Episode 62

Sleep Central

What issues are most central to getting a good night’s sleep?

In this  episode, I breakdown the latest research on what lies at the core of feeling well rested. 

From the perspective of sleep scientists and clinicians, there are several key components to sleep health. These include duration, timing, regularity, sleep disorders, and quality of sleep. Many of these have objective metrics or validated scales to track, so we can measure an individual’s or a groups sleep health and see how it changes over time or after an intervention. 

But this group out of France took another approach to measuring what really matters in sleep health. Recently published in the journal Sleep Epidemiology in December 2021, the researchers analyzed the completely subjective sleep complaints of nearly 36,000 respondents who were concerned about their sleep. 

These central components of sleep health in this network analysis included excessive daytime sleepiness, non-restorative sleep, circadian irregularity, and chronic sleep deprivation. 

Chronic sleep deprivation is all about duration, and influenced by timing and regularity.

Circadian irregularity is all about sleep schedule regularity as well as timing.

And both non-restorative sleep and its consequence of excessive daytime sleepiness are frequently the result of problems of sleep quality and sleep disorders. 

To address chronic sleep deprivation requires providing oneself adequate opportunity to get the appropriate duration of sleep: for adults that’s about 7-9 hours in bed, and increasingly longer the younger one is. 

To address circadian irregularity requires maintaining a consistent wake up time each and every day - that means explicitly not sleeping in on days off or weekends. Emphasizing this timing: getting up at the same time every morning and exposing yourself to bright light and not napping across the day means that you’ll fine yourself ready for sleep around the same time each and every night within a short window of time. Now for those with truly disturbed circadian misalignment, this may require the help of an expert to guide one through an example as discussed in Episode 58. 

And to address non-restorative sleep and excessive daytime sleepiness requires an assessment and ultimately the improvement of sleep quality, which usually comes in the form of adhering to the basic sleep hygiene tips and treating any and all sleep disorders present. 

So there really isn’t much disagreement at all between the AASM’s sleep health metrics of duration, timing, regularity, sleep disorders and sleep quality compared to the patient’s central concerns of excessive daytime sleepiness, non-restorative sleep, circadian irregularity, and chronic sleep deprivation. 

But to address these complaints of the sleepers, means focusing back on the core principles of sleep health. The authors then evaluated how each and everyone of these 39 different sleep issues is related - to tease out the strength of that relationship and the direction - as well as determine what, if any, sleep issues are the most central - the most linked with all others. 

And while the short list doesn’t line up exactly with the National Sleep Foundation's or the American Academy of Sleep Medicine’s conceptualizations of sleep health, it provides a unique patient perspective on the issue and highlights the core of what we can focus on to improve someone’s own self-assessment of their sleep health.