INTRODUCTION People work or move as time makes a day, those days that make a week, weeks that make

a month and months that make a year until it would make another years. As humans, those times to do the usual things aside from the daily routine, the job that serves as the source of living, people should exercise to maintain healthy, to travel from place to place or just to transfer from a new residence and some other things and everything require movement. But movement doesnt only point out to motor movement such as moving the muscles like to lift things and push or pull but it also includes the mind because people first think of things before they act. At the end of the day humans feel exhausted because of use energy for the entire day and thats the time that people wanted to rest, a rest that could ease up body from being tired and that is sleep. (Diel, Harold et. al., 1990) People sleep because it is essential to maintain normal levels of cognitive skills such as speech, memory, innovative and flexible thinking. In other words, sleep plays a significant role in brain development. A good way to understand the role of sleep is to look at what would happen if people don't sleep. Lack of sleep has serious effects on the brain's ability to function. If ever pulled an all-nighter, people will be familiar with the following after-effects such as grumpiness, grogginess, irritability and forgetfulness. After just one night without sleep, concentration becomes more difficult and attention span shortens considerably. With continued lack of sufficient sleep, the part of the brain that controls language, memory, planning and sense of time is severely affected, practically shutting down. In fact, 17 hours of sustained wakefulness leads to a decrease in performance equivalent to a blood alcohol level of 0.05% (two glasses of wine). (Diel, Harold et. al., 1990) Research also shows that sleep-deprived individuals often have difficulty in responding rapidly to changing situations and making rational judgments. Sleep deprivation not only has a major impact on cognitive functioning but also on emotional and physical health. Sleep occurs in a recurring cycle of 90 to 110 minutes and is divided into two categories: non-REM (which is further split into four stages) and REM sleep. In Non-REM sleep: the first stage is Light Sleep, during the first stage of sleep, people are half awake and half asleep. The muscle activity slows down and slight twitching may occur. This is a period of light sleep, meaning can be awakened easily at this stage. Second stage is called True Sleep where within ten minutes of light sleep, people enter stage two, which lasts around 20 minutes. The breathing pattern and heart rate start to slow down. This period accounts for the largest part of human sleep. Stages three and

four is Deep Sleep where during stage three, the brain begins to produce delta waves, a type of wave that is large (high amplitude) and slow (low frequency). Breathing and heart rate are at their lowest levels. Stage four is characterized by rhythmic breathing and limited muscle activity. If awakened during deep sleep it does not adjust immediately and often feel groggy and disoriented for several minutes after waking up. Some children experience bed-wetting, night terrors, or sleepwalking during this stage. In REM sleep it is first rapid eye movement (REM) period usually begins about 70 to 90 minutes after falling asleep. People have around three to five REM episodes a night. Although not conscious, the brain is very active - often more so than when awake. This is the period when most dreams occur. The eyes dart around (hence the name), our breathing rate and blood pressure rise. However, the bodies are effectively paralyzed, said to be nature's way of preventing from acting out dreams. After REM sleep, the whole cycle begins again. There is no set amount of time that everyone needs to sleep, since it varies from person to person. Results from the sleep profiler indicate that people like to sleep anywhere between 5 and 11 hours, with the average being 7.75 hours. Jim Horne from Loughborough University's Sleep Research Centre has a simple answer though: "The amount of sleep we require is what we need not to be sleepy in the daytime. (http://www.bbc.co.uk/science/humanbody/sleep/articles/whatissleep.shtml).

FRAMEWORK Lack of sleep negatively affects the mental and physical health of students. Sleepdeprived students are unable to function well in the classroom, and lack of sleep affects other aspects of their lives as well. To sleep after studying could lead to another tiresome activity after a stressful day for nursing students which can also become a factor affecting the academic performance of the nursing students. The longer the period of sleep deprivation, the more likely it results to headaches, irritability, attention lapses, extreme emotionality, and even psychotic reactions. Aside from that there are lots of factors to be considered why a student prefers that sleeping habit in studying. Whether students sleep before or after studying, this study also aims to distinguish the outcome of sleep to the performances of nursing students both academically and clinically.

