SLEEP PATTERN AND ITS RELATED FACTORS IN RELATION TO COLLEGE STUDENT’S ACADEMIC PERFORMANCE ALMAAREFA COLLEGES, RIYADH, SAUDI ARABIA 2014/2015

* Dr. Mona Hassan, Areen AlHarbi, Asma Mohameden, Aisha NajiMohiuddin, Ghaliah Hamdan Albugami, Hala Ahmed Abuhomoud, Hanan Musa, Israa Mohammed Alammari, Nada Aboalela, Rawan Adel Farhat and Raya Assenay Osman and Razan Badr Alsaad. Medicine Faculty member. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

Objectives:-1. To describe the sleeping patterns of college students. 2. To identify the related factors affecting the sleep patterns. 3. To verify the influence of sleeping patterns on college student's academic performance.
Literature review:-A study was conducted in India by Kagathra in 2012. The subjects were 131 first year medical students. The aim of this study is to know sleep wake pattern in medical student, role of residence and individual characterization on sleep wake cycle. The sleep wake cycle of the students is quite different and characterized by delayed onset, partial sleep deprivation, poor sleep quality, insufficient sleep duration and occurrence of napping episodes during the day. Poor sleep quality in medical student irrespective of residence. They found poor sleep quality and sleep deprivation is more pronounced in evening type of the students and partial compensation found on weekends. Morning type students adjust their life better than evening type and manage their academic schedule. (7) A study of Sleep Patterns and Disorders among University Students which was published in Lebanon by Assaad, this study released in 2014,the aim of this study was to investigate sleep habits and disorders in a population of university students across Lebanon,the study carried out in 2012 among 735 students aged 18-25 years old. Results of this study suggest that sleep problems such as poor sleep quality and less sleep duration among Lebanese college students were common and such problems may interfere with daily. (4) 1263 The study was conducted in the UAE among 105 males and 185 females by Afandi. It was conducted to evaluate the impact of external factors on sleep quality in college students. The study found that the majority of college students suffer from sleep disturbances. College students older than the age of 24 suffered from less sleep disturbances. Users of social networks got less sleep and many ended up sleeping during class. It was also found that sleep deprived students had felt a significant amount of anxiety throughout the day. (8) The study was conducted by Loprinzi in 2011 in USA, Oregon, in the purpose of the study was to examine the association between objectively-measured physical activity and a variety of self-reported sleeping parameters, 3081 adults ranging in age between 18 and 85 were included in the analyses. This study demonstrate a link between regular PA and perceptions of sleepiness during the day, which suggests that participation in PA on a regular basis may positively influence an individual's productivity at work, or in the case of a student, influence their ability to pay attention in class. Increasingly, the scientific evidence is encouraging as regular PA may serve as a nonpharmaceutical alternative to improve sleep. (9) Another study in Portugal in 2002 was performed out of 1150 students by Jose, 150 were chosen and it aimed to find the relationships between sleep, circadian rhythms, and academic performance and the result was that the associations between insufficient sleep duration and lower university grades are understandable in the view of sleep functions. Such findings agree with the supposition that, during sleep, learning and memory consolidation occur. based on the that, we believe that the knowledge about sleep-wake patterns and circadian rhythms may be important for a better understanding of the academic failure/success at the university. (10) Wolfson on 2003 and it discusses the relation between sleep patterns, sleep quality, and school performance. The majority of studies related on self-report. Studies were made on two thousand thirty four college students in the united states to look at sleep/wake patterns and usual grades, school start time and phase preference in relation to sleep habits and quality and academic performance, and the results were erratic sleep/wake schedules, late bed and rise times, and poor sleep quality are negatively associated with academic performance. (11) The objective of the present study, which is by Tyler, was examination of the relationship between sleep and college academic performance; grade point average (cumulative GPA). For the study, 1039 students were recruited from undergraduate psychology classes in Texas during 2006 and 2007. Results indicated that later bed and wake times and increased nap taking were related to lower cumulative GPAs, as were greater variability in bedtimes, wake times, total sleep time, sleep efficiency, sleep onset latency, and napping. Conversely, greater sleep efficiency was significantly related to higher cumulative GPAs. (12) This study was conducted by Flood at Huntingon University, America 2008, on The Impact of Sleepiness Levels on Academic Achievement for College Students. The study was of a sample size of 392 students. The results did not support the hypothesis that sleepiness and GPAs would negatively correlate. The lack of statistical significance between the two variables suggests that a student's GPA is not affected by their sleepiness; therefore, other factors need to be identified that may correlate with low GPA. (13) The study was conducted in Riyadh, Saudi Arabia in 2009 and 2010 by BaHammam. The aim of this study was to assess the relationship between sleep habits and sleep duration with academic performance. The study included 410 students, 115 students (1/3) had "excellent" performance, and 295 students (2/3) had "average" performance. The "average" group had a higher Epworth Sleepiness Scale (to evaluate daytime sleepiness) score and a higher percentage of students who felt sleepy during class. In contrast, the "excellent" group had an earlier bedtime and increased total sleeping time (TST) during weekdays. Subjective feeling of obtaining sufficient sleep was the only independent predictors of "excellent" performance. Decreased nocturnal sleep time, late bedtimes during weekdays and weekends and increased daytime sleepiness are negatively associated with academic performance in medical students. (14) This study, which was conducted by Aabid, was designed to discover a relationship between a healthy sleeping schedule and academic success in the undergraduates in Lahore so that we may be able to encourage medical students to seek healthier sleep habits, by using academic success as motivation. The study was carried out in 2011. 591 students (379 female and 212 male) consented to participate. All students selected were aged between 18 to 23 years. Medical students are subjected to high levels of stress during their academic year that can lead to ISSN: 2320-5407 Int. J. Adv. Res. 5(11), 1261-1272 1265

