EXPLORATION OF SLEEP HABITS IMPACT ON SLEEP QUALITY 1

Exploration of Sleep Habits Impact on Sleep Quality

Sharee Osborne
Health Science, Brigham Young University- Idaho
HS 391: Research Methods
Brother Standifird
November 25, 2020
EXPLORATION OF SLEEP HABITS IMPACT ON SLEEP QUALITY 2

Abstract

Lack of sleep is a problem that impacts roughly one third of American adults. Chronic

sleep loss can lead to physical, cognitive, and emotional issues (Center for Disease Control and

Prevention, 2017). The purpose of this research was to explore how habits and routines before

sleep affect the quality and quantity of sleep. The study surveyed 91 respondents that were 18

years of age or older and attending Brigham Young University. Respondents were found using

an university approved mailing list and a total of 300 email invitations were sent out. Those that

responded and consented to the study completed a 15-item self-report survey on questions

related to demographics, pre-sleep routines, and reported quality and quantity of nightly sleep.

The study found that when compared, there was a statistical significance between hours slept

each night by those who utilized a pre-sleep routine compared to those that did not have a pre-

sleep routine. In addition, the study found that the relationship between having a pre-sleep

routine and reported quality of sleep showed no statistical significance.

EXPLORATION OF SLEEP HABITS IMPACT ON SLEEP QUALITY 3

Exploration of Sleep Habits Impact on Sleep Quality

Introduction

Poor sleep is a common problem in society and can be impacted by many different

factors. Ramamoorthy et al. (2019), argued that the workload size that individuals take on

contributes to an increase in stress levels which in turn have a negative impact on the quality of

sleep. Poor quality of sleep can thus result in poor performance, impaired mood, and increased

risk of academic or professional shortcomings (Hershner & Chervin, 2004). Stress impairs sleep,

impaired sleep impacts quality of life, poor quality of life increases stress, and the cycle

continues. This study sought to identify contributing factors that impair sleep and the potential of

a personal sleep hygiene routine as an intervention to improve sleep quality and break the cycle.

Literature Review

Sleep Deprivation

According to the Center for Disease Control and Prevention (2017), it is recommended

that adults aged 18 years and over should get more than seven hours of sleep per night and that

anything less than that would be considered a “short sleep duration”. Roughly 30% of American

adults fall into this category of receiving too little sleep (Center for Disease Control and

Prevention, 2017). The long-term effect of sleep deprivation or not getting adequate sleep can be

detrimental to one’s health. Adults that regularly get less than 7 hours of sleep per night are more

likely to report increased levels of stress, depression, stroke, heart attacks, obesity, physical

inactivity, and poor professional/academic performance (Center for Disease Control and

Prevention, 2017; Hershner & Chervin, 2004).

With poor sleep quality and quantity being a problem affecting roughly a third of the

adult population in America (Center for Disease Control and Prevention, 2017), there has been

much research dedicated to the negative impacts and consequences of lack of sleep. In addition,
EXPLORATION OF SLEEP HABITS IMPACT ON SLEEP QUALITY 4

ther has also been a great deal of research focused on potential interventions to improve sleep

quality and quantity. This research has investigated the mental and physical toll that chronic lack

of sleep has on quality of life. In addition, there is mounting research done on the potential habits

that can improve sleep, different methods for providing that information and education, and the

feasibility of sleep hygiene routines (Paavonen, et al., 2016; Leonard & Duncan, 2020; Kuula, et

al., 2020; Schlarb, et al., 2017; Kawai, et al., 2018.; Knowledge, et al., 2012.; Gipson, et al.,

2019.).

Consequences of Lack of Sleep

Prolonged lack of sleep can have negative impacts on health and quality of life.

Ramamoorthy et al. (2019), found that those that reported inadequate sleep were more prone to

heightened levels of stress. These heightened levels of stress correlated with individuals

reporting being more prone to psychosomatic disease and poor quality of life. Psychosomatic

disease occurs when “psychological stresses adversely affect physiological (somatic) functioning

to the point of distress” (Encyclopedia Britannica, 2019). Hershner and Chervin (2004), claimed

that insufficient amounts of sleep among college students resulted in lower grade point averages

and an increased risk of academic failure.

According to a 2014 study, the Center for Disease Control and Prevention, found that

those that reported chronic short sleep durations were at 4.8% greater risk for a heart attack,

3.6% greater risk for a stroke, 11.1% greater risk for diabetes, and 22.9% greater risk for

depression (Center for Disease Control and Prevention, 2017). Sleep is an integral part of health

and living. Without adequate sleep, research has found that it puts individuals at increased risk

for physical and mental health challenges.

