Insomnia and Related Anxiety Among Medical Students

Elsadig Yousif Mohamed^1*, Salah Ahmed Abdulrahim², Waqas Sami¹, Abdulrahman Nasser Althaqib², Ahmed Abdullah Alzuwayyid², Khalid Abdullah Almutiri², Abdulrahman Musaad AlAbdulmunim² and Khalid Hamed Alhokel²

^*Correspondence: Elsadig Yousif Mohamed, Department of Community Medicine and Public Health, College of Medicine, Majmaah University, Majmaah 11952, Saudi Arabia, Email:

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Introduction

Insomnia is defined as “persistent problems in falling asleep, maintaining sleep, or poor quality of sleep”, it arises as a result of multiple environmental, medical, psychological and mental disorders [1]. Sleep is important for several brain functions, including how neurons communicate with each other. Recent studies stated that sleep plays a housekeeping role that removes toxins in the brain that build up while the person is awake [2]. Sleep deprivation due to work shift may cause disruption in the brain EEG recordings by affecting the biological rhythm [3]. Gumustekin K et al. reported that sleep deprivation may delay wound healing [4].

Many studies demonstrated the effect of short duration of sleep and increased risk of hypertension and acute myocardial infarction [5,6]. In the Nurses’ Health Study, Ayas et al. reported that short or long sleep duration is independently associated with an increased risk of coronary heart diseases [7]. Sleep deprivation can disrupt the autonomic control of heart rhythm and predispose to cardiovascular morbidity and mortality [8], it may also cause sympathovagal imbalances by affecting the biological rhythm due to work shift [9].

Insomnia in youth and adolescence is poorly recognized, under diagnosed and under-treated. Insomnia is considered as a nocturnal disorder that have an impact on individual’s performance during waking time, taking the physical and cognitive functions that sleep usually provides [10,11]. Insomnia related disorder is associated with depressive illnesses and other psychiatric problems and is independent risk factor for suicide and substance abuse [12-16]. The prevalence of insomnia differs with different age and gender. Elderly, female gender and excessive tea consumption is associated with increased risk of insomnia [17,18]. A study conducted in Riyadh; Saudi Arabia revealed a crude prevalence of insomnia as 77.7%. This study showed that insomnia was higher in females (88.7%) than for males (70.4%), and the young age group (64.2%) [19]. According to the results of the National Sleep Foundation, 59% of young adults from 18 to 29 years cannot fall asleep early at night, and not getting enough sleep [20,21]. Short sleep time in the adolescent has many negative somatic, neurodevelopmental and psychological consequences [22-24].

A study conducted on medical students of medical schools in a Saudi Arabia to assess sleep habits during clinical years showed that students acquired an average 5.8 hours of sleep each night, with an average bedtime at 01:53 am. Poor sleep quality was present in 30%, excessive daytime sleepiness (EDS) in 40%, and insomnia symptoms in 33% of the students [25]. Medical students tend to reduce their sleep, in an effort to adjust and cope with their workload and stressful environment and they may not consider sleep as the first priority and some reduce the sleeping time in order to have an extra hours for studying especially before exams [26,27].

Insomnia is becoming a real problem that interferes with students’ performance and predispose to psychological problems. Studying this disorder is vital in order to assist in finding solutions and improving students’ health and academic performance. The objectives of this study were to determine the prevalence of insomnia among students of college of medicine, Majmaah University, Saudi Arabia and to identify the rate of anxiety-related insomnia.

Materials and Methods

The design was cross-sectional to study the prevalence of insomnia among college of medicine students, Majmaah University, Saudi Arabia. All college of Medicine students of both sexes and all levels are included in the study. Students who were not registered for the current semester were excluded. The sample size was 190, taken by simple random sampling using the table of random selection. Data were collected by a pre-tested questionnaire after obtaining ethics approval. The questionnaires consisted of sociodemographic characteristics of the sample along with questions related to insomnia and anxiety. Epworth Sleepiness Scale (ESS) was included in the questionnaire [28]. The State Anxiety Scale (S-Anxiety) was employed for anxiety [29]. Data analysis was done by SPSS version 23. Descriptive statistics was used (frequency and standard deviation). For qualitative data, comparisons between groups were determined using the chi-squared test and p value less than 0.05 was considered as significant.

