Date Presented 04/02/2022
Sleep disturbances may negatively influence an individual’s mental and psychosocial functioning, with higher education students of particular concern while managing daily stress. This exploratory study examined technology-aided interventions for sleep routine establishment, sleep hygiene, a mindfulness app, and a sensory pillow. Findings suggest improvements in sleep quality and sleep hygiene knowledge, no change in perceived stress, and various changes in objective sleep tracking data.
Primary Author and Speaker: Sara Benham
Additional Authors and Speakers: Karlie Brogan, Lauren Brown, Caitlin Gladwell, Christine Neu
Contributing Authors: Nabila Enam
PURPOSE: Higher education students, specifically those enrolled in professional health programs, experience daily stress (Yilmaz et al., 2017), which is related to sleep quality. The occurrence of sleep difficulties may be related to mental health, particularly stress and anxiety with these transitional life changes (Amaral et al., 2017). Sleep preparation focuses on engagement in healthy routines and establishing consistent sleep patterns and environments, which may lead to optimal participation in the occupation of sleep (AOTA, 2020). An exploratory study examined three technology-aided sleep interventions for an adult sample utilizing sleep hygiene education, a meditation app, and the DreamPad sensory pillow, and reported a reduction in wake times throughout the night for the DreamPad group (Gutman et al., 2017). This replicable design may apply to students in higher education programs by addressing stress and quality of sleep, although this has not been examined. Research questions included: Does sleep quality and perceived stress change after two weeks of sleep hygiene, mindfulness practices, and DreamPad pillow use? Other aims included examining pretest to posttest sleep hygiene knowledge changes and tracking objective measures of sleep utilizing a Fitbit.
DESIGN: Exploratory and quantitative design over a three-week time period. Inclusion criteria were first year occupational therapy students, and agreement to download the Headspace app on their smartphone. Exclusions were a history of motion sickness, a diagnosis of anxiety, depression, and/or insomnia, current prescription sleep medications, and pregnancy.
METHOD: The Pittsburgh Sleep Quality Index (PSQI) measured sleep quality, the Perceived Stress Scale (PSS) measured stress, and the Sleep Hygiene Awareness and Practice Scale (SHAPS) measured sleep hygiene knowledge, and were all administered at enrollment (pretest) and posttest, then analyzed using the Wilcoxon signed-rank test. The first week was obtaining baseline Fitbit sleep data, without intervention. The second week included sleep hygiene education, mindfulness practices, and use of a sleep diary. The third week continued with the second week interventions, and additionally integrated the DreamPad pillow. Fitbit data weekly sleep averages were calculated, then analyzed over three time periods using Friedman’s two-way analysis.
RESULTS: For the 8 participants, PSQI changes were significant (p = 0.041) while the PSS changes were not (p = 0.125). The sleep hygiene knowledge (SHK) section of the SHAPS was significant (p = 0.028). Over the three time points of measurement (pretest, after sleep hygiene and mindfulness, and posttest after DreamPad pillow integration), light sleep decreased (p = 0.050), deep sleep decreased (p = 0.028), and REM sleep increased (p = 0.050). At pretest, 75% (n = 6) participants were classified as “poor sleepers” as defined by the PSQI, with two improving to be interpreted as “good sleepers’’ after the three-week study.
CONCLUSION: Our findings support that sleep quality may improve following a program of combined sleep interventions for higher education students. Sleep quality improvement did not appear to be related to changes in perceived stress which were not significant in changes, but relationships should be further explored. Future studies with larger sample sizes and an increased study timeframe may provide more sleep tracking data on deep, light, and REM sleep cycles and how changes in sleep architecture may be related to DreamPad pillow use. This study highlights the importance of sleep interventions for higher education students and the need for comprehensive assessment in order to develop routine establishment plans for positive, individualized sleep hygiene practices.
References
Amaral, A. P., Soares, M. J., Pinto, A. M., Pereira, A. T., Madeira, N., Bos, S. C., ... & Macedo, A. (2018). Sleep difficulties in college students: The role of stress, affect and cognitive processes. Psychiatry Research, 260, 331-337. https://doi.org/10.1016/j.psychres.2017.11.072
American Occupational Therapy Association. (2020). Occupational therapy practice framework: domain and process—fourth edition. American Journal of Occupational Therapy, 74(Supplement 2), 1–87. https://doi.org/10.5014/ajot.2020.74S2001
Gutman, S. A., Gregory, K. A., Sadlier-Brown, M. M., Schlissel, M. A., Schubert, A. M., Westover, L., & Miller, R. C. (2017). Comparative effectiveness of three occupational therapy sleep interventions: A randomized controlled study. OTJR: Occupation, Participation, and Health, 37(1) 5-13. https://doi.org/10.1177%2F1539449216673045
Yilmaz, D., Tanrikulu, F., & Dikmen, Y. (2017). Research on sleep quality and the factors affecting the sleep quality of the nursing students. Current health sciences journal, 43(1), 20. https://doi.org/10.12865/CHSJ.43.01.03
