The relationship between the medical students’ sleep quality and the bed curtain phenomenon, an interesting behavior style
 
Ying Zhu¹, Xiaoyan Tang¹, Jie Shui¹, Deqin Geng^2
 
1Department of Clinical Medicine, Xuzhou Medical College, Xuzhou City, Jiangsu Province,221002,P.R.China;
²Department of Neurology, Xuzhou Medical College Affiliated Hospital, 99 Huaihai West Road, Xuzhou City, Jiangsu Province, 221002, China
 
Abstract: Although more than one fourth medical resident students hang bed curtain, there is almost no professional research on the phenomenon in China. To study the relationship between the medical students' sleep quality and the bed curtain phenomenon, a research was conducted. By using an investigating method of random sampling, 400 medical students were asked to complete the Pittsburgh Sleep Quality Index (PSQI) and a self-designed questionnaire. The rates of sleep disorder of medical students were 19.3% and female’s (12.5%) was higher than male’s(6.8%) (χ²=4.590,P<0.05 ). The insomnia rates of high grades (44.3%) were higher than low grades(39.0%) (χ²=4.594, P<0.05 ). There existed significant differences between the bed curtain phenomenon and gender, grades, sleep steady rate, dormitory environment and part scores of the PSQI ( sleep efficiency, sleep disorders, total score) (χ²=23.155, 18.610, 4.499, 6.745, 7.153, 8.532, P<0.05 ). What’s more, the students who lived in the dormitories with bright light and noise, as well as high grades students or females, had a higher rate of hanging curtains. And also sleep disorders (PSQI scores ≥8) tended to hang the curtains. Our founding demonstrated that sleeping problems are common in medical students and extrinsic factors (dormitory environment, lighting etc.) could cause sleep disorders to a certain extent. The improvement of bed curtain to sleep quality was limited. In order to improve the sleep quality of medical students, comprehensive measures should be taken.
Keywords: medical students, sleep disorders, bed curtain, mental health 
Citation: Zhu Y et al, The relationship between the medical students’ sleep quality and the bed curtain phenomenon, an interesting behavior style. J Gen Neuro 2016; 1(1):
 
Citation: Zhu Y et al. The relationship between the medical students’ sleep quality and the bed curtain phenomenon, an interesting behavior style. J Gen Neuro 2016; 1(1):
 
 
*Correspondence to: Deqin Geng, Department of Neurology, Xuzhou Medical College Affiliated Hospital, 99 Huaihai West Road, Xuzhou City, Jiangsu Province 221002,People’s Republic of China, gengdeqin@hotmail.com
 
 
 
 
 
Introduction
With the progress of society and time, life rhythm is speeding up and sleep deprivation have become a big problem among many. With the aim to remind people to pay attention to the quality of sleep, the World Health Organization (WHO) set the March 21st of each year as ‘International Sleeping Day’. Liu Xianchen and coworkers used Pittsburgh Sleep Quality Index (PSQI) for a survey of 560 college students from 16 to 25-year of age found that 13.93% of them had sleep quality issues^[1]. Medical students belong to a different group among college students. With heavy task of study and great mental stress, the students had a series of sleep quality problems.
Recent college students have undergone a lot of changes from those of the past. In many university dormitories, some beds are concealed by a piece of cloth, called bed curtain, making the dormitory divided into a plurality of spaces. This is the so-called “bed curtain phenomenon”^[2]. However, there is almost no systematic research on the relationship between the medical students' sleep quality and bed curtain phenomenon in China. This paper discusses a survey on the sleep quality among 400 medical students to explore the relationship between the medical students' sleep quality and bed curtain phenomenon and aimed to provide scientific basis and methodology support for improving their sleep quality.
 
Methods
Participants
Participants of this study were students from freshmen to senior students in Xu Zhou Medical College. 440 questionnaires were distributed and received with a valid response rate of 90.9%. Among the 400 medical students, there were 184 males (46.0%) and 216 females (54.0%). 93 students were freshmen (23.3%) with 37 males and 56 females; 104 students were sophormores (26.0%) with 54 males and 50 females; 109 students were juniors (23.7%) with 48 males and 61 females; 94 students were seniors (23.5%) with 45 males and 49 females.
 
