Reading Time: 2 minutes Love cracking your knuckles? Our doctor addresses whether this habit can cause any long-term problems.

Reading Time: 3 minutes A doctor discusses the health and academic effects when your sleep is “fragmented.”

Reading Time: 2 minutes Find out how ringworm spreads and what you can do if you have it.

Reading Time: 3 minutes Think you have mono? Our expert discusses how to know.

Reading Time: 2 minutes A doctor discusses common stomach problems and what to do about them.

—Jamie K.*, Ashford University (online)

(*Name changed)

I spent a winter break working at Okemo Mountain as a lift operator. I was staying on a hill across the valley from the mountain and had a steep downhill drive to get to work. One morning after a fresh snowfall, I lost traction and slid into a ditch. After a kind man used his truck to pull my car back out to the road, I asked him: “What’s the best way to slow down my car in such a situation?” His answer? “Don’t drive so fast.” The moral of the story is that safe driving and good health are about preparation and prevention. Think about staying healthy during the semester and, chances are, you’ll succeed. Wait until it’s too late and…it will be too late.

No secrets here: Get enough sleep, be regularly physically active, eat well, wash your hands, limit your saliva sharing, get a flu shot, and avoid overindulging in intoxicants and smoke.

Sleep

There’s compelling evidence that people who don’t get enough sleep are about 30 percent more likely to catch a cold than those who do. Sleep eight-plus hours a night, ideally going to sleep and waking up at about the same time most nights. I’m a firm believer, and the evidence supports me, that it’s better to get a full night’s sleep even if you haven’t finished your work. Go to bed, get a good night’s sleep, and find time the next day to get caught up. Cut back on whatever you’re doing instead of studying, and get your work wrapped up by an hour or so before a reasonable bedtime. Sleep helps you concentrate better and learn more efficiently. More attention to sleep means less time needed to accomplish the same amount of studying, reading, writing, etc.

Physical activity

Like sleep, regular physical activity has a positive effect on your mood. It can serve as a mental break from other pursuits and lead to more efficient study time.

Maintain a healthy diet

Eat some fresh fruits and vegetables. If you have the facilities, why not prepare a nice meal for you and a friend?

Wash your hands

You’d be amazed at the benefits of adding a little soap and water to your hands before touching your nose or face and before eating. This can prevent many illnesses. Also remember to dry your hands thoroughly.

Limit saliva sharing

Most illnesses are spread from person to person, especially common ones like colds, flu, and mono. Sharing things like food and drinks is nice. Try to do it in a way that limits the number of people that have contact with your food before you eat it.

Get a flu shot

Nothing to explain. Get a flu shot. You heard it here first. Actually, you probably didn’t. I sure hope not, at least.

Avoid overindulgence

I’m not trying to take all the fun out of your life. I’m just saying that when you overindulge, your decision making will be negatively affected. Your devotion to care and caution may slip a bit—or a lot.

Bonus piece of unsolicited advice, yours absolutely free!

Allow me to introduce you to the idea of productive procrastination: If you’re not going to work, spend the time doing something positive, like cleaning up your living space, working out, preparing a good-quality meal, or knitting toques for seafarers. You’ll feel better about the time away from the books and your quality of life will be improved.

Sometimes your luck is bad. Despite all your efforts to prevent illness, you might still get sick when the demands on you are high. It’s not the end of the world. If the stress is academic, get in touch with your instructors and dean ASAP. It’s not the first time this has happened. You can work it out.

—Jayden*, Portland State University, Oregon

Yes, in ways both large and small. Are there students who drink from time to time and still manage to get good value out of their investment in higher education? Of course. In fact, most students would fit this description. But alcohol can still impair your learning experience. Here are several ways that this can happen:

Time lost to intoxication, hangovers, and/or injuries

If you’re drinking, you aren’t in a state to concentrate or remember, meaning you aren’t learning. For many college students, drinking is part of blowing off steam and relaxing after a hard few hours of academic work. In moderation, this may not present any problems. You just have to weigh the risks and be conscientious in your decision-making. It’s certainly the case that drinking to the point of being sick or having to go to the hospital, or getting in fights or injured, will likely soak up much more time than you’ve budgeted. If you have a big paper due Monday, perhaps it would make sense to take a weekend off from drinking so you have plenty of time to complete your work at a high-quality level. I often challenge students to take two to three weeks off from drinking just to prove to themselves that they can, and to see what it’s like.