In Repair and Restoration Theory of Sleep, sleeping is essential for revitalizing and restoring the physiological processes that keep the body and mind healthy and properly functioning. This theory suggests that NREM sleep is important for restoring physiological functions, while REM sleep is essential in restoring mental functions. Support for this theory is provided by research that shows periods of REM sleep increase following periods of sleep deprivation and strenuous physical activity. During sleep, the body also increases its rate of cell division and protein synthesis, further suggesting that repair and restoration occurs during sleeping periods. (http://psychology. about.com/od/state of consciousness/TheoriesofSleep.htm) Second theory is the Evolutionary theory, or the adaptive theory of sleep, which suggests that periods of activity and inactivity evolved as a means of conserving energy. According to this theory, all species have adapted to sleep during periods of time when wakefulness would be the most hazardous. Support for this theory comes from comparative research of different animal species. Animals that have few natural predators, such as bears and lions, often sleep between 12 to 15 hours each day. On the other hand, animals that has many natural predators have only short periods of sleep, usually getting no more than 4 or 5 hours of sleep each day. (http://psychology. about.com/od/state of consciousness/TheoriesofSleep.htm) The Information Consolidation Theory of Sleep is based on cognitive research and suggests that people sleep in order to process information that has been acquired during the day. In addition to processing information from the day prior, this theory also argues that sleep allows the brain to prepare for the day to come. Some research also suggests that sleep helps cement the things learned during the day into long-term memory. Support for this idea stems from a number of sleep deprivation studied demonstrating that a lack of sleep has a serious impact on the ability to recall and remember information.

(http://psychology.about.com/od/statesofconsciousness/p/TheoriesofSleep.htm) Even if there is research and evidence to support each of these theories of sleep, there is still no clear-cut support for any one theory. It is also possible that each of these theories can be used to explain why we sleep. Sleeping impacts many physiological processes, so it is very possible that sleep occurs for many reasons and purposes.

OBJECTIVES OF THE STUDY The objectives of the study were: (1) to describe the experiences on lack of sleep among the level 3 nursing students under the new curriculum; (2) to determine their academic performance in terms of grades and attendance; and (3) to determine the relationship between the lack of sleep and academic performance.

Independent Variable:

Dependent Variables:

Literature Review Experiences of Lack of Sleep

Academic Performance

Significance of the Study

Figure 1. Schematic Diagram

SIGNIFICANCE OF THE STUDY Level 3 Students. Through this study, students will be able to rate performance in school according to the experiences on lack of sleep and schedule study time preferences. Students will also be able to identify the most effective study time. Nursing Students. Student nurses can utilize this study in determining the most common experiences on lack of sleep that yields better academic performance. Clinical Instructors. C.I.s will be able to know the effects of a certain quality of sleep to the academic performance of students and identify the factors that lead to poor sleep, such as requirements, assignments and research works and to have a better understanding of why some students have poor academic performance.

College of Nursing: Dean and Chairs. This would provide ideas on what is happening to the students when they lack sleep. It would give an idea on the time that students are most likely to function well, academically speaking. Future Researchers. This study serves as reference for future research and encourage to conduct a more relevant study in relation to the quality of sleep and academic performance.

SCOPE AND LIMITATION This study focused on the experiences on lack of sleep of the LEVEL 3 Nursing students. The respondents were limited only to the Nursing students of NCM 103 and 104/105 of the school year 2010-2011 of the College of Nursing of Liceo de Cagayan University.

LITERATURE REVIEW Brain=Behavior Theory, is becoming a commonly postulated theory among researchers that the BRAIN=BEHAVIOR, and if true, it means that as the health of the brain declines so does the quality of the behavior in the world. Anxiety and panic attacks are associated with decreased alpha waves, increased high beta waves, and can be affected by low delta and theta waves. There is a delicate balance of the chemicals called neurotransmitters required within the body for best emotional and physiological health. Certain brain waves are related to the release of certain neurotransmitters. Alpha waves are associated with meditation and a sense of inner peacefulness created by the release of acetylcholine. Beta waves in the high frequencies can cause agitation and anxiety perhaps caused by too much dopamine release. Delta waves are produced during deep sleep and are essential to releasing human growth hormone and serotonin, both of which are essential to repairing the brain and body. Theta waves instigate the release of GABA which balances the brain by inhibiting over-excitement. It is the "calming" or "peacemaker" chemical in the brain. GABA is needed to induce relaxation and reduce stress and anxiety. Anxiety and panic attacks are caused by more than fear and insecurities. It can be chemically driven states from an imbalanced and poorly regulated brain. (http://www.psyarticles.com/sleep/adolescent-sleep.htm)

