Being in control of your life and having realistic expectations about your day­-to-­day challenges are the keys to stress management, which is perhaps the most important ingredient to living a happy, healthy and rewarding life. ­—Marilu Henner, actress

Mental Health Basics

Knowing how to take care of your mental health when you’re in college is just as important as maintaining your physical health. In fact, there’s a strong link between the two: doctors are finding that positive mental health can actually improve your physical health. Mental health can be defined as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”^[1] Having good mental health doesn’t necessarily mean being happy or successful all the time. Most people feel depressed, lonely, or anxious now and then, but those with good mental health can take these feelings in stride and overcome them. When such feelings or moods persist and interfere with a person’s ability to function normally, though, it may be a sign of a more serious mental health problem and time to seek help.

The term mental illness refers to mental disorders or health conditions characterized by “alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.”^[2] Depression is the most common type of mental illness, and it affects more than 26 percent of the U.S. adult population. It has been estimated that by the year 2020, depression will be the second leading cause of disability throughout the world, trailing only ischemic heart disease.

Evidence has shown that mental disorders, especially depressive disorders, are strongly linked to the occurrence and course of many chronic diseases—including diabetes, cancer, cardiovascular disease, asthma, and obesity and many risk behaviors for chronic disease, such as physical inactivity, smoking, excessive drinking, and insufficient sleep. In other words, if your mental health is poor, you may be at greater risk for disease and poor physical health.

Mental Health Indicators

In the public health arena, more emphasis and resources have been devoted to screening, diagnosis, and treatment of mental illness than mental health. Little has been done to protect the mental health of those who are free from mental illness. Here are some known indicators of mental health:

• Emotional well-being: life satisfaction, happiness, cheerfulness, peacefulness.
• Psychological well-being: self-acceptance, personal growth including openness to new experiences, optimism, hopefulness, purpose in life, control of one’s environment, spirituality, self-direction, and positive relationships.
• Social well-being: social acceptance, belief in the potential of people and society as a whole, personal self-worth and usefulness to society, and a sense of community.

The former surgeon general suggests that there are social determinants of mental health—just as there are social determinants of general health—that need to be in place to support mental health. These include adequate housing, safe neighborhoods, equitable jobs and wages, quality education, and equity in access to quality health care.

There are also some common-sense strategies that you can adopt to support and improve your emotional, psychological, and social health:

• Eat a balanced diet
• Get enough sleep
• Get regular physical activity
• Stay socially connected with friends and family
• Make smart choices about alcohol and drugs
• Get help if you are anxious or depressed

Depression

Depression is a common but serious mood disorder that’s more than just a feeling of “being down in the dumps” or “blue” for a few days. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks. If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness, or pessimism
• Irritability
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies and activities
• Decreased energy or fatigue
• Moving or talking more slowly
• Feeling restless or having trouble sitting still
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping, early-morning awakening, or oversleeping
• Appetite and/or weight changes
• Thoughts of death or suicide, or suicide attempts
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Depression is one of the most common mental disorders in the United States. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors. It usually starts between the ages of fifteen and thirty, and is much more common in women. Women can also get postpartum depression after the birth of a baby. Some people get seasonal affective disorder in the winter, when there is less natural sunlight. Depression is one part of bipolar disorder.

Depression, even the most severe cases, can be treated. The earlier treatment begins, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two.

There are days that you will feel down, especially when the demands of college get to you. These feelings are normal and will go away. If you are feeling low, try to take a break from the pressures of college and do something you enjoy. Spend time with friends, exercise, read a good book, listen to music, watch a movie, call a friend, talk to your family, or anything else that makes you feel good. If you feel depressed for two weeks, or the feeling keeps coming back, you should talk to a counselor at your college – they see lots of students who are anxious, stressed, or depressed at college, and are trained to help you.

Loneliness

Most people experience occasional loneliness, and it’s an especially common experience among first-time college students who find themselves in an unfamiliar environment with a completely new social scene. Loneliness isn’t necessarily about being alone—you can be surrounded by people and still feel alone. It’s the feeling of being alone that counts, along with feeling empty, unwanted, or isolated. In the following TED Talk, Sherrie Turkle describes how, in this age of near-constant digital “connection,” loneliness is a challenge that faces us all:

If you’re feeling lonely, try taking Turkle’s advice and start a conversation with someone. College is a great place to meet new people and develop new and interesting relationships. Others in college are new, just like you, and will welcome the chance to connect with and get to know another classmate. Try joining a campus interest group or club, play a team sport, or just ask another student if they’d like to meet for coffee or to study. If feelings of loneliness persist, and especially if you also feel depressed, you should get help from a counselor or health services.

Eating Disorders

Eating disorders are mental health illnesses that involve emotional and behavioral disturbance surrounding weight and food issues. The most common are anorexia nervosa, bulimia nervosa, and binge eating disorder. Eating disorders can have life-threatening consequences.

Anorexia nervosa is characterized by self-starvation and extreme weight loss either through restriction or through binge-purging. This may frequently be a result of body dysmorphic disorder (a condition in which someone feels that their body looks differently than it actually does) or a result of other psychiatric complications such as obsessive-compulsive disorder (OCD) or depression. Starvation can cause harm to vital organs such as the heart and brain, can cause nails, hair, and bones to become brittle, and can make the skin dry and sometimes yellow or covered with soft hair. Menstrual periods can become irregular or stop completely.

People with bulimia nervosa eat large amounts of food (also called bingeing) at least two times a week and then vomit (also called purging) or exercise compulsively. Because many people who “binge and purge” maintain their body weight, they may keep their problem a secret for years. Vomiting can cause loss of important minerals, life-threatening heart arrhythmia (irregular heartbeat), damage to the teeth, and swelling of the throat. Bulimia can also cause irregular menstrual periods.

