Sleep disturbance, mental health, wellbeing and educational impact in UK university students: a mixed methods study

Figures & data

Table 1. Demographic characteristics of total sample and London and South Coast-based cohorts separately.

Demographic characteristic	Total (n = 153)	London based cohort (n = 77)	South Coast based cohort (n = 76)
Gender
Female	128 (84%)	75 (97%)	53 (70%)
Male	24 (16%	1 (1%)	23 (30%)
Other	–	–	–
Prefer not to say	1	1 (1%)	–
Age group (years)
18–24	125 (82%)	68 (88%)	57 (75%)
25–34	20 (13%)	7 (9%)	13 (17%)
35–44	6 (4%)	1 (1%)	5 (7%)
45–54	1 (1%)	–	1 (1%)
≥55	1 (1%)	1 (1%)	–
Year of study
1^st Year	111 (73%)	64 (84%)	47 (62%)
3^rd Year	41 (27%)	12 (16%)	29 (38%)
Living Circumstances***
Student halls (shared bedroom)	1 (1%)	1 (1%)	–
Student halls (private bedroom)	29 (19%)	3 (4%)	26 (34%)
Private rented (shared)	10 (7%)	8 (10%)	2 (3%)
Private rented (private)	35 (23%)	12 (16%	23 (30%)
Living with parents/relatives	68 (44%)	52 (68%)	16 (21%)
Living on own	10 (7%)	1 (1%)	9 (12%)
Employment status
Not working	63 (41%)	19 (46%)	34 (45%)
Working PT (<20 hours)	50 (33%)	10 (24%)	17 (22%)
Working PT (>20 hours)	12 (8%)	3 (7%)	4 (5%)
Working on Uni breaks only	23 (15%)	8 (20%)	19 (25%)
Other	4 (3%)	1 (2%)	2 (3%)

Where frequencies do not equal n, there is missing data.

***p < 0.001 (2-tailed) between London based and South Coast based cohorts.

Table 2. Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scores (ESS) scores for the total sample and London and South Coast-based cohorts separately.

Scale	Total (n = 153) n (%)	London based cohort (n = 77) n (%)	South Coast based cohort (n = 76) n (%)
Pittsburgh Sleep Quality Index (PSQI)
Mean (SD)	7.9 (3.2)	8.1 (3.0)	7.7 (3.5)
Range (0–21)	1–19	3–14	1–19
Global Score
Good sleepers (0–5)	33 (25%)	16 (23%)	17 (27%)
Bad sleepers (6–21)	100 (75%)	54 (77%)	46 (73%)
Subjective sleep quality
Very good	12 (8%)	3 (4%)	9 (12%)
Fairly good	70 (46%)	39 (51%)	31 (41%)
Fairly bad	64 (42%)	34 (44%)	30 (40%)
Very bad	7 (5%)	1 (1%)	6 (8%)
Sleep latency
≤15 min	45 (29%)	18 (23%)	27 (36%)
16–30 min	53 (35%)	28 (26%)	25 (33%)
31–60 min	29 (19%)	16 (21%)	13 (17%)
>60 min	26 (17%)	15 (20%)	11 (15%)
Sleep duration
<5 h	6 (4%)	2 (3%)	4 (6%)
5–5 h 59 min	19 (13%)	8 (11%)	11 (15%)
6–6 h 59 min	66 (45%)	34 (47%)	32 (44%)
≥7 h	55 (38%)	29 (40%)	26 (36%)
Sleep efficiency
>85%	74 (54%)	39 (55%0	35 (54%)
75–84%	31 (23%)	17 (24%)	14 (22%)
65–74%	16 (12%	9 (13%)	7 (11%)
<65%	15 (11%)	6 (9%)	9 (14%)
Use of medication
Not at all	139 (91%)	70 (91%)	69 (91%)
< once per week	7 (5%)	2 (3%)	5 (7%)
1 or 2 times per week	3 (2%)	2 (3%)	1 (1%)
3 or more times per week	4 (3%)	3 (4%)	1 (1%)
Epworth Sleepiness Scale (ESS) scores
Mean (SD)	8.1 (4.5)	8.4 (4.5)	7.8 (4.5)
Range (0–24)	0–21	0–20	0–21
Level of daytime sleepiness
0–5 (Lower normal)	48 (33%)	21 (29%)	27 (37%)
6–10 (Higher normal)	57 (39%)	28 (38%)	29 (40%)
11–12 (Mild excessive daytime sleepiness)	21 (14%)	13 (18%)	8 (11%)
13–15 (Moderate excessive daytime sleepiness)	11 (8%)	6 (8%)	5 (7%)
16–24 (Severe excessive daytime sleepiness)	9 (6%)	5 (7%)	4 (6%)

Where frequencies do not equal n, there is missing data as not all scale items were responded to.

