Team:SCU China/HP/Silver/Survey

01.  Questionnairs

      Our team has always focused on solving the existing issue seen in the society, and we value our connection with the vast public as well as the society. According to our shared daily experience, nowadays many people have trouble with sleeping, one of the most important and dominant, yet mysterious activity in our life. For the youth, social pressure brought by both work and family may lead to irregular sleeping time or even sleeping disorder, while many elders also suffer from difficulty in falling asleep or awakening easily – problems involving sleeping has become more and more common.
      However, in order to determine more precisely the current sleeping conditions of the public and to evaluate more objectively about the people’s knowledge on melatonin – the core of our project, surveys are to be made. Though there are surveys on people’s sleeping quality made by CDC 1, The Sleep Council of the UK 2 and China Sleep Research Association 3 etc., the data are always too generalized and from a few years ago; more importantly, there’s no existing research on the public’s awareness and acceptance of melatonin.
      Therefore, our main focus in this survey is to answer 1) how is people’s sleeping quality, 2) what are the common problems that stalls people from sleeping. For the special groups that will go for night shifts, we also seek to know 3) frequency of their night shifts and the effect of night shifts on their sleep. To access the practicality of our project, we also investigated 4) how people regulate their sleep and the acceptance, usage of sleeping pills and 5) how are the understanding and acceptance of melatonin of both groups who have regular schedules and who have night shifts.

1.1 Methodology

      We choose questionnaire survey as our investigating method, because to know about subjective issues like sleeping quality and mental state etc., the best way is to directly listen to the people and ask them about their feeling. In this survey, we designed two different questionnaires for different targeting groups: one is for the vast public with normal day/night schedule, while the other is for the groups who are requested to go for night shifts – from the first questionnaire we expect to know the general situation, while through the second questionnaire we could learn more about the living, sleeping and demand of the people with reversed night/light-rest/work periods.
      Sleeping is obviously a universal activity; so for the first questionnaire aiming at the common individuals, we distributed the questionnaire via the Internet and encouraged people to forward our questionnaire through the social network to reach as much population as possible – largely, we regard the respondents are chosen by random sampling. For the second questionnaire, we randomly choose the individuals from groups that would have night shifts as our interviewee, for instance the servicemen who would go for night watch and the flight attendance as well as doctors and nurses who would work at night occasionally by their schedule. After careful assessment, we regard our samples could represent the general condition and view of the public as well as those of the groups with night shifts.

1.2 Results

      For Questionnaire 1, 442 questionnaires are retrieved and for Questionnaire 2, 77 questionnaires are retrieved (for gender, age and job distribution of the respondents, see Supplementary Materials).

1.2.1 Sleeping Quality
Fig 1. Time to go to bed
Fig 2. Sleep duration
Fig 3. Time spent on average to sleep
Fig 4. The sleeping quality of groups with night shifts

1.2.2 Problem in Sleeping
Fig 5. Having problem related to sleep or not
Fig 6. Commonly reported problems related to sleep

      Surprisingly, 93% of the respondents admit that they have been troubled by problems related to sleep. Among the commonly reported problems, “Find it difficult to fall asleep”, “Be weaken up easily” and “Feel hot” rank the first three, where the first two might resulted from shift or disorder in circadian rhythm.

Frequency of Night Shifts and Its Effect on Sleep
Fig 7. The frequency of night shifts
Fig 8. The sleep duration after being on a night shift
Fig 9. The subjective evaluation of night shifts’ effect on sleep

      Among the 77 respondents, about two thirds of them would go on night shifts for no less than 5 times every month on average (for age and job distribution, see Supplementary Materials). What’s more, according to our interview, most of them are not always work at night, which means they also have to always adjust their sleeping time; this would easily lead to disordered circadian rhythm as well as endocrine dyscrasia, where melatonin could be of great help on easing the symptoms. As for the sleeping time after being on night shift, only about 30% percent of people sleep more than 8 hours while 42% people sleep less than 5 hours, which shows the great impact on being on night shifts on sleep; moreover, on a subjective evaluation of how being on night shifts affects their sleep, only 26% people think that night shifts affect their sleep a little or not at all, which corresponds to the objective statistics.

