Test Anxiety and Poor Sleep is a Vicious Cycle for College Students

Just in time for spring semester final exams, new research from the University of Kansas in Lawrence analyzes the vicious cycle between test anxiety and poor sleep in college students.

The night before final exams is not a pleasant night on college campuses as many college students struggle with the symptoms of test anxiety. The University of Kansas researchers shed light on the relationship between test anxiety and poor sleep and its effects on academic performance. The impact of the study goes beyond students in Lawrence, Kansas.

The University of Kansas published Test Anxiety and Poor Sleep: A Vicious Cycle in The International Journal of Behavioral Medicine. This paper addresses the underlying biopsychosocial process behind test anxiety, suggesting interventions may improve academic performance and reduce student dropouts. Colleges and universities are paying attention as data shows about 40% of first-year US students do not return to their universities for their second year.

It is normal for students to feel some degree of nervousness before tests. For some students, this feel motivates students to study and prepare. For others, test anxiety causes a negative feedback loop of anxiety and lack of productivity. Test anxiety is a group of disparate physical and psychological disparate symptoms. Physical symptoms include nausea, headaches, sweaty palms, and rapid heart rate.

Psychological symptoms include stress, anxiety, insomnia, and poor concentration. For some, test anxiety can be pretty debilitating, leading to poor coping mechanisms.

Chainarong Prasertthai

Test anxiety is a serious academic problem for college students. Between 10 and 40% of students experience test anxiety. Students with higher levels of test anxiety perform more poorly on tests and have lower grades.

The University of Kansas research team proposes that some of student academic failure anxiety may stem from a biological cycle where test anxiety leads to poor sleep, and sleep disruption worsens the underlying anxiety. The team tested the hypothesis in a passive observational study following students for two days before a midterm statistics exam and compared their results on the Sleep Anxiety Performance Process (SAPP) model.

Lead researcher and KU professor of psychology Nancy Hamilton stated, “We were interested in finding out what predicted students’ performance in statistics classes — stats classes are usually the most dreaded undergrad class. We wanted to find out what the relationship was between sleep, anxiety, and test performance to find the correlation and how it unfolds over time.”

The authors were seeking insight into how anxiety and sleep predict exam performance and watch the effects over two days before an exam. The study evaluated 167 college students. The team measured student sleep habits by using an electronic sleep diary.

Sleep data included bedtime, the time it took to fall asleep, the number of awakenings, number of awakenings after sleep onset, time in bed, sleep duration, sleep quality, restfulness, total sleep time, and sleep efficiency.

A standardized questionnaire capture data measuring test anxiety during the two-day study period.

The Sleep Anxiety Performance Process Model (SAPP).

The study showed test anxiety and sleep quality have a bidirectional relationship. Poor sleep worsened test anxiety. Improved sleep improved it. Hamilton hopes these findings will encourage universities to improve communication with students about test anxiety. Universities can educate students and faculty on the prevalence of test anxiety and help provide students with helpful resources.

If universities attack the test anxiety problem proactively, student outcomes may improve, and student dropouts may decrease. Test anxiety awareness may also reduce student maladaptive coping mechanisms.

“Studies have shown students tend to cope with anxiety through health behaviors,” Hamilton said. “Students may use more caffeine to combat sleep problems associated with anxiety, and caffeine can actually enhance sleep problems, specifically if you’re using caffeine in the afternoon or in the evening. Students sometimes self-medicate for anxiety by using alcohol or other sedating drugs.”


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Dr Jeff Livingston
Dr Jeff Livingston
Jeff is Co-Founder of Medika Life. He is a Board Certified Obgyn and CEO of MacArthur Medical Center in Irving, Texas. He is a nationally recognized thought leader, speaker, writer, blogger, and practicing physician who is considered an expert in the use of social media to educate patients, using new and innovative technology to improve care outcomes and the patient experience.

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