Table 3. PHQ-9 depression, GAD-7 anxiety and WEBWBS scores.

Scale	Total (n = 153) n (%)	London based cohort (n = 77) n (%)	South Coast based cohort (n = 76) n (%)
Depression PHQ-9
Mean (SD)	10.8 (6.4)	11.9 (6.5)*	9.7 (6.2)*
Range (0–27)	0–27	1–27	0–26
Severity of depression
None (0–4)	29 (19%)	12 (16%)	17 (23%)
Mild (5–9)	41 (27%)	19 (25%)	22 (29%)
Moderate (10–14)	42 (28%)	21 (28%)	21 (28%)
Moderately Severe (15–19)	24 (16%)	16 (21%)	8 (11%)
Severe (20–27)	15 (10%)	8 (10%)	7 (9%)
GAD-7 Anxiety
Mean (SD)	9.0 (5.6)	10.4 (5.4)**	7.7 (5.5)**
Range (0–21)	0–21	0–21	0–21
Severity of anxiety
None (0–5)	49 (32%)	19 (25%)	30 (40%)
Mild (6–10)	48 (31%)	21 (27%)	27 (36%)
Moderate (11–15)	31 (20%)	22 (29%)	9 (12%)
Severe (16–21)	25 (16%)	15 (20%)	10 (13%)
Warwick-Edinburgh Mental Wellbeing Scales (WEMWBS)
Mean (SD)	41.1 (10.0)	40.8 (9.9)	41.4 (11.8)
Range (14–70)	14–70	15–61	14–70
Level of mental wellbeing
Low mental health (14–40)	70 (47%)	34 (44%)	36 (49%)
Normal mental health (41–58)	73 (49%)	41 (53%)	32 (43%)
High mental health (59–70)	7 (5%)	1 (1.3%)	6 (8%)

Where frequencies do not equal n, there is missing data as not all scale items were responded to.

*p < 0.05 (2-tailed)

**p < 0.01 (2-tailed)

Table 4. Pearson correlation coefficients between PSQI, ESS, PHQ-9, GAD-7 and WEMWBS scores.

	1 PSQI	2 ESS	3 PHQI	4 GAD-7
1 PSQI
2 ESS	0.437***
3 PHQ-9	0.451***	0.531***
4 GAD-7	0.369***	0.447***	0.738***
5 WEMWBS	−0.285**	−0.335***	−0.622***	−0.502***

***p < 0.001 (2-tailed)

**p < 0.01 (2-tailed)

Table 5. Qualitative findings from the open-ended questions.

Theme	Sub-theme	Example quote
(1) Sleep disruption is a direct strain on students learning capacity and academic performance	1.1 Students productivity levels are at risk (n = 33)	‘When I don’t get a good night’s rest, I wake up feeling less energetic. It’s harder to feel motivated to get out of bed and do the things I have to do during the day, like go to university or work’.
	1.2 Students attention is at risk (n = 63)	‘I’m unable to concentrate on my work or in lectures which means I miss vital information which I would have to catch up on later’.
	1.3 Students attendance is at risk (n = 6)	‘Because I have been getting to sleep really late. I don’t want to get up for my lectures or seminars’
(2) Sleep disruption is a direct strain on student’s mental wellbeing and physical health	2.1 Experiencing complex psychosocial responses (n = 61)	‘If I get a bad night’s sleep it will always affect my mood the next day’.
	2.2 Experiencing physical symptoms of exhaustion (n = 81)	‘I went through a period when I was getting less than 7 hours sleep every night for a few months and my health had never been so bad as it was during that time, I was constantly feeling like I wanted to collapse because I was so tired, I didn’t want to eat, I felt sick and I felt very anxious constantly’.
	2.3 Experiencing irregular sleep management (n = 53)	‘I constantly need sleep. I often feel dizzy or disoriented and need multiple naps during the day just to get basic work done’.
	2.4 The importance of regular sleep and good sleep habits (n = 28)	‘The more sleep the better not just mentally but also physically and spiritually. Sleep relaxes your body and allows the brain to focus on other functions and process all the new info[rmation] learnt that day and keep the body healthy and ready for the next day to absorb more information’.
(3) Sleep preventing factors versus sleep aiding strategies	3.1 Controllable and uncontrollable factors that prevent sleep (n = 20)	‘Most of the time it is a noise that prevents me from falling asleep or wakes me up during the night’.
	3.2 Successful factors that improve sleep (n = 26)	‘This year, I have tried my best to go to sleep at regular times and wake up fairly early even on weekends. My mental health is so much better this year’.

Data availability statement

The data that support the findings of this study are available from the corresponding author [RS], upon reasonable request.