People who binge without purging also have a disorder called binge eating disorder. This is frequently associated with feelings of loss of control and shame surrounding eating. People who are diagnosed with this disorder tend to gain weight, and many will have all of the consequences of being overweight, including high blood pressure and other cardiac symptoms, diabetes, and musculoskeletal complaints.

If you think you might have an eating disorder, you should go to the student health center or counseling center and get help. Talk with your family and close friends. Going for help and talking to others about your feelings and illness can be very difficult, but it’s the only way that you’re going to get better. Many colleges have treatment programs for these conditions and trained counselors who can relate to people with an eating disorder.

Anxiety Disorders

People with anxiety disorders respond to certain objects or situations with fear and dread. They have physical reactions to those objects, such as a rapid heartbeat and sweating. An anxiety disorder is diagnosed if a person has an inappropriate response to a situation, cannot control the response, and/or has an altered way of life due to the anxiety. Anxiety disorders include the following:

Obsessive-compulsive disorder (OCD) is a type of anxiety disorder. If you have OCD, you have repeated, upsetting thoughts called obsessions. You do the same thing over and over again to try to make the thoughts go away. Those repeated actions are called compulsions. Examples of obsessions are a fear of germs or a fear of being hurt. Compulsions include washing your hands, counting, checking on things or cleaning. Untreated, OCD can take over your life. Researchers think brain circuits may not work properly in people who have OCD. It tends to run in families. The symptoms often begin in children or teens. Treatments that combine medicines and therapy are often effective.

Panic disorder is a kind of anxiety disorder that causes panic attacks. Panic attacks are sudden feelings of terror for no reason. You may also feel physical symptoms, such as fast heartbeat, chest pain, breathing difficulty, or dizziness. Panic attacks can happen anytime, anywhere and without warning. You may live in fear of another attack and may avoid places where you have had an attack. For some people, fear takes over their lives and they cannot leave their homes. Panic disorder is more common in women than men. It usually starts when people are young adults. Sometimes it starts when a person is under a lot of stress. Most people get better with treatment. Therapy can show you how to recognize and change your thinking patterns before they lead to panic. Medicines can also help.

A phobia is a strong, irrational fear of something that poses little or no actual danger. There are many specific phobias. Acrophobia is a fear of heights: you may be able to ski the world’s tallest mountains but be unable to go above the fifth floor of an office building. Agoraphobia is a fear of public places, and claustrophobia is a fear of closed-in places. If you become anxious and extremely self-conscious in everyday social situations, you could have a social phobia. Other common phobias involve tunnels, highway driving, water, flying, animals, and blood. People with phobias try to avoid what they are afraid of. If they cannot, they may experience panic and fear, rapid heartbeat, shortness of breath, trembling, and/or a strong desire to get away. Treatment helps most people with phobias. Options include medicines, therapy, or both.

Post-traumatic stress disorder (PTSD) is a real illness. You can get PTSD after living through or witnessing a traumatic event, such as war, a hurricane, rape, physical abuse, or a bad accident. PTSD makes you feel stressed and afraid after the danger is over. It affects your life and the people around you. PTSD can cause problems like flashbacks, feeling like the event is happening again, trouble sleeping, nightmares, feeling alone, angry outbursts, or feeling worried, guilty, or sad.

PTSD starts at different times for different people. Signs of PTSD may start soon after a frightening event and then continue. Other people develop new or more severe signs months or even years later. PTSD can happen to anyone, even children. Medicines can help you feel less afraid and tense. It might take a few weeks for them to work. Talking to a specially trained doctor or counselor also helps many people with PTSD. This is called talk therapy.

Suicidal Behavior

Suicide causes immeasurable pain, suffering, and loss to individuals, families, and communities nationwide. On average, 112 Americans die by suicide each day. Suicide is the second leading cause of death among 15–24-year-olds, and more than 9.4 million adults in the United States had serious thoughts of suicide within the past twelve months. But suicide is preventable, so it’s important to know what to do.

Warning Signs of Suicide

If someone you know is showing one or more of the following behaviors, he or she may be thinking about suicide. Don’t ignore these warning signs. Get help immediately.

• Talking about wanting to die or to kill oneself
• Looking for a way to kill oneself
• Talking about feeling hopeless or having no reason to live
• Talking about feeling trapped or in unbearable pain
• Talking about being a burden to others
• Increasing the use of alcohol or drugs
• Acting anxious or agitated; behaving recklessly
• Sleeping too little or too much
• Withdrawing or feeling isolated
• Showing rage or talking about seeking revenge
• Displaying extreme mood swings

Get Help

If you or someone you know needs help, call the National Suicide Prevention Lifeline at 1.800.273.TALK (8255). Trained crisis workers are available to talk 24 hours a day, 7 days a week.

If you think someone is in immediate danger, do not leave him or her alone—stay there and call 911.

OK2TALK is a community for young adults struggling with mental health problems. It offers a safe place to talk.

Stress

As a student, you’re probably plenty familiar with the experience of stress—a condition characterized by symptoms of physical or emotional tension. What you may not know is that it’s a natural response of the mind and body to a situation in which a person feels threatened or anxious. Stress can be positive (the anticipation of preparing for a wedding) or negative (dealing with a natural disaster). As a college student, it may feel like stress is a persistent fact of life. While everyone experiences stress at times, a prolonged bout of it can affect your health and ability to cope with life. That’s why social support and self-care are important. They can help you see your problems in perspective . . . and the stressful feelings ease up.