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Dewald-Kaufmann et al. (2013), argued that chronic levels of sleep reduction impacted

one’s daytime functioning. Measuring functionality amongst adolescent aged children in the

areas of attention, school functioning, and school performance for those that had chronic levels

of sleep reduction. They found that when compared with those students that received higher

levels of sleep, the students with chronic sleep reduction showed greater impairment in the areas

of daytime functioning.

The research is not clear on what specific variables or combinations of variables

contribute to poor sleep quality or quantity. The variables they have identified include the areas

of environmental, physiological, cognitive, and emotional stressors. Although, there remains

much to be considered regarding contributors to poor sleep the impacts of long-term and chronic

sleep loss are detrimental to physical and mental health as well as the quality of life.

Potential Interventions

With mounting research suggesting the negative outcomes of inadequate sleep, research

has also investigated potential interventions. These interventions have included aromatherapy,

slowed breathing techniques, education on sleep hygiene, and even integration of technology

through smartphone apps (Paavonen, et al., 2016; Leonard & Duncan, 2020; Kuula, et al., 2020;

Schlarb, et al., 2017; Kawai, et al., 2018.; Knowledge, et al., 2012.; Gipson, et al., 2019.). These

studies have investigated various methods for both educating individuals about sleep and

teaching them skills to improve sleep.

The importance of sleep in both mental and physical health has such a high level of

importance that the Federal Government developed a smartphone app designed to address issues

of sleep quality, dysfunctional beliefs about sleep, and sleep hygiene. Even though the app was

originally developed for the military, both active and inactive, it is available to the civilian
EXPLORATION OF SLEEP HABITS IMPACT ON SLEEP QUALITY 6

market as well (Leonard & Duncan, 2020). Leonard and Duncan (2020), found that the

Cognitive Behavioral Therapy-Insomnia (CBT-I) app helped its users to increase their reported

sleep quality, decrease their dysfunctional beliefs, and decrease problematic sleep behaviors over

a three week period of implementation.

Schlarb et al. (2017), argued that due to irregular daytime routines, chronotype changes,

side jobs, and exam periods, college students need specialized treatments for improving sleep.

Through the utilization of “Studieren wie im Schlaf” (SWIS; (studying in your sleep)), a

multicomponent sleep training methodology designed to improve students’ sleep, insomnia

symptoms, and nightmares. They found that student participants showed improvements in sleep

quality and duration within a relatively short period of time.

Not all studies found that their intervention produced successful results. The use of text

messaging to educate college students on sleep hygiene resulted in no statistical difference in the

control and experimental group (Gipson, et al., 2019). The effects of essential oil inhalation on

sleep quality reported increase a self-reported increase, but the data identified that the increases

proved to be statistically insignificant (Kawai, et al., 2018).

Education of proper sleep hygiene and the importance of sleep is only part of the

solutions. Brown et al. (2002), found that simply having a knowledge of sleep hygiene did not

directly correlate with reported increases in sleep quality and quantity. Rather, they found that

the practice of learned sleep hygiene routines was a greater indicator of improved sleep quality

and quantity.

Searching for Sleep

Although, there has already been much research done on the topics of sleep quality and

quantity and its impacts on physical and mental health there remain many unanswered questions.
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There is still little known about the specific variables that negatively impact sleep, such as

medical conditions, environmental conditions, mental diagnoses, and more. We know even less

about effective interventions for treating chronic sleep issues and improving the quality and

quantity of sleep.

Continued research in the areas of specificity is needed. This would allow for a greater

understanding of specific variables that negatively impact sleep and the interventions that could

be used to improve sleep quality and quantity. By understanding the habits of those who receive

adequate sleep and contrasting them with the habits of those that report inadequate sleep, a better

understanding of specific variables can be identified for further study.

Methods

Participants

Participants in this study consisted of 91 adults over the aged of 18, attending Brigham

Young University-Idaho. Participants were volunteers that responded to an email invitation to

participate in research survey regarding sleep habits and quality of sleep. Of the 300 emails sent

out, using a provided email list from the university, 102 responded. Out of the 102 responses 11

responses were not utilized in the study due to three being uncompleted and eight of the surveys

being test survey to ensure the online survey was operating correctly.

