SLEEP PATTERNS OF MEDICAL STUDENTS; THEIR RELATIONSHIP WITH ACADEMIC PERFORMANCE: A CROSS SECTIONAL SURVEY

Abstract

Objectives: To identify sleep patterns of medical students and determinethe relationship between sleep habits and academic performance. Background: Humanbeings adopt three different sleeping patterns; monophasic, biphasic and polyphasic. Sleepallows synaptic molding to return by developing faster memory union. When such memoryprocessing is not present, memory keeping is reduced which can have an adverse effecton the academic performance of students. Professional education in the field of medicinerequires learning a greater amount and variety of syllabi to practice as a satisfactory medicalgraduate. Among medical students, the burden of the extensive curriculum often results inthe development of non-recuperative sleeping patterns, which can, in turn, affect their overallacademic performance. This study strives to deduce the sleeping patterns of students and theconnection between those sleeping patterns and academic performance. Study Design: Across-sectional questionnaire based survey. Setting: Jinnah Medical & Dental College, Karachi.Period: 2013. Methods: Sleep patterns of 347 medical students from year 1 -4. The resultsof the midterm examinations were cross-tabulated with the sleep patterns to determine therelationship between them. Results: Our study showed that out of 347 medical students, 38.9%(n=135) had monophasic, 46.7% (n=162) had biphasic and 14.4% (n=50) had a polyphasicsleep pattern. 67.4% of monophasics, 87.0% of biphasics and 66.0% of polyphasics passedtheir midterm examination. Conclusion: Biphasic students performed the best in their midtermexaminations. This is in agreement with scientific proof that sleeping in two phases matchesthe body’s instinctive circadian rhythm, hormonal regulation and memory creation. These twophases are sleeping once at night and having one shorter period during the day. Professionalcolleges should advise and educate students in order to encourage them to acquire adequatesleep through appropriate sleeping patterns by which they may support their academic learning.

Full text

Professional Med J 2015;22(7):919-923. www.theprofesional.com
SLEEP PATTERNS OF MEDICAL STUDENTS
919
The Professional Medical Journal
www.theprofesional.com
SLEEP PATTERNS OF MEDICAL STUDENTS;
THEIR RELATIONSHIP WITH ACADEMIC PERFORMANCE: A
CROSS SECTIONAL SURVEY.
Dr. Zeba Saeed1, Dr. Zainab Hasan2, Dr. Maria Atif
ORIGINAL PROF-2898
ABSTRACT… Objectives: To identify sleep patterns of medical students and determine
the relationship between sleep habits and academic performance. Background: Human
beings adopt three different sleeping patterns; monophasic, biphasic and polyphasic. Sleep
allows synaptic molding to return by developing faster memory union. When such memory
processing is not present, memory keeping is reduced which can have an adverse effect
on the academic performance of students. Professional education in the eld of medicine
requires learning a greater amount and variety of syllabi to practice as a satisfactory medical
graduate. Among medical students, the burden of the extensive curriculum often results in
the development of non-recuperative sleeping patterns, which can, in turn, affect their overall
academic performance. This study strives to deduce the sleeping patterns of students and the
connection between those sleeping patterns and academic performance. Study Design: A
cross-sectional questionnaire based survey. Setting: Jinnah Medical & Dental College, Karachi.
Period: 2013. Methods: Sleep patterns of 347 medical students from year 1 -4. The results
of the midterm examinations were cross-tabulated with the sleep patterns to determine the
relationship between them. Results: Our study showed that out of 347 medical students, 38.9%
(n=135) had monophasic, 46.7% (n=162) had biphasic and 14.4% (n=50) had a polyphasic
sleep pattern. 67.4% of monophasics, 87.0% of biphasics and 66.0% of polyphasics passed
their midterm examination. Conclusion: Biphasic students performed the best in their midterm
examinations. This is in agreement with scientic proof that sleeping in two phases matches
the body’s instinctive circadian rhythm, hormonal regulation and memory creation. These two
phases are sleeping once at night and having one shorter period during the day. Professional
colleges should advise and educate students in order to encourage them to acquire adequate
sleep through appropriate sleeping patterns by which they may support their academic learning.
Key words: Sleep patterns, medical students, academic performance
1. MBBS, MPH
Assistant Professor,
Department of Community Health
Sciences, Jinnah Medical & Dental
College.
2. MBBS, MSc.
Assistant Professor,
Department of Community Health
Sciences, Jinnah Medical & Dental
College.
3. MBBS, MPH
Assistant Professor,
Department of Community Health
Sciences, Jinnah Medical & Dental
College.
Correspondence Address:
Dr. Zeba Saeed
Assistant Professor
Department of Community Health
Sciences, Jinnah Medical & Dental
College, 22-23, Shaheed-e-Millat
Road, Karachi 74800
zebasaeed437@gmail.com
Article received on:
20/04/2015
Accepted for publication:
21/05/2015
Received after proof reading:
09/07/2015
Article Citation: Saeed Z, Hasan Z, Arif M. Sleep patterns of medical students; their relationship
with academic performance: a cross sectional survey. Professional Med J
2015;22(7):919-923.
INTRODUCTION
Sleep is an important, reversible and involuntary
action coupled with repeated periods of time
when the person will be awake. It is a source of
diversion from day to day stress and a state of mind
denoted by a temporary lack of consciousness as
well as reduced vigilance and responsiveness.1,2
There is a large variety of duration of sleep
between species, but for humans, eight hours
of good quality sleep at night is important.
There are three different types of sleep patterns;
monophasic (sleeping once for more than 6 hours
every 24 hours), biphasic (sleeping twice every 24
hours) and polyphasic (taking multiple naps per
day). Szymanski (1920) happened to be one of
the rst to describe “polyphasic” sleep activity.
Sleeping for eight hours a day is considered
adequate by experts with a biphasic pattern being
the healthiest.
Most human beings experience anger, lethargy
and inability to concentrate when in need of
sleep.3,4 Partial sleep impecunious (less than
6 hours of sleep per night) can lead to lack of
attention, attentiveness, rememberance, and
judgemental thinking in a person’s day to day
life. Even students who regularly obtain 8 hours
of sleep per night but shift their sleep schedule
by more than 2 hours may experience attention,

