Introduction
Health is a definitory aspect for the quality of life whether it is physical or mental. Sleep plays an important role in the health of any individual as constant lack of sleep increases the risk of health issues such as obesity, heart disease and diabetes and can have an impact on one’s immune systems, body weight and mental wellbeing (NHS, 2018).
Defining the problem
Students all around the world have hectic sleeping schedules that are usually ever-changing depending on the workload and their social life. It has been well proven that poor sleep habits have been associated with mental health problems in university students (Zochil & Thorsteinsson, 2018). Moreover, a study regarding the academic performance and stress levels in medical students in relation to sleeping patterns showed that adverse sleeping routines (insomnia and excessive daytime sleepiness) are associated with poorer intellectual performances in academia and with stress (Mohammed et al., 2016). Another important social aspect that is present in university students is alcohol consume and drug use. Fucito et al. (2018) showed that young adults who on average drank more heavily slept less and had a delayed sleep cycle, while young adults who thought to have a good sleep, woke up earlier and those who slept for less periods of time, tended to drink more and, similarly, so did young adults who felt more alert upon waking up. Other social and psychological aspects could also be linked to sleep issues. John‐Henderson et al. (2018) shows evidence that adaptation to university life can have a negative impact on the sleep quality in certain individuals. Also, Haghighi and Gerber (2018) found that mental toughness was positively correlated with less frequent sleep issues as well as less burnout and stress and lower anxiety and depressive levels.
The research clearly shows that young people and especially students are at risk when it comes to sleep related issues.
Previous solutions to the problem
Many solutions to poor sleep involve psychotherapy, hypnosis, drugs, but it seems that the domain of sleep technology also offers a wide range of products and is investing in life-changing and cutting-edge technologies with predictions of becoming an 80 billion dollars industry by 2020 (Persistence Market Research, 2015). One of the revolutionary technological products that have been created to offer an alternative for people who would like to improve their sleep are smart beds. Such beds can adjust the firmness of the mattress according to one’s position, regulate feet temperature using embedded heating devices in the mattress, detect snoring and elevate the bed to help breathing and gather information about the users sleep patterns (Sleep Number 360 Smart Bed). Apart from the technological products there are well researched mobile applications with which users can keep track and be more aware of their sleeping schedule. Nguyen (2016) proposes a personalized smartphone application for college students, costumed for the user’s personality and natural inclination towards when they would prefer to sleep or when their energy levels would normally be high. In addition, Stefano et al. (2017) suggests that the cost and the time involved in the diagnosis of the patient regarding sleep disorders are high and proposes a simple wireless device that measures the definitory parameters for sleep disorders through two sensors applied on the body. The results are parsed on a microcontroller and then collected on a smartphone via low energy Bluetooth. Other sleep applications such as Sleep Cycle track the user’s sleep using the phone’s microphone and accelerometer and calculates the sleeping phases of the users in their sleep by analysing movements, sounds or vibrations and finds the optimal time to wake up the user in a predefined time limit. (Comstock, 2017; AppStore, n.d).
Methodology
To collect data, we have conducted 12 interviews among students at the University of Southampton, one student who has just graduated and one student from another university. The mean average age of the participants was 21, with 33% female and 67% male. The interviews were designed as semi-structured interviews as we predefined ten default questions as a guideline and then added more questions subsequently during each interview. Data from an online survey was also collected and analysed along with the interviews. The survey was completed by 38 students. The participants had ages between 18 and 21 years old, representing 15% female and 85% male. All participants were undergraduate students. The quantitative data was designed to aid the analysis of the magnitude of the problem, of the awareness of the students regarding their sleeping problems or general sleep health and to find some possible causes of the problem. The participants were selected by convenience sampling for both the interviews and the survey.
The way analysis of the qualitative data, i.e. the interviews, was conducted was based on the grounded theory which was performed using open coding and axial coding. The data was initially split between the group and then it was colour coded according to the recursive themes that appeared in the sectioned data. The iteration was repeated as a group across all the interviews and homogenous themes were selected and used for axial coding of the qualitative data. To help accurately categorise the themes some categories were previously predefined during the literature review stage and changed accordingly during the coding stage.
Results
The results from the survey shows that there is a discrepancy between the number of people who identified their sleep disturbances and the number of people having problems with their sleep. Only 5 people identified their sleep disturbances, but 29 said they have problems with their sleep every week, 11 of them having problems for 4 – 6 days out of week. The disparity shows that students are not aware of their sleeping problems or their sleep habits. This is further confirmed by the low number of people monitoring their sleep, only 2 students keep track of their sleep.
As mentioned above, the affinity diagram is constructed from the homogenous themes that have arisen across all interviews. The identified themes are strongly related to the original hypothesis of positive correlation between university students and poor sleep quality.
The concept of sleep quality can be clearly subdivided into two categories: factors that contribute to a better sleep and factors that can have a negative impact on sleep and sub-themes from both concepts were identified in the data. Furthermore, the adverse factors can be further categorised into external and internal factors. Some external aspects that were reported by the participants are bad air quality, high room temperature and noise in the surrounding area. Internal factors that have been reported are usually psychological factors or factors that generally depend on the individual such as high stress levels, overthinking and redundant activities such as spending too much time on the internet or on the phone before falling asleep.
On the one hand, oversleeping has been categorised by some participants as a negative factor, reporting that they would feel less energetic after sleeping longer, but also as a positive factor by others who think it is a convenient way to compensate for previous lack of sleep. These findings show that some factors have different outcomes for each person depending on biological or other individual predispositions. On the other hand, people reported that sleep deprivation would lead to headaches, decreased levels of productivity and moodiness. The identified habits that people used to avoid sleep deprivation are noise cancellation, using ear plugs or music, and being in a relaxed environment or relaxing their body or mind.
