Original Article

CME Article: Sleep Patterns and Health Behaviors in Healthcare Students

Authors: Kenneth Nugent MD, Rishi Raj MD, Rebecca Nugent PhD


Objectives: Personal health behavior can influence the academic development of healthcare students. This study was designed to evaluate the personal health behavior, including sleep time, of healthcare students at a large health sciences center.

Methods: An anonymous online survey based on standardized questionnaires about sleep, insomnia, depression, alcohol use, and exercise was sent to all of the healthcare students (including medical, nursing, pharmacy, graduate biomedical science, and allied health students) in the Texas Tech University Health Sciences Center graduate education programs in Lubbock.

Results: In total, 412 students replied to this survey. Their mean sleep duration during the weekday was 7.5 ± 1.2 hours; 16.5% were short sleepers (<7 hours) during weekdays; 33% of the students woke up “feeling tired or worn out” >15 days during the last month. Many students were either moderately or severely bothered by “the lack of energy” because of poor sleep, and 56.6% of students rated their sleep as either fair or poor. Approximately 35% of students had drinking patterns that qualified as hazardous drinking, 6.3% of students smoked, and 23% of students did not do even mild exercise during the week. Eighty-nine percent of students reported stress in their life, including family stress, job stress, financial stress, legal stress, and other stress. Thirty-five percent of students considered their health as either poor or fair. Approximately 50% of students did not expect any change in their situation during the next 3 to 6 months.

Conclusions: Although most healthcare students report adequate sleep times, more than half of them rate their sleep as fair or poor. In addition, some have poor health habits, including excessive alcohol use. Health science centers should introduce programs to promote healthy behaviors and reduce stress in healthcare students.
Posted in: Mental Health10

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Brick CA, Seely DL, Palermo TM. Association between sleep hygiene and sleep quality in medical students. Behav Sleep Med 2010;8:113-121.
2. Silva RMD, Costa ALS, Mussi FC, et al. Health alterations in nursing students after a year from admission to the undergraduate course. Rev Esc Enferm USP 2019;53:e03450.
3. Accreditation Council for Graduate Medical Education. Common Program Requirements. https://www.acgme.org/What-We-Do/Accreditation/Common-Program-Requirements. Accessed April 1, 2019.
4. American Medical Association. Medical student well-being. https://www.ama-assn.org/topics/medical-student-well-being. Accessed April 1, 2019.
5. American Association of Colleges of Nursing. AACN partners with ANA Enterprise to launch student ambassador program https://www.aacnnursing.org/News-Information/Press-Releases/View/ArticleId/23043/Healthy-Nurse-Healthy-Nation. Published January 22, 2019. Accessed July 29, 2019.
6. Santen SA, Holt DB, Kemp JD, et al. Burnout in medical students: examining the prevalence and associated factors. South Med J 2010;103:758-763.
7. Gates R, Musick D, Greenawald M, et al. Evaluating the Burnout-Thriving Index in a multidisciplinary cohort at a large academic medical center. South Med J 2019;112:199-204.
8. Jenkins CD, Stanton BA, Niemcryk SJ, et al. A scale for the estimation of sleep problems in clinical research. J Clin Epidemiol 1988;41:313-321.
9. Buysse DJ, Reynolds CF, 3rd Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213.
10. McKenzie N, Marks I. Quick rating of depressed mood in patients with anxiety disorders. Br J Psychiatry 1999;174:266-269.
11. Bush K, Kivlahan DR, McDonell MB, et al. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med 1998;158:1789-1795.
12. Alberts M, Smets EM, Vercoulen JH, et al. <"Abbreviated fatigue questionnaire": a practical tool in the classification of fatigue]. Ned Tijdschr Geneeskd 1997;141:1526-1530.
13. Godin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci 1985;10:141-146.
14. Buscemi D, Anvari R, Raj R, et al. Characterization of sleep patterns and problems in healthcare workers in a tertiary care hospital. South Med J 2014;107:11-16.
15. Frank E, Carrera JS, Elon L, et al. Basic demographics, health practices, and health status of U.S. medical students. Am J Preventive Med 2006;31:499-505.
16. Ghodasara SL, Davidson MA, Reich MS, et al. Assessing student mental health at the Vanderbilt University School of Medicine. Acad Med 2011;86:116-121.
17. Ball S, Bax A. Self-care in medical education: effectiveness of health-habits interventions for first-year medical students. Acad Med 2002;77:911-917.
18. BaHammam AS, Alaseem AM, Alzakri AA, et al. The relationship between sleep and wake habits and academic performance in medical students: a cross-sectional study. BMC Med Educ 2012;12:61.
19. Ahrberg K, Dresler M, Niedermaier S, et al. The interaction between sleep quality and academic performance. J Psych Res 2012;46:1618-1622.
20. Genzel L, Ahrberg K, Roselli C, et al. Sleep timing is more important than sleep length or quality for medical school performance. Chronobiol Int 2013;30:766-771.
21. Tanaka M, Mizuno K, Fukuda S, et al. Relationships between dietary habits and the prevalence of fatigue in medical students. Nutrition 2008;24:985-989.
22. Tanaka M, Fukuda S, Mizuno K, et al. Stress and coping styles are associated with severe fatigue in medical students. Behav Med 2009;35:87-92.
23. McGrady A, Brennan J, Lynch D, et al. A wellness program for first year medical students. Appl Psychophysiol Biofeedback 2012;37:253-260.
24. Caldwell K, Harrison M, Adams M, et al. Effect of Pilates and taiji quan training on self-efficacy, sleep quality, mood, and physical performance of college students. J Bodyw Mov Ther 2009;13:155-163.
25. Por J, Barriball L, Fitzpatrick J, et al. Emotional intelligence: its relationship to stress, coping, well-being and professional performance in nursing students. Nurse Educ Today 2011;31:855-860.
26. Yüksel A, Bahadir-Yilmaz E. The effect of mentoring program on adjustment to university and ways of coping with stress in nursing students: a quasi-experimental study. Nurse Educ Today 2019;80:52-58.
27. Fliege H, Rose M, Arck P, et al. The Perceived Stress Questionnaire (PSQ) reconsidered: validation and reference values from different clinical and healthy adult samples. Psychosom Med 2005;67:78-88.