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2
concentration, rationalizing and psychomotor
difculties, as well as increased touchiness,
apprehension, and sadness.5 The sleep-wake
cycle follows a pattern and works in coordination
with other patterns in the human body, for example,
deep body temperature and cellular mitosis.6
Therefore, we inclined to maintain comparatively
non uctuating rourines and sudden changes
in sleep-wake schedules may cause internal
separation among these patterns, which in turn
may cause adverse effects such as dullness or
lethargy, lack of attention, problems in focusing ,
and low performance caliber.
Research in the neurosciences continues to provide
proof that sleep plays a role in the processes
of learning and memory. Combining evidence,
from the molecular to the phenomenological,
undoubtedly conrms that subconscious memory
reprocessing during sleep is an essential part
of how our memories are formed and ultimately
molded.7,8 Therefore sleep has a relevant part
to play in academic learning and memorization.
Alternatively, inadequate sleep and/or irregular
sleeping patterns usually hamper these functions.
Current studies have shown that the type of
sleeping pattern an individual follows has a
substantial impact on the academic performance
of students and their learning abilities. First of all,
poor or inconsistent sleep is often associated
with behavioral and thinking or mental processing
difculties. Secondly, these impairments often
reduce academic achievement and retention.
Finally, this fall in neurocognitive functioning can
easily be reversed by adopting healthy sleep
schedules (xed bedtimes and waking times, no
extended periods of sleep deprivation, etc.)
With regards to the sleep-wake patterns of the
student, the admission of a student at an institute
of higher education is dependant on many
factors that may cause changes in sleep habits,
such as stress of better academic performance,
socialintegrations, and change in sleeping
situations, decrease in parental supervision,
and restless college/university timetables. It is
then easy to understand that, across the years
atinstitution, a lot of students may develop
unhealthy sleep patterns.9 As indicated by the
International Classication of Sleep Disorders
(DCSC, 2001), sleep-wake patterns are usually
followed by unpleasant outcomes during daytime:
reduced levels of motivation, achievement,
ability to focus, awareness and humor, as well
as increase restlessness and lethargy. Hence
it is reasonable to assume that those university
students that develop such sleep patterns may
suffer adverse outcomes in their academic
advancement. However, literature regarding this
particular subject among university students is
hard to nd.10
This study was conducted to ascertain the sleep
pattern of medical students. Furthermore, it
determined the connection between the sleep
patterns and academic performance in a collective
examination conducted within three months of
survey.
MATERIALS AND METHODS
We conducted a questionnaire-based survey of
undergraduate medical students at Jinnah Medical
& Dental College, Karachi, across a timespan of
two months. Students from rst to fourth year
MBBS were included using convenience sampling.
Final year students were excluded due to their
study break. A questionnaire was constructed
which included questions on sleeping pattern,
duration of sleep, problems with recalling and
ability to focus on studies. The questionnaire was
distributed to all 397 enrolled students of these
batches. 347 responders submitted completed
questionnaires through the Student Affairs
Department. Academic performance of students
was evaluated in terms of their performance in
midterm examination which was held within one
month of this survey. Students performance was
measured as Pass (>50% aggregate marks) or
Fail (<50% aggregate marks). Permission to
conduct the study was obtained from the college
administration and Departmental Heads before
the start of study. The participants consent was
obtained and condentiality was assured. Data
was analyzed using SPSS version 16.0 to obtain
descriptive frequencies and cross tabulation of