1.2.3 Regulating Sleep and Sleeping Pills
Fig 10. Ways to regulate sleep
Fig 11. The usage of sleeping pills

      People use a variety of methods to help them falling asleep and sleep better, while 15.64% of the respondents report that they use sleeping pills to assist their sleep. Other methods might finally falling into the range of sheer self-comfort. However, among the mostly used methods, approaches like “Watch TV” and “Play on the phone” may disrupt sleep even more due to the shortwave light the screens emit. Among the sleeping pill using individuals, only about one third uses melatonin (age and job distribution could be find in the Supplementary Material) while the others use traditional medicines.

1.2.4 Understanding and Acceptance of Melatonin
Fig 12. Ways to improve sleeping quality of the groups with night shifts

      For the people who have night shifts, about half of them choose to sleep more after being on night shift to ease the influence. There are still many ones choose to use diazepam, and in this survey only one person uses melatonin.

Understanding and Acceptance of Melatonin
Fig 13. Awareness of melatonin of the public
Fig 14. Acceptance of melatonin of the people with night shifts

      Not so surprisingly, over two third of the people we investigated showed no acknowledgement of melatonin, while 24% of the people have heard of melatonin but not sure about its usage and only 8% know its curative effect. When asked whether they will try melatonin, 50% of the people who go for night shifts state that they don’t need medicine and 39% of them keep cautious and want to learn more; distrust is also seen where 3% of the respondents regard melatonin is not reliable. Only 8% percent of the night shift groups say that they would try melatonin. Obviously, more toil must be committed to educate the people about melatonin.

1.3 Conclusion & Discussion

      To determine more precisely the current sleeping conditions and to evaluate more objectively about the knowledge on melatonin of both the groups having normal schedules and having night shifts, we conducted two questionnaire survey targeting the two groups, respectively, and we get a deeper understanding of our questions.
      Considering the people’s sleeping quality, the data apparently show that most people do not meet the healthy sleep time standard (≥ 8 hours). Besides the common sleep problems like going to bed too late or not having enough time to sleep, people suffer from other problems that affect their sleep quality like feeling difficult to fall asleep or easy to be waken up. The population in China is large, so the absolute number of people who have trouble with sleeping is enormous which makes this no trivial issue. As stated above in the Results section, many dominating sleeping problems result from the disrupted circadian clock, whose symptoms could be eased by taking exogenous melatonin.
      As for the awareness of sleeping, we regard most of our respondents lack sufficient knowledge, which is reflected by their ways of regulating sleep and improving sleep quality – the methods are indeed traditional, but they have no apparent effect and easily falls into the range of placebo. To sleep better, know more about sleep first; science popularizing sessions and activities can serve as very good ways to arouse public attention and improve public awareness.
      For the people who goes for night shifts, such as servicemen, flight attendance and medical staffs, most of our respondents go for more than 5 night shifts every month on average and have a much shorter sleep when they go off duty; their sleeping quality is more severely affected than the normal people, as indicated by both the objective statistics and subjective evaluation. What’s more, we also discovered that the older the more likely that one would go for night shifts (see Supplementary Material); the adjusting capability of circadian rhythm declines as aging, which enforced the negative effects of night shifts.
      There are people who uses sleeping pills to regulate their sleep, and most of them uses traditional tablets like Barbital and Diazepam. The public showed widespread ignorance on the new medicine of melatonin, and many are suspicious about its effect. The people having night shifts accept melatonin more, and many are willing to try it. This inspires us that we still have to publicize melatonin more so more people could get known of its positive effects and benefit from it.
      Though our survey would be more objective when conducted on a larger sample, we still regard the data and results valid and could be used to guide our project.