Sometimes stress can be good. For instance, it can help you develop skills needed to manage potentially challenging or threatening situations in life. However, stress can be harmful when it is severe enough to make you feel overwhelmed and out of control. Strong emotions like fear, sadness, or other symptoms of depression are normal, as long as they are temporary and don’t interfere with daily activities. If these emotions last too long or cause other problems, it’s a different story.

Signs and Effects of Stress

• Disbelief and shock
• Tension and irritability
• Fear and anxiety about the future
• Difficulty making decisions
• Being numb to one’s feelings
• Loss of interest in normal activities
• Loss of appetite (or increased appetite)
• Nightmares and recurring thoughts about a particular event
• Anger
• Increased use of alcohol and drugs
• Sadness and other symptoms of depression
• Feeling powerless
• Crying
• Sleep problems
• Headaches, back pains, and stomach problems
• Trouble concentrating

It’s not only unpleasant to live with the tension and symptoms of ongoing stress; it’s actually harmful to your body, too. Chronic stress can impair your immune system and disrupt almost all of your body’s processes, leading to increased risk of numerous health problems, including anxiety, depression, digestive problems, heart disease, sleep problems, weight gain, and/or memory and concentration impairment.^[3]

That’s why it’s so important to learn healthy ways of coping with the stressors in your life.

Ways of Managing Stress

The best strategy for managing stress is by taking care of yourself in the following ways:

• Avoid drugs and alcohol. They may seem to be a temporary fix to feel better, but in the long run they can create more problems and add to your stress instead of taking it away.
• Manage your time. Work on prioritizing and scheduling your commitments. This will help you feel in better control of your life which, in turn, will mean less stress.
• Find support. Seek help from a friend, family member, partner, counselor, doctor, or clergy person. Having a sympathetic listening ear and talking about your problems and stress really can lighten the burden.
• Connect socially. When you feel stressed, it’s easy to isolate yourself. Try to resist this impulse and stay connected. Make time to enjoy being with classmates, friends, and family; try to schedule study breaks that you can take with other people.
• Slow down and cut out distractions for a while. Take a break from your phone, email, and social media.
• Take care of your health. Eat well, exercise regularly, get plenty of sleep, try a relaxation technique (such as meditation or yoga), and maintain a normal, predictable routine.

Not surprisingly, these techniques are similar to those recommended for supporting good mental health in general. If the self-care techniques listed above aren’t enough and stress is seriously interfering with your studies or life, don’t be afraid to get help. The student health center and college counselors are both good resources.

Wellness

Nutrition

A diet is anything that you consume on a regular basis. If you drink Diet Coke for breakfast every day, that’s part of your diet. When people talk about “going on a diet,” they usually mean changing their existing dietary habits in order to lose weight or change their body shape. All people are on a diet because everyone eats! Having a healthy diet means making food choices that contribute to short- and long-term health. It means getting the right amounts of nutrient-rich foods and avoiding foods that contain excessive amounts of less healthy foods. The right mix can help you be healthier now and in the future.

Developing eating healthy eating habits doesn’t require you to sign up for a gimmicky health-food diet or lifestyle: you don’t have to become vegan, gluten-free, paleo, or go on regular juice fasts. The simplest way to create a healthy eating style is by learning to make wise food choices that you can enjoy, one small step at a time. The key is choosing a variety of foods and beverages from each food group (vegetables, fruits, grains, protein foods, and dairy) and making sure that each choice is limited in sodium, saturated fat, and added sugars.^[4] The current USDA Healthy Eating Guidelines are a great reference for making healthy food choices.

USDA Healthy Eating Guidelines

Make half your plate fruits and vegetables: Focus on whole fruits, and vary your veggies

• Choose whole fruits—fresh, frozen, dried, or canned in 100% juice.
• Enjoy fruit with meals, as snacks, or for a dessert.
• Try adding fresh, frozen, or canned vegetables to salads, side dishes, and recipes.
• Choose a variety of colorful veggies prepared in healthful ways: steamed, sautéed, roasted, or raw.

Make half your grains whole grains

• Look for whole grains listed first or second on the ingredients list—try oatmeal, popcorn, whole-grain bread, and brown rice.
• Limit grain desserts and snacks, such as cakes, cookies, and pastries.

Vary your protein routine

• Mix up your protein foods to include a variety—seafood, beans and peas, unsalted nuts and seeds, soy products, eggs, and lean meats and poultry.
• Try main dishes made with beans and seafood, like tuna salad or bean chili.

Move to low-fat or fat-free milk or yogurt

• Choose fat-free milk, yogurt, and soy beverages (soy milk) to cut back on your saturated fat.
• Replace sour cream, cream, and regular cheese in recipes and dishes with low-fat yogurt, milk, and cheese.

Drink and eat less sodium, saturated fat, and added sugars

• Eating fewer calories from foods high in saturated fat and added sugars can help you manage your calories and prevent overweight and obesity. Most of us eat too many foods that are high in saturated fat and added sugar.
• Eating foods with less sodium can reduce your risk of high blood pressure.
• Use the Nutrition Facts Label and ingredients list to compare foods and drinks. Limit items high in sodium, saturated fat, and added sugars.
• Use vegetable oils instead of butter, and choose oil-based sauces and dips instead of those with butter, cream, or cheese.
• Drink water instead of sugary drinks.

Eat the right amount

• Eat the right amount of calories for you based on your age, sex, height, weight, and physical activity level. Visit the USDA SuperTracker, which can help you plan, analyze, and track your diet and physical activity.
• Building a healthier eating style can help you avoid overweight and obesity and reduce your risk of diseases such as heart disease, diabetes, and cancer.