Relaxation methods or routines that have been endorsed by participants are diverse, depending on everyone’s preferences and personality. One of the techniques that was mentioned by a participant was the army technique (a relaxation method used by the US Army) while others preferred taking a hot shower before going to bed, using a smart alarm to wake them up during the optimal sleeping cycle or having the pillow be colder when going to sleep and warmer when waking up. Some participants reported that having TV shows that they have previously watched running in the background helped them fall asleep.
Moreover, an interesting recurrent theme was that people used different theories that have been proven scientifically to improve their sleep or aid their sleep (the army technique, making up for lost sleep by oversleeping). Some interviewees reported that substance use, especially cannabis, helped their sleep.
Other isolated but nonetheless significant reported reasons for poor sleep was changing of environment (having to start a new academic year) and other general change of habits.
Affinity diagram
Research has shown that even though the passive use of technology (TV, music players) do not have a major impact on the one’s sleep health, there is astrong correlation between the use of more interactive technologies (phone, mobile applications, video games) and sleep problems (Gradisar et al., 2013). Therefore, participants who reported using their phones before sleep in a manner such as: “I usually play video games or check my phone until I feel sleepy enough to go to bed” (Appendix, Interview 8) might be postponing their sleep.
Furthermore, many participants have reported that there are external factors that play an important role in their quality of sleep: disruptive noises, alarms or the way they are being woken up in general, the quality of the air and room temperature. Most of these problems can be reduced with current technology. Other problems included underlying psychosomatic reasons for poor sleep such as stress, overthinking, going through changes in their everyday life or drinking alcohol for the first time. Similar results have been found by Insaf et al. (2012) in a cross-sectional study, researching factors that cause poor sleep in university students.
Lastly, many of the interviewees reported that cannabis use helps them sleep. Research on the topic has shown that daily users tend to report more sleep disturbance than non-daily users (Kurth et al., 2016). Moreover, Bolla et al. (2010) has shown that individuals who reported a discontinuation of cannabis use also reported having more difficulty in sleeping and that users who interrupt the use of cannabis and experience sleep issues may relapse in order to improve their sleep. However, research on this topic is still new and unclear.
Summary of problem
The analysis of the findings from the qualitative and quantitative data combined shows that poor quality sleep is a problem among students either because of external and internal factors or are not aware of what causes sleep problems and do not correctly identify their sleep problems.
Designing Alternatives
Following the information gathered from the analysis of the gathered data, some important aspects related to sleep problems such as lack of comfort, room temperature, disruptive noise, disruptive methods of waking up, general unawareness of the students could be regulated or minimised through technological products. As suggested in our data and in the existing literature, one of the important characteristics of these products should be that they are non-intrusive (Gradisar et al., 2013).
1. The smart alarm
The device is a small, plastic box that wakes up the user using subsonic sound waves at the time set by the user or at the time it calculates to be optimal for your waking up. It should be placed under the pillow or inside the pillow case (Figure 2).
Apart from its feature of being an alarm, it also has an embedded accelerometer that is used to track the user’s movement in their sleep to determine their sleep cycles and calculate the optimal time when the user should wake up. All the data is extracted on an embedded microcontroller and the resulted data is gathered in the mobile application via Bluetooth. Furthermore, the pattern of the sound waves can be set from a variety of options through the connecting app. An on/off button can be used to turn on or off the device and to snooze the alarm a tapping movement can be used. The mobile application has options for the aforementioned features as well (Figure 3). This application meets the specified needs of the interviewed participants as some of them mentioned that they would prefer to be woken up in a non-intrusive way and in a different manner each day. Moreover, the quality of the device of tracking the sleeping patterns of the user should improve their awareness about their sleep.
2. The ear buds
The ear buds are used during sleep to isolate the noise by using noise cancellation. In addition to this feature, the ear buds are wireless, controlled via an app which allows the user to play a wide range of sounds such as white noise sounds or calming sounds like rain sounds, wave sounds or a fire cracking in the fireplace (Figures 4, 5). The ear buds can also be controlled with voice assistance to assist people with disabilities and provide greater accessibility. The product helps the users by trying to remove possible noise existing in the surrounding area, a problem mentioned by most of the interviewees or by creating a relaxing environment with sounds for the users which can help reduce stress levels, another aspect that was reported by interviewed participants to be an impediment when trying to fall asleep.
3. The smart pillow
The product is composed of a water cooler or heater device which is connected to a pad filled with water through a cord (Figure 6). The desired behaviour of the device is that the user’s pillow will already be at some preset temperature when they go to sleep, then during the night the device slowly decreases the temperature to a pre-set minimal by cooling the water inside the pad and finally the device would slowly heat the water inside the pad until it reaches a pre-set higher temperature, optimal for waking up. The starting temperature, minimal and maximal temperatures can be set through the app to which the device is connected but can also be changed manually at any time using the buttons available on the device if the temperature of the pillow does not feel comfortable (Figure 7). The device also releases a scent during the morning when the users has set the pillow to start warming up, preparing the user for waking up. The scents can be bought online and should be placed in a special compartment at the top of the device. The user can change the intensity of the pulverised scents or turn off this feature through the app. The device comes in support of people who find the temperature of the room and especially the temperature of their pillow to be an important factor when sleeping, as many of the interviewed participants have reported. Furthermore, Sleep.org powered by the National Sleep Foundation (n.d.) suggests that there might be specific scents such as citrus or peppermint can boost one’s energy levels.