Results:-
The survey was conducted on 100 female students of AlMaarefa Colleges of Science and Technology. Out of the 100 participants 52% were medicine. 21% were pharmacology, 8% Nursing, 17% Respiratory Therapy, 2%Computer Science as shown in figure below.  45% of the students slept from 6 to 8 hours during weekdays and 30% during weekends, 10% of the students slept more than 8 hours during weekdays, and 66% during weekends. The table above shows the factors affecting sleeping pattern. It has been found that 78% of the students with normal sleeping rarely had nightmares. According to the value of p=0.000012, we can say that nightmares have a relationship with developing disturbed sleeping pattern and are statistically significant. 54% of the students with normal sleeping drank caffeine, whereas 67% of who had normal sleep pattern did not drink caffeine. 66% of the students who had normal sleep pattern watched TV before sleep, whereas 61% didn't. 65% of the students with a normal sleep pattern did not use energy drinks, whereas 56% experienced a disturbed pattern of sleep of those who had it. 75% of the students with a normal sleeping pattern always had naps, therefore we can say that naps are statistically significant according to the value of p=0.0017, whereas 43% developed a disturbed pattern of sleep.
Having caffeinated drinks, watching TV and having energy drinks before sleep don't show any statistical significance but show some variation.

Figure 3:-Sleep patterns in different majors
It was found that 37% of the students experienced disturbed sleep pattern out of which 22% were medical students, 6% pharmacy students, 5% Respiratory therapy students, 2% nursing students and 2% were from the department of computer science. Whereas 63% of students experience a normal pattern of sleep, out of which 30% were medical students, 15% pharmacy students, 12% Respiratory therapy students, 6% nursing students as shown in figure above.  The study showed the relationship between the nature of sleep and the academic performance of the students. 51% who had a continuous sleep had their performances improved. Whereas of those who had interrupted sleep pattern, only 20% had an improved outcome. According to the value of p=0.0014, it shows that the nature of sleep pattern has a direct association with the academic performance, and that it is statistically significant.

Figure 4: Alertness and academic performance
It was found that 70% were alert during classes out of which 31% had their academic performance improved. And it showed that 30% were not alert during classes, out of which 40% had an improved academic performance. However, there's no statistical significance difference.  Total  improved  worse  Same  Continuous sleep  28  23  4  55%  Interrupted sleep  9  33  2  44%  Inapplicable  0  1  0  1%  Total  37  57  6  100% 1269 First group, student whom had GPA more than 3 which is considered as outstanding students making them about 38% , second group are those whom had GPA from 2 to 3 and are considered as average students which makes about 50% , and the last group are students with GPA below 2 and are considered as below average students.  GPA and academic performance  academic_performance  Total  Improved  worse  static  last_term_GPA  Less than 2  0  11  1  12  From 2 to 3  17  31  2  50  More than 3  20  15  3  38  Total  37  57 6 100 The table above shows the relationship between the GPA and the academic performance of the students of the previous term. It shows excellent students (GPA of above 3) had 53% improved academic performance. It was found that there was significant association between academic performance and GPA of the previous term, according to the value of p=0.00365.

Discussion:-
Sleep is a vital necessity for people to conduct normal daily functions and maintain social, mental and physical health. It is also necessary for cognitive functions and memory consolidation, which are important for academic performance and career for college students.
This study has shown the presence of a relationship with minor variations between academic performance and sleep pattern among Almaarefah's college students, which initially supported the main hypothesis. In this study more of those who had an adequate, continuous time of sleep had their Grade point Average (GPA) improved since starting college. While those who had an interrupted type of sleep had their GPA decline since starting college. A recent study in The United States found that college students were at significant risk for having sleep disorders, most notably insomnia, and that those at risk for sleep disorders were performing more incompetently in school [12].
Also this study looked at the factors associated with sleep pattern holistically, such as naps, watching TV, nightmares energy and caffeinated drinks. It showed that more of those who claimed they had naps had normal sleep pattern than those who had disturbed pattern of sleep. Previous studies in USA have shown that less frequent naps have been associated with poor academic performance [12]. Watching TV before bedtime did not show any influence on their sleep patterns; and the same applies for energy and caffeinated drinks. Another study has found that exercise and caffeine consumption were not significant predictors of sleep quality [16].On the other hand, this study showed an evident relationship between nightmares and sleep pattern, for those who suffered from regular and recurrent nightmares displayed a disturbed sleep pattern more than those who had normal sleep.
It had been noticed that most of the students who claimed sleeping for 6-8 hours during weekdays have shown an improved GPA among their peers. While those who either had >6 or <6 hours, have expressed a worsened performance. Also, It has been perceived from the study that students generally sleep more hours ( >8 hours) in the weekends than in the weekdays, and that could be attributed to students recompensing for weekdays' sleep deprivation due to academic stress, anxiety and other psychological and habitual factors that have not been thoroughly studied in this paper. In other studies in USA, students have overwhelmingly stated that emotional and academic stress negatively impacted their sleep [16].Also in a recent study, a decrease in the total sleeping time has been consistently shown to be correlating with lower academic performance [12]. Decreased nocturnal sleep time, late bedtimes during weekdays and weekends and increased daytime sleepiness are negatively associated with academic performance in medical students in a study done in Saudi Arabia [14].
In this study, the first GPA since entering the college was compared to the last semester's GPA to determine if the academic status of the student has improved, worsened or remained the same. Also, two sleep patterns have been perceived from the questionnaire, normal and disturbed. The rest of the results varied from those who remained the same to those who improved. This point does not support the research's hypothesis, for it does not show any consistency with the other findings nor shows any significant relation. It may also suggest factors other than sleep pattern to contribute more markedly on the academic status of the college students in Almaarefah. Previous studies