Reinforcing sleep education with behavioral change strategies: intervention effects on sleep timing, sleep duration, and academic performance.

Study objectives: Sleep education programs are emerging in university settings, but educating students about sleep health does not always change nighttime behaviors. A potential solution for bridging this knowledge-behavior gap is to incorporate behavioral change techniques into sleep education programs. This study's objective was to test one technique-the implementation intention-in students completing an academically-demanding gateway course for medical career paths.

Methods: Participants were undergraduate students enrolled in organic chemistry courses (N=101, 64.4% females, 51.5% nonwhite). After completing baseline questionnaires and actigraphy monitoring, participants took the Sleep 101 educational program. They were randomly assigned to an Education-Only condition or to also form an implementation intention (Education+II). Education+II individuals formed specific plans to go to bed earlier for the next five school nights. Participants repeated questionnaires at mid-semester (M=50.33 days) and next-semester (M=248.51 days) follow-ups. Academic performance records were extracted prior to the study, during the study semester, and during the following semester.

Results: Following the educational program, both groups reported improvements in sleep quality, but only Education+II participants showed actigraphy-measured improvements in bedtimes and sleep duration. Some effects in the Education+II condition persisted at mid-semester and next-semester follow-ups. Adjusting for prior academic performance, the Education+II condition showed worse academic outcomes initially (but not long term) than the Education-Only condition, particularly amongst students with evening circadian preferences.

Conclusions: Incorporating behavioral change strategies into sleep education programs can improve sleep outcomes. The relationship between sleep and academic performance is complex in demanding academic programs.