Olha Romaniuk states that college is a busy time for every student, whether he or she is academically, athletically, or socially inclined. Between classes, extracurricular activities and social obligations, many students find themselves struggling with managing their tasks and allotting time to complete them. Whereas freshmen may be spending too much time trying to fit in and make new friends, seniors may be stressing out with going to job interviews and preparing for the real world. In other words, stress is as prevalent at the latter stages of a college career as it is during the initial stages. So in this case stress could be another factor that some nursing students prefer to sleep before studying and how it affects to their performances as well. (http://www.helium.com/items/357060-the-link-between-sleep-deprivation-and-collegegrades) College students who go to bed late are more likely to have poor quality sleep, which may affect their mental health and academic performance, according to new research [Science Daily]. The study, conducted by Jung Kim, PhD, of Pohang University of Science in Technology in South Korea, was based on a survey of 399 college students in Korea. "The present study shows that the greater one stayed up at night, the more maladjusted in college life, in terms of global mental health, sleep quality and academic performance," said Kim. "It seems important to give relevant information and helpful guidance on good sleep habits to students from the beginning of college life." The amount of sleep a person gets affects his or her physical health, emotional well-being, mental abilities, productivity and performance. Recent studies associate lack of sleep with serious health problems such as an increased risk of depression, obesity, cardiovascular disease and diabetes. Experts recommend that adults get between seven and eight hours of sleep each night to maintain good health and optimum performance. An abstract of this research was presented June 13 at SLEEP 2007, the 21st Annual Meeting of the Associated Professional Sleep Societies. (http://www.sciencedaily.com/) According to principal investigator Jennifer C. Cousins, PhD, post doctoral fellow at the University of Pittsburgh Medical Center, it was surprising that although more and better sleep produced overall improvements, different types of sleep measures were related to different types of functioning. "Sleep deficits cause problems for adolescents, but students differ in their personal resources and in how chaotic their sleep-wake schedules are," said Cousins. "The more regular and predictable their sleep is, the better they are likely to do when confronted with short-term sleep deficits. Therefore, participants with better sleep overall may be affected differently in a sleep condition compared to those who have a more varying sleep/wake schedule." The study involved data from 56 adolescents (34 female) between the ages of 14

and 18 years who had complaints of daytime sleepiness and or insufficient sleep at night. Participants reported their subject grades and overall academic standing. Sleep was measured objectively with actigraphy and subjectively through sleep diaries. Higher math scores were related to less night awakenings, less time spent in bed, higher sleep efficiency and great sleep quality; there was also a trend for decreased sleep onset latency (SOL). Higher scores in English were associated with less nighttime awakenings. Increased SOL during the weekends was related to worse academic performance. According to Cousins, poor sleep and poor sleep habits are associated with substance use, emotional problems, cognitive problems and a general decline in daily functioning. Sleep education may be a preventative tool to help increase awareness of the importance of sleep and of the negative consequences of poor sleep. Authors of the study state that results provide overwhelming evidence of the importance of sleep during a period of development that is critical in adolescents and highlight the importance of the development of sleep intervention programs for students in order to improve existing problems with sleep and daily functioning. (http://www.medicalnewstoday.com/articles/110640.php) The survey of 280 high school students confirmed what most parents with a teenager know that they are not getting enough sleep. More sleep would translate into improved academic performance, according to the teens questioned. They all attended Harriton High School in suburban Philadelphia, where the school day begins at 7:30 a.m. and ends at 2:25 p.m. The survey found that: 78% of students said it was difficult to get up in the morning only 16% said they regularly had enough sleep, 70% thought their grades would improve if they had more sleep, 90% thought their academic performance would improve if school were to start later. The surveyed teens said they do not feel alert while taking tests during early morning periods, and they do not think they can perform at the pinnacle of their ability during the early morning hours. Most students said they thought the best time to take a test would be from 11 a.m. to 1 p.m. They thought they would perform better academically and that their grades would improve if they could sleep longer. (http://www.medicalnewstoday.com/articles/110640.php) Richard Schwab, M.D., of the University of Pennsylvania, conducted the study with his daughter Amanda, one of the sleep-deprived teens who attended Harriton High School. "I watched her get up early for four years, and saw how difficult it was," Dr. Schwab says. "Teenagers need more sleep than adults and their circadian rhythms are phase shifted so that their ideal bedtime is midnight to 1:00 a.m.; yet they have to get up at 6:30 or earlier for high school. While adults usually need 7 to 8 hours of sleep, teens need 8 to 9 hours, he says. In addition, teens go to bed much later -- their biological clock often keeps them up until 1 a.m. to 2