Design

The research design for this study was non-experimental and utilized a correlational

analysis. The study was designed to examine the relationship between personal behaviors and

quality and quantity of sleep through the use of a self-report survey. The variables in this study

consist of the individual’s reported pre-sleep behavioral habits or lack thereof. The variables
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range from behaviors that could promote quality and quantity of sleep and those that would

diminish quality of sleep along with quantity and quality of nightly sleep.

Materials

The materials utilized in this research study consisted of a 15-item Research Survey

HS391 questionnaire created by the authors of this research. The questionnaire consisted of 15-

items categorized in demographic questions, sleep habit/routine questions, and sleep

quantity/quality questions.

Procedure

The procedures for this study consisted of obtaining an authorized email list from the

university. Then an email was sent to 300 individual university student’s email accounts. The

email invite explained that the study was anonymous and voluntary and that by completing and

submitting the survey they were consenting to the information being utilized in the research

study. The recipients were also informed in the instructions that there would be no compensation

for their participation and that the study was part of a Health Science Research Methods class.

Results

In total there were 102 responses to the Research Survey HS391, 11 of the surveys were

not included in the results. Of the 11 excluded surveys, three were excluded due to the surveys

not being completed, and eight were excluded because they were test surveys used to ensure the

online survey was operating properly. In total, 91 survey responses were utilized in the analysis

of the data. The Research Survey HS391 is a 15-item survey that asked questions related to

contributing factors and interventions associated with sleep quality and quantity. During the

analysis of the data, two sub-questions were not utilized due to technical errors which rendered

the data undecipherable.

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The analysis focused on, how habits and routines before sleep affect the quality and

quantity of sleep. The results found that respondents who reported having a nightly sleep routine

also reported higher numbers of hours slept each night. Table 1 shows that those that for those

reported to have a sleep routine reported having an average of 7.260 hours of sleep per night

compared to those that did not have a sleep routine reporting an average of 6.732 hours of sleep

each night. The higher average of hours slept for those reporting to have a pre-sleep routine was

significant (P<.05).

Table 1

ANOVA - On average, how many hours of sleep do you get each night? -
Hours
Sum of Mean
Cases df F p
Squares Square
Do you have a pre-
6.287 1 6.287 4.735 0.032
sleep routine?
Residuals 118.169 89 1.328

Note. Type III Sum of Squares

Descriptive - On average, how many hours of sleep do you get each night? -
Hours
Do you have a pre-
Mean SD N
sleep routine?
No 6.732 1.260 41
Yes 7.260 1.056 50

Table 2 analyzed the relationship between having a pre-sleep routine and reported quality

of sleep. The results show that although there was an increase in the number of days respondents

with a pre-sleep routine reported waking up feeling refreshed and energized. Those that had a

pre-sleep routine reported on average having 2.872 days out of the week that they awake feeling

refreshed and energized. For those that did not have a pre-sleep routine, they reported an average

of 2.179 days out of the week that they awake feeling refreshed and energized. When compared
EXPLORATION OF SLEEP HABITS IMPACT ON SLEEP QUALITY 10

the p-value is larger than 0.05, and we cannot conclude that a significant difference exists

between those that had a pre-sleep routine and those that did not.

Table 2

ANOVA - How many days during the week do you wake up feeling refreshed and
energized? - Days
Cases Sum of Squares df Mean Square F p
Do you have a pre-
10.232 1 10.232 3.424 0.068
sleep routine?
Residuals 250.978 84 2.988
Note. Type III Sum of Squares
Descriptive - How many days during the week do you wake up feeling refreshed and energized?
- Days
Do you have a pre-
Mean SD N
sleep routine?
No 2.179 1.355 39
Yes 2.872 1.985 47

The study sought to identify a variety of potential interventions utilized as a part of

participants' pre-sleep routines. The participants were surveyed on the following seven different

pre-sleep interventions; Take a sleeping supplement/aid; Eat something within an hour before

bed; Turn on/ use background noise/fan; Shower; Read/ use electronics; Exercise; Pray/

meditate. The results indicated that the most reported pre-sleep routine was “Read/use

electronics” with 36 respondents selecting this intervention. The least reported pre-sleep routine

was “Exercise” with 3 respondents selecting this intervention. Table 3 identifies the number of

total yes responses to all seven pre-sleep routine options.

Table 3

If you have a pre-sleep routine, what is your routine?

Intervention Total Yes Responses
Take a sleeping supplement/aid 11
Eat something within an hour before bed 9
Turn on/ use background noise/fan 30
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Shower 9
Read/ use electronics 36
Exercise 3
Pray/ meditate 31

Discussion

The present study examined how habits and routines before sleep affect the quality and

quantity of sleep. The expectation was that those individuals that had pre-sleep routines would

have higher levels of nightly sleep quality and quantity. The results of the study suggest that

there may be a reason to believe that having a pre-sleep routine can improve sleep quantity but

may not have the anticipated impacts on the quality of sleep.

