Universiti Malaya students participating in the zumba session during the Jom Tidur campaign to emphasise that exercise can help students get a good night’s sleep.NSTP/ROHANIS SHUKRI

FOR many university students, getting a good night’s sleep is a distant dream. With the mounting assignments, heavy workloads and other engagements, it has become a norm for students to survive on a few hours of sleep.

“I usually go to sleep between 2am and 3am daily,” said Universiti Malaya (UM) Geology student Hazwan Hamizan Azhari, 20, who forfeits sleep for both academic responsibilities and leisure.

“Sometimes I sleep late to watch football. However, recently it is more due to college projects, assignments, and studying.

“If there are tasks that can be done quickly, such as quizzes, I would sleep a little early. But most of the time, my course requires me to carry out tasks that will take a long time to finish, like presentations and reports. So, during that period, I will definitely have to work through the night.”

Being sleep-deprived, Hazwan normally experiences drowsiness during the day. “I usually find myself sleepy and losing focus, but only in certain subjects. After the class is complete, I usually go to the surau to take a nap and catch up on lost sleep.”

However, due to the university’s campaigns, he has become more informed about sleep health.

“UM recently held a Jom Tidur programme to make college students aware of the importance of getting enough sleep,” said Hazwan.

Nur Fatin Sorfina Hanafiah, 21, from the UM Faculty of Medicine usually calls it a night at 12.30am.

“As a medical student, the course does affect my sleeping schedule, especially ever since the fully clinical year started. During the exam week, I have to do revision so I usually sleep later than my normal sleeping time, by two to three hours.”

Fully understanding the repercussions of sleep deprivation, Nur Fatin Sorfina felt like she has no choice but to stay awake to summarise everything that she has learnt for the exam.

“I’m aware that sleep deprivation can affect mental health. I get emotionally unstable and I cannot think straight if I hadn’t had enough sleep the night before. I have experienced micro-sleep before, falling asleep for a few seconds, two to three times a week,” said the third-year medical student.

Final-year Mass Communications student Nur Shafiqah Mohd Safuan, 22, from INTI International College Subang has to sacrifice sleep for extracurricular activities.

“I practise a rigorous form of time management so I don’t have to study at night. However, as the president of INTI International College Subang Student Body, I would have to sleep late to catch up on my work when we are organising activities or events.

“Once, I experienced staying awake for up to 60 hours as I needed to finish an assignment that required a significant amount of commitment. But I don’t always stay up late as I know the value of sleep.”

Nur Shafiqah added that she has experienced the effects of lack of sleep.

“I know that sleep deprivation can affect my health. After a night of little sleep, my body feels physically sore and I function slower mentally. I won’t be able to focus well but I can still get my work done at a slower pace.”

To cope with this problem, she regains her lost hours of sleep by sleeping in during the weekend.

COGNITIVE FUNCTIONS

Sleep problems have become a prevalent issue in society. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), insomnia is stated as one of the most common sleeping disorders in society.

Meanwhile, the National Sleep Survey 2018 by The Nielsen Company revealed that nine out of 10 Malaysians suffer from one or more sleep problems.

Universiti Malaya (UM) Student Health Clinic head and Family Medicine specialist Dr Mohazmi Mohamed said that the problem is also most common among university students.

“Having sleep problems is a significant issue among university students. We’re not talking about one or two students. When we asked them why they couldn’t sleep, the reasons ranged from assignments to video game addiction.”

Sleep plays a role in learning, so students should think twice before skimping on their night time slumber. While students will be able to get some work done by burning the midnight oil, poor sleeping habits can lead to a detrimental impact on their physical and mental health, as well as academic performance.

“In the past, humans were thought to be in a passive state during sleep, but it has been proven otherwise,” said Universiti Malaya Medical Centre (UMMC) psychiatrist Associate Professor Dr Rusdi Abdul Rashid.

“Sleep is an active process which regenerates brain cells and restores bodily functions. It is vital for memory consolidation.

“After studying during the day, students need to have quality sleep to retain the new information that they have learnt,” said Dr Rusdi.

Students acquire information during class and lectures. “The process of memory consolidation, where recent learnt experiences are turned into long-term memory, occurs during sleep through the strengthening of neural connections,” said Dr Rusdi.

He added: “There are four stages of sleep, comprising the Non-REM (rapid eye movement) sleep and REM sleep.”

REM sleep is mostly related to the cognitive benefits of sleep, hence lack of sleep can impair students’ cognitive functioning. “During REM sleep, dreams will occur and memory consolidation takes place. This stage is also important in the acquisition of learned material.

“When students don’t have enough sleep, they would not be able to remember the factual information they have studied,” said Dr Rusdi.

CAUSES

Dr Rusdi said that there are several types of sleep disorders.

“Insomnia is a sleep disorder where one is not able to fall or stay asleep. Another type is sleep apnea which occurs due to obstruction to your airway which is common among obese people.”

There are several main causes of sleep disorders.

Dr Rusdi said: “Students who have sleeping disorders may actually have underlying psychiatric problems such as depression. Having difficulty falling asleep, their sleep duration will be cut short and they will feel lethargic and tired.

“Secondly, sleep deprivation can be caused by a disturbance in the sleep wake cycle. This happens when students don’t have a daily routine or set schedule to sleep.”

A more worrying cause is substance-induced sleep disorder.