The following short video recaps the USDA’s current healthy eating guidelines:

Healthy Eating in College

College offers many temptations for students trying to create or maintain healthy eating habits. You may be on your own for the first time, and you’re free to eat whatever you want, whenever you want. Cafeterias, all-you-can-eat dining facilities, vending machines, and easy access to food twenty-four hours a day make it tempting to overeat or choose foods loaded with calories, saturated fat, sugar, and salt. You may not be in the habit of shopping or cooking for yourself yet, and when you find yourself short on time or money, it may seem easier to fuel yourself on sugary, caffeinated drinks and meals at the nearest fast-food place. Also, maybe you played basketball or volleyball in high school, but now you don’t seem to be getting much exercise.

On top of that, it’s common for people to overeat (or not eat enough) when they feel anxious, lonely, sad, or stressed, and college students are no exception. It’s incredibly important, though, to develop healthy ways of coping and relaxing that don’t involve reaching for food, drink, or other substances. It’s also important to eat regular healthy meals to keep up your energy.

Kidshealth.org offers the following advice on ways for college students to adopt a healthy food attitude:^[5]

• avoid eating when stressed, while studying, or while watching TV
• eat slowly
• eat at regular times and try not to skip meals
• keep between-meal and late-night snacking to a minimum
• choose a mix of nutritious foods
• pick lower-fat options when you can, such as low-fat milk instead of whole milk or light salad dressing instead of full-fat dressing
• watch the size of your portions
• resist going back for additional servings
• steer clear of vending machines and fast food
• keep healthy snacks like fruit and vegetables on hand in your room
• replace empty-calorie soft drinks with water or skim milk

Regular Exercise: Health for Life

The importance of getting regular exercise is probably nothing new to you. The health benefits are well known and established: regular physical activity can produce long-term health benefits by reducing your risk of many health problems, such as heart disease, cancer, and diabetes, and it can also increase your chances of living longer, help you control your weight, and even help you sleep better.

As a busy college student, you may be thinking, I know this, but I don’t have time! I have classes and work and a full life! What you may not know is that—precisely because you have such a demanding, possibly stressful schedule—now is the perfect time to make exercise a regular part of your life. Getting into an effective exercise routine now will not only make it easier to build healthy habits that you can take with you into your life after college, but it can actually help you be a more successful student, too. As you’ll see in the section on brain health, below, exercise is a powerful tool for improving one’s mental health and memory—both of which are especially important when you’re in school.

The good news is that most people can improve their health and quality of life through a modest increase in daily activity. You don’t have to join a gym, spend a lot of money, or even do the same activity every time—just going for a walk or choosing to take the stairs can make a difference.

Physical Fitness and Types of Exercise

Physical fitness is a state of well-being that gives you sufficient energy to perform daily physical activities without getting overly tired or winded. It also means being in good enough shape to handle unexpected emergencies involving physical demands—that is, if someone said, “Run for your life!” or you had to rush over and prevent a child from falling, you’d be able to do it. There are many forms of exercise—dancing, rock climbing, walking, jogging, yoga, bike riding, you name it—that can help you become physically fit. The major types are described below.

Aerobic exercise increases your heart rate, works your muscles, and raises your breathing rate. For most people, it’s best to aim for a total of about thirty minutes a day, four or five days a week. If you haven’t been very active recently, you can start out with five or ten minutes a day and work up to more time each week. Or, split up your activity for the day: try a brisk ten-minute walk after each meal. If you are trying to lose weight, you may want to exercise more than thirty minutes a day. Examples of aerobic exercise include going for a run or brisk walk, dancing, swimming, and cycling.

Strength training, done several times a week, helps build strong bones and muscles and makes everyday chores like carrying heavy backpacks or grocery bags easier. When you have more muscle mass, you burn more calories, even at rest. You could join a strength training class or lift weights at home.

Flexibility exercises, also called stretching, help keep your joints flexible and reduce your risk of injury during other activities. Gentle stretching for 5 to 10 minutes helps your body warm up and get ready for aerobic activities such as walking or swimming. Check to see if your college offers yoga, stretching, and/or pilates classes, and give one a try.

In addition to formal exercise, there are many opportunities to be active throughout the day. Being active helps burns calories. The more you move around, the more energy you will have. You can increase your activity level by walking instead of driving when possible, taking the stairs instead of the elevator, doing some house or yard work every day, or by parking a little farther from your destination.

Benefits of Exercise and Physical Fitness

Longevity

Exercise, even after age fifty, can add healthy, active years to one’s life. Studies continue to show that it’s never too late to start exercising and that even small improvements in physical fitness can significantly lower the risk of death. Simply walking regularly can prolong your life. Moderately fit people—even if they smoke or have high blood pressure—have a lower mortality rate than the least fit. Resistance training is important because it’s the only form of exercise that can slow and even reverse the decline of muscle mass, bone density, and strength. Adding workouts that focus on speed and agility can be especially protective for older people. Flexibility exercises help reduce the stiffness and loss of balance that accompanies aging.

Diabetes

Diabetes, particularly type 2, is reaching epidemic proportions throughout the world as more and more cultures adopt Western-style diets, which tend to be high in sugar and fat. Aerobic exercise is proving to have significant and particular benefits for people with both type 1 and type 2 diabetes; it increases sensitivity to insulin, lowers blood pressure, improves cholesterol levels, and decreases body fat. In fact, studies show that people who engage in regular, moderate aerobic exercise (e.g., brisk walking, biking) lower their risk for diabetes even if they do not lose weight. Anyone on insulin or who has complications from diabetes should get advice from a physician before embarking on a workout program.