a.m. Because they have to get up so early for school, many teens achieve only 6 to 7 hours of sleep or, in some cases, much less. That means they tend to sleep in on the weekends, often until 11 am or later, to try to make up for their sleep deficit. "Right now, high schools usually start earlier in the morning than elementary schools. But if school start times were based on sleep cycles, elementary schools should start at 7:30 and high schools at 8:30 or 8:45 -- right now it's the reverse. School systems should be thinking about changing their start times. It would not be easy--they would have to change the busing system--but it would increase their student's sleep time and likely improve their school performance." (http://www.sciencedaily.com/) According to Sujata Parashar early to bed & early to rise (proper sleep), makes you wise, besides making you healthy & wealthy. There is no doubt about that. Proper sleep is as vital to students as is preparing them for an upcoming exam. Like, if they do not study or prepare themselves for the exams they have a high possibility of flunking it. Similarly if they continuously abuse their body with lack of sleep their grades will seriously suffer. Lack of sleep can negatively affect the college grades in 4 ways: First is Feeling of tiredness in which the human body is like a very busy but efficient factory, working nonstop till the time we are awake. But to function to its optimum level it needs to rest and recuperate. Thus, when we deprive ourselves of sleep, we are overloading our body. It can take overloading for few days but after a while it will give up. The result is a tired and sick body and mind. And a tired body, like an overworked factory will not function properly, leading to low productivity and even become prone to accidents (physical ailments & diseases). In such a case, students will have to miss out on their classes and studies. (http://www.helium.com/items/357060-the-link-between-sleepdeprivation-and-college-grades) Second is Loses Concentration, lack of sleep also makes a person lose concentration. One feels dizzy and gets distracted to other things very easily. It becomes difficult to sit still and concentrate on your subject for a long time. Students who suffer from lack of sleep would want to run away from study classes. They will find themselves unable to attend lectures and even if they do, they will not be able to grasp much in the class. (http://www.helium.com/items/357060the-link-between-sleep-deprivation-and-college-grades) Next is Loses clarity, when one cannot concentrate, it obviously becomes difficult to get clarity also. The mind becomes hazy due to lack of sleep and thus clear thinking is inhibited. This affects their quality of the studies and subsequently their grades. Due to sleep deprivation students can also become irritable. There can be lots of ups and downs in their moods. Since

they are not fresh, the body and mind is tired, their biological clock is upset, and maybe their digestive system has also gone for a toss. (http://www.helium.com/items/357060-the-linkbetween-sleep-deprivation-and-college-grades) Last is Lack of interest & confidence, this is due to the above mentioned factors they will lose their interest in studies & other day to day activities. Due to loss of concentration and clarity they might not be able to put a good impression on their peers and professors. This will lead to low self-esteem and lack of confidence. All the above factors will directly and seriously affect the grades of the students. So it is better to sleep proper and be wise, rather than to sleep less and develop a vice. (http://www.helium.com/items/357060-the-link-between-sleep-deprivation-andcollege-grades

METHODOLOGY Research Design This study utilized the descriptive and correlational type of research. This design is appropriate in the study because the purpose of this was to describe, observe and document aspects as it naturally occurs. The researchers would also like to know whether the academic performance of Nursing Students is related to the quality of their sleep. Research Setting The study was conducted at Liceo de Cagayan University, College of Nursing located at the Kauswagan Carmen junction, Rodolfo N. Pelaez Boulevard, Carmen, Cagayan de Oro City. The main campus of the University is a 6-hectarelot beside Cagayan de Oro River. This study was conveniently conducted in the North Academic Cluster (NAC) building were most classes of nursing students were held and at the main canteen, where they used to do their research and paperworks. Research Ethics Our respondents for our study were the level III BS-Nursing students of Liceo de Cagayan University, and these include the following levels 103, 104/105. In lieu with this, first, we gave consent to the Dean Ma. Chona V. Palomares, RN, MAN, Level III Chair, Ma. Dolores Mercado RN, MAN, respective clinical instructors during their classes and the most important to the respondents, explaining fully the nature and purpose of the research and its potential risks