Similarly, to Brown, et al. (2002), this study found that the implementation of a pre-sleep

routine had positive impacts on the participants' reported sleep. Both found that by

implementing a pre-sleep or sleep hygiene routine individuals experienced an increase in hours

slept each night. However, unlike Leonard and Duncan (2020), the use of pre-sleep

interventions did not improve reported sleep quality to a point of statistical significance. This

would leave us to believe that a pre-sleep routine may improve an individual’s quantity of sleep

but may not necessarily impact the quality of their sleep. One reason for this difference might be

due to a confounding variable not accounted for in the design of the study.

Strengths and Weaknesses

A strength of this study was the sample size. We had over 100 responses to the Research

Survey HS391. This was more responses than was anticipated and the increased sample size in

research can help to make the finding more generalizable. Also, the 15-item survey was designed

in a way that, although not all statistically significant findings, the information gained can help to

further research studies in the field of sleep hygiene.

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One of the weaknesses of the study was a lack of control over the variables. The use of a

self-report survey to measure results can bring the validity of the responses into question. By

having the respondent’s self-report, the study is open to the potential for confounding variables

and subject bias. The respondents may be underreporting variables that are present in their

uncontrolled environment that might impact their sleep in positive or negative ways. Also, the

respondents may have answered the survey in a way that they believe would paint them in a

more favorable light, or answer in the way they believe the researcher would want them to.

Future Research

In further research more could be done to explore the impact of specific pre-sleep

routines. Many studies have identified the positive impact interventions have had on sleep

quantity and quality (Paavonen, et al., 2016; Leonard & Duncan, 2020; Kuula, et al., 2020;

Schlarb, et al., 2017; Kawai, et al., 2018.; Knowledge, et al., 2012.; Gipson, et al., 2019.) but

there has not been research done to identify one intervention over another. A study could be

designed with multiple experimental groups that would test out the effectiveness of specific

interventions. The information gathered in this study, found in Table 3, could be utilized for this

future research. Each group would be in a controlled sleep setting and the results of the different

interventions could be compared to each other as well as the control group's results.

This would help to identify the most effective intervention for pre-sleep routines. With

this knowledge education efforts could be implemented to help the public address the growing

issue of sleep deprivation. If sleep deprivation can be addressed with knowledge and/or

interventions, it may lead to lower numbers of physical, mental, and emotional distress that is

often exacerbated by chronic lack of sleep.

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References
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33-8. doi:http://dx.doi.org.byui.idm.oclc.org/10.1080/08964280209596396

Center for Disease Control and Prevention. (2017). Sleep and sleep disorders: Data and statistics.

Retrieved October 24, 2020, from https://www.cdc.gov/sleep/data_statistics.html

Dewald-Kaufmann, J. F., Oort, F. J., Bogels, S. M., & Meijer, A. M. (2013). Why sleep matters:

differences in daytime functioning between adolescents with low and high chronic sleep

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org.byui.idm.oclc.org/10.1080/07448481.2018.1462816

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Appendix

Table 1
ANOVA - On average, how many hours of sleep do you get each night? - Hours
Mean
Cases Sum of Squares df F p
Square
Do you have a pre-sleep
6.287 1 6.287 4.735 0.032
routine?
Residuals 118.169 89 1.328
Note. Type III Sum of Squares
Descriptive - On average, how many hours of sleep do you get each night? - Hours
Do you have a pre-sleep
Mean SD N
routine?
No 6.732 1.260 41
Yes 7.260 1.056 50

Table 2
ANOVA - How many days during the week do you wake up feeling refreshed and
energized? - Days
Cases Sum of Squares df Mean Square F p
Do you have a pre-
10.232 1 10.232 3.424 0.068
sleep routine?
Residuals 250.978 84 2.988
Note. Type III Sum of Squares
Descriptive - How many days during the week do you wake up feeling refreshed and energized?
- Days
Do you have a pre-
Mean SD N
sleep routine?
No 2.179 1.355 39
Yes 2.872 1.985 47

Table 3
If you have a pre-sleep routine, what is your routine?
Intervention Total Yes Responses
Take a sleeping supplement/aid 11
Eat something within an hour before bed 9
Turn on/ use background noise/fan 30
Shower 9
Read/ use electronics 36
Exercise 3