A protocol study on assessment of sleep cycle pattern, quality, and its determinant among Young Adults in an urban area of Wardha.

Introduction

Sleep is essential for maintaining life and growing a healthy brain. A “sleep deprivation epidemic” among humans has drawn increasing attention from the public and scientists.¹ Only 21% of the 17,040 participants in the ResMed-commissioned study who completed online surveys from Atomik Research in India (5004), Korea, Japan, China, Mexico, and Brazil stated that they felt rested when they woke up in the morning. The majority of the participants reported having difficulty getting enough sleep or having poor-quality sleep.² The three pillars of health are frequently regarded as sleep, exercise, and food.³ In India, 81% agreed that poor sleeping habits could reduce one’s quality of life and that immunity is maintained by getting enough sleep; 53% tried to increase their sleep-in to address this. Sleep issues were also associated with mood fluctuations (24%), trouble concentrating during the day, and daytime fatigue 21%.²

External factors like early school start times, bedroom conditions (such as noise, excessive temperatures, or too much light), and access to electronic media are all likely related to or made worse by poor sleep.⁴ Poor sleep may be impacted negatively by psychological and physiological changes that occur in adolescence, but it may also be related to or made worse by these outside causes.⁴ Insufficiency of sleep is associated with lower life satisfaction, weight gain, and an increased risk of myocardial infarction, anxiety, and depressive disorders.³ Despite the benefits of getting enough good-quality sleep, sleep concerns are rarely given priority in today’s 24/7 world.³ It should be noted that men and women have different propensities for using inhalants. Additionally, the research shows that female are more likely than male to experience anxiety and despair.³ According to estimates, one-third of the world’s population suffers from sleep disorders, especially insomnia, which affects women and elderly more frequently than males because of stressful jobs and ageing.^5,6 Negative emotions are linked to poor sleep, which may influence emotional eating (EE). A recent review discovered a possible mutual relationship between getting enough sleep and eating fruits and vegetables (FV). Although a few research has examined this association in humans, the reviewed data permitted the possibility that consuming (Fruit and Vegetable) FV sources of melatonin would enhance sleep quality, according to the scientists.⁷

Sleep is not a passive experience. While you sleep, the brain’s activity changes normally throughout the night. Non-rapid-eye-movement (NREM) sleep and rapid-eye-movement (REM) sleep are the two basic categories these patterns fall into.⁸ N1, N2, and N3 are the three unique stages of NREM sleep. The brain waves throughout these stages get bigger and slower as they go. N1 sleep is the lightest stage of sleep, N2 sleep is slightly deeper, and N3 sleep, also known as slow-wave sleep, is the deepest stage of NREM sleep.⁸ It is thought that REM sleep, which is commonly connected to dreaming, promotes brain development, especially in the early years of life. Unsurprisingly, infants frequently experience REM sleep for about twice as long as adults do.⁸ A child’s sleep cycle lasts roughly 50 minutes, but an adult’s cycle, which includes both REM and NREM sleep, lasts 90 minutes. Infants and children spend a significant amount of their sleep cycles in slow-wave (N3) sleep, also called deep sleep and the restorative kind of non-dreaming sleep. Early adulthood marks the beginning of slow-wave sleep decline. Elderly people typically experience slower wave sleep for shorter periods and less frequently. In other words, sleep is erratic and lighter, with short or protracted awakenings spread throughout the night.^8,9

