Eric Suni , Staff Writer
Medically Reviewed by
Dr. Anis Rehman , Endocrinologist
Our team of writers, editors, and medical experts rigorously evaluates each article to ensure the information is accurate and exclusively cites reputable sources. Learn More
We regularly assess how the content in this article aligns with current scientific literature and expert recommendations in order to provide the most up-to-date research.
Do you often feel tired and groggy in the morning, even on nights when you’ve gotten enough sleep? It’s a frustrating experience, but there may be a simple explanation: you have poor sleep quality. Poor sleep quality can impair your focus, worsen your mood, and is even linked to an increased risk of Alzheimer’s disease.
Figuring out that you’re not getting enough sleep is easy. Figuring out why that sleep isn’t restful is trickier, but certainly achievable. Read on to learn the signs of lack of sleep, what could be causing your poor sleep quality, and how to improve it.
Signs Your Sleep Quality Needs To Improve
If you think you’re getting poor sleep, consider whether you possess any of these tell-tale signs:
- You take more than 30 minutes to fall asleep after you get into bed.
- You regularly wake up more than once per night.
- You lie awake for more than 20 minutes when you wake up in the middle of the night.
- You spend less than 85 percent of your time in bed asleep.
- You feel tired and have difficulty concentrating during the day. You may be drinking more caffeine to stay alert.
- Your skin is breaking out and your eyes are puffy, red, or developing dark circles or bags.
- You feel hungry more often, especially for junk food, and gaining weight.
- You feel more stressed out, emotionally exhausted, and angrier than usual.
- You’ve been diagnosed with insomnia.
What Is Sleep Quality?
Sleep quality is different from sleep quantity. Sleep quantity measures how much sleep you get each night, while sleep quality measures how well you sleep.
Measuring sleep quantity is simple, as it’s quick to determine if you’re getting the recommended amount of sleep per night (usually defined as 7-9 hours for adults). Measuring sleep quality is a little more of an art than a science. Generally, good sleep quality is defined by the following characteristics:
- You fall asleep soon after getting into bed, within 30 minutes or less.
- You typically sleep straight through the night, waking up no more than once per night.
- You’re able to sleep the recommended amount of hours for your age group.
- You fall back asleep within 20 minutes if you do wake up.
- You feel rested, restored, and energized upon waking up in the morning.
Reasons for Poor Sleep Quality
Any number of things could be contributing to your poor sleep quality. Some potential causes include poor sleep hygiene, stress, sleep apnea, or another chronic health condition or sleep disorder.
Poor Sleep Habits
Poor sleep habits, like having an irregular sleep schedule or consuming too much caffeine or alcohol, can interfere with your sleep quality. In a study of nursing students, smoking and daily coffee consumption were two of the largest factors associated with poor sleep quality. Alcohol also disturbs your sleep, even though it’s considered a sedative.
Stress and Anxiety
Poor mental health, whether from increased stress or a depression or anxiety disorder, also contributes to poor sleep quality. Problematically, sleep deprivation and the resulting insomnia worsen these conditions, creating a vicious cycle.
Chronic Health Conditions
Certain chronic health conditions are associated with poor sleep patterns and less sleep overall. These include chronic lung diseases, asthma, acid reflux, renal disease, cancer, fibromyalgia, and chronic pain. Unfortunately, as with stress and anxiety, poor sleep quality can exacerbate the symptoms and discomfort felt with these conditions.
A person with sleep apnea experiences temporary lapses in breathing during their sleep, resulting in gasping, choking, and snoring sounds. Even if they don’t consciously wake up, their brain has to kick start breathing again, disrupting sleep quality. Sleepiness and lack of energy are two of the most common complaints of individuals with sleep apnea.
Undiagnosed Sleep Disorder
Because they occur in your sleep, some sleep disorders go undiagnosed until a person seeks care for other symptoms like poor sleep quality, or a sleep partner alerts them to the symptoms. For example, individuals with periodic limb movement disorder (PLMD) experience involuntary jerking movements in their legs while they sleep, resulting in reduced sleep quality, and fatigue and poor concentration during the day. Individuals with narcolepsy likewise often suffer from poor sleep quality, and experience daytime fatigue.
How To Improve Your Sleep Quality
Fortunately, improving your sleep quality may be as simple as improving your sleep hygiene. Just like dental hygiene involves regularly brushing and flossing to maintain your teeth, sleep hygiene is all about practicing good habits that help you get good sleep consistently.
- Stop watching television and using your phone or computer for at least 30 minutes before bedtime. Electronic devices emit bright blue light that your brain perceives as sunlight, tricking it into delaying sleep and keeping you awake longer than you’d like.
- Transform your bedroom into a dark, quiet, and cool oasis. Set your thermostat to somewhere in the low- to mid-60 degrees Fahrenheit, and use blackout curtains or a white noise machine to further relax your senses.