and benefits such as applying it into their day to day lives. We promised that they will be informed whatever will be the outcome of the study, that there will be no violation of ones rights and most of all the data that will be gathered will be kept confidential. Respondents and Sampling There were 28 respondents in this study based on the random sampling procedure. The criteria included only the NCM 103, 104/105 students who are currently enrolled in the school year 2010-2011. Research Instruments The instrument that was used in collecting the data for the study is in the form of questionnaire. The questionnaire is composed of a series of question that were answered by respondents. Another is the questionnaire designed by the above named, is composed of questions which are open-ended. Sampling Procedure Questionnaires are formulated and were given to the adviser for approval. A formal letter was made stating the approval to conduct the study on their meant time noted by the adviser and approved by the Dean by the College of Nursing. Prepared questionnaires will be given to the respondents and will be answered individually with the permission of the clinical instructor handling them. Random sampling is the method used in choosing the samples.

RESULTS AND DISCUSSION This study had three objectives, namely: to describe the experiences on lack of sleep among the level 3 nursing students under the new curriculum, to determine their academic performance in terms of grades and attendance and to determine the relationship e between the lack of sleep and academic performance. In the 1st objective which is all about the effects of lack of sleep on the respondents. It is clearly seen that almost half of the respondents felt tired in both body and mind which bring it on top of the list of effects that students feel. Next to it is losing concentration and getting distracted easily. Third on the list is lacking interest and self confidence in class.

Based on the results, it can be clearly seen that lack of sleep among students feel tired, lose concentration and lack self confidence in class. There is a deep relationship between sleep and tiredness. If a student suffers from tiredness on a long-term basis, it should aim to improve sleep. In fact, students should do this anyway because sleeping well is a positive way of improving general health and enhancing the response of immune system. Too little sleep and too little quality sleep can certainly aggravate adrenal exhaustion, which is one of the causes of fatigue. However, adrenal exhaustion and stress can cause sleeplessness and poor quality sleep. Some may have to break the cycle of stress, sleeplessness and tiredness in a number of ways. (http://www.stop-being-tired.com/tiredness-and-sleep/) Fatigue from sleep deprivation is probably the most common cause for an inability to concentrate on one topic for very long. Many studies have shown that students are not getting enough sleep, and sleep deprivation has serious physical, emotional, and cognitive effects. (http://homeworktips.about.com/od/homeworkhelp/a/concentration.htm) A good way to understand the role of sleep is to look at what would happen if people didn't sleep. Lack of sleep has serious effects on brain's ability to function. After just one night without sleep, concentration becomes more difficult and attention span shortens considerably, with the following after-effects: grumpiness, grogginess, irritability and forgetfulness. With continued lack of sufficient sleep, the part of the brain that controls language, memory, planning and sense of time is severely affected, practically shutting down. In fact, 17 hours of sustained wakefulness leads to a decrease in performance. People have to sleep because it is essential to maintaining normal levels of cognitive skills such as speech, memory, innovative and flexible thinking. In other words, sleep plays a significant role in brain development. Research also shows that sleep-deprived individuals often have difficulty in responding to rapidly changing situations and making rational judgments. Sleep deprivation not only has a major impact on cognitive functioning but also on emotional and physical health. (http://www.bbc.co.uk/science/humanbody/sleep/articles/whatissleep.shtml) Missing out on consistent, quality, deep sleep can create a host of problems ranging from poor performance, a weakened immune system, irritability, weight gain, and low self esteem/confidence to anxiety and depression. There are a host of ill effects when the brain is not allowed to rest and repair itself.

