AN INVESTIGATION OF THE PREVALENCE OF INSOMNIA IN

COLLEGE STUDENTS AND ITS RELATIONSHIP TO TRAIT ANXIETY

MICAH R. SADIGH, PH.D. Cedar Crest College
SHARONA. HIMMANEN, Pn.D. Cedar Crest College
JAMES A, SCEPANSKY, PH.D. Cedar Crest College
A number of empirical studies have established that insomnia, poor or inefficient sleep, can significantly impact
physical and psychological well-being of college students, as well as interfere with their academic success. A
major contributor to the experience of insomnia is that of persistent anxiety. In this study, we investigated the
prevalence of insomnia in first-year college students, and explored the correlation between insomnia and trait
anxiety. Data revealed a significant prevalence of insomnia in our sample (N = 100). There was also a strong
correlation between trait anxiety and insomnia, in addition to a strong correlation between sleep-onset latency
(e.g., pre-sleep experience) and sleep quality (e.g., post-sleep experience). Implications of the findings in
addition to suggestions for improving students' sleep hygiene and quality are discussed.
Keywords: sleep, insomnia, college students, anxiety, trait anxiety

Recent studies have suggested that as many as 70 percent of college students qualify as sleep deprived
(Hicks & Pellegrini, 2001; KIoss, Nash, Horsey, & Taylor, 2011). A lack of quality sleep can significantly
affect students' physical and cognitive functioning, particularly in terms of information processing, and
difficulties with concentration and recall (Backhaus et al., 2006). In a true sense, many students may be
compromising their education and inadvertently sabotaging their future by not paying enough attention to
their need for quality and restorative sleep. Those who do recognize the importance of proper sleep
hygiene may not have the resources to address this problem, and may end up relying on ineffective, if not
potentially harmful, approaches, such as abusing prescription and non-prescription medications. The
relationship between insomnia, academic performance, and quality of health cannot be overestimated
(Lund, Reider, Whiting, & Pichard, 2010).
Insomnia is a complex, behavioral and psychophysiological phenomenon that has various, measureable
manifestations. Based on the diagnostic criteria of DSM-5 (American Psychiatric Association, 2013),
insomnia may have three often independent, and at times interdependent, presentations. These may be
referred to as sleep-onset latency insomnia, sleep maintenance insomnia, and sleep quality insomnia.
Although a variety of instruments and inventories for the assessment of sleep disorders are available for
experimental and clinical investigations, none of these instruments specifically focus on insomnia in
college students. For this reason, an original instrument (The College Student Sleep Assessment Inventory;
see Appendix) was developed to investigate the manifestations of the various dimensions of insomnia on
three independent scales. A fourth scale explores the use of a variety of sleep enhancement interventions
that may be employed by students (Sadigh, 2012a).
Anxiety is a major contributor to a variety of sleep disorders that may compromise sleep quality. JanssonFrojmark and Lind-blom (2008) found a close link between anxiety, depression, and insomnia. College life
is fraught with the experience of anxiety in different forms, such as test anxiety, performance anxiety,
anticipatory anxiety, etc. Often times, students may rely on ineffective or maladaptive interventions to
address their anxiety, which my invariably affect their ability to benefit from restorative sleep. Hence, it is
only prudent to explore the impact of persistent anxiety on sleep. A commonly used instrument that
measures anxiety on two dimensions of state and trait anxiety is that of the State-Trait Anxiety inventory
(Spielberger, 1983), This is a validated instrument that can be administered and scored in a short span of
time.
The purpose of this study was to investigate the prevalence of insomnia in first-year college students.
Additionally, the study explored the relationship between insomnia and trait anxiety.
Method Participants

One hundred first-year, female college students (N= 100) were recruited to participate in a study of
college student sleep habits. The median age of the participants was 18, and the range was 18-20.
Data collection occurred at the beginning of the semester.