Brain: Mood, Memory, Creativity

In addition to keeping your heart healthy, helping with weight loss, and helping you live longer, regular exercise can also improve your mood and help keep depression and anxiety at bay. The following video explains why and challenges you to give it a try:

If you still aren’t persuaded, check out this slightly longer but excellent TEDx Talk, which describes how aerobic exercise can improve your cognitive functioning, memory, and creativity:

The Benefits of Sleep

We have so many demands on our time—school, jobs, family, errands, not to mention finding some time to relax. To fit everything in, we often sacrifice sleep. But sleep affects both mental and physical health. Like exercise and a healthy diet, it’s vital to your well-being. Of course, sleep helps you feel rested each day. But while you’re sleeping, your brain and body don’t just shut down. Internal organs and processes are hard at work throughout the night. Sleep can help you “lock in” everything you’re studying and trying to remember.

“Sleep services all aspects of our body in one way or another: molecular, energy balance, as well as intellectual function, alertness, and mood,” says Dr. Merrill Mitler, a sleep expert and neuroscientist at NIH. When you’re tired, you can’t function at your best. Sleep helps you think more clearly, have quicker reflexes, and focus better. “The fact is, when we look at well-rested people, they’re operating at a different level than people trying to get by on one or two hours less nightly sleep,” says Mitler. Tired people tend to be less productive at work and school. They’re at a much higher risk for traffic accidents. Lack of sleep also influences your mood, which can affect how you interact with others. A sleep deficit over time can even put you at greater risk for developing depression.

But sleep isn’t just essential for the brain. “Sleep affects almost every tissue in our bodies,” says Dr. Michael Twery, a sleep expert at NIH. “It affects growth and stress hormones, our immune system, appetite, breathing, blood pressure, and cardiovascular health.” Research shows that lack of sleep increases the risk for obesity, heart disease, and infections. Throughout the night, your heart rate, breathing rate, and blood pressure rise and fall, a process that may be important for cardiovascular health. Your body releases hormones during sleep that help repair cells and control the body’s use of energy. These hormone changes can affect your body weight.

A good night’s sleep consists of four to five sleep cycles. Each cycle includes periods of deep sleep and rapid eye movement (REM) sleep, when we dream. “As the night goes on, the portion of that cycle that is in REM sleep increases. It turns out that this pattern of cycling and progression is critical to the biology of sleep,” Twery says.

Sleep can be disrupted by many things. Stimulants such as caffeine or certain medications can keep you up. Distractions such as electronics—especially the light from TVs, cell phones, tablets and e-readers—can prevent you from falling asleep.

How Much Sleep Do We Need?

The amount of sleep each person needs depends on many factors, including age, and getting a full night of quality sleep is important. For most adults, 7-8 hours a night appears to be the best amount of sleep. The amount of sleep a person needs also increases if he or she has been deprived of sleep in previous days. Getting too little sleep creates a “sleep debt,” which is a lot like being overdrawn at a bank. Eventually, your body will demand that the debt be repaid. We don’t seem to adapt to getting less sleep than we need; while we may get used to a sleep-depriving schedule, our judgment, reaction time, and other functions are still impaired. If you’re a student, that means that sleep-deprivation may prevent you from studying, learning, and performing as well as you can.

Experts say that if you feel drowsy during the day, even during boring activities, you haven’t had enough sleep. If you routinely fall asleep within five minutes of lying down, you probably have severe sleep deprivation, possibly even a sleep disorder. “Microsleeps,” or very brief episodes of sleep in an otherwise awake person, are another mark of sleep deprivation. In many cases, people are not aware that they are experiencing microsleeps. The widespread practice of “burning the candle at both ends” in western industrialized societies has created so much sleep deprivation that what is really abnormal sleepiness is now almost the norm.

Many studies make it clear that sleep deprivation is dangerous. Sleep-deprived people who are tested by using a driving simulator or by performing a hand-eye coordination task perform as badly as or worse than those who are intoxicated. Sleep deprivation also magnifies alcohol’s effects on the body, so a fatigued person who drinks will become much more impaired than someone who is well rested. Driver fatigue is responsible for an estimated 100,000 motor vehicle accidents and 1,500 deaths each year, according to the National Highway Traffic Safety Administration. Since drowsiness is the brain’s last step before falling asleep, driving while drowsy can—and often does—lead to disaster. Caffeine and other stimulants cannot overcome the effects of severe sleep deprivation. The National Sleep Foundation says that if you have trouble keeping your eyes focused, if you can’t stop yawning, or if you can’t remember driving the last few miles, you are probably too drowsy to drive safely.

Falling Asleep and Getting a Good Night’s Rest

Many people, especially those who feel stressed, anxious, or overworked, have a hard time falling asleep and/or staying asleep, and this can shorten the amount of time and the quality of sleep when it actually comes. The following tips can help you get to sleep, stay asleep, and wake up feeling well rested:

