Medical students must talk about sleep problems – Study

Vérité Cyubahiro Karangwa rarely has an easy day, thanks to his tight academic schedule. The third-year medical student from the University of Rwanda says his studies are so demanding that he has time for little else.

“We are always busy, and get little time to relax,” he said. “As medical students, our days are different [from those of other students]. We spend more time in classes and in laboratories during practicals and, at some point, we are involved in practicals in health facilities,” he added.

“We don’t have enough hours of sleep. Whenever we have tight assignments [which is often]. I sleep four to five hours a night and sometimes three hours only,” he noted.

“It is hectic, and that is the life we live as medical students. Sometimes I wonder what life will be like as doctors who work long hours. Even when they start employment, I think life will always be hard,” he added.

Karangwa’s experience is shared by many medical students from the school and from different universities in Rwanda and beyond. A recent study has revealed that, on average, medical students in Rwanda sleep 5.5 hours per night.

The research was carried out by a team of researchers composed of medical doctors, pharmacists and psychologists to assess the sleep quality among undergraduate medical students in the country.

They found mild to moderate sleep disturbances among 84.5% of medical students in the current study. Comparatively, this rate is higher than the global prevalence of sleep disturbances (76.8%) in medical students.

According to the study, the poor sleep quality of students in Rwanda may be explained by the aftermath of post-conflict situations, such as the 1994 genocide against the Tutsi and the COVID-19 pandemic and its impact on students’ learning. The study also showed that final-year medical students encounter financial hardships that raise their stress levels and, in turn, worsen their sleep quality.

Students have to speak up

“Therefore, open discussions between medical students and academic staff are needed to identify ways to alleviate potential causes that contribute to fewer hours of sleep among medical students in Rwanda,” suggests the report.

Factors that contribute to the lack of sleep include, as Karangwa pointed out, a combination of an excessive academic burden, heavy schedules and intensive practical work, including time in medical facilities.

The study was carried out for medical students from the University of Rwanda, the University of Global Health Equity and the Adventist University of Central Africa.

It used a psychometric tool that provides a standardised measure of sleep quality, according to the research team.

The study found that 53.5% of the respondents had difficulties falling asleep, as it takes them more than 15 minutes to sleep, while 6.6% of the surveyed students said they used sleeping pills.

Planning ahead

For Karangwa and his peers, planning ahead is the best solution, as medical students need good sleep quality to have the optimum cognitive function, memory and decision-making abilities to master their learning needs, according to the research.

“We need to have representatives in the planning and setting up of programmes. That would be the best solution as we can tell what we think can favour us as well,” he said, stressing that the students feel relieved during holidays.

Medical students undergo five intensive years of courses and practical, plus one year’s professional internship before graduating.

Much as the research did not investigate the impact of the lack of sleep on the medical students, science suggests that sleeping less than seven hours a night is associated with poor general health, increased risks for chronic diseases, medical errors, and a decrease in academic performance.

Jean Nepomuscene Ntawurushimana, a clinical psychologist at the University Teaching Hospital of Butare said: “Poor sleep quality is a dangerous thing and has a long-term effect on people’s lives.

“It leads to health problems like blood pressure, heart attack, sleepless nights and can cause strokes. These are dangerous and killing diseases, so people with poor sleeping patterns are at a high risk and a solution is needed to avert them,” he told University World News.

He suggests that, although many medical students have tight schedules and longer programmes, they have got to work on their health and get time to rest and relax.

“Regardless of long hours studying and practising, medical students have to try to manage their time and get time to relax and ensure they get more time to sleep. They need to be healthy if they are to ensure better health for others once they start practising,” he added.

However, the researchers noted that, elsewhere – in Saudi Arabia, for instance – 65.1% of medical students took more than 15 minutes before falling asleep, while the same was true for 72% of medical students in Brazil.