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sleep patterns with academic performance.
RESULTS
Mean age of the participants was 20±6 months;
male to female ratio was 1:3. Distribution of sleep
patterns is shown in Fig. 1. 50% of the monophasic,
58.2% of biphasic and 32% in polyphasic had
sufcient sleep. 20.4% of monophasic overslept
as compared to 32% of biphasic and 58%
polyphasic, respectively.
Sleep Pattern Academic Performance
Pass Fail
Monophasic 67.4% 32.6%
Biphasic 87.0% 13.0%
Polyphasic 66% 34%
Table-I. Relationship of sleep patterns with academic
performance.
DISCUSSION
Our results show that most students had a
biphasic sleep pattern and most students
with adequate sleep duration had this pattern.
However, they are inclined to oversleep more than
monophasics, but not as much as polyphasics.
Biphasic pattern was also linked with increased
pass percentage, meaning that there were
higher chances of academic improvement. The
second most common pattern happened to be
monophasic; half of the students with this pattern
had sufcient sleep and held the least probability
of oversleeping. The least common pattern was
polyphasic, but these students overslept the
most, which was consistent with insufcient
restful sleep. There was no notable difference
in academic performance between mono and
polyphasic students.
Sufcient sleep duration is necessary for the
best possible performance as it enables medical
students to hold on to information during the
learning process.11 In comparison to other studies,
we observed that the standard requirement for
sleep (6-8hrs) was attained among majority of our
students, indicating difference with other studies
where problems with sleep duration were reported
among medical students.12 Our results were in
line with the research on students in which the
mean sleep duration came out to be 7.7 hours.13
We found that biphasics were able to continue
with ample sleep duration most effectively.
We found that students who sleep enough
are more likely to be biphasics, as compared
to monophasics and polyphasics. Most
possible cause might be recurrent naps among
polyphasics which cause a hurdle in forming a
uniform method and schedule of study. This fact
is also evident in another study conducted with
university students.5 Moreover, our study agreed
with the hypothesis about the importance of rapid
eye movement (REM) sleep and its importance
in memory collection.14 Previous studies showed
that a continuous sleep allows a person to get
the most of REM sleep, therefore a better ability
to remember events. We were able to notice the
same outcome in our students: biphasics had
the most amount of recalling ability. Monophasics
do get a part of REM sleep, but denitely not as
much as biphasics.
As far as polyphasics are concerned, although
they had the highest amount of sleep duration,
however their ability to remember events was
very low, mainly because of absences of constant
REM sleep. In regards to study patterns, it was
noted that a regular study method is benecial
for students as constant reinforcements help in
remembering the events.15
The sleeping pattern of students was not different
Fig-I. Frequency of sleeping patterns

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on the level of sleepiness they have during study,
a nding already proven by a study conducted
in Pakistan, where most of the students reported
day time sleepiness.16,17 We found that students
having a greater amount of recall actually scored
higher in exams in comparision to those who had
a lower level of recall. This nding is idicative of
a direct link of sleeping patterns with academics.
Depending on the ndings of our study we believe
that the knowledge about sleeping patterns may
be essential for a better understanding of the
academic recall at medical colleges, and may be
used to enhance greater success in academics.
For example, information about sufcient sleeping
methods may help student to learn efciently and
with less wastage of resources including time,
effort, energy and motivation.
As a connection between sleep and academic
performance, it was shown18 that students with
more uniform sleep-wake patterns (shorter sleep
inconsistencies, fewer night awakenings, later
school rise times, earlier rise times on weekends)
reported higher GPA, whereas students with lower
grades reported increased daytime drowsiness,
also as a result of shorter sleeping nights.
Some studies in undergraduates pointed out
that non uniformities of 2-4 hours in the sleep-
wake schedules are linked with greater tiredness,
moodiness and lower level of performance, and
that18,19 students with irregular sleeping schedules
had increased daytime lethargy in comparison to
regular class mates .
It is also necessary that students should have
same timings either for going to bed and rising
up in the morning to avoid disturbance of the
patterns inside the body, as this particular pattern
stability leads to better sleep. Good quality of
sleep is therefore important to enable university
students to understand, resolve and retain huge
amounts of knowledge and information during
study.5
However, researchers who have studied
relationships between sleep hygiene and
applications in nonclinical sub groups and overall
sleep standard have produced variable ndings,
may be because of controversial methods.
CONCLUSION
It is concluded from our study that students
following biphasic sleeping pattern have adequate
sleep and improved academic performance than
students following monophasic and polyphasic
sleeping patterns.
Copyright© 18 May, 2015.
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AUTHORSHIP AND CONTRIBUTION DECLARATION
Sr. # Author-s Full Name Contribution to the paper Author=s Signature
1
2
3
Dr. Zeba Saeed
Dr. Zainab Hasan
Dr. Maria Atif
Principal investigator, conception
of design, data collection and
authorship
Data analysis & results, manuscript
preparation and intellectual review.
Literature review and discussion.