Sleep is defined as a behavioral state marked by decreased response to stimuli, diminished consciousness and engagement with the environment, muscle relaxation, and decreased movement (Ahrberg, 2012). It is also a period of high physiological and neurological activity that includes changes in brain activity during the sleep cycle (Haregu, 2015). According to the National Sleep Foundation, adults aged 18 to 64 should obtain 7 to 9 hours of sleep per night (Whiton, 2015). Similarly, the American Academy of Sleep Medicine and the Sleep Research Society recommend that adults should sleep 7 hours or more every night (Hägg, 2015). The National Sleep Foundation advises against sacrificing sleep time for academics or social activities due to its negative consequences, including increased fatigue, impaired psychomotor performance, accidents, poor physical and psychological health, and low academic achievement (Whiton, 2015).
A typical night's sleep, which is 7–8 hours for adults, consists of four to five repeated cycles, each with four stages of sleep. The sleep stages are divided into NREM (non-rapid eye movement) and REM (rapid eye movement) sleep. NREM sleep makes up approximately 75%-80% of the total sleep duration and comprises three stages: NREM 1, NREM 2, and NREM 3 (ASA, 2017). In NREM Stage 1, individuals progress through drowsiness to light sleep, with slowed eye movement, muscle activity, and breathing. NREM Stage 2 involves further reductions in eye movement, muscle activity, and body temperature, as well as disengagement from the external environment. NREM Stage 3 is characterized by deep sleep with no eye movement or muscle activity and slower breathing, making it difficult to wake up. REM sleep, accounting for roughly 20–25% of total sleep time, is marked by rapid eye movements, muscle paralysis, irregular breathing, and vivid dreams (ASA, 2017).
Getting enough sleep is crucial for physical, mental, and emotional health (Johnson, 2014). During sleep, the body repairs and replenishes itself, which is essential for fighting infections, regulating sugar metabolism, and maintaining overall health (Meldrum, 2014). Adequate sleep is also important for academic success and safe functioning in daily activities (Healthy People, 2015). Poor sleep quality negatively impacts students' academic performance, daily activities, and mood, and it has been linked to increased perceived errors among emergency care nurses (Weaver, 2016). Nurses with poor sleep quality are more likely to experience work-related stress and have difficulty coping with life's challenges compared to those with high sleep quality (Ogunsemi, 2017).
Recent research has focused on the subjective quality of sleep across various populations. According to the World Health Organization, around 27% of people globally have sleep problems (Ye, 2015). On school nights, 70% of adolescents get less than 7 hours of sleep on average (Lukowski, 2015). Sleep problems in adolescence can predict long-term issues in adulthood, such as mood disorders, heart disease, and diabetes (Ferreira, 2012). In the United States, it is estimated that between 50 and 70 million people suffer from sleep disorders regularly (Silva, 2016). Studies have shown that a significant percentage of university students in Thailand (48.1%), Tehran (60%), and Saudi Arabia's Jazan University (64.4%) experience poor sleep quality (Lohsoonthorn, 2013; Rezaei, 2018; Manzar, 2015).
Despite the importance of sleep, the public remains largely unaware of its significance, the amount of sleep required, current sleep quality, and the serious health consequences of sleep deprivation (Perry, 2013). Sleep deprivation has both acute and chronic health effects, as well as impacts on the quality and safety of patient care, which university students like the public are often unaware of (Agarwal, 2015). Therefore, this study seeks to explore how student nurses evaluate their sleep quality and the factors that contribute to poor sleep quality.
Problem Statement
Many students have developed problems with sleep, and it is affecting their academic performance. Students develop the notion of sacrificing their sleep to meet deadlines, do assignments, and study for examinations. Other students lose sleep to keep up with recreational activities and gratify their technological needs by connecting with people on social media (Alimirzae, 2014). This lack of sleep affects students negatively as it reduces their quality of life. With every part of their life affected, their academic performance dwindles, and they begin to perform poorly in schoolwork and other activities (Ahrberg, 2012). Student nurses are at risk of experiencing poor sleep quality and consequently sleep deprivation because of their tedious studies and schedules (Agarwal, 2015). The extent to which both student nurses and nurses are affected by sleep deprivation is alarming; sleep deprivation may extend from college years into working years for some nurses and ultimately can lead to errors and unsafe patient care (Thomas, 2017).
The current study seeks to bridge a knowledge vacuum; it is crucial to address poor sleep quality in nursing students since they are at risk of sleep deprivation and making errors that jeopardize the safety of their patients, both as students and after graduation. Many factors cause poor sleep. These factors range from stress to lack of exercise. Among university students, the most common factors associated with poor sleep quality are school work, stress, studying, and homework (Agarwal, 2015). Students were found to be overwhelmed with academic work that they chose to sacrifice their night sleeps to meet deadlines and turn in their assignments. Poor sleep quality has also been associated with depression symptoms, stress, employment, drinking, use of drugs, and smoking (Berhane, 2012). Students who had mental health issues or who abuse drugs also had problems with sleeping well (Stiles, 2013). Additionally, students were deprived of their sleep due to technological distractions (Adams, 2017). Many were preoccupied with cell phones and too involved on social media platforms that they chose to forgo their sleep to their detriment. Other students lost their sleep from the consumption of energy drinks to keep them active and studying all night (Stiles, 2013). Nursing students have reported using substances to stay awake or aid in sleeping, with approximately 85% reporting consuming caffeine to stay awake and 33% using sleep aid medications (Thomas, 2017).
The causes of poor sleep quality also come with numerous effects. Poor sleep in students obstructs higher cognitive functions such as learning, problem-solving, and creativity, which increases the risk of lower grade points, compromised learning, impaired mood, and motor vehicle accidents (Kernan, 2008). All of these cause poorer academic performance, and students who had little or no sleep performed badly in exams. Poor sleep quality has been linked to decreased learning in university and college students (Ahrberg, 2012). Sleep problems and poor sleep quality have been linked to reduced academic performance in nursing students, including fewer study hours and lower marks (Menon, 2015). Poor sleep quality also brings about unhealthy behavior such as the use of alcohol and medications to induce sleep or to compensate (Lund, 2010). The higher consumption of alcohol leads to distortion of cognitive functions and makes it difficult for students to study (Kenney, 2012).
In Ghana, research on sleep quality issues among university nursing students is sparse, and no studies to the researcher's knowledge have been undertaken to address these issues. Although there is a large amount of information evaluating sleep in adults and children, few studies have looked into the prevalence of poor sleep and the factors that influence it among university nursing students. Institutions, educators, and clinicians have an opportunity to learn more about nursing students' understanding of sleep quality and contributing factors so that interventions can be created to minimize sleep deprivation.