- Go to bed and wake up at the same time every day. Following a consistent sleep schedule trains your brain to recognize when it’s time to sleep and when it’s time to wake.
- Make sure your sleep schedule allows for enough time to sleep. Adults need 7-9 hours of sleep per night.
- Create a relaxing bedtime routine. Select activities that relax and calm you, like taking a warm bath, listening to an audiobook, or journaling. Performing these activities in the same order every night creates a pattern for your brain to recognize them as the prelude to sleep.
- Limit your caffeine and alcohol intake. Both of these substances can stay in your system for some time and disrupt your sleep quality. Avoid drinking alcohol within three hours of bedtime, and caffeine within five hours.
- Get some sunlight in the morning. Just 15-30 minutes outside in the sun can help wake you up and reset your circadian rhythm.
If you still have trouble sleeping after implementing these suggestions, talk to your doctor. They may recommend other lifestyle changes, therapies, or medications that can improve your sleep quality.
Sleep problems can be caused by various factors. Although causes may differ, the end result of all sleep disorders is that the body’s natural cycle of slumber and daytime wakefulness is disrupted or exaggerated.
Factors that can cause sleep problems include:
- Physical disturbances (for example, chronic pain from arthritis, headaches, fibromyalgia)
- Medical issues (for example, sleep apnea)
- Psychiatric disorders (for example, depression and anxiety disorders)
- Environmental issues (for example, it’s too bright, your partner snores)
Short-term or acute insomnia can be caused by life stresses (such as job loss or change, death of a loved one, or moving), illness, or environmental factors, such as light, noise, or extreme temperatures.
Long-term or chronic insomnia (insomnia that occurs at least three nights a week for at least three months) can be caused by factors such as depression, chronic stress, and pain or discomfort at night.
Other factors that can interfere with sleep include:
- Genetics: Researchers have found a genetic basis for narcolepsy, a neurological disorder of sleep regulation that affects the control of sleep and wakefulness.
- Night shift work: People who work at night often experience sleep disorders, because they cannot sleep when they start to feel drowsy. Their activities run contrary to their biological clocks.
- Medications: Many drugs can interfere with sleep, such as certain antidepressants, blood pressure medication, and over-the-counter cold medicine.
- Aging: About half of all adults over the age of 65 have some sort of sleep disorder. It is not clear if it is a normal part of aging or a result of medications that older people commonly use.
National Sleep Foundation. American Alliance for Healthy Sleep. Tang, N. Rev Sleep, September 2008.
February 23, 2022
Share this on: Copied!
Feeling like a zombie this morning? You’re not alone. Millions of Americans suffer from a lack of sleep or sleep deprivation.
Even if you make the effort to get to bed early, there may be a number of reasons why you can’t get the proper amount of rest to help you feel functional the next morning. You may be surprised by these 10 common reasons why you’re not getting enough sleep:
- Late night dnacks – The late night munchies spell disaster for more than your diet. Eating and drinking too close to your bedtime can cause heartburn and the need to use the bathroom during the night. Fill up on a healthy dinner so you’re not tempted to snack!
- Anxiety – Worries from the work day keeping you awake? Lying awake thinking will only cause you more anxiety! Break the cycle by reading a book until you’re eyes feel heavy and you’re relaxed enough to doze off.
- Temperature – If you’re too hot or too cold, odds are you will wake up in the middle of the night. Before bed, find the ideal temperature using your thermostat and a blanket, so you can sleep soundly through the night.
- Electronics – Too much stimulation (and artificial light) before bed can make it difficult to fall asleep.
- Alcohol – Having a nightcap before bed may sound tempting. Even though alcohol may make you feel sleepy ,it fragments your sleep. To wake up feeling less zombie-like, skip the alcohol.
- Caffeine – Coffee, tea, and energy drinks may be your go-to morning boost, but drinking them too late in the afternoon can keep you awake at night.
- Sleep schedule – Make a schedule and stick to it. Going to sleep and waking up at different times every day stops your body’s natural sleep rhythm, making it even harder to get a good night’s rest.
- Exercising – There’s no denying that breaking a sweat is essential to a healthy lifestyle. Unfortunately, raising your heart rate right before bed makes it harder to fall asleep, so opt for a morning workout instead.
- Artificial light – Light dictates your body’s natural sleep pattern, so switch off that bedside lamp and you’ll find yourself drifting off much faster.
- Sleep apnea – This sleep disorder is marked by disruptions in breathing during the night, which causes you to wake up abruptly. Seeking treatment will drastically improve your sleep!
Do you feel like any of these reasons apply to you? Are you tired of being tired? Visit the UPMC Sleep Medicine Center online to learn more about sleeping habits or to schedule a sleep study to uncover the reason why you haven’t been getting the right amount of sleep.
