ateneo de Zamboanga University. The goal of the study is to

determine the incidence level of sleep deprived level IV nursing students and also to determine

what are the commonalities that causes them to be sleep deprived and how does the level IV

nursing students handle sleep deprivation. The scope area of the study included the premises of

Ateneo de Zamboanga University, Main Campus.

 25

The study participants for this research study was chosen from the fourth year college,

nursing students from both groups A and B. The reason for the selection of this group is due to

the fact that the level IV nursing are considered to have stressful RLE duties and also the level

IV nursing students have lots of quizzes, requirements, and Sunday Review examination, by this

the researchers are expecting a great number of incidence of sleep deprivation among the level

IV nursing students. By using the Total Enumeration as for gather the study participants, an

estimate of 102 (excluding the researchers) or the total population of level IV nursing students

was selected as study participants

DEFINITION OF TERMS

Sleep Deprivation. This refers to the condition of not having enough sleep translating enough

sleep into numbers, it means the college students ages 18-25 years old cannot complete the

recommended sleeping hours which is 8-9 hours per night.

Student Nurses. The nurses from this study are the level IV student nurses currently enrolled to

the program Bachelor of Science in Nursing (BSN) S.Y. 2018-2019.

Quality of Sleep This refers to the amount of sleep that the students nurses can have while

juggling academic requirements as well as the student nurses related learning experience (RLE)

duty.

Incidence This refers to the frequency, occurrence or rate of sleep deprivation of level IV

student nurses in Ateneo de Zamboanga University

 CHAPTER II

RESEARCH METHOD

This chapter will be discussing the Research Design, Research Locale, Participants of the

Study, Instrument of the Study, Data Gathering Procedure, Plan of Analysis, and Ethical

Considerations. This will be needed to determine the Incidence of Sleep Deprivation

among Level IV Nursing Students S.Y. 2018-2019 of Ateneo de Zamboanga University

RESEARCH DESIGN

This research study used a descriptive research design with quantitative measures.

According to Earl Babbie (2010), quantitative measures emphasize objective measurements

and the statistical, mathematical, or numerical analysis of data collected through polls,

questionnaires, and surveys or by manipulating pre-existing statistical data using

computational techniques. This research study sought to find out Incidence of Sleep

Deprivation among Level IV Nursing Students S.Y. 2018-2019 of Ateneo de Zamboanga

University. Descriptive research design with quantitative measures was used to describe and

interpret the number of hours of sleep of the level IV nursing students on a regular day, the

incidence of sleep deprivation among level IV nursing students, the common causes of sleep

deprivation among level IV nursing students, and lastly how students cope with sleep

deprivation.
 27

RESEARCH LOCALE

The research was conducted in Zamboanga City, Philippines, particularly Ateneo de

Zamboanga University is the only school Jesuit school that exists in Western Mindanao. The

school was founded in the year 1912 as Escuela Catolica and the second oldest Jesuit school

to be named Ateneo. In 2001, the Commission on Higher Education officially declared

Ateneo de Zamboanga a university.

PARTICIPANTS OF THE STUDY

The study participants of this research was selected from the nursing students of Ateneo

de Zamboanga University. Participants for this study was chosen from the Level IV nursing

students. The reason for the selection of this group is due to the fact that the level IV nursing

students are those who have accumulated the most exposure to Related Learning Experience

(RLE), whether in a hospital or community set-up. The population of the study is 102

(excluding the researchers) level IV nursing students of Ateneo de Zamboanga University.

The sample for this research study was taken from all the 102 level IV nursing students using

the total population sampling by studying and examining the entire population to get the most

accurate findings for the study of incidence of sleep deprivation.

Inclusion Criteria:

The study participants for this research was chosen based on the following

criteria: a) bona fide student of Ateneo de Zamboanga University, b) level IV Bachelor of

Science in Nursing student, c) having Related Learning Experience (RLE) duty, d) been

to a health center or hospital duty, & e) those who are sleep deprived.
 28

Exclusion Criteria:

Those who are not chosen for this study was chosen based on the following

criteria: either, a) not bona fide student of Ateneo de Zamboanga University, b) not a

level IV Bachelor of Science in Nursing student, c) not having Related Learning

Experience (RLE) duty, d) never been to a health center or hospital duty, & e) those who

are not sleep deprived.

INSTRUMENTS OF THE STUDY

This study utilized a research instrument in order to obtain the needed data for this study.

