Sleep Education for Nursing Students
Yasunori Oka1, Norimi Takata2, Junko Takahashi2
1

Center for Sleep Medicine, Ehime University Hospital2

Department of Nursing, Shikoku University

Abstract

individual difference in behavior patterns (Dietrich, 2016).
Self-administered behavioral approach including sleep

A sleep educational session was conducted with threehealth education has been proposed as a solution as thefourth-year nursing students. The percentages of correctentry step of the intervention (Espie, 2009). Targeting ofanswers to basic sleep quiz items at the beginning andmodifiable behavior provides healthcare professionals anend of the session were 66.6% and 96.7%, respectively.

opportunity to educate college students about the need

Students chose three sleep hygiene intervention targets

for adequate sleep (Owens, 2017).

to improve their sleep. After 1 week of the intervention,
their sleep habits showed improvements such as
extended sleep duration and fixed wake times, which
resulted in decreased sleepiness during the day and arefreshed feeling in the morning.

Objectives
The aims of this study were to conduct an educationalsession on sleep problems targeting fourth-year nursing
school students and to determine how the session affected

Background
Sleep health is important for the maintenance of overall
health and quality of life. Unhealthy sleep behaviors havethe students’sleep behavior.

Methods

been reported among older adolescents and young adults

Seventy-four fourth-year nursing school students

resulting in insufficient sleep and daytime consequenceat Shikoku University were invited to participate in a(Owens, 2014; Forquer, 2008). This is particularly true

survey conducted in August 2019. Students were asked

for college students who are frequently balancing school,

about their interest in joining the sleep educational

work, and social obligations (Owens, 2017). Insufficientsession. Among the forty-three students who returned

sleep in college students has been associated with

the questionnaire (58.1% response rate), six students

inattention, poor academic performance, impaired social

were interested in joining the educational session. Three

relationships, and poor health (Owens, 2014). Collegeof these students, who were studying the midwifery

students may have limited knowledge about sleepcurriculum, attended the sleep educational session in

hygiene to support sleep health, which may lead to poor

September 2019 (Figure 1).

sleep hygiene behavior. Healthcare providers working

Before and after the educational session, the students

with college students have an opportunity to impact

were asked to keep sleep diaries for one week and filled

health behaviors including sleep behaviors.

in the sleep questionnaire with items regarding sleep

The importance of sleep education and sleep hygiene

habits (n = 14) and sleep problems (n = 24). In order tointervention to improve sleep health in this population

elucidate the sleep pattern of students under nursing

has been emphasized, however, systematic reviews

school curriculum, sleep diary recording and the sleep

have indicated that the success of sleep education

education session were conducted when the students

programs has thus far been inconsistent, due to theare under midwifery practicum. A board-certified sleep

lack of tailored approach that allows for evaluation ofspecialist conducted the sleep educational session of 60

大学教育実践ジャーナル 第18号 202021

Yasunori Oka, Norimi Takata, Junko Takahashi

minutes using “Sleep Management” teaching materials

Regarding sleep hygiene, more than two students

provided by H. Tanaka (Hiroshima International

indicated that they had already achieved items 3 (“eatUniversity, Tanaka 2014).

breakfast regularly every morning”), 4 (“keep in touch

At the beginning of the session, the students wereactively with others during the day”), 9 (“avoid going toasked to take a 10-item basic sleep quiz (5 minutes,

bright places such as convenience stores after 9 pm”), 10Table 1). A short lecture about the basics of human(“avoid eating a nighttime snack after dinner”), 13 (“avoidsleep and strategies to improve sleep hygiene was thenwatching TV or reading in bed”), and 14 (“change clothesgiven (20 minutes). The lecture include human sleep

from usual wear to nightwear at bedtime”; Table 2). Morephysiology, favorable and unfavorable sleep hygiene

than two students considered item 11 (“spend some timeand recommendations to improve sleep quality. Aftertaking a bath in lukewarm water”) to be unachievable.

the lecture, the students shared their pre-session sleep

As targets for sleep improvement, all students selecteddiaries and discussed their sleep problems with the sleep

item 6 (“avoid taking a nap after coming home”), twospecialist (10 minutes). The specialist gave each student

students selected item 7 (“avoid drinking caffeinatedindividual comments on her sleep habits (5 minutes). The

beverages after dinner”), and one student each selectedstudents were then asked to rate sleep hygiene items

items 1 (“wake up at a fixed time in the morning”), 2 (“get(Table 2) as “already achieved, ○” “not achieved butenough sunlight after waking up”), 20 (“go to bed whenachievable, △” or “not achievable, ×” based on their

you become sleepy”), and 21 (“avoid delaying your wakecurrent situations (10 minutes). Then, three “not achieved

time by more than 2 hours on holidays”).

but achievable” items were selected for each student as

Student 1 chose items 6, 20, and 21 as sleep

targets to improve sleep hygiene (5 minutes). Finally, theintervention targets. Her sleep diary showed delayedsame sleep quiz was readministered to determine what

bedtime on days with practicum (Figure 2). After thethe students had learned during the session (5 minutes).

