Reframing the Cognitive Cost of Caffeine: A Quality Improvement Analysis of Sleep, Stress, Symptoms, and Academic Performance Among Osteopathic Medical Students

Introduction: Caffeine is widely consumed among medical students as a strategy to combat fatigue and maintain academic performance. However, increasing evidence suggests that inadequate sleep and elevated stress may be more influential determinants of student well-being and academic outcomes than stimulant use itself. This quality improvement (QI) study evaluated the relationships between sleep duration, stress, caffeine use, symptom burden, and academic performance among osteopathic medical students.

Methods: An anonymous, cross-sectional survey was distributed via Google Forms to osteopathic medical students at PCOM South Georgia. Students received the survey link by email and participation was voluntary. All responses were de-identified. Data collected included sleep duration, perceived stress (0-10 scale), caffeine intake patterns, caffeine-related symptoms, and self-reported GPA. Descriptive statistics characterized behavioral patterns, and correlation analyses explored associations among sleep, stress, caffeine use, symptoms, and GPA.

Results: Thirty-nine students participated, with 82.1% reporting caffeine consumption greater than 50mg/day. Coffee was the most commonly reported source of caffeine. Shorter sleep duration demonstrated a clear association with higher perceived stress levels and increased symptom burden, with students reporting 4-5 hours of sleep exhibiting the highest stress scores and symptom prevalence, including anxiety, palpitations, and insomnia. Higher caffeine intake was also associated with increased stress and symptoms, suggesting compensatory use in response to fatigue. No statistically significant association was observed between caffeine intake and GPA (r = 0.17, p = 0.40). Trends suggested that sleep and stress were more closely related to academic outcomes than caffeine consumption.

Discussion: In this cohort, inadequate sleep was a key driver of stress and symptom burden, while caffeine appeared to function primarily as a compensatory coping mechanism rather than an academic performance enhancer. These findings support sleep hygiene and stress management as priority targets for quality improvement initiatives in medical education.