Review of Related Literature

To determine the history of our study we used these related literature so that we can understand deeper
the correlation between Sleep quality and Anxiety and over all classroom behavior of students, using
studies from the past like “What is the relationship between anxiety disorders and specific types of sleep
quality complaints in a large epidemiological sample?”, “Is poor sleep associated with increased
functional impairment beyond that explained by anxiety disorders?”, “ How does Sleep quality and
anxiety can affect students and their daily life?” By reading these former studies from several years in the
past we can clearly determine the correlation between Sleep quality and Anxiety and over all classroom
behavior of students.

Mohr et al.,(2003); Alfano et al., (2007) conducted a study to examine the relationship between sleep
quality and functional impairment in anxiety disorders. To date, few studies have examined this
association. However, there is a paucity of information regarding whether certain types of sleep
complaints are associated with specific psychiatric conditions, including anxiety disorders. In addition,
few studies of this nature have taken comorbid depression or substance disorders into account when
investigating the anxiety–insomnia relationship. Both mood disorders and substance use-related disorders
have consistently been linked with sleep complaints and disruption.(p.1) Moreover, Willis & Gregory,
(2015) in technology have facilitated the objective measurement of sleep, the majority of studies
examining associations between sleep and anxiety disorders in pediatric samples have employed
subjective (typically parent-report) measures of sleep quality and sleep related with fewer studies
examining associations between objective measures of sleep-related problems and anxiety disorders.(p.2)

Alfano et al., (2010) findings reveal that sleep function was associated with anxiety-related
symptomatology in childhood, but not adolescence. In addition, contrary to our hypotheses, results of the
current study suggest that relatively increased sleep, rather than decreased sleep, obtained by an objective
measurement of sleep function, is associated with higher anxiety-related symptomatology in childhood,
highlighting increased somnolence in childhood as a potential clinical marker of anxiety symptomatology
onset.(p.2) Study suggests that the association between sleep and anxiety may be age dependent,
longitudinal research is needed to further probe the directionality of this association. Previous research
testing associations between daytime affect and objectively measured sleep quality sheds light on the
bidirectional nature of the relation between sleep quality and symptomatology. Within a sample of
clinically anxious youth, increased negative affect was associated with more time spent awake the
following night (measured by actigraphy), and more time spent awake at night predicted higher levels of
negative affect the following day (Cousins et al., 2011, p.8). Clinicians may wish to modify their
treatment regimen for a given patient if sleep complaints are detected; for example, this could entail
relaxation techniques for a patient who has occasional difficulty falling asleep at night, or the addition of
a hypnotic or cognitive behavioral treatment for insomnia (CBT-I) for patients with moderate to severe
sleep complaints. While there are no formal recommendations for treatment of comorbid sleep problems
in individuals with anxiety disorders at this time, recent data suggest that sleep-focused interventions may
lead to improvement in anxiety disorder symptoms (Pollack et al., 2008; Perlman et al., 2008,p.6).
In essence, going to nearest hospital to check if they have sleep difficulties or anxiety doctors can help
them by doing giving medicines or observing their health. However, we do know that if we cannot go to
hospital in a mean time the anxiety or sleep difficulties can be more dangerous anxiety can get.

I. Individual’s self-satisfaction of the sleep experience and Anxiety Levels in High School Students

This study in Africa looked how often targeted a group of 450 conveniently sampled health professions
students at King Saud Bin Abdulaziz University for Health Sciences (KSAUHS) to collect data pertinent
to the research study. They found out identified that mental illness among university students will have
abundant effects on the individuals. Almojali et al. (2017,p.2.) reported that the combined effects of
psychological variables and poor sleep quality among health professions students are a source for concern
as it may have a negative influence on their personal and academic life. These different psychological
issues should be strictly monitored, controlled and managed as soon as possible in order to prevent these
consequences (Pandey & Chalise, 2017p.2). In addition the significance of health professionals role in
society health give emphasis to the need to pay attention to the potential health risks among students that
can prevent them from making the most of their potential on an individual and professional level.

Ramachandiran & Dhanapal (2018) emphasized that academic stressors generate can pose far-reaching
physical and psychological morbidities around the world. Alias, Mustafa and Hamzah (2020) found that
perceived stressors among young adults entering university life can contribute to psychosomatic disorder
as well as negatively disturb a person’s mental condition and well-being. Ribeiron et al. (2018), results of
systematic review of 13 studies, highlighted the negative association between perceived stress and QoL in
university students, pointing that factors as burnout and depression can maximize this negative
association, deteriorating even more the physical and mental domains of the QoL. Ghrouz et al. (2019)
found that depressive symptoms unfavorably influence the academic performance of students, thus
negative impacting student’s self-esteem, coping skills, and increasing their liability to additional
psychological health problems. Previous studies additionally show that in the advanced stage of
depression, it can lead to nervous breakdown and mental illness (Pandey & Chalise, 2017; Wang et al.,
2020).

The present study futher showed that nursing students had higher sleep disturbances than their colleagues
from UPP and college of medicine. Almojali et al. (2017); Schlarb et al. (2017b) identified common
elements contributing to delay of sleep which included stress related to academic demands (e.g.,
reviewing late at night, working on projects, concerns from exams), relationships, followed by using a
mobile and browsing social networks. Ghrouz et al. (2019) revealed that sleep disorders have traditionally
been seen as a consequence of mental health disorders. Furthermore, Ramachandiran and Dhanapal
(2018) findings show that 88% of the respondents confirmed that studies are the main cause of their
stress, while 78% admitted facing a moderate stress level and out of this, 54% experienced sleeping
disorders. Examining and clarifying the causal relationships between sleep quality and mental health, is
therefore important.
The study of h Amiri et al. (2020); Dinis and Bragança (2018) revealed a significant association between
sleep quality and depression. Among participants with depression, notably, 84.0% had a poor sleep
quality. This was in line with Amiri et al. (2020); Dinis and Bragança (2018) findings that increased
depression was associated with sleep disorders among college students. Further, Dinis and Bragança
(2018) highlighted that despite the strong association between sleep quality, or sleep hygiene, and
depression, the literature is not consensual regarding the direction of this relationship.