Reduced sleep quality and impaired memory formation

Learning has several components. You have to be concentrating when exposed to ideas, in order to form short-term memories. While you sleep, those short-term memories are consolidated into long-term memories. Research has shown a linear relationship between hours of sleep and GPA—in other words, the more you sleep, the better you do academically.

Not sleeping enough, or getting poor-quality sleep, impedes long-term memory formation and thus the learning process. Drinking often affects decision-making, leading you to stay up later than you’d planned, and the sleep that you get when intoxicated is relatively poor quality (though it’s healthier than engaging in other activities while intoxicated; e.g., driving).

Reduced control of emotions (e.g., higher risk of depression)

There are many reasons not to drink on a particular night. Maybe you’re sick or taking medication. Maybe you have a big test the next day, or want to do well at tryout. Maybe you just don’t feel like it. At the top of the list is depression and anxiety. If you are unhappy, don’t drink. Very few things in this world are 100 percent true, but this is one of them: Drinking will worsen your experience of depression. There are much better medicines than alcohol. Ask for help at your student health center or counseling center.

Relationship complications causing upset and distraction from learning

Drinking amplifies most emotions. This can lead to euphoria, arousal, the belief that you’re an amazing dancer, and so on. Drinking can also lead to drama, and sometimes physical violence.  It’s your life, of course. Personally, I find my life complicated enough without alcohol ramping things up.

Getting in trouble

Getting in trouble for underage possession, intoxication, vandalism, or anything else does not provide any short-term benefit to your educational experience.

Addiction

For some students, the stakes are much higher than getting a B instead of the A- you were capable of. About 10–15 percent of people are at particularly high risk for addiction. Their brains are wired in such a way that they struggle to control their relationship with alcohol and/or other substances.  Unless they get help, and that help is effective, they are at high risk for suffering serious consequences, such as damaged relationships, financial difficulties, and the inability to complete their schooling on schedule. Sometimes it takes a serious consequence, like failing out of school, to help them come to terms with their condition. But ideally the problem would be identified and rectified before the consequences became profound.

(*Name changed)

—Gordon N.*, Northern Illinois University
(*Name changed)

Kudos to you for acknowledging that there’s an issue here: your avoidance of seeing health care providers and perhaps getting tested for a health condition. It’s not uncommon for people to be uncomfortable about this. Asking somebody to help interpret your own body is a sensitive, even intimate, thing to do. Moreover, there’s an obvious power imbalance. The provider has knowledge and training that you (probably) lack. They may tell you something that will affect your sense of self.

So let’s take a step back. What do you really have to worry about?

Are you worried the provider might be a paternalistic, patronizing jerk? Check out your student health center.

No one should be made to feel ashamed by a doctor. If that’s the case, ask people you trust for a recommendation for a health care provider who is likely to be a good fit for you. You’re entitled to choose your provider not just on the basis of convenience, but because that person makes you comfortable and because you have reason to trust their sensitivity and expertise.

Student health center providers are usually excellent at making students feel comfortable. They’re very practiced in speaking with and helping students who don’t have much experience being on their own in a health care setting. They are good at discussing anxieties that patients may bring. They may also have systems in place to help mitigate some of these anxieties, such as same-day results for certain testing.

Are you afraid of what you might find out? Talk this through and take control of the timing.

I’ve had a number of patients over the years convinced they have contracted HIV and terrified to get tested. We sometimes spend two or three visits talking it through before actually doing the test. The point I emphasize is that testing doesn’t affect the diagnosis. If you have the condition already, you won’t have it any less by not getting tested. On the other hand, a positive test will start you on the path to treating the condition and potentially helping prevent the transmission of HIV to others. It’s also possible that you don’t have the condition at all and that you’re wasting enormous psychic resources worrying about having a disease you don’t have.

For non-emergency situations, most testing can wait. You may feel more comfortable if you can control the timing of testing while engaging with your health care provider. I suggest you talk with your provider about your discomfort.

Are you still stuck? Consider talking this through with a counselor.

If you remain absolutely unable to act, perhaps because of worries that you might have a particular diagnosis, consider talking this through with a counselor first. The counselors at your campus counseling center will likely have encountered this anxiety before, and can help you figure out ways forward. Good luck.