Materials and Procedures

The College Student Sleep Assessment Inventory (TCSSI) (Sadigh, 2012a), and the State-Trait
Anxiety Inventory (STAT) (Spiel-berger, 1983) were implemented for data collection. The TCSSAI is
a 30-item inventory, consisting of 4 scales, that asks respondents to indicate frequency of
behavior/feelings in four areas of sleep hygiene: pre-sleep experience (e.g., "I often think of things
than have happened in the past"), sleep experience (e.g., "I wake up frequently during the night"),
post-sleep experience (e.g., "I have a difficult time getting out of bed"), and pre-sleep routine (e.g., "I
normally snack before going to bed"). The first three parameters are consistent with sleep onset
latency, sleep maintenance, and sleep quality. The pre-sleep routine data are meaningful mainly for
long term use of the instrument, which was not the focus of the present study. Hence, we only focused
on pre-sleep experience, sleep experience, and post-sleep experience scales.
All responses were made using a 10-point scale anchored by "Never" and "Always," High scores
reflect less adaptive sleep related behavior. In addition, the instrument requested basic demographic
information (e.g., age, weight, academic rank) as well as student identification number (for tracking
purposes). The State-Trait Anxiety Inventory (Spielberg-er, 1983) assesses two distinct dimensions of
anxiety, state and trait. For the purpose of this study, we only used the trait scale (i.e., dispositional
tendencies, consisting of 20 items, such as: "I worry too much over something that really doesn't matter").
Results
Only participants who answered all questions on both the TCSSI and the STAI were included in the data
set (N= 100). The overall score on the TCSSI, calculated by adding the responses for questions 1 through
30 for each participant for a possible score of 300, positively correlated with scores on the STAI,
r(98)=.60,j0<,0001.
The TCSSI was also divided into four subscales, the Pre-Sleep Experience scale (questions 1 through 10,
100 points), the Sleep Experience scale (questions 11 through 17, 70 points), the Post-Sleep Experience
scale (questions 18 through 24, 70 points), and the Pre-Sleep Routine scale (questions 25 through 30, 60
points). Participants' score on each subscale were calculated by summing the numerical values of their
responses (0 = "never"; 10 = "always) to the appropriate questions for each subscale. The median score for
the Pre-Sleep Experience subscale was 42 (Range = 55); the median score for the Sleep Experience
subscale was 26.5 (Range = 57); and the median score for the Post-Sleep
Figure 1. Grouped frequency distribution for the Pre-Sleep Experience subscale of the TCSSI (N = 100).
(GAMBAR1)
Experience subscale was 32 (Range = 56), Figures 1, 2, and 3 show the distribution of total scores for the
Pre-Sieep Experience scale, the Sleep Experience scale, and the Post-Sleep scale, respectively. Figure 4
shows the distribution of STAI scores (trait anxiety). Total scores for the Pre-Sleep Experience subscale
positively correlated with scores on the Sleep Experience subscale [H98) = .2975, p < .003], the PostSleep Experience subscale [r(98) = 0.4986, p < .0001], and the STAI, r(98) = .5675, p< .0001. Scores on
the Sleep
Figure 2. Grouped frequency distribution for the Sleep Experience subscale of the TCSSI (N = 100).
(GAMBAR2)

Experience subscale positively correlated with scores on the Post-Sleep Experience subscale [r(98) = .
3825, p < .0001] and the STAI [r(98) = .372, p < ,0001], Scores on the Post-Sleep Experience subscale
positively correlated with scores on the STAI, [r(98) = .5074, p<, 0001].
Figure 4. The distribution of scores on the Trait STAI (N = 100).
(GAMBAR4)

