Many things can influence our sleep. Various medical conditions and some medications can negatively affect sleep quality, as can nicotine, caffeine, alcohol, and illicit drugs (National Center for Integrative Primary Healthcare [NCIPH], 2017). Conditions that can impair sleep include heart conditions, PTSD, anxiety, diabetes, hyperthyroidism, and pregnancy (NCIPH, 2017).

Sleep problems often accompany conditions like anxiety or depression; extreme sleep issues like insomnia can lead to further mental health problems (McCall et al., 2019). Medications possibly disrupting sleep include steroids, water pills and medications for seizures, ADD, and depression (NCIPH, 2017). NOTE: It is very important to discuss with your healthcare provider any changes to your sleep when starting a new medication if you feel that is a possible cause.

Quality sleep
Sleep quality refers to your satisfaction with all parts of your sleep experience, especially the “four attributes: sleep efficiency, sleep latency, sleep duration, and wake after sleep onset” (Nelson et al., 2022).

• Sleep efficiency is the ratio of total time asleep to the total time in bed which usually declines with age; optimal efficiency is 85% or more (Nelson et al., 2022).
• Sleep latency, which varies among different people, is the time it takes to fall asleep with a range of 16 to 30 minutes considered good quality (Nelson et al., 2022).
• Sleep duration is the total time asleep, less any waking periods, during a 24-hour 
  period. This will vary person to person, but generally 7 hours is considered good for adults (Nelson et al., 2022).
• Wake after sleep onset is the total time awake after first falling asleep and until fully waking up; 20 or fewer minutes is characteristic of good sleep quality (Nelson et al., 2022).

Influencing factors include physiological, psychological, environmental, and personal lifestyle choices (Nelson et al., 2022). Physiological factors include age, BMI, circadian rhythm, diet, fitness level, time spent in REM; psychological factors include stress level, depression, anxiety; environmental factors include noise, lighting, room temperature, comfort of bed or pillow; lifestyle choice factors include television or other screen use, social activities at varying hours, diet (Nelson et al., 2022). Constant entertainment, 24-hour content online and streaming, and constantly changing schedules have challenged us to maintain a regular sleep schedule in modern America (Dedhia & Maurer, 2022). Decisions about diet and exercise directly influence sleep quality. Large meals eaten before bedtime disrupt sleep. Regular exercise is more likely to promote restorative sleep; however, poor sleep promotes a lack of exercise due to fatigue and loss of motivation (Dedhia & Maurer, 2022).

Impact of poor sleep
Maintaining a regular sleep routine, including consistent sleep and wake times, supports overall better health compared to those with irregular sleep patterns (Lunsford-Avery et al., 2018). Irregular sleep corresponds to increased likelihood of being overweight, higher blood pressure and blood sugar levels, increased risk of stroke or heart attack, higher stress levels, and increased reported depression (Lunsford-Avery et al., 2018). Those with poor sleep quality experience daytime dysfunction, irritability, slowed response time / reflexes, fatigue, and often increased caffeine / alcohol consumption (Nelson et al., 2022). Prolonged insufficient sleep, usually less than 7 hours per night, corresponds to increased inflammation and reduced endothelial function which may cause arteries to narrow when they should open which can cause chest pain (Hijmans et al., 2019).

However, optimal sleep time changes for each person at different stages of their life and varies person to person since 10-15% require either less than 6 hours or more than 9 hours to maintain healthy functioning (Dedhia & Maurer, 2022). Prolonged poor sleep quality can lead to insomnia; you can read more about insomnia and overcoming poor sleep here.

There is some good news if you sometimes struggle with sleep. According to the NCIPH (2017), daily exercise can improve sleep (as well as overall health). Additional tips for better sleep from the American Academy of Sleep Medicine (2020) include:

1. Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
2. Set a bedtime that is early enough for you to get at least 7-8 hours of sleep.
3. Don’t go to bed unless you are sleepy.
4. If you don’t fall asleep after 20 minutes, get out of bed. Go do a quiet activity without a lot of light exposure. It is especially important to not get on electronics.
5. Establish a relaxing bedtime routine.
6. Use your bed only for sleep and sex.
7. Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
8. Limit exposure to bright light in the evenings.
9. Turn off electronic devices at least 30 minutes before bedtime.
10. Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
11. Exercise regularly and maintain a healthy diet.
12. Avoid consuming caffeine in the afternoon or evening.
13. Avoid consuming alcohol before bedtime.
14. Reduce your fluid intake before bedtime.

Also, you are not alone. Between 35-40% of Americans get less than 7 hours of sleep nightly (Hijmans et al., 2019; Reddy, 2022).

Importance of quality sleep
Those experiencing good sleep quality have the positive effects of a stronger immune system, reduced risk of chronic diseases such as diabetes and heart disease, normal reflexes, clearer cognitive function, better overall mood, better interpersonal relationships, and an easier time maintaining a healthy weight (Dedhia & Maurer, 2022; McCall et al., 2019; Nelson et al., 2022; Rindfleisch, 2020). Quality sleep is essential for healing and physical, mental, and emotional health (Dedhia & Maurer, 2022). Sleep is also a key component of other core areas of integrative health, such as exercise and diet, which are improved when you are well rested but suffer when you are not (Dedhia & Maurer, 2022). Those components also directly influence the quality of sleep, completing the interdependence and relationships among them.

Note: All content provided on this page is for informational purposes only and should not be used as a substitute for advice from your health care provider.

Sleep References