• Set a schedule: Go to bed at a set time each night and get up at the same time each morning. Disrupting this schedule may lead to insomnia. “Sleeping in” on weekends also makes it harder to wake up early on Monday morning because it resets your sleep cycles for a later awakening.
• Exercise: Try to exercise 20 to 30 minutes a day. Daily exercise often helps people sleep. A workout soon before bedtime may interfere with sleep, though, so try to get your exercise about 5 to 6 hours before going to bed.
• Avoid caffeine, nicotine, and alcohol before bed: Avoid drinks that contain caffeine, which acts as a stimulant and keeps people awake. Sources of caffeine include coffee, chocolate, soft drinks, non-herbal teas, diet drugs, and some pain relievers. Smokers tend to sleep very lightly and often wake up in the early morning due to nicotine withdrawal. Alcohol robs people of deep sleep and REM sleep and keeps them in the lighter stages of sleep.
• Relax before bed: A warm bath, reading, or another relaxing routine can make it easier to fall sleep. It’s also a good idea to put away books, homework, and screens (that means your computer and phone) at least 30 minutes before bed. You can train yourself to associate certain restful activities with sleep and make them part of your bedtime ritual.
• Sleep until sunlight: If possible, wake up with the sun, or use very bright lights in the morning. Sunlight helps the body’s internal biological clock reset itself each day. Sleep experts recommend exposure to an hour of morning sunlight for people having problems falling asleep.
• Don’t lie in bed awake: If you can’t get to sleep, don’t just lie in bed. Do something else, like reading or listening to music, until you feel tired. Avoid digital screens, though: watching TV, and being on the computer or a smartphone are too stimulating and will actually make you more wakeful. The anxiety of being unable to fall asleep can actually contribute to insomnia.
• Control your room temperature: Extreme temperatures may disrupt sleep or prevent you from falling asleep.
• Screen out noise and light: Do what you can to drown out any bright lights and noise of loud roommates, etc.
• See a doctor if your sleeping problem continues: If you have trouble falling asleep night after night, or if you always feel tired the next day, then you may have a sleep disorder and should see a physician. Your primary care physician may be able to help you; if not, you can probably find a sleep specialist at a major hospital near you. Most sleep disorders can be treated effectively, so you can finally get that good night’s sleep you need.

Substance Abuse

A drug is a chemical substance that can change how your body and mind work. Drugs of abuse are substances that people use to get high and change how they feel. They may be illegal drugs like pot, cocaine, or heroin. Or they may be legal for adults only, like alcohol and tobacco. Medicines that treat illness can also become drugs of abuse when people take them to get high—not because they’re sick and following their doctor’s orders. People abuse drugs for many reasons:

• They want to feel good. Taking a drug can feel really good for a short time, and people keep taking them to have those good feelings again and again. But even though someone may take more and more of a drug, the good feelings don’t last. Soon the person is taking the drug just to keep from feeling bad.
• They want to stop feeling bad. Some people who feel very worried, afraid, or sad abuse drugs to try to stop feeling so awful. This doesn’t really help their problems and can lead to addiction, which can make them feel much worse.
• They want to do well in school or at work. Some people who want to get good grades, get a better job, or earn more money might think drugs will give them more energy, keep them awake, or make them think faster. But it usually doesn’t work, may put their health at risk, and may lead to addiction.

Cigarettes and Tobacco

It might surprise you to learn that cigarettes and other forms of tobacco are drugs. It’s legal to use tobacco once you’re 18 or 19 years old, depending on where you live. But it’s not healthy for you at any age. Tobacco contains nicotine, a substance that excites the parts of the brain that make you feel good. You can get addicted to nicotine just like other drugs. Use of cigarettes and tobacco can cause lung diseases, bad breath, bad teeth, mouth cancer, heart and blood problems, and many other health issues.

The nicotine in tobacco is what makes you addicted. When you smoke, the effects wear off quickly. This makes you want to keep using tobacco again and again throughout the day. The more you do this, the more your body and brain get addicted to the nicotine. Fortunately, there are medicines, other treatments, and hotlines that can help people quit tobacco.

Alcohol

Drinks like beer, malt liquor, wine, and hard liquor contain alcohol. Alcohol is the ingredient that gets you drunk. Hard liquor—such as whiskey, rum, or gin—has more alcohol in it than beer, malt liquor, or wine. The following drink sizes contain about the same amount of alcohol:

• 1 ½ ounces of hard liquor
• 5 ounces of wine
• 8 ounces of malt liquor
• 12 ounces of beer

Being drunk can make a person feel very silly, angry, or sad for no reason. It can make it hard to walk in a straight line, talk clearly, or drive. Drinking too much–on a single occasion or over time—can take a serious toll on the health of your brain, heart, liver, and create other health issues.

So how much is “drinking too much”? The following guidelines are from the National Institute on Alcohol Abuse and Alcoholism (NIAAA):

Sexual Health

Sexuality is a big part of being human. Love, affection, and sexual intimacy all play a role in healthy relationships. They also contribute to your sense of well-being. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence.

Your sexuality is your own private business, of course, but whether you abstain from sexual intercourse or decide to become or continue being sexually active, the decisions you make can affect the health and safety of your sexual partner(s)—just as their decisions can affect yours. Therefore, it’s important to get the facts about what you can do to protect yourself and your partner from sexually transmitted disease, unwanted pregnancy, and sexual violence.

Sexually Transmitted Diseases (STDs)

STDs are diseases that are passed from one person to another through sexual contact. These include chlamydia, gonorrhea, genital herpes, human papillomavirus (HPV), syphilis, and HIV. Many of these STDs do not show symptoms for a long time, but they can still be harmful and passed on during sex. You can get an STD by having sex (vaginal, anal, or oral) with someone who has an STD. Anyone who is sexually active can get an STD. You don’t even have to “go all the way” (have anal or vaginal sex) to get an STD, since some, like herpes and HPV, are spread by skin-to-skin contact.

STDs are common, especially among young people. There are about twenty million new cases of STDs each year in the United States, and about half of these are in people between the ages of fifteen and twenty-four. Young people are at greater risk of getting an STD for several reasons:

• Young women’s bodies are biologically more susceptible to STDs.
• Some young people do not get the recommended STD tests.
• Many young people are hesitant to talk openly and honestly with a doctor or nurse about their sex lives.
• Not having insurance or transportation can make it more difficult for young people to access STD testing.
• Some young people have more than one sex partner.