A self-administered questionnaire with 4 parts was formulated by the researchers. Prior to

conduction the gathering of the data, a consent was given to the study participants as an approval

sheet and making sure that all data gathered will be kept highly confidential. The draft of the

questionnaire was drawn out based on the researcher’s readings, previous studies, literature

published and unpublished thesis relevant to the study.

The self-administered questionnaire contains four (4) parts. The first part of the instrument

talks about the demographic data. This part of the instrument solicited the study participant's

name, age, year and section. A follow up question was asked whether the participant has been

sleep deprived for the past few weeks. If the participant answered “yes, I have been sleep

deprived then he or she can proceed in answering the rest of the instrument and if the study

participant, he or she was asked to return the questionnaire. The second part of the questionnaire

talks about the incidence of sleep deprivation, this part of the instrument solicited the number of

nights in which they are deprived of sleep in a week. In those nights of being sleep deprived, the

study participants was asked as to how many hours they sleep during those nights including
 29

power naps in the afternoon. The third part of the questionnaire talks about the causes of why

nursing students are sleep deprived, a select that all apply (close ended) type of questionnaire

was utilized. The researchers gave 10 different options regarding the causes of why nursing

students are sleep deprived. The study participants was given a chance to specify what causes

him or her to be sleep deprived if the given options did not match their idea. This part of the

instrument answered the question “What are the common causes of sleep deprivation among

level IV nursing students?”

The last part of the questionnaire aims to determine as to how the level IV nursing students

cope with sleep deprivation. This part of questionnaire was answered by the use of a 4 point

Likert Scale in which the participant agreed, very much agreed, disagreed, or very much

disagreed to the given statement. The likert questionnaire have a total number of 10 items that is

focused as to how do level IV nursing students cope with sleep deprivation whether during duty

or at school.

A rubric was designed by the researchers to determine how well they cope up with sleep

deprivation. Strongly agree means that the study participants were very sure that they used that

coping mechanism to cope up with sleep deprivation and without any uncertainty. Agree means

that the study participants were sure that they used that coping mechanism to cope up with sleep

deprivation but with some levels of uncertainty. Disagree means that the study participants were

sure that they did not used that coping mechanism to cope up with sleep deprivation. Strongly

disagree means that the study participants were very sure that they did not used that coping

mechanism to cope up with sleep deprivation and with no levels of uncertainty.

 30

Predilection Remarks
Study participants were very sure that they
Strongly Agree used that coping mechanism to cope up with
sleep deprivation and without any uncertainty.
Study participants were sure that they used that
Agree coping mechanism to cope up with sleep
deprivation but with some levels of uncertainty
Study participants were sure that they did not
Disagree used that coping mechanism to cope up with
sleep deprivation
Study participants were very sure that they did
Strongly Disagree not used that coping mechanism to cope up
with sleep deprivation and with no levels of
uncertainty.

Table 1” Rubric for the Four Levels of Predilection”

Another rubric was made by the researchers to determine the level regarding how they cope

up with sleep deprivation which was based from the mean scores of the responses for each item.

A score of 5 was given as the highest score and a score of 1 is given as the lowest score. Each

response from each item is being scored from 1 to 5. A mean score of 4.000 – 5.000 means that it

is one of the most commonly used coping mechanism. A mean score of 3.000 – 3.999 means

that that coping mechanism is used often used by all. A mean score of 2.000 – 2.999 means that

that coping mechanism is rarely used by the study participants. And lastly, a mean score of

1.000 – 1.999 it is the most least used coping mechanism by the study participants.
 31

Mean Score Remarks

4.000-5.000 Most commonly used coping mechanism

3.000-3.999 Often used coping mechanism

2.000-2.999 Rarely used coping mechanism

1.000-1.999 Least used coping mechanism

Figure 2 “Rubric for the Mean Scores”

Reliability Test

To fully know the incidence of sleep deprivation among level IV nursing students, a test

retest reliability was used. It measured the reliability obtained by administering the same test

twice over a period of time (one to two months) to the group of individuals. The researchers gave

the same test to same respondents on two separate occasions. The first test given can be referred

as T1 was given on the month of June and the second test can be referred as the T2 was given on

the month of July. After tallying the results of T1 and T2 the researchers already knew the test

retest reliability coefficient. The participant’s scores on T1 and T2 were very close and similar.

The results therefore conclude that the material used was reliable and can already be used for

gathering data.

Validity Test

The different instruments of the study used in this research were referred to the Ms. Dyana

Marciana Saplan, RN, PhD for the face validity for assessments of the appropriateness and

suitability of the instruments. The face validity is the degree to which a procedure appears

effective in terms of its stated aims. With the recommendation of the adviser or to the experts in
 32

the research field, the research instruments was then subjected to a validity testing and some

items or part of the questionnaire that seemed to be vague to the study participant was modified

and improved.