sleep educational session, she extended her sleep duration

The results of the two sleep quizzes were compared.

on weekdays and holidays (Table 3), and reduced theThe students’ rating of sleep hygiene items wasnumber of days on which she played games or used theanalyzed. In addition, changes in sleep habits (bedtime,internet before bedtime. Her subjective sleepiness during

waketime and sleep duration) and sleep problems (playthe day decreased after the sleep hygiene intervention.

games or use internet before bedtime, early morning

Student 2 chose items 1, 6, and 7 as sleep intervention

awakenings, unrefreshed feeling in the morning,targets. After the sleep educational session, she tried tosubjective soundness of sleep and sleepiness during thefix her wake time and extended her sleep duration onday) from before to after the sleep education session

weekdays by 1 hour (Table 4). After the sleep education

were described for each student based on the sleepsession, she extended her sleep duration, but some of thequestionnaire filled in by the students. This study wassleep episodes were late in the afternoon (Figure 3). Her

approved by the Institutional Review Board of Shikoku

early morning awakenings and unrefreshed feeling in theUniversity.

morning decreased after the sleep hygiene intervention.
Student 3 chose items 2, 6, and 7 as sleep intervention

Results

targets. Her pre-session sleep diary showed nocturnal
awakening for about 2 hours almost every night.

The students answered 66.6% of items on theAfter the sleep education session, the frequency of hersleep quiz administered at the beginning of the sleep

nocturnal awakening decreased (Figure 4). In addition,

educational session correctly. More than two students

her subjective sleep duration on weekdays increased

provided incorrect answers to questions 2 (“the human(Table 5). After the educational session, she felt that she

body rhythm is not 24 hours”), 8 (“taking a bath inslept more soundly and her sleepiness during the day

lukewarm water can make you sleep better”), and 9 (“itdecreased.

is better to stay lying in bed even if you are not able tofall asleep”; Table 1). The percentage of correct answers
increased to 96.7% on the quiz administered at the end of
the session, with only one student providing an incorrect
answer to question 9.
22Discussion
Nurses must educate patients with medical disorders,
and they need to have sufficient knowledge about sleep.
大学教育実践ジャーナル 第18号 2020

Sleep Education for Nursing Students

In this study, fourth-year nursing students had insufficient

students: A state of the science review with implications forbasic knowledge about sleep. Sleep education to improvepractice”. J Am Assoc Nurse Pract, 29(11), 695-703.

such knowledge in this population is needed, as sleep

Dietrich, SK. (2016) “Effectiveness of sleep education programs

problems are known to cause or worsen a variety of

to improve sleep hygiene and/or sleep quality in college

medical disorders.

students: a systematic review”. JBI Database System Rev

The sleep intervention with “Sleep Management”
educational material used in this study is designed tohelp people try to improve their sleep by choosingintervention targets that they consider to be “achievable”(Tamura, 2016, 2017). Selected targets are issues thatparticipants feel are problematic and that they wish
to improve. Although the intervention period was only
one week, participants in this study showed some
improvement in their behavior and sleep. Although thechange in the sleep habits and sleep problems were
not directly associated with the selected target ofintervention, short term self-administered intervention
showed some improvement in sleep.

Implement Rep, 14(9), 108-134.
Espie, CA. (2009) “Stepped care: A health technology solution
for delivering cognitive behavioral therapy as a first line
insomnia treatment”. Sleep, 32, 1549-1558.
Tanaka, H. (2014) “Sleep and health promotion for the elderly”.
Stress Science Research, 29, 10-19 (Japanese).
Tamura, N. (2016) “Effects of a sleep education programwith self-help treatment on sleeping patterns and daytime
sleepiness in Japanese adolescents: A cluster randomizedtrial”. Chronobiol Int, 33(8), 1073-85.
Tamura, N. (2017) “Effects of sleep management with self-help
treatment for the Japanese elderly with chronic insomnia: aquasi-experimental study”. J Behav Med, 40(4), 659-668
Martin, JL. (2017) “A Four-Session Sleep Intervention

The limitation of the study was that sleep diary

Program Improves Sleep for Older Adult Day Health Care

recording and the sleep education session were conductedParticipants: Results of a Randomized Controlled Trial”.

when the students are under midwifery practicum.

Sleep 40(8), zsx079.

Irregular practicum schedule affected their sleepschedule. In addition, the sleep education session wasconducted only once. The need for continuous or repeatedsleep intervention for the long-term improvement of sleep
has been emphasized (Martin, 2017). To enable nursing
students to gain sufficient knowledge about sleep earlier,and to acquire good sleep hygiene and health outcomes,
sleep interventions for this population need to be initiatedearlier and offered continuously.