The surest way to protect yourself against STDs is to not have sex – that is, by practicing abstinence. That means not having any vaginal, anal, or oral sex. There are many things to consider before having sex, and it’s okay to say no if you don’t want to have sex. If you do decide to have sex, you and your partner should get tested beforehand and make sure that you and your partner use a condom—every time you have oral, anal, or vaginal sex, from start to finish. Know where to get condoms and how to use them correctly. It’s not safe to stop using condoms unless you’ve both been tested, know your status, and are in a mutually monogamous relationship.

Before you have sex, talk with your partner about how you will prevent STDs and pregnancy. If you think you’re ready to have sex, you need to be ready to protect your body and your future. You should also talk to your partner ahead of time about what you will and will not do sexually. Your partner should always respect your right to say no to anything that doesn’t feel right.

There are places that offer confidential and free STD tests, meaning no one has to find out you’ve been tested. Visit GetTested to find an STD testing location near you. If you find out that you have an STD, it’s important to seek treatment—since some STDs can be fatal if left untreated. Although certain STDs (like herpes and HIV) aren’t curable, a doctor can prescribe medicine to treat the symptoms. If you are living with an STD, it’s important to tell your partner before you have sex. Although it may be uncomfortable to talk about your STD, open and honest conversation can help your partner make informed decisions to protect his or her health.

Unintended Pregnancy

Seven in ten pregnancies among single women between the ages of eighteen and twenty-nine are unplanned.^[6] As with STDs, the surest way to avoid unintended pregnancy is abstinence, since no birth control method is 100 percent reliable. However, if you are sexually active, it’s important to protect yourself and your partner from pregnancy and HIV and other STDs. Birth control (such as the pill, patch, ring, implant, shot, or an IUD) provides highly effective pregnancy prevention, but it doesn’t protect you from HIV and other STDs. Condoms can reduce the risk to both of you for pregnancy and most STDs, including HIV. Even if you or your partner is using another type of birth control, agree to use a condom every time you have sex. Think of it this way: his condom + her hormonal birth control or IUD = DOUBLE PROTECTION.

If a condom breaks or you have unprotected sexual intercourse, it’s possible to take an emergency contraceptive pill (ECP)—sometimes called a “morning-after pill”—which may prevent a pregnancy from occurring. ECPs generally contain a higher dose of the same hormones found in regular oral contraceptive pills, and they are most effective when used shortly after intercourse (not the next morning, as the name suggests). It’s important to note that ECPs are not abortion pills, and they do nothing to either prevent or cure STDs.

Visit your campus health center or talk to your doctor to get more information about birth control, condoms, and other reproductive and sexual health issues.

Sexual Assault

Sexual assault is any type of sexual activity that a person doesn’t agree to. It can include touching that is not okay; putting something into the vagina; sexual intercourse; rape; and attempted rape. Sexual assault happens on college campuses as well as in communities. One in five women has been sexually assaulted while in college and 80 percent of female rape victims experience their first rape before the age of twenty-five. The following statistics show that sexual assaults usually aren’t random acts of violence carried out by strangers: ^[7]

• Approximately 4 out of 5 rapes are committed by someone known to the victim.
• 82 percent of sexual assaults are perpetrated by a non-stranger.
• 47 percent of rapists are a friend or an acquaintance.
• 25 percent are an intimate partner.
• 5 percent are a relative.

Date Rape Drugs

One of the great things about being in college is having the chance to meet and get to know so many new people. Protecting yourself against sexual assaults doesn’t mean you have to sacrifice exciting social opportunities. It just means being informed about risks and taking common-sense steps to protect yourself.

One very real risk on college campuses—and elsewhere—is the use of date rape drugs to assist sexual assaults. Date rape drugs are powerful and dangerous drugs that can be slipped into your drink when you are not looking. The drugs often have no color, smell, or taste, so you can’t tell if you are being drugged. The drugs can make you become weak and confused or even pass out, so that you are unable to refuse sex or defend yourself. If you are drugged, you might not remember what happened while you were drugged. Date rape drugs are used on both women and men.

The three most common date rape drugs are Rohypnol, GHB, and Ketamine:

• Rohypnol comes as a pill that dissolves in liquids. Some are small, round, and white. Newer pills are oval and green-gray in color. When slipped into a drink, a dye in these new pills makes clear liquids turn bright blue and dark drinks turn cloudy. But this color change might be hard to see in a dark drink, like cola or dark beer, or in a dark room. Also, the pills with no dye are still available. The pills may be ground up into a powder.
• GHB has a few forms: a liquid with no odor or color, white powder, and pill. It might give your drink a slightly salty taste. Mixing it with a sweet drink, such as fruit juice, can mask the salty taste.
• Ketamine comes as a liquid and a white powder.

These drugs also are known as “club drugs” because they tend to be used at dance clubs, concerts, and “raves.” The term “date rape” is widely used to describe sexual crimes involving these drugs, but most experts prefer the term “drug-facilitated sexual assault.” These drugs are also used to help people commit other crimes, like robbery and physical assault. The term “date rape” can be misleading because the person who commits the crime might not be dating the victim. Rather, it could be an acquaintance or stranger.

Alcohol and Other Drugs

Alcohol is also a drug that’s commonly used to help commit sexual assault. Be aware of the risks you take by drinking alcohol at parties or in other social situations. When a person drinks too much alcohol,

• it’s harder to think clearly.
• it’s harder to set limits and make good choices.
• it’s harder to tell when a situation could be dangerous.
• it’s harder to say “no” to sexual advances.
• it’s harder to fight back if a sexual assault occurs.
• it’s possible to black out and to have memory loss.

The club drug “ecstasy” (MDMA) has been used to commit sexual assault. It can be slipped into someone’s drink without the person’s knowledge. Also, a person who willingly takes ecstasy is at greater risk of sexual assault. Ecstasy can make a person feel “lovey-dovey” toward others. As with alcohol, it also can lower a person’s ability to give reasoned consent. Once under the drug’s influence, a person is less able to sense danger or to resist a sexual assault.