“This sleep disorder is caused by the use of alcohol, drugs or medications. As a psychiatrist, I have met students who used drugs, more specifically stimulants such as methamphetamine in order to stay awake to study,” said Dr Rusdi.

INTI International College Subang Counselling and Development Unit (CDU) student counsellor Dhevaania C. Gendsen said: “As a counsellor, it is unfortunate to see many young adults with so much potential complaining about feeling tired and overwhelmed from their very first semester in university.”

Upon further probe, Dhevaania observed that sleep can be disrupted due to the adjustment to college life.

“Students may have difficulties coping with leaving home. This is common among international students or local students from different states. Additionally, independence puts pressure on students to look after themselves.

“For high performing students, the pressure of maintaining good grades can also increase stress, leading to a lack of sleep.”

Students may opt to stay awake all night to prepare for their exams.

“Many students work under the pretext that they will be able to make up their lost sleep by sleeping in during weekends or during a break. Faced with assignment deadlines and exams, the pressure to perform kicks in and students will forgo their sleep to complete their revision — what is commonly known as cramming,” said Dhevaania.

NEGATIVE EFFECTS

Poor sleep can lead to negative health consequences that affect the entire body.

Dr Mohazmi said: “I found that many students have been coming to the clinic complaining of health problems ranging from headaches and heart palpitations. Upon further examination, most of the problems are caused by a lack of sleep.”

Sleep deprivation can also be dangerous as it mounts one’s sleep debt.

Dr Rusdi said: “When people do not get enough sleep for a few days, their sleep debt accumulates. This will lead to extreme sleepiness during the day.

“Extreme exhaustion can lead to micro-sleep — which is a temporary episode where one can fall asleep suddenly for a few seconds.”

Micro-sleep happens when the brain fails to respond to some sensory input and becomes unconscious.

“This is very dangerous as it can cause accidents and injuries or worse, death. It is also highly hazardous to students who have to conduct experiments at the laboratories, work with machines at workshops, or those in the field of medicine.”

Dr Rusdi asserted that mental health issues can also develop from sleep problems. “Sleep deprivation can affect brain activity and may lead to hallucinations and depression,” he said.

Dr Mohazmi added: “There is an increased risk of mental health problems among people with insomnia or those who experience a prolonged lack of sleep. The mental illnesses and symptoms include anxiety and panic attacks.”

Sleep deprivation can take its toll on students’ academic performance, according to Dhevaania.

“One of the challenges faced by universities is absenteeism which is partly due to students suffering from ‘morning tiredness’. They find it challenging to attend classes early in the morning, which causes them to miss lectures and tutorials.

“It can even lead to suspension and barring due to poor attendance. The long-term outcomes include students losing motivation, resulting in low grades or even dropping out from their programme.

“Additionally, it impedes learning as students may have a shorter attention span or even fall asleep during their lessons. Students are unable to focus, which may lead to procrastination,” said Dhevaania.

GETTING HELP

Students who are experiencing sleep problems should seek medical treatment from healthcare professionals.

Dr Rusdi said: “Students can go to any public or private hospitals as we have more than 20 sleep study centres in Malaysia.

“At the hospital, students can meet with professionals, and these include psychiatrists, respiratory and sleep medicine specialists, otorhinolaryngology (ENT) specialists and neurologists. A polysomnography or sleep study will be conducted to diagnose your illness.”

Students can start by visiting their university’s health centre.

Dr Mohazmi said: “UM students can seek help from doctors at the Student Health Clinic or counsellors at the Counselling Unit.

“The Student Health Clinic has organised awareness programmes on the importance of sleep and rest, such as the recent Jom Tidur campaign last month. It comprised an educational talk, activities and booths manned by health organisations such as the Cheras Rehabilitation Hospital and Malaysian Mental Care Association.”

Dr Mohazmi added: “We also try to create a healthy campus culture by emphasising on a healthy diet, exercise and sleep. The faculties and residential colleges need to work together to better coordinate student activities to ensure they have sufficient sleep.”

Dhevaania said that sleep problems should be addressed early on. “INTI International College Subang offers counselling services through CDU to help students address their challenges and improve their quality of life and sleep.

“To improve their circumstances, students must realise that change takes time and that they must also work for it.”

Aside from supporting students who require counselling, CDU also organises relevant activities.

Dhevaania said: “For instance, CDU will host a psycho-education workshop named ‘Transitioning to College’ at the beginning of each semester. We work to improve students’ resilience through workshops on stress management, personal expression, psychological well-being, self-compassion and mindfulness, all of which are correlated to sleep deprivation.

“Recently, we held the Holistic Wellness Week to educate students and make them aware that reaching out for help is not a weakness. It was launched by Subang Jaya assemblywoman Michelle Ng Mei Sze.”

Dhevaania added that concerted efforts from different stakeholders in the university is needed.

“In addition to counselling, INTI students’ performance is monitored closely by the faculty through Blackboard Analytics. This system allows the faculty to assess how well a student is engaging in their studies, and provide early intervention to students who are having challenges coping.

“When students are willing to seek help, it becomes more effective for counsellors to help them make lifestyle changes. This will enable them to manage their studies and improve their quality of sleep.

“This is why even though we have experienced a few cases of sleep problems in INTI, most of the student population are able to balance their sleep and commitments,” said Dhevaania.

In addition to professional help, individuals can start practising good sleep hygiene to attain quality sleep and prevent sleep problems.