We thank Quan et al. for their comments and emphatically agree with many of the points raised in the letter.1 College students often obtain insufficient sleep as they sacrifice sleep for employment, socialization, exercise and academic pursuits.2 Indeed, many students are unaware that insufficient sleep, erratic sleep patterns, and overall poor sleep behaviors may have a deleterious impact on grades, learning, mood, risk-taking behavior and overall performance. Sleep education has been shown to increase sleep knowledge and improve some sleep behaviors and thus interventions that encourage healthy sleep behaviors are urgently needed.3,4
We agree that it is time that schools and administrators consider mandatory sleep education for all college students. It is critical that future sleep education programs and related research evaluate the optimal semester timing, content, and potential repetition of these interventions. Sleep education programs may need to be repeated and content tailored to a student's academic program. For example, presentation of material to encourage behavior modification may be different for an 18-year-old undergraduate student as compared to an older student pursing a master's degree. Alcohol and sexual assault material is rarely provided at only one opportunity; it is reasonable to assume that sleep education may also need repetition.
In addition to providing sleep education, universities and colleges need to consider adopting sleep friendly policies such as the following:
Minimize 8:00 am classes. Young adults often have a delayed circadian rhythm and early morning classes assure inadequate sleep.
Decrease late assignment time. As professors have control of assignment deadlines, an early morning assignment deadline may encourage inadequate sleep and all-night study sessions.
Development of college nap locations. As naps may enhance learning, a location for a nap other than the floor, table or cubicle could enhance learning and provide an opportunity for placement of sleep hygiene information.5
Enforced dormitory quiet hours.
Encourage a wellness culture such that sleep deprivation is no longer considered advantageous and as evidence of a strong student work ethic.
Provide adequate sleep education to college health providers, wellness counselors, and health administrators. According to Mindell et al., the average amount of time spent on sleep education during medical school is under 2.5 hours while 27% of medical schools provided no sleep education.6 In discussion with college health providers from the American College Health Association, only 12% had been taught about sleep during their formal education.
College students, as well as the universities and colleges they attend, need to understand the importance sleep. Sleep education and sleep friendly policies should be prioritized to promote healthy and adequate sleep for students.
Sleep to Stay Awake is a free online-education resource owned by the Regents of the University of Michigan and developed by Shelley Hershner. The authors attest to the integrity of the manuscript and have approved the final manuscript. Work for this study was performed at the Department of Neurology, University of Michigan, Ann Arbor, MI. Funding was provided by the Michigan Institute for Clinical and Health Research (MICHR) / Practice Oriented Research Training Program. The authors report no conflicts of interest.
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Quan SF, Ziporyn PS, Czeisler CA. Sleep education for college students: the time is now. J Clin Sleep Med. 2018;14(7):1269
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Quan SF, Ziporyn PS. The impact of an online prematriculation sleep course (Sleep 101) on sleep knowledge and behaviors in college freshmen: a pilot study. Southwest J Pulm Crit Care. 2017;14(4):159–163
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Mindell JA, Bartle A, Abd Wahab N, et al. Sleep education in medical school curriculum: A glimpse across countries. Sleep Med. 2011;12(9):928–931. [PubMed]