Conclusions

College life, particularly for first-year students, is fraught with stressors that are bound to affect rest and
much needed restorative sleep, which may in turn compromise students' health and academic performance.
The purpose of the current study was to investigate the prevalence of insomnia in first-year, female college
students. We also explored the correlation between insomnia and trait anxiety. The findings suggested that
there was a significant prevalence of insomnia in our sample of 100 students. Specifically, our data
revealed that nearly 50% of the participants reported difficulty in falling asleep, maintaining sleep, and
experiencing quality sleep. This is consistent with the findings of Lund, Reider, Whiting, and Prichard
(2010), who found that over 60% of their sample of over one thousand students suffered from insomnia
and were considered as "poor quality sleepers." These authors concluded that insufficient and poor sleep is
reaching disquieting rates within the college student population in the United States.
Additionally, our findings revealed a strong correlation between trait anxiety and sleep at the three levels
of: pre-sleep experience, sleep experience, post-sleep experience. The role of anxiety as a major
contributor to the experience of insomnia has been explored in previous studies (i.e., Johnson, Roth, &
Breslau, 2006). Our data adds additional credence to such a formulation, particularly as far as a
predilection for persistent anxiety (e.g., trait anxiety) is concerned. More specifically, our findings
suggested that those students with high trait anxiety tended to suffer more from disturbed, and poor quality
sleep as compared to those students with lower levels of trait anxiety.
Finally, our study showed a significant positive correlation between pre-sleep experience (e.g., sleep-onset
latency) and post-sleep experience (e.g., sleep quality). This is an important finding that has practical
implications and is germane to developing proper sleep enhancement interventions. Since for those
participants who spend a longer time falling asleep there is a reduction in sleep quality, one can propose
that by shorting the sleep onset latency, chances are that we may be able to enhance their sleep quality. One
way of addressing this problem is by employing a variety of cognitive and behavioral interventions that
purport to reduce the tune necessary to initiate sleep. Both anxiety and rumination have been found to be
major contributors to a delay in initiating sleep. Zoccola, Dickerson, and Lam (2009) found a strong
correlation between rumination and sleep onset latency. While rumination has to do with cognitive activity
due to past experiences and stressors, such as the events or activities of the previous day, cognitive anxiety,
in particular, suggests thinking or worrying about potential future events (Watts, Coyle, & East, 1994;
Harvey, Tang, & Browning, 2005), There is ample empirical data demonstrating the effectiveness of a
variety of techniques for reducing excessive cognitive activity that could interfere with proper sleep
(Edinger, Wohlgemuth, Radtke, Marsh, & Quillian, 2001).
Morin (2004) stated that in its very essence, insomnia is the consequence of "maladaptive behaviors" that
if not properly addressed, may result in long term health-related complications, Maladaptive behaviors
may be defined as those behaviors that may initially bring about some desirable outcomes, but inevitably,
and in the long run, they cause far more enduring complications. For example, watching television, or
playing games on a laptop or a smart phone while in bed may be initially considered as methods of
"relaxation" for the purpose of promoting sleep. Such behaviors, indeed, can inadvertently create and
reinforce associations that will in time interfere with initiating sleep. Going to bed, for example, may
become associated with playing games, engaging in social media interactions, etc., all of which will
compromise quality sleep by increasing arousal. To remedy this, new and proper associations need to be
formed.
From a behavioral perspective, stimulus control and sleep restriction strategies have shown to be effective
in improving overall sleep. Such strategies, for example, include going to bed only when one is sleepy,
waking up at the same time in the morning, avoiding naps, avoiding excessive time in bed especially when
one is not able to initiate sleep, etc. Such behavioral approaches have shown to be particularly effective in
improving problems with sleep-onset latency (Edinger et al., 2001), a concern which was particularly
prevalent in our sample. Other methods of reducing somatic tension and cognitive anxiety may include
relaxation-meditative techniques, cognitive refraining, and other methods of reducing excessive thinking
(Sadigh, 2012b). Finally, cognitive and behavioral strategies for sleep enhancement have found to be
superior to pharmacological interventions, particularly as far as primary insomnia is concerned (e.g.,
Sivertsen et al., 2006).

Two obvious limitations of our study are the relatively small sample size, as well as the exclusive inclusion
of first-year student participants. While these may limit the gen-eralizability of the findings, nevertheless,
the findings clearly suggest a need for further investigations, as insomnia can significantly affect college
students' health and academic performance.
Based on our findings, it is imperative to address the problem of ineffective and inadequate sleep in the
college student population as soon as possible, perhaps at the beginning of their college career as it can
compromise their health and academic performance in years to come. The importance of quality sleep on
the health and wellbeing of college students cannot be overestimated. There is simply too much at stake
and there is now enough data to guide us in terms of proper interventions that could bring about
meaningful changes in students' sleep quality. One of the key findings of our study was that of a strong
correlation between trait anxiety and sleep. Screening tools such as the trait scale of the STAI may be used
to determine early on during students' college career whether they are suffering from elevated and
persistent anxiety. These students, in particular, may be good candidates for educational and experiential
strategies that have consistently demonstrated their effectiveness in enhancing sleep. Finally, proper
education about the functions of sleep and the need for proper sleep hygiene (see American Academy of
Sleep Medicine, 2004) should be included in the college orientation programs, and workshops which focus
on preparing students for their college journey.