The effects of Stress levels on Classroom Behavior

Recent studies by Zhang et al. (2023). That these findings may be related to differences in the research
objects and national culture. In addition, Tokiya and colleagues investigated the association between sleep
and internet addiction in teenagers. Their finding indicated a correlation between the use of electronic
devices and sleep disorders .Electronic devices have integrated into every aspect of life due to
technological advancements.(p.4)

A longitudinal study revealed that sleep disturbance predicted increases in the prevalence of subsequent
anxiety and depression. In addition, the relationship between sleep and mental health problems in
adolescents must be considered in both directions, which anxiety symptoms and depressed mood may be
the most prevalent causes of sleep disturbance. Mental health literacy is defined which “knowledge and
beliefs about mental disorders, which aid their recognition, management or prevention”, it includes being
knowledgeable about the preventive measures, clinical symptoms, treatment of mental disorders, self-
support strategies and others experiencing from mental health status. Growing evidences have shown that
mental disorders can be halted and even reversed by elevating MHL level, particularly for those
adolescents who exhibit depression and anxiety. In the present study, we found that HL and sleep
problems are associated with mental health problems. Namely, low HL and sleep problems are correlated
with the increased prevalence of anxiety symptoms and depressive symptoms. Recent study has
demonstrated that 14.58% of American adolescents (12–15 years) had self-reported sub-clinical
internalizing problems, while 85.42% of them were clinically reported symptoms of depression, overall
anxiety, or a specific anxiety disorder [based on the Screen for Child Anxiety and Related Disorders-
Children (SCARED-C subscales), which include somatic/panic symptoms (e.g., ‘‘When I feel frightened,
it is hard to breathe”), generalized anxiety (‘‘I worry about other people liking me”), separation anxiety
(e.g., ‘‘I get scared if I sleep away from home”), social phobia (e.g., ‘‘I don’t like to be with people I don’t
know well”), and school phobia (e.g., ‘‘I get headaches when I am at school”). In India, 25.5% of 7 904
students reported sadness and hopelessness that are considered as symptoms of depression, 8.6% reported
persistent loneliness, and 7.8% reported insomnia that is related to anxiety. In addition, the prevalence of
all these markers of mental health problems significantly increased with age. The prevalence of
depressive symptoms among 19467 Chinese youths was 14.81%. In the current study, a higher prevalence
of 45.2% was observed, which may be due to different measurement tools. Considering that our
participants were students of combined junior and senior high school, the results are reasonable. Many
studies in China suggested that the students of combined junior and senior high school have more anxiety,
depressive symptoms, interpersonal problems, character flaws, behavior and learning problems, etc., than
normal middle school and high school students. Our results indicated anxiety symptoms and depressive
symptoms were associated with low family economy condition, and non-only child had more anxiety
symptoms, which was similarly reported in previous studies. Zhang et, al (2019 p. 2,6,9).

Impacts of Sleep Deprivation in Senior high School

Recent studies by Perotta et al, (2021) that the sleep disturbances in medical students are higher than in
non-medical students. There are many reasons to the high prevalence of sleep problems in medical
students, including many hours of classes and study, clinical clerkships that include overnight work,
emotional stress, choices concerning lifestyle and many hours using virtual social media. There is
evidence that enough good quality sleep is important for long term learning, for neurocognitive and
psychomotor performance and for physical and mental health. In addition, sleep deprivation in medical
students can make them more vulnerable to depressive and anxiety disorders. Moreover, there are
concerns related to patient safety when health professionals are sleep deprived. (p.1). In relation to partial
sleep deprivation, both the severity of sleep restriction each night and the number of nights sleep was
restricted have generally been lesser than in adult studies. In the current study, we evaluated the effect of
7 nights of partial sleep deprivation on adolescents, seeking to fill gaps left by previous studies. First, we
recruited students from top high schools – the type of students many lay persons expect to transcend the
need for sleep when motivated to attain desired goals. Second, the modest effects of partial sleep
deprivation in prior experiments could have resulted from insufficiently severe sleep restriction compared
to similar studies in adults. (Ong, et al. ,2016,p.2)

Need for further Study

Although these related literatures has somewhat explained the correlation between Sleep quality and
Anxiety and overall students’ performance. However, there is a gap between the literatures on the
relationship Between Sleep quality and Anxiety Level of Senior High School in Crisostomo O. Retes
National High School correlate with their classroom behavior, considering the negative effects of Sleep
quality and anxiety of student’s classroom behavior. To answer this gap, a study should look at how
students' sleep quality and anxiety affect how they behave in class. Researchers could check when
students feel uneasiness. They could also ask both students and teachers to share their observations and
experiences to understand better how anxiety relate to classroom behavior. In addition, researchers could
also look at specific things students do in class, like paying attention, joining discussions, finishing tasks,
and whether they disrupt class. It's also important to consider how students' backgrounds, like how much
their parents no support on their child, might affect their physical, mental health and behavior. They
could explore ways to help students have giving them an advice, like telling what to do or teaching
students having mentally stable is important. Long-term studies could show how anxiety affect students'
grades and behavior over time, giving a clearer picture of how sleep quality and anxiety relates to
classroom behavior of students in Crisostomo O. Retes National High School.

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