—Addison P.*, New Jersey Institute of Technology

(*Name changed)

It’s generally recommended that people 18–25 years old get in touch with a healthcare professional once every year or two. A physical is also known as a preventive health visit, because the goal is to help you stay healthy. This includes spotting small problems early, before they become bigger problems.

Insurance covers one preventive visit a year Under the Affordable Care Act (“Obamacare”), one preventive care visit a year is covered by all insurance plans that are sold via state or federal government websites. Ideally, your healthcare provider should be someone that you’ve gotten to know and trust over time—someone you find it relatively easy to talk to—although this may not be possible if you’ve recently relocated for school.

It’s a valuable opportunity to talk with your doctor Studies suggest that for most people at a preventive care visit, the conversation with the healthcare provider is more valuable than the physical exam. If you’re completely healthy, checking in once every year or two is a good opportunity to ask questions that may have come up since your last physical. For example, you may want advice about returning to a vigorous sport after time away, guidance about a new diet plan you’re considering, or advice about a possible symptom.

Additionally, a wellness visit is a good opportunity for the provider to ask you some age-appropriate questions. There are questions designed to screen for health risks specific to your demographic, which cover topics such as sleep habits, diet, physical activity, sexual health, drugs and alcohol, mood, and risk-taking behaviors.

If you see a provider regularly, you may or may not need an annual visit If you have regular or occasional contact with a provider, especially if you have a chronic condition, this sort of check-up visit may be less important, especially if you cover these topics during your ongoing visits. Often, though, visits for illnesses or problems don’t allow the time and space for the broader “State of the Union” conversation I describe above. It may be worth taking additional time for a comprehensive health assessment. It’s not always easy to open up about personal issues, and having a visit that allows time for a broad conversation may help you raise a topic you’ve hesitated to mention.

—Alyssa O., California State University, San Bernardino

Here’s what I generally recommend to students:

• Go to school with ibuprofen (instead of aspirin)
• Keep a supply of acetaminophen too (Paracetamol and Tylenol are common brands)

To see why, read on.

Aspirin and ibuprofen do have quite a lot in common—I think of them as close cousins.

Aspirin is salicylic acid, a naturally occurring substance that Native Americans used to extract from willow bark. It’s an analgesic (meaning it blocks pain) and anti-inflammatory. It also inhibits platelets in the blood from clumping together. This can be a benefit, as when it decreases the risk of a blood clot after a heart attack or surgery. Aspirin can also be a risk, as it can lead to gastrointestinal (GI) bleeding (more commonly in the elderly).

Ibuprofen is a synthetic molecule based on the chemical structure of aspirin. It was originally a prescription medication, but proved safe enough that it went over-the-counter in the early 1980s. Ibuprofen is widely available in both name-brand and generic forms, as well as in combination with antihistamines or decongestants designed to treat colds or the flu. Ibuprofen shares many of the same risks as aspirin: Overuse can lead to GI bleeding or kidney damage. Occasional use, though, is generally safe. The over-the-counter doses are 200 mg a pill, which allows some flexibility in dosing.

Aspirin and ibuprofen are both useful medications for treating common pains (headaches, sore throats) and inflammation (ankle sprains). They also work nicely for the woozy headache one can get after sun overexposure.

I generally recommend ibuprofen instead of aspirin because aspirin carries the potential risk of a rare but serious condition called Reye’s syndrome. This can occur when a person under 18 takes aspirin while infected with the influenza virus (flu). Because the risks and benefits of aspirin and ibuprofen are similar, I keep it simple and recommend ibuprofen.

Acetaminophen isn’t an anti-inflammatory like ibuprofen or aspirin, so it’s not as good for musculoskeletal injuries. On the upside, it doesn’t have the risk of GI bleeding or kidney injury. It can cause liver injury if overused. The mechanism of action is different enough from aspirin and ibuprofen that it’s useful to have acetaminophen on hand too. Some pain responds better to one than the other.

“Is it possible to get too much sleep?”

—Ana H., Towson University, Maryland

Not exactly. But are there circumstances in which the amount of sleep someone is requiring would be concerning? Yes.

It’s common to meet with students who are tired all the time and seem unable to get sufficient sleep. Most of the time, people who sleep a lot need to. Young adults generally need 8–9 hours a night, ideally on a fairly regular schedule (same bedtime and wake time). Straying from this can lead to “sleep debt.” Just like student loan debt, sleep debt has to be paid off eventually. The more you accrue, the more intensely your body will want to pay it down—by getting more sleep.

