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Test Anxiety and Poor Sleep: A Vicious Cycle



Test anxiety may be better thought of as a biopsychosocial process affecting academic performance during the days leading up to an exam, rather than a static appraisal of attitudes related to test taking. This was a passive observational study following students 2 days before a midterm exam and was designed to test the Sleep Anxiety Performance Process (SAPP) model in the context of a psychology statistics exam.


Undergraduates (N = 167) enrolled in a statistics class, January–November 2015. Participants completed an electronic battery of measures and Sleep Mood Study Diaries (SMS) during the mornings, 2 days before a statistics exam. Instructors confirmed exam scores.


A path model showed a reciprocal bi-directional relationship between Sleep Quality and restfulness (Q&R) and test anxiety 2 days before a scheduled exam, with test anxiety measured in the morning, before the exam predicting exam performance. Prior exam performance, being a non-native English speaker (ESL), and class performance motivation also predicted exam performance.


These data support the SAPP model’s premise that that sleep and anxiety feed one another, as a reciprocal process, that collectively impairs academic performance, with direct effects on academic performance, but with implications for overall student health.

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Fig. 1


  1. It should be noted that race/ethnicity was a significant predictor of exam score. However, the effect was entirely dependent upon a single student’s outlier (poor) test score. Because of the low probability for replication, this effect is not pictured in the model or reported in Table 2.


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Correspondence to Nancy Hamilton.

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Hamilton, N., Freche, R., Zhang, Y. et al. Test Anxiety and Poor Sleep: A Vicious Cycle. Int.J. Behav. Med. 28, 250–258 (2021).

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  • College students
  • Anxiety
  • Sleep
  • Academic performance