Restless sleep is associated with increased anxiety in physical therapy students: a cross sectional survey study

Sleep and mental health are intimately related and shown to impact graduate students enrolled in health sciences programs, including physical therapy education. Doctorate of Physical Therapy (DPT) students' attitudes and behaviors surrounding sleep and whether these factors are associated with mental health are unknown. This study aimed to describe sleep behaviors and attitudes of entry-level DPT students and to explore the relationship between subjectively reported sleep quality and self-reported symptoms of anxiety in these students.

A cross-sectional online survey consisting of the Sleep Practices and Attitudes Questionnaire (SPAQ), the Generalized Anxiety Disorder-7 (GAD-7) questionnaire, and demographic questions were used. Analyses investigated sleep behaviors and attitudes, along with the relationship (unadjusted odds ratio) between restless sleep and anxiety in DPT students in hybrid and traditional DPT programs across the United States (US).

A total of 271 DPT students completed the survey. A majority of students reported feeling tired during most days (80.8%, n = 219), a quarter of participants (24.7%) reported having a history of trouble sleeping and four (1.5%) reported being diagnosed with a sleep disorder. Of those who reported their sleep duration, participants slept an average of 6.86 h. The mean GAD-7 score was 7.68 (SD = 4.90), suggestive of mild anxiety. Sixty-seven (24.7%) reported having a diagnosed anxiety disorder, with generalized anxiety being the most common diagnosis. Those who reported having restless sleep were 4.09 times more likely to have moderate to severe anxiety [unadjusted odds ratio = 4.09 (95% CI 2.27,7.35; p < 0.001)] compared to those who reported restful sleep.

DPT students who rated sleep as restless exhibit signs of poor subjective sleep quality associated with an increased risk of experiencing moderate to severe anxiety compared to students who had restful sleep. Students reported behaviors surrounding sleep that may contribute to anxiety. These findings have implications for including sleep and mental health education and practices within DPT programs.