Survey questionnaires
A self-designed questionnaire with 30 items was used and PSQI was taken as a research tool for influencing factors. PSQI is a self-rating scale of sleep quality, which was designed by Buysse and some other in 1989^[3]. PSQI is used to evaluate people’s sleep quality in last month. It consisted of 19 self-rating items and 15 other-rating items including which the 19th and the 5 other-rating items which are not been scored. The 18 items constitute 7 components, and each of them is scored according to 0,1,2,3 level. By adding up each level of score, a cumulative score ranged from 0~21 is obtained. The higher score is, the worse the sleep quality is. According to clinical experience, 7 points is taken as a reference critical point, ≤7 is normal and ≥8 can be diagnosed with sleep disorder ^[4].
 
Procedures
  Prior to the formal investigation, 4 investigators were chosen from our team members who were familiar with the purpose, content, significance, methods and other conditions of the investigation. In addition, members of the group added something such as the procedure, schedule, workload, etc, to the investigation. Simulated investigations were also practiced through a formal procedure. Next, questionnaires were set out to different dormitories which were randomly selected through different grades. Then, the questionnaires were collected for further analysis.
 
Statistical Analyses
  The data was analysed by EpiData3.0 and processed with the Microsoft Excel and SPSS17.0. The numeration data were tested with chi square test. The measurement data were tested with t test, p ＜ 0.05 meant the difference was significant.
 
Results
Gender difference
  The incidence of sleep disorder was 19.3% and there was a significant difference in gender (χ² = 4.590，p < 0.05). Female students had a higher prevalence of sleep disorder (Table 1).
 Grade difference
  Different rates of insomnia had significant difference in different grades (χ²=4.594，p < 0.05. The rate of high grades was higher (Table 2).
 
Analysis of sleep related factors and bed curtain phenomenon
The research showed that 117(29.3%) students hung bed curtains while 283 students did not (70.8%). Among the 117 curtain students, 93(79.5%) of them believed that their sleep quality had improved after hanging the bed curtains while 24(20.5%) of them did not.
 
 
Difference comparison between different factors and bed curtain phenomenon
   There existed significant differences between the bed curtain phenomenon and gender, grades, sleep steady rate, dormitory environment and part scores of the PSQI (sleep efficiency, sleep disorders, total score) (χ² = 23.155, 18.610, 4.499, 4.667, 6.745, 7.153, 8.532, p < 0.05). The students who lived in the dormitories of bright light and noise had a higher rate of hanging curtains the same as high grade students or females. And, 46.2% students who suffered from insomnia hung bed curtains because of external reasons (light and noise) while 34.6% of insomnia students for other reasons. The former was 11.6% higher than the latter. The sleep steady rate of the curtain students was 69.2% while students who did not hang bed curtains was 79.2%, the former was lower 10.0% than the latter. The students with curtains had high scores which meant poor quality of sleep was more prominent in comparison to the students who did not hang bed curtains. That was to say, students who hang bed curtains tend to suffer from sleep disorders (high PSQI scores) (Table 3).
 