1. Centers for Disease Control and Prevention. 2017. CDC – Data and Statistics – Sleep and Sleep Disorders. Retrieved from
2. The Sleep Council. 2013. The Great British Bedtime Report. Retrieved from
3. China Sleep Research Association. 2017. 2017 China Youth Sleeping Quality White Paper [in Chinese]. Retrieved from

02  Consulting With Experts
2.1 Sleep Medical Center, West China Hospital

      Melatonin, the protagonist of our project, turns out to be a mild and efficient medication in treatment of sleep disorder. But in what extant would melatonin influence our sleep? As there are so many different claims about this question, we decided to interview professors of West China sleeping center as an authority to confirm the effects that melatonin has on sleep. The sleeping center once carried on a project about developing a melatonin sustained release tablets. Also, it has done lots of other researches on melatonin. Thus, we believed West China sleeping center would give us the authoritative answer we want. With the help of team “SCU-WestChina”, we got in touch with Professor Tang Xiangdong and his postdoctor Doctor Zhang Ye from the sleeping center.

Fig. 1 We had a face to face conversation with Dr. Zhang on efficacy of melatonin as well as our project at West China hospital’s sleeping center.

      After we interviewed them about sleep disorder treatment and our project design, we improved our understanding about our project deeply.

Fig. 2 After our interview, we are greeted for Dr. Zhang to share his rest time to talk with us.

      Firstly, we were more confident about the potential use of melatonin as a common medicine for sleep disorder. As Doctor Zhang mentioned, melatonin, with a short half-life, is more appropriate for sleep disorder due to smaller 'hangover' effects on the following morning. And previous studies indicate that patients are unlikely to develop dependence and tolerance on melatonin. Doctor Zhang emphasized that our project, using microorganism to produce melatonin in intestine, is more economical compared with chemical method. So we were convinced that our project is possible to generate economic benefits in the future.
      Additionally, with the help of Doctor Zhang, we found there were so many things to do in order to optimize our project. For safety purposes, we were recommended to use a safer bacterial strain in the final products. What’s more, Doctor Zhang explained sleep associated neural circuits to us, which enlightened us to consider the relationship of melatonin expression and sleep associated neural circuits or other neural activities.

Fig. 3 The fourth China Sleep Research Association Youth Academic Forum

      Furthermore, we were honored to be invited to the fourth China Sleep Research Association Youth Academic Forum and Sichuan Medical Association Sixth Session of Sleep Medicine academic conference. Lots of professors in Sichuan province gave a presentation on their projects. Some of these projects illustrate how melatonin worked in our sleeping process. We have learned a lot about most recent melatonin research.  Attending the conference, we realized some of the points we didn't consider before. We are supposed to adjust the rhythmic expression in Escherichia to human's bio-clock.
      Thanks to advice from Professor Tang Xiangdong and Doctor Zhang Ye, we completed our project more excellently.

More details about this interview

2.2 CFDA

      In order to learn more about the supervision standards of health-care products as well as safety and potential market value of melatonin, we sent emails to consult a staff member of China Food and Drug Administration (CFDA).
      From this online interview, we have learnt that there are specific criterions for different health products. The test always includes pesticide effect, physicochemical properties and bacteria levels. Generally, products without high purity have difficulties in passing the test, and melatonin in the market was produced by chemical synthesis, whose major problem is that by-products produced in chemical production and those catalysts are toxic. Thus, biosynthesis of melatonin in our project will be of great practical application value. However, the existing drugs made from bacteria are used to improve digest ability merely. So it is uncertain whether our final products can appear on the market or not. But we are inspired to consider a safer bacteria strain used in our project in terms of present microbial products in the future.
      In addition, the staff member of CFDA mentioned that melatonin has a high pass rate in the test, which convinced us of the potential usage of our expected products. Also, we have learnt that people having special work often take melatonin health products regularly. Hence, it is necessary to research and develop a more efficient melatonin health product.

More details about this interview