Results

Table 1 shows the sociodemographic data. There were 145 (76.3%) male and 45 (23.7%) female students. Forty-four (23.2%) students were in level 1, 33 (17.4%) were in level 2, 35 (18.4%) were in level 3, 42 (22.1%) were in level 4, and 36 (18.9%) were in level 5. One hundred and eightyseven (98.4%) of the students were single.

Table 1: Socio-demographic characteristics of the students.

Table 2 shows the prevalence of insomnia among the students of college of medicine. Students with no clinically significant insomnia were 57 (30%). Students with the subthreshold, moderate clinical and severe insomnia were 48.9%, 17.4% and 3.7% respectively. Table 3 shows the characteristic of insomnia. Sixty (31.6%) of the students have no difficulty in falling asleep. Forty-nine (25.8%) have mild difficulty. students with moderate difficulty, severe difficulty and very severe difficulty in falling asleep were 55 (28.9%), 14 (7.4%) and 12 (6.3%) respectively. Seventy-four (38.9%) of the students have no difficulty staying asleep. Mild difficulty presented in 52 (27.4%), moderate difficulty in 44 (23.2%). Students who have severe and very severe difficulty in staying asleep were12 (6.3%) and 8 (4.2%) respectively. In waking early, 52 (27.4%) of students have no problems in waking early, 44 (23.2%) have mild problem, 46 (24.2%) have moderate problem; those who have severe and very severe problem in waking up early were 27 (14.2%) and 21 (11.1%) respectively.

Table 2: Insomnia among college of Medicine students (n=190).

Table 3: Characteristics of insomnia among students.

Thirty-five (50.0%) of students who were insomniacs had mild anxiety. Forty-four (72.1%) and fifty-four (91.5%) who had moderate and severe anxiety had insomnia respectively. The insomnia and anxiety comorbidity data are presented in Table 4.

Table 4: Insomnia and anxiety comorbidity.

Discussion

This research was conducted to study the prevalence of insomnia among college of medicine students, Majmaah University in Saudi Arabia. In general, our result shows that more than 2/3 of the students (70%) are insomniacs. In a study, Sing CY reported a rate of insomnia as 68.6% among Hong Kong college students [15]. In another study, Almojali et al. reported that 76% of students in King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia were insomniac [26]. Al Qahtani MS et al reported a high prevalence (78%.0) of insomnia among students of three medical schools in Riyadh, Saudi Arabia [30]. A high prevalence (86.3%) of poor sleep quality was reported by Haytham I et al who conducted a study among residents in programs supervised by the Saudi Commission for Health Specialties [31]. The reasons behind medical students sleep deprivation may be due to pre-sleep cognitions such as active thinking, worrying, planning, and analyzing problems and issues [32]. Lichstein KL et al. suggested that intrusive cognitions are far more prevalent than somatic factors in creating insomnia [33].

The characteristics of sleep problems was presented as difficulty staying asleep 38.9%, difficulty in falling asleep 31.6% and problems of waking up too early 27.4%. These findings are consistent with Narisawa H et al. and Shen Y et al. [34, 35].

Our results show that students who are insomniac and having severe anxiety were 54 (91.5%), and insomnia prevalence increases as the anxiety increases from mild to moderate to severe (p=< 0.001). These findings agree with previous study conducted in Riyadh, Saudi Arabia. The authors also demonstrated that insufficient sleep and daytime sleepiness can lead to problems in interpersonal relationship, anxiety and depression [36]. Another study done earlier by Ford et al. reported that 40% of those with insomnia and 46.5% of those with hypersomnia had anxiety and others psychiatric disorders compared with 16.4% of those with no sleep complaints [37]. Monti et al. earlier reported an association between sleeping disorders and anxiety [38]. Our study concluded that the prevalence of insomnia among medical students, Majmaah University Saudi Arabia is high. There is a significant association between insomnia and anxiety, more than half of students are complaining of insomnia and anxiety comorbidity.

Acknowledgment

The authors would like to thank the Deanship of Scientific Research, Majmaah University, Saudi Arabia for supporting this research.

Authors Contribution

Proposal development, data collection and writing the drafts of the proposal and the report were done by all the students. Supervision of the work editing and proofreading the manuscript were conducted by Dr. Elsadig Yousif Mohamed and Dr. Salah Ahmed Abdulrahim. Data analysis were done by Dr. Waqas Sami. All authors contributed and approved the final manuscript.

Conflict of Interest

Nil for all authors.

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