Conclusion
A sleep educational session with a short-term sleep
hygiene intervention improved the sleep behavior ofnursing students and resulted in some improvements insleep and daytime symptoms. The effects of continuous
sleep improvement efforts need to be evaluated.

References
Owens, JA. (2014) “Insufficient sleep in adolescents and young
adults: An update on causes and consequences”. Peditrics,134(3), e921-932.
Forquer, LM. (2008) “Sleep patterns of college students at apublic university”. Journal of American College Health, 56,563-565.
Owens, H. (2017) “Sleep behaviors in traditional-age college

大学教育実践ジャーナル 第18号 202023

Yasunori Oka, Norimi Takata, Junko Takahashi
Table 1. Sleep quiz items and numbers of correct answers
If you think the sentence is correct, mark“O”; if you think it is incorrect, mark“X”.

Question (correct answer)
1.

Pre-Post-

sessionsession2

3

There is a relationship between sleep and obesity. (O)2.

The human body rhythm is not 24 hours. (O)

0

3

3.

It is better to not open the curtain soon after waking up. (X)3

3

It is better to sleep if you are sleepy after coming home in the

3

3

3

3

4.

late afternoon. (X)5.

It is better to sleep until the afternoon on holidays. (X)6.

The body temperature is elevated while sleeping. (X)

2

3

7.

Using a cellphone in bed makes you sleep better. (X)

3

3

8.

Taking a bath in lukewarm water will make you sleep better. (O)13

9.

It is better to stay lying in bed even if you are not able to02

3

3

fall asleep. (X)10.

It is better not to go to bright places such as convenience
stores before bedtime. (O)Table 2. Sleep hygiene items and numbers of student responses〇△×1.

Wake up at a fixed time in the morning.

1

20

2.

Get enough sunlight after waking up.

1

203.

Eat breakfast regularly every morning.

2104.

Keep in touch actively with others during the day.

2105.

Enjoy hobbies and group activities actively.

1116.

Avoid taking a nap after coming home.

0307.

Avoid drinking caffeinated beverages after dinner.

1208.

Finish taking meals two hours before bedtime.

0309.

Avoid going to bright places such as convenience stores after 9 pm.

30010.

Avoid eating a nighttime snack after dinner.

21011.

Spend some time taking a bath in lukewarm water.

01212.

Keep the cellphone away from the bed or turn it off at bedtime.

02113.

Avoid watching TV or reading in bed.

21014.

Change clothes from usual wear to nightwear at bedtime.

30015.

Make your bedroom a comfortable space.

12016.

Try to relax your brain and body before bedtime.

03017.

Avoid irregular bedtimes.

03018.

Go to bed before midnight (12 pm).

03019.

Avoid worrying about things in bed.

02120.

Go to bed when you become sleepy.

03021.

Avoid delaying your wake time for more than 2 hours on holidays.

12022.

Avoid irregular sleep durations.

020

Note: Students were asked to rate the items based on their current situations; 〇 , already achieved; △ , not achieved but achievable; × , notachievable.

24

大学教育実践ジャーナル 第18号 2020

Sleep Education for Nursing Students
Table 3. Student 1’s sleep habits before and after the sleep educational session

Pre-session

Post-session

Bedtime on weekdays

24:00

24:00

Bedtime on holidays

24:00

24:00

Wake time on weekdays

7:50

8:00

Wake time on holidays

8:30

9:00

Sleep duration on weekdays

6 hours

7 hours

Sleep duration on holidays

7 hours

8 hours

Table 4. Student 2’s sleep habits before and after the sleep educational session

Pre-session

Post-session

Bedtime on weekdays

24:00

24:00

Bedtime on holidays

24:00

25:00

Wake time on weekdays

4:00

5:00

Wake time on holidays

5:00

6:00

Sleep duration on weekdays

4 hours

5 hours

Sleep duration on holidays

5 hours

5 hours

Table 5. Student 3’s sleep habits before and after the sleep educational session

Pre-session

Post-session

Bedtime on weekdays

24:00

24:00

Bedtime on holidays

24:0024:00

Wake time on weekdays

5:00

7:00

Wake time on holidays

9:00

9:00

Sleep duration on weekdays (hours)

5 hours

7 hours

Sleep duration on holidays (hours)

9 hours

9 hours

Figure 1. Diagram of Study Design and Participants

Number of participant of the study and the timing of evaluation before and after sleep education session.

大学教育実践ジャーナル 第18号 202025

Yasunori Oka, Norimi Takata, Junko Takahashi

Figure 2. Student 1’s sleep diary before and after the sleep educational session
Delayed bedtime on days with practicum.

Figure 3. Student 2’s sleep diary before and after the sleep educational session
Sleep duration was extended after the sleep education session, but some of the sleep episodes were in the afternoon.

26

大学教育実践ジャーナル 第18号 2020

Sleep Education for Nursing Students

Figure 4. Student 3’s sleep diary before and after the sleep educational session
Awakening in the middle of the night was less prominent after the session.

大学教育実践ジャーナル 第18号 202027