Role of sleep on alertness among medical students from a tertiary care hospital, Thrissur district, Kerala: cross-sectional study


  • Alisha Johnson Amala Institute of Medical Sciences, Thrissur, Kerala, India
  • Sruthi M. Valsan Department of Community Medicine, Amala Institute of Medical Sciences, Thrissur, Kerala, India



Alertness, Nap, Medical students, Sleep duration


Background: Alertness and ability to perform vary as functions of homeostatic factors such as sleep duration, sleep quality, and time awake. As far as medical students are concerned, alertness during the lectures is important due to their vast curriculum, and their alertness aids in the development of better doctors in their future. Though the importance of sleep is known, there is scarcity of studies on how adequate sleep among medical students affects their alertness during lecture classes. The aim was to study effect of sleep duration on alertness among medical students from a tertiary care hospital in Thrissur district, Kerala.

Methods: A cross-sectional study was conducted among undergraduate medical students and alertness was assessed following afternoon lecture classes, using a Stanford sleepiness scale questionnaire. The sample size was calculated with a formula 4PQ/d2 and total 202 undergraduate students were included. The data regarding overnight sleep duration and post lunch nap was also collected using a semi-structured questionnaire.

Results: Based on stanford sleepiness scale 66.3% of students were alert and responsive, 29.2% were not alert and only 4.5% of students were sleepy following afternoon lecture classes. Out of total 202 undergraduate students 43.6% of them had poor overnight sleep and only 32.7% had taken post lunch nap. There was a statistically significant association between alertness and post lunch nap (p=0.01).

Conclusions: Those students who had good overnight sleep and post lunch nap had better alertness during lecture classes.


Buysse DJ, Barzansky B, Dinges D, Hogan E, Hunt CE, Owens J, et al. Sleep, fatigue, and medical training: setting an agenda for optimal learning and patient care. SLEEP. 2003;2:218-225.

Basner M, Dinges DF, Shea JA, Small DS, Zhu J, Norton L, et al. Sleep and Alertness in Medical Interns and Residents: An Observational Study on the Role of Extended Shifts. Sleep. 2017;40(4).

Giri P, Baviskar M, Phalke D. Study of sleep habits and sleep problems among medical students of pravara institute of medical sciences loni, Western maharashtra, India. Ann Med Health Sci Res. 2013;3(1):51–4.

Ficca G, Axelsson J, Mollicone DJ, Muto V, Vitiello MV. Naps, cognition and performance, Sleep Med Rev. 2010;14:249–58.

Schweitzer PK, Randazzo AC, Stone K, Erman M, Walsh JK. Laboratory and field studies of naps and caffeine as practical countermeasures for sleepwake problems associated with night work. SLEEP 2006;29(1):39-50.

Takahashi, Masaya, Arito H. Maintenance of alertness and performance by a brief nap after lunch under prior sleep deficit. Sleep. 2000;23(6):813-9.

Stanford sleepiness scale; American Thoracic society. Available at: ~dement/sss.html. Accessed on 3 May 2019.

Herscovitch J, Broughton R. Sensitivity of the Stanford Sleepiness Scale to the Effects of Cumulative Partial Sleep Deprivation and Recovery Oversleeping; Sleep. 1981;4(1):1.

Htwe TT, Ismail SB, Tun KD, Rao PJ. Napping and its effects upon medical students ability to concentrate: Libyan. J Med Res. 2014;8(1).




How to Cite

Johnson, A., & Valsan, S. M. (2019). Role of sleep on alertness among medical students from a tertiary care hospital, Thrissur district, Kerala: cross-sectional study. International Journal Of Community Medicine And Public Health, 6(7), 2867–2870.



Original Research Articles