Rationale: Poor sleep produces a general imbalance in the body, especially in the brain chemicals that control the sleep-wake cycle, memory consolidation, and control of body temperature.⁹ Lack of sleep-related physiological repair may also contribute to greater stress levels, mnemonic and attention deficiencies, as well as behavioural and emotional issues.¹⁰ Sleep is crucial for development and learning, and a lack of sleep for an extended period can be harmful to one’s physical and mental health.⁴ The usage of electronic media devices in daily life has caused a significant change in lifestyle over the past few decades.¹¹ Children today are raised in a world where electronic media is pervasive and It has grown to be an essential component of young people’s lives. Although surveys suggest that most children, even those as young as four months, have used such devices, teenagers still consume the most electronic media.¹¹ Poor sleep quality is more common in young people, when they engage in formal employment in addition to their studies, worry about grades, lack socializing, lack sports practice and other extracurricular activities, increased screen time, have unhealthy lifestyles, lack parental supervision or bedtime rules.¹⁰ More specifically, students who are anxious, agitated, or depressed are less likely to use adaptive coping strategies, which leads to less sleep overall or more fluctuation in sleep latency. On the other hand, it seems that optimism is a predictor of high-quality sleep.¹⁰

Aim: A research aim to cross-sectional study of sleep cycle pattern, quality, and its determinants among young adults in an urban area of Wardha.

Protocol

The Protocol for this study involves a self-report survey and cross-sectional study design, which will be used to analyze the sleep cycle pattern, quality, and its determinants amongst a defined population of young adult. The study will be conducted in in Higher Schools, Communities, Coaching Centres, and Colleges in an urban area of Wardha, Maharashtra, India, and will take place over a period of 12 months, from October 2022 to September 2023.

The study population will be young adults aged between 18 and 25 years. The inclusion criteria are young adults who are in Wardha only and who want to participate and fill out the form. The exclusion criteria are young adults aged 18-25 who are married and those who do not want to fill out the form at the study time.

The number of participants (“N”), the normal deviation for a two-tailed alternative hypothesis at a level of significance (“Z/2”), the standard deviation (“p”), and the extent to which the mean can be estimated (“d”) are all taken into account when determining the sample size for the study. In pervious study they take large sample of 3778 and there result for poor sleep quality is 57.45%.⁶ Sample size n = [DEFF*Np(1-p)]/[(d²/Z²_1-α/2*(N-1) +p*(1-p)]. Population size (for finite population factor) (N): 1000000, Hypothesized % frequency of outcome factor in the population (p): 57.45%±5, Confidence limit as % of 100(absolute±%) (d): 5%, Confidence level is 95% and the sample size after calculation is 376.

To collect data, a structured questionnaire will be used, which includes a self-reporting questionnaire using Google form Close-ended quantitative data will be taken. Formal administration permission will be taken from the administrative management of the School of Epidemiology and Public Health, Data Meghe Institute of Higher Education and Research Sawangi, Wardha, Maharashtra. The data will be collected from Wardha, Maharashtra, and the confidentiality of the respondents will be maintained throughout the study and also, we don’t take their names, any kind of identity and any confidential question in the google form.

The research goal for this study is to evaluate the sleep cycle pattern, quality, and determinants among young adults in Wardha’s urban location. This study’s demographic of interest is young adults aged 18 to 25 years. The study’s major come is the sleep cycle pattern and quality, while the secondary goal is the timeliness of the daily routine.

The degree of mobile/electronic device/TV usage during the night hours, as well as food/dietary habits, will be analysed. These characteristics will be used as explanatory variables to assist investigate the relationship between sleep quality and potential influencing factors.

Discussion

In study by Malhotra et al. we observed an interesting trend in sleep patterns among females and males during adolescence and young adulthood. Females reported significantly more sleep at ages 19 and 20 compared to age 14, indicating that they tend to get more sleep during their college years in comparison to their high school years. On the other hand, males exhibited a consistent sleep duration throughout adolescence, suggesting that their sleep patterns remain relatively stable during this period. The lower sleep duration observed in females aged 14 – 16 years may be influenced by gender-specific differences that are prevalent during high school. However, they made an intriguing discovery that females aged 18-20 years tended to wake up later, which could be the underlying factor contributing to the increased sleep duration observed in this demographic. This adjustment in wake time allows females to catch up and match the amount of sleep obtained by males.³