How and Where to Get Help

Take the following steps if you or someone you know has been raped, or you think you might have been drugged and raped:

• Get medical care right away. Call 911 or have a trusted friend take you to a hospital emergency room. Don’t urinate, douche, bathe, brush your teeth, wash your hands, change clothes, or eat or drink before you go. These actions may alter or wipe out evidence of the rape. The hospital will use a “rape kit” to collect evidence.
• Call the police from the hospital. Tell the police exactly what you remember. Be honest about all your activities. Remember, nothing you did—including drinking alcohol or doing drugs—can justify rape.
• Ask the hospital to take a urine (pee) sample that can be used to test for date rape drugs. The drugs leave your system quickly. Rohypnol stays in the body for several hours and can be detected in the urine up to 72 hours after taking it. GHB leaves the body in 12 hours. Don’t urinate before going to the hospital.
• Don’t pick up or clean up where you think the assault might have occurred. There could be evidence left behind—such as on a drinking glass or bed sheets.
• Get counseling and treatment. Feelings of shame, guilt, fear, and shock are normal. A counselor can help you work through these emotions and begin the healing process. Calling a crisis center or a hotline is a good place to start. One national hotline is the National Sexual Assault Hotline at 800-656-HOPE.

Safety Consciousness on Campus and in College

College and university campuses tend to have a special feel—so special that when you are on campus you may feel you are fully apart from the wider world around you. But the reality is that any campus is subject to the same influences and crimes as the towns and cities that flank the campus. And so it is important to be aware of your surroundings, the people near you, and the goings on in your physical spaces and in your virtual spaces at all times. In this topic, we explore college safety concerns, and share tips and resources to help ensure that you are always safe, protected, and no more than a phone call away from help if you need it.

Safety Consciousness

Safety consciousness is a term describing your awareness of hazards and your alertness to potential danger. In order to have safety consciousness, you must value safety no matter where you are or what time of day it is.

Your college or university must also be safety conscious—not only by choice, but also by law. In 1990, Congress enacted the Crime Awareness and Campus Security Act, which required all schools that receive federal student aid to share information about crime on and around their campuses. The act is now generally just referred to as the Clery Act, in memory of Jeanne Clery, a student killed in her dorm room in 1986. What does the Clery Act require your college to do? If your college is receiving federal student aid, here are the major legal requirements it must comply with:

• Have emergency notification and evacuation procedures for alerting the campus community about significant emergencies or dangerous situations, and disclose these policies and procedures in the annual security report.
• Issue timely warnings to alert the campus community about crimes that pose a serious or continuing threat to safety, and disclose this policy in the annual security report.
• Keep a crime log that records, by date reported, all crimes reported to the campus police or security department.
• Keep a fire log that records by date reported, all fires in on-campus student housing facilities.
• Collect crime reports from campus security authorities within the institution.
• Request crime statistics from local law enforcement in the jurisdiction where the institution is located.
• Submit crime and fire statistics to the Department of Education via a Web-based data collection.
• Have missing-student notification procedures to aid in determining if a student is missing, and in notifying law enforcement personnel. Disclose these policy and procedures in the annual security report.
• Publish an annual security report containing campus security policy disclosures and crime statistics for the previous three years.
• Publish an annual fire-safety report containing policy disclosures and fire statistics for on-campus student housing facilities for the previous three years.

This valuable set of requirements is important for every student to be aware of. It is readily available to you and your family. You don’t need to be a student to access this information about any school.

Indicators of School Crime and Safety

The following video, from the National Center for Education Statistics (NCES), gives statistical details about safety and crimes on campus. You can visit the NCES website to view the full related report and learn more about crime and safety in America’s schools and colleges.

Strategies for Staying Safe on Campus and Beyond

One of the best strategies for staying safe on campus and beyond is to ask questions. Take the initiative to learn more about your college surroundings, the community culture, and safety precautions you’d be well advised to implement.^[8] Below are some questions you can ask to open up important conversations about campus and community safety.

Tips for Staying Safe

Walking, driving, traveling: Travel with a buddy. Use the campus escort service at night, especially if you are alone. If you live off-campus, call someone when you get home. Keep moving; don’t linger (especially at night). Carry pepper spray or pepper gel. Keep a personal alarm (for example, on a keychain). If you have a car, lock it. At home: Keep your windows and doors locked. Keep the main door to your home, hall or apartment building locked at all times. Don’t let anyone into your dwelling that you don’t know.

On campus: Keep a close eye on your belongings when you’re in a library. Get a locking device for your laptop. Participate in a college safety program. Be cautious, not paranoid. Anywhere: Make sure your phone is charged. Know the phone number for Campus Safety. Put emergency numbers in your cell phone. Carry emergency cash. Speak up if you notice something going on.

Also, don’t hesitate to take advantage of campus and community resources, which may include any of the following:

• Web sites, offices, organizations, and individuals with safety information
• Campus police and campus security
• Local police
• Sexual assault and relationship-violence services
• Shuttle services
• Escort services
• Counseling programs
• Mental health programs
• Substance abuse programs
• Local health care centers
• Campus abuse hotlines

The following video focuses on how to stay safe when on campus. The interviewee, David Nance, sheds light on overlooked areas and situations where students are vulnerable.

Safety Apps

One of the very best safety measures you can take at any time is to keep emergency numbers handy, either on your phone or in your wallet or backpack or a place where you can easily access them. You may also find it helpful to have a safety app on your mobile device. Consider downloading any of the following free apps.

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