DATA GATHERING PROCEDURE

The data gathering began with a letter made by the researchers for the dean of the college

of nursing to allow the researcher to conduct a study. Indicated in the letter is to ask permission

to invite the 102 level IV nursing students excluding the researhcers to be the participants of the

study entitled Incidence of Sleep Deprivation among Level IV Nursing Students S.Y. 2018-2019

of Ateneo de Zamboanga University.

After the researchers are done choosing their study participants, a letter was then be handed

informing the participants of what the focus, significance, and goals of the study are. This letter

also asked for their consent to answer a self-administered questionnaire prepared by the

researchers which contains 4 parts. A specific date and time was also announced to the study

participants for them to answer the questionnaires. The study participants answered the questions

truthfully, independently and without the help of others and with that desired result was obtained.

After the study participants answered the given questionnaire the researchers immediately

collected the questionnaires and checked it and tallied the results. The data obtained was

analysed using the frequency table and the central tendency mode. The test took place at the

Nutrition Lab and Amphitheater, BC building, Ateneo de Zamboanga University on July 15,

2018 Main Campus and the duration of the data gathering was approximately 30 to 40 minutes
 33

PLAN OF ANALYSIS

The gathered data obtained from the participants undergone a process which utilized a

descriptive quantitative statistics. This part of the research analyzed how the problems was

answered by the use of descriptive quantitative statistics. The statistical tool that was utilized in

this study was the frequency distribution table and central tendency mode. The central

tendency “mode” or the most frequently occurring number found in a set of numbers was

identified. The results were tabulated in a frequency table to help identify the mode in each of the

different options provided to the study participants.

To answer the question “What are the number of hours of sleep of the level IV nursing

students on a regular day?” the researchers utilized the central tendency “mode” in order to

identify the most occurring hour in which the study participants are sleep deprived on a regular

day. The data obtained were interpreted by the use of a pie chart in order to classify the different

hours of sleeps the study participants had. The use of the pie chart also helped the researchers on

discussing the most significant and the least significant data obtained.

To answer the question “What is the incidence of sleep deprivation among the level IV

nursing students?” it was analysed by the use of the central tendency “mode” or the most

frequently occurring number found in a set of numbers. The results were tabulated in a frequency

table and was interpreted by the use of a bar graph presenting the different days in which the

study participants became sleep deprived and the different number of hours of sleep in which the

study participants had during the days of July 08, 2018 to July 14, 2018. The use of the bar graph

also helped the researchers in identifying and discussing the most and the least significant data

obtained.
 34

To answer the question “How often are the level IV nursing students sleep deprived on a

regular week?” the researchers utilized the central tendency “mode” in order to identify the days

in which most of the study participants are sleep deprived on a regular week. The data obtained

were interpreted by the use of a bar graph in order to classify the different days in which the

study participants became sleep deprived. The use of the bar graph also helped the researchers on

discussing the most significant and the least significant data obtained.

To answer the question “What are the common causes of sleep deprivation among level

IV nursing students and “How do level IV nursing cope with handle sleep deprivation” the data

obtained was again analysed by the use of the central tendency mode. The results obtained were

tabulated on a frequency table in order to identify the mode and was then be interpreted by the

use of a tabular form. For the common causes of sleep deprivation, the use of a tabular form was

used to rank the questions or set of choices from most agreed question or choice from the least

agreed question or choice.

For the question “How do level IV nursing students cope with sleep deprivation?” since

the data obtained for this question is a likert type scale, each question was ranked as to whether

the study participants strongly agree, agree, disagree, and strongly disagree. The data was

analysed by the use of the mean and standard deviation. This was used in order to identify how

the data are spread out from the average or mean. A low standard deviation means that the

numbers are very close to the average or mean and that the data was not spread out. A high

standard deviation on the other means that the numbers are very far to the average or mean and

that the data was spread out.

 35

ETHICAL CONSIDERATIONS

The ethical consideration was made to ensure the safety of the students in research and who

assist in making sure that human rights are not violated. The research also helped to protect the

institution and the researchers against potential legal implications from any behavior that may be

deemed unethical.

The first ethical consideration in this research was the approval of the dean of College of

Nursing. Second ethical consideration was about the student voluntary participation in the

research and informing them that they can withdraw from the research anytime. Lastly was

about, the students being properly informed regarding the purpose of the consent of the study and

that there was no harm for them. Lastly, Ethical standards also protected the confidentiality and

anonymity of the subjects.