The current body of literature regarding melatonin release in adolescents and children is limited and lacks consistency. Few research has looked into nocturnal melatonin patterns and found a decline in baseline melatonin levels during the pubertal phase, which contradicts previous studies.¹² Furthermore, new research reveals that young people may be more sensitive to evening light and less sensitive to morning light than adults.¹³ These findings emphasize the possible importance of light stimulation in phase-delaying effects in this population. Consistent with these studies, the circadian chronotype tends to move from early-morning to evening hours during adolescence, and then progressively returns to a morning chronotype in later adulthood (beyond 50 years of age). These findings add to our understanding of the dynamic nature of melatonin release and circadian rhythms at various stages of development. However, additional research is required to understand the underlying processes and implications of these discoveries.¹³

Examining sleep patterns requires a thorough understanding of the many variables that might affect sleep, especially during times of growth, development, and maturation. It is critical to understand that these elements can evolve over time, as can how they interact. It has been discovered that not every person would benefit from a generic sleep programme. A method that focuses on identifying specific sleep-related problems and solving them is more fruitful. It takes more than just providing information on sleep to affect behaviour. One efficient tactic is to have conversations with the child (and, if appropriate, their family) to learn about their perceptions of sleep and to go through good sleep hygiene habits. A consistent practice that encourages a regular sleep and wake time is known as sleep hygiene. Avoiding daytime naps, abstaining from afternoon stimulants like caffeine, reserving the bed just for sleeping, providing a peaceful and soothing sleep environment, maintaining exposure to natural daylight, and promoting regular exercise are important components of good sleep hygiene. Individuals can enhance their sleeping patterns and general sleep quality by implementing these practices.¹⁴

An increased risk of developing clinical depression has been linked to poor sleep quality. Teenagers with depressed symptoms were more likely to have sleep issues, according to a Chinese study by Guo et al. In particular, all facets of poor sleep quality were associated with a higher risk of clinical depression.¹⁵ The lateral orbitofrontal cortex, which is connected to negative thoughts, the cingulate cortex, which is connected to recent memory, and the precuneus, which is connected to consciousness, were found to be correlated with depression scores. These links support a loop of overthinking and the amplifying of unpleasant emotional events, which in turn disturbs the sleep cycle and reduces the quality of sleep. Additionally, the sleep-wake cycle can be further disrupted by hormonal imbalances that are frequently seen in depressive disorders. These imbalances can lead to circadian disturbances, irregular sleep-wake patterns, difficulty falling asleep or staying awake in response to environmental demands, as well as insomnia or excessive daytime sleepiness.¹⁶ These findings demonstrate the complex interplay between poor sleep and depression, highlighting the need of addressing sleep issues in the treatment and avoidance of depressive symptoms.¹⁰

In a study, Mona El-Sheikh et al. investigated the relationship between sleep habits and a range of behavioural and cognitive outcomes in young people from lower socioeconomic backgrounds. The results showed a number of important correlations. First of all, externalising behaviours were connected to lower sleep duration and greater sleep-wake issues in these people. Second, internalising symptoms were linked to shorter sleep durations, less effective sleep, and more sleep-wake issues, suggesting a link between disturbed sleep and emotional challenges. Last but not least, people who slept less effectively showed decreased cognitive ability. These findings emphasise how critical sleep length, quality, and consistency are for behavioural and cognitive outcomes in children from lower socioeconomic families.¹⁷

Study implication – The study’s findings may aid in the development of therapies to improve sleep quality in young adults. This research is anticipated to contribute to the enhancing body of knowledge on young adults’ sleep quality and offers crucial insights into elements that could affect their sleep patterns. The study will help understand and address sleep quality in young adults. The information gathered in the study can further help serve as data for future research. The understanding regarding why sleep quality is poor among young adults and also how their sleep cycle pattern is disturbed. Sleep deprivation and sleep disturbances have been linked to a variety of unfavorable health outcomes, including a higher risk of diabetes, obesity, hypertension, depression, heart attack, and stroke.