In the 2nd objective which is to determine their academic performance in terms of grades and attendance as the level goes higher the easier the lecture becomes for students. On the level 103, we can see that 21% of the total number of respondents incurred a failing grade while on the levels 104 & 105 less students or almost none had a failing grade. As per interview with the N103 respondents, some students are still adjusting with the new lessons since the lecture for N103 is the beginning of Medical Surgical Nursing and it is a combination of Anatomy, Pathology, Pharmacology, Health Assessment and Microbiology. Students also said that one factor that affected the grades is the kind of lecturers. Requirements also play a great role in affecting the grades of the students especially if the deadline of the submission of requirements falls on lecture days. The numbers of units of students carry also play a role, as verbalized by some of the respondents. Medical Surgical Nursing is a field of nursing that most students find complicated since its a combination of many other nursing subjects and it requires critical thinking more than other subjects do. Based on experience, 100% understanding of the lesson would not be possible if the students were not able to read in advance. The clinical instructor giving the lecture is also one big factor which affects grades. It is in the way the lecturer presents his/her lesson. Another is if the night before the lecture day, the student is busy doing requirements for other subjects, they will definitely have no time to prepare for the next days activity. All the attention would be focused on making the paper works and studying would become a lesser priority. The number of units the students enrolled into determines the schedule. If students have a very busy schedule, students would have lesser time to study for their major subjects because time would be divided to all their subjects, not only the majors. In the levels N104 and N105, though the schedules were very hectic because of so many subjects and 2 majors at the same time, the students have adjusted to this kind of scenario because of same pressure experienced at the lower levels. Some students even coped positively with their situation which is the reason why more students got grades 2.3 2.5. The RLE (Related Learning Experience) is the application of the theories learned in Lectures in the fields of nursing. Here, as the students first entered the medical surgical field of nursing in the clinical area, still find it hard to adjust for this new step. The exposures of N103 are the OR, Surgical Ward, Pediatric Ward, Medical Ward and Community Health Nursing. Each exposure, the students would submit individual care studies per term, PONR per rotation,

Journals with reaction, General Objective per week, Specific Objectives and Plan of Activities every duty day, quizzes (at least 2 per Clinical Instructor) and Return Demonstrations of procedures. All of these could not be finished in just a week, especially if the clinical instructors are busy as well. Students adjust to their CIs free time and tend to leave other stuffs behind when the CI would schedule them on a day which happens to fall on their lecture day. On the third objective which was the relationship between the lack of sleep and academic performance. Based on the result shows, the relation of lack of sleep on the related learning experience (RLE) performance of the N103, N104 and N105 had no significant in study done. On the other hand on the lecture of N103 and N104 it showed that there is no significance in relation to lack of sleep on the students. Meanwhile, in the lecture of N105 specifically the Psychiatric Nursing, the result shows that there is significance on the lack of sleep on the academe of the students.

CONCLUSIONS Based on the data gathered, regarding the experiences on lack of sleep among the Level 3 Nursing students under the new curriculum, researchers found that the respondents commonly have experiences due to lack of sleep. In terms of their academic performance, the grades of respondents were significantly affected because of the effects of lack of sleep such as feeling of tiredness, loses clarity and thinking ability which were due to following reasons such as academic, social and psychological factors. Statistically, the relationship between lack of sleep and academic performance, one subject appeared to be affected and significant to the study which was the lecture in N105 the Psychiatric Nursing which was due to academic reason. This study is one of the many studies which support that there is a significant relationship between the lack of sleep and academic performance. The better quality of sleep the better is the academic performance, likewise happen if there is lack of sleep.

RECOMMENDATIONS In light of the results of the study, the following recommendations are presented: students of level III should learn to manage time effectively so that they will be able to balance

all their activities in school and that the standard of 8-10 hours of sleep at night is observed. The students should spend time to study and prepare school requirements but must not forget to give time and importance to sleep. Students should be prudent enough and make an academic calendar to keep track on what are the things to be done and to be prioritized. Some of the tasks can wait a little while, more of it can wait even longer, and some of it may never get done. Should be flexible enough to accept possible interruptions and distractions and try to allow time to do them. Students should utilize vacant times and make use of it to study and do school requirements and minimize hang-outs and parties to avoid cramming and lack of time to do the required tasks. The faculty of the College of Nursing should arrange the schedule of the level III students well that could help the students have more time to prepare and do school works. There should be a seminar to be conducted regarding on how to handle busy schedules and how to improve study skills. For the future researchers, it is recommended to have a study about the Lack of Sleep to the Nursing Faculty and Staffs.

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