This starts with REM (dreaming) sleep. Do you know that sensation of falling asleep suddenly and immediately starting to dream? It can be quite disorienting, especially when it happens in class. (Not that I’d know about that. OK, maybe a little.) That’s a sleep-deprived brain desperately trying to do some catch-up.

If you don’t need the sleep, it’s usually pretty hard to sleep. I think most people are familiar with the experience of leaving school for a vacation and sleeping nonstop for the first several days. I certainly remember times that I woke up at 11 a.m., had a little something, went back to bed until 2 or 3 p.m., did a little something, took a 5 p.m. nap… you get the idea. After a few days, though, staying awake wasn’t so excruciating. After another few days, I was back to sleeping 9–10 hours a night. This was my body paying off sleep debt then resetting to a baseline rhythm. Once I’d done that, I didn’t have the intense appetite or need for sleep any more.

When people just can’t seem to get enough sleep, regardless of hours sleeping, including naps, we start to worry that there’s an underlying cause, such as mono or another illness. Psychological causes can also be at play, especially depression.

So can you get too much sleep? Usually when we feel the need to sleep more than the standard pattern, there’s a good reason. Generally, it’s a good idea to listen to your body.

If after 4–5 days of intense sleeping, especially if you don’t know why you need so much sleep and/or don’t feel that you’re getting any benefit from all the extra sleep, it might be time to talk with a medical provider and maybe get some testing done.

“I make sure to get enough sleep, but I still always feel tired. Why could this be?”

—Ariel B., Red Rocks Community College, Colorado

This is a very common dilemma. It can be helpful to determine whether you’re experiencing fatigue, somnolence, or a combination of both.

• Fatigue means that you get tired more easily doing physical activity—even day-to-day activities, such as walking and climbing stairs—and that you just don’t have your usual energy supply.
• Somnolence means that you’re sleepy and can fall asleep readily at times other than bedtime.

These are two different problems with two different sets of possible causes.

Some people can’t really distinguish whether they’re fatigued or somnolent. That’s OK, too. It just makes it less likely that there’s a single identifiable cause.

If you’ve been feeling unusually tired for two weeks or less, the list of possible causes is different than if it’s a long-standing problem.

So what are the possible causes? Sometimes we can identify a single cause, but most often there are a combination of factors. Here are some:

Poor sleep quality

Many students overestimate the amount and quality of sleep they get. If you’re someone who needs nine hours a night and are consistently getting closer to seven, and those seven hours are on a variable schedule (sleeping in or waking early depending on that day’s schedule), you’re accumulating sleep debt.

The more sleep debt you accumulate, the groggier you feel. Chronic sleep debt can lead to poor concentration, decreased capacity for learning, increased risk of getting sick, decreased athletic performance, and more.

Aim for a consistent sleep schedule. Get up at the same time every day, and don’t sleep more than an hour later on weekends. (This is usually easier than going to bed at a consistent, early bedtime, and helps reset your body clock.)

Diet

Taking vitamins or other supplements is unlikely to provide a benefit for your tiredness. Most of us get the nutrients we need from our diet. Rarely, malabsorption (the inability to absorb essential nutrients from foods because of a problem with the function of the gut) can cause fatigue. There are usually accompanying symptoms that a clinician can identify.

Mood

Another common cause of feeling tired all the time is depression. Classic symptoms include anhedonia, the inability to take pleasure in things that used to be enjoyable, and hopelessness or feeling like there’s no point to getting out of bed in the morning. If this seems familiar, make an appointment with your school counseling center.

Illness

One potential cause of increased fatigue among college students is mononucleosis (Epstein Barr virus infection). Mono is usually transmitted by saliva, like colds and many other viral infections. It often causes a terrible sore throat but sometimes presents as fatigue only. People typically complain of feeling drained, of needing to take long naps, and of diminished ability to exercise. Other illnesses, as well as certain medical conditions such as sleep apnea, can also cause fatigue. Sorting through the possibilities may take a few doctor visits and some lab testing

When to seek help

If you feel tired all the time, especially if the symptoms have lasted more than a week or are accompanied by other symptoms such as fever, diarrhea, rash, sore throat, cough, etc., contact your primary care provider or school health center and schedule an evaluation. This is especially important if the symptoms are hampering your academic, athletic, or social pursuits, or are otherwise getting in the way of your life.