Discussion
   According to the survey, the incidence of sleep disorder was 19.3%. The result was almost similar to the previous domestic research by Liu et al., where the incidence of sleep disorder was 13.93% ^[1]. Previous study^[4] showed that the incidence of college students was 18.2% while another survey conducted by Wang et al. was 19.0%^[5]. The results indicated that medical students had a certain degree of sleep disorder and the incidence in female was higher in accordance with similar studies ^[6,7]. This may be related to gender difference as it was reported that males preferred social event, causality and so on, while females paid more attention to human beings and were more sensitive to interpersonal relationships^[8]. Just like how gender influences the way we think of ourselves, it also teaches us how to behave. Gender roles (an older term is sex roles) are attitudes and activities which a society links to each sex. A culture that defines males as ambitious and competitive encourages them to seek out positions of leadership and play team sports. To the extent that females are defined as deferential and emotional, they are expected to be supportive helpers and quick to show their feelings^[9]. Moreover, the female students’ mental and emotion can be easily influenced by external environmental factors which triggers them to be more sensitive and worried. As a result, sleep disorders can be caused easily.
The result showed that medical students in different grades had great differences in the rate of insomnia which was consistent with other domestic reports ^[10-12]. The rate in high grades was higher. Moreover, there was a significant difference in the rate of hanging curtains among different grades. Students in high grades tended to hang the curtains. This may be due to aspects where high grade students were confronted with the problems of academic, postgraduate entrance exams, employment, amativeness and so on. With fierce competition and great pressure, senior students need a relatively quiet and personal space to release a variety of physiological, psychological and social pressure. At the same time, it was easy for them to suffer from insomnia due to psychological fluctuation. In addition, the noisy dormitory environment and the bright light were also the common causes of insomnia. The dormitory environment played an important role to result in obvious difference. The noisy dormitory environment with brighter lights, caused more students to hang bed curtains. It might be due to the bed curtain’s function of shade which helped students to enter sleep state.
The result also showed that significant differences existed between the bed curtain phenomenon, sleep steady rate and part scores of the PSQI (sleep efficiency, sleep disorders, total score, p < 0.05). We found that students who hung bed curtains had a low steady sleep rate and high scores of PSQI which indicated that the students who hung bed curtains had high incidence of sleep disorder. In our opinion, however, it should not be attributed to hanging bed curtains as 93 of 117 students (79.5%) felt their sleep quality had improved after hanging bed curtains. And among the students who hanged bed curtains, the rate (69.2%) of peaceful sleep was higher than those who did not (30.8%). The students who got lower PSQI (≤1 points, 7 points) scores were more than the students whose scores were higher (≥2 points,8 points). The reason for the above phenomena was probably because there were many sleep disorders among curtain students. The students with sleep disorders tended to hang bed curtains. The improvement of sleep quality, however, was limited. The effect may be remarkable due to the noisy dormitory environment and the bright light while there would be limited improvements when it came to psychological problems or pressures. A multiple regression analysis showed that the most three important factors on sleep quality were the facts of individual physical condition, mental symptoms and personality characteristics. Thus, we held the idea that medical students’ sleep quality was influenced by external factors and internal ones. The latter was greater operative. Therefore, quick effective psychological guidance, persuasion and counseling should be provided based on students’ own practical situations. And, the sleep quality of medical students will be improved through enhancing the physical quality and helping them build correct views of the world and about his life, and develop appropriate values and a healthy personality. Besides, attention should be paid to bed curtain phenomenon as it can provide available clues for the sleep situation of students and measures to sleep disorder caused by external factors.
 
Acknowledgements
The study was supported by the college students' practical innovation training program of Jiangu province in 2011 (No. 1006) with voluntary participants.
 
References
 
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3. Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric Practice and Research. Journal of Psychiatric Research 1989; 28(2): 193-213. doi.org/10.1016/0165-1781(89)90047-4
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Tables
Table 1 Difference comparison of prevalence of sleep disorder between male and female

		Gender				χ2	p
		Male		Female
		n	%	n	%
PSQI	≤7points	157	39.3	166	41.5	4.590	0.032*
	≥8points	27	6.8	50	12.5

(* p < 0.05, ** p < 0.01, the same below)
 
Table 2 Difference comparison of insomnia in different grades

		Not Insomnia		Insomnia		χ2	P
		n	%	n	%	4.594	0.032*
Grade	Low grades	42	10.3	156	39.0
	High grades	26	6.5	177	44.3

 
 
 
 
 
 
 
 
 
Table 3 Difference comparison between different factors and bed curtain phenomenon

				Bed curtain				χ2	p
			Yes			No
			N		%	n	%
Gender	Male		32		8.0	152	38.0	23.155	0.000**
	Female		85		21.3	131	32.8
Grade	Low grades		38		9.5	159	39.8	18.610	0.000**
	High grades		79		19.8	124	31.0
wake up several times during sleep	Yes		36		9.0	59	14.8	4.499	0.034*
	No		81		20.3	224	56.0
External factors of insomnia(roommates, noise, light, et al.)	Yes		54		13.5	98	24.5	4.667	0.031*
	No		63		15.8	185	46.3
Score of sleep efficiency	≤1		106		26.5	274	68.5	6.745	0.009**
	≥2		11		2.8	9	2.3
Score of sleep disorder	≤1		98		24.5	262	65.5	7.153	0.007**
	≥2		19		4.8	21	5.3
Total score	≤7		84		21.0	239	59.8	8.532	0.003**
	≥8		33		8.3	44	11.0