There has been a rise in the prevalence of mental health disorders among western industrialized populations.1 By 2020, depression will be second to heart disease in its contribution to the global burden of disease as measured by disability-adjusted life years.2 Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States ages 18 and older, or 18.1% of the U.S population every year.3
Mental disorders are prevalent in young adults and frequently present between 12-24 years of age.4 The top five sources of stress reported by college students were changes in sleeping routines, changes in eating habits, increased amount of work, new responsibilities, and breaks/vacations.5 Overall, a total of 73% of college students report occasional difficulties sleeping, and 48% of students suffer from sleep deprivation, as self-reported.6,7
Lifestyle factors such as diet, exercise and sleep may influence symptoms related to stress and depression.8 Symptoms of depression include but are not limited to, persistent anxious or sad moods, feeling guilty or helpless, loss of interest in hobbies, irritability, and other behaviors that may interrupt daily living.9 Inadequate intake of folic acid from fruits and vegetables, and essential fatty acids in fish, may increase symptoms of depression.10 Unhealthy eating habits may be associated with increases in depression-like symptoms in women, supporting the notion that healthier eating habits may decrease major depression.11 Diet is only one component of how lifestyle may influence depression and stress in adults. Exercise may be another important component in decreasing depression-related symptoms due to the release of endorphins.12 It has been found that participating in regular physical activity may decrease tension levels, increase and stabilize mood, improve self-esteem, and lead to better sleeping patterns.13 It has been concluded that individuals who consume a healthy diet are less likely to experience depression whereas people eating unhealthy and processed diets are more likely to be depressed.14
Poor sleep quality as well as unstable sleeping patterns may lead to poor psychological and physical health.15 Poor sleep includes longer duration of sleep onset latency, which is defined as the amount of time it takes to fall asleep, waking up multiple times throughout the night, and not getting a restful sleep because of tossing and turning.16 In healthy adults, the short-term consequences of sleep disruption consist of somatic pain, emotional destress and mood disorders, reduced quality of life, and increased stress responsivity.17 Irregular sleep-wake patterns, defined as taking numerous naps within a 24 hour span and not having a main nighttime sleep experience, are present at alarming levels (more than a quarter) among college students.18 A study done with 2,000 college students concluded that more than a quarter of the students were at risk of a sleeping disorder.19 Therefore, college students who were classified as poor-quality sleepers, reported experiencing more psychological and physical health problems compared to their healthy counterparts. Perceived stress was also found to be a factor in lower sleep quality of young adults.20
The link between depression-like symptoms and sleep remains poorly understood. It is mentioned that there are risk factors of poor sleep, depression and anxiety among college students but this topic has not yet been heavily studied within this population.

Background Osteoporosis is a major health problem that can occur in people of all ages. It can stem from poor bone health during childhood and adolescence. It hinders independent living, impacts social living, reduces participation in physical activity, and increases risk of fractures and physical pain. In addition to age, gender, race, physical activity and diet, sleep is considered to be a risk factor in the development of osteoporosis in both the young and elderly population. Bone-specific alkaline phosphatase, a bone formation biomarker was measured to determine osteoporotic risk while an actigraphy device was used to measure sleep efficiency in college students. Objective The purpose of this study is to evaluate the relationship between sleep efficiency and bone-specific alkaline phosphatase levels. Recognition of any association may help in understanding how sleep is related to bone health. Methods Twenty-seven participants were recruited with the use of flyers distributed on campus and in residential halls, social media, email, and student newsletters. Bone-specific alkaline phosphatase biomarker was measured using human specific enzyme-linked immunosorbent assay (ELISA). Sleep data were collected from participants who wore ActiWatch for 7 days and completed a 7-night sleep diary. Linear and multiple regression analysis were performed to evaluate association between B-ALP (outcome) and sleep efficiency while adjusting for covariates (age, BMI, race, gender). Results and Conclusions Overall, there was no significant association between sleep efficiency and bone-specific alkaline phosphatase. Gender, however, showed a significant influence on the levels of bone-alkaline phosphatase. This is supported by a study that found higher bone turnover marker in males than in females. The result from the study could be due to limitations such as small sample size. More participants may provide a better comparison or association between variables. Genetic factors are believed to influence the outcome of the study as genetics can influence rate of bone loss or formation. Findings may be beneficial for public health and policy initiatives and allow health / nutrition educators to more adequately encourage proper habits such as physical activity, healthy diet and sufficient sleep for good bone health.

Osteoporosis is a medical condition that leads to decreased bone mineral density, resulting in increased fracture risk.1 Research regarding the relationship between sleep and bone mass is limited and has primarily been studied in elderly adults. While this population is most affected by osteoporosis, adolescents are the most proactive population in terms of prevention. The purpose of this study was to evaluate the relationship between sleep efficiency and serum osteocalcin in college-aged individuals as a means of osteoporosis prevention. Thirty participants ages 18-25 years (22 females, 8 males) at Arizona State University were involved in this cross-sectional study. Data were collected during one week via self-recorded sleep diaries, quantitative ActiWatch, DEXA imaging, and serum blood draws to measure the bone biomarker osteocalcin. Three participants were excluded from the study as outliers. The median (IQR) for osteocalcin measured by ELISA was 11.6 (9.7, 14.5) ng/mL. The average sleep efficiency measured by actigraphy was 88.3% ± 3.0%. Regression models of sleep efficiency and osteocalcin concentration were not statistically significant. While the addition of covariates helped explain more of the variation in serum osteocalcin concentration, the results remained insignificant. There was a trend between osteocalcin and age, suggesting that as age increases, osteocalcin decreases. This was a limited study, and further investigation regarding the relationship between sleep efficiency and osteocalcin is warranted.