Editor’s Note: This gallery was originally published on January 13, 2015 , and was last reviewed on February 23, 2022 . Refreshed Feb. 23, 2022
thensf October 28, 2020 Sleep and You
You might be getting enough hours, but that doesn’t necessarily mean you’re getting the most restful type of sleep. These strategies can help.
When it comes to sleep, quantity is important—but so is quality. Most adults need somewhere between seven and nine hours a night to wake up feeling well-rested, but a lot depends on exactly what happens during those hours. The quality of your sleep ensures that you get the essential physical, mental, and emotional benefits you need from your slumber.
How Do You Measure Good Sleep Quality?
Sleep quality is the measurement of how well you’re sleeping—in other words, whether your sleep is restful and restorative. It differs from sleep satisfaction, which refers to a more subjective judgment of how you feel about the sleep you are getting. Sleep quality is more complicated to measure than sleep quantity, but it’s not entirely subjective. Guidelines give an overview of sleep quality goals, and they include some individual and age differences. Four items are generally assessed to measure sleep quality:
Sleep latency: This is a measurement of how long it takes you to fall asleep. Drifting off within 30 minutes or less after the time you go to bed suggests that the quality of your sleep is good.
Sleep waking: This measures how often you wake up during the night. Frequent wakefulness at night can disrupt your sleep cycle and reduce your sleep quality. Waking up once or not at all suggests that your sleep quality is good.
Wakefulness: This measurement refers to how many minutes you spend awake during the night after you first go to sleep. People with good sleep quality have 20 minutes or less of wakefulness during the night.
Sleep efficiency: The amount of time you spend actually sleeping while in bed is known as sleep efficiency. This measurement should ideally be 85 percent or more for optimal health benefits.
If you’re curious, this is how you can calculate it: First find your actual sleeping duration. Take your total time in bed (in minutes) minus how many minutes it took you to fall asleep and minus how many minutes you spent awake during the night. Divide that figure (actual sleeping time) by your total time in bed (in minutes). Finally, multiply that number by 100 to arrive at your sleep efficiency percentage. For example: 480 (total minutes in bed) – 30 (minutes to fall asleep) – 0 (minutes awake during the night) = 450 (actual sleep time in minutes). 450 / 480 = .9375 x 100 = 93.75% sleep efficiency
Together, these four elements can help you assess the quality of your sleep. They contribute to an overall sense you have of your sleep being “satisfying” or not. Improving your sleep quality can help ensure that your sleep cycles won’t be interrupted, which in turn helps assure that you will wake up feeling energized.
What Is Poor Sleep Quality?
Not surprisingly, poor sleep quality is characterized by the opposite factors. If it takes you longer than 30 minutes to fall asleep, if you wake up during the night more than once, or if it takes you longer than 20 minutes to drift back asleep after waking up, your sleep quality is considered poor. You’re likely to feel tired the next day, even if you get the recommended number of sleep hours. It is important to note that there are some individual and age differences in these factors. For example, it’s common to wake up more frequently during the night as we get older. As long as you return to sleep quickly, this won’t hurt your sleep.
How to Improve Sleep Quality
If you’re concerned that your sleep quality is subpar, simple strategies may help. For instance, make sure that your bedroom is entirely dark (use blackout curtains to block outside street lights) and the temperature is cool (between 60 and 67 °F is ideal). Other lifestyle changes—such as drinking less alcohol and getting more exercise—may also help you upgrade your sleep quality.
It’s not just a matter of counting the number of hours of sleep you get. “Experts typically recommend between seven to nine hours of sleep per night, but it is dependent on age and lifestyle and it’s also important to keep a consistent sleep schedule to avoid sleep troubles like sleep debt,” says Frida Rångtell, PhD, sleep educator and science advisor at Sleep Cycle.
Of course, you want to make sure your sleep duration offers the most benefits, so you’re truly making the most of the hours and waking up more refreshed come morning.
What counts as good sleep quality?
Good quality sleep is not only about the number of sleep hours we clock in but also about timing, our sleep regularity, and the quality, as we slumber. ”Sufficient sleep quantity is irrelevant if the sleep is low quality, and if you do not get enough sleep, you may miss out on crucial time in each different sleep stage,” she says.
During the night, our bodies cycle through four sleep stages, which all have important functions. REM sleep is important for memory, learning, and creativity. “There is an increase in brain activity during REM sleep, as this is when dreams are most likely to occur and REM sleep can be anywhere from 0 to 60 minutes of your sleep cycle,” she says. A healthy REM cycle will mean a longer duration.
Good sleep quality will leave you feeling energized and refreshed when you wake up. “You will be sleeping through the night with few-to-no disturbances and you will be falling asleep easily and potentially wake up naturally due to your trained circadian rhythm,” she says. People experiencing good sleep quality typically don’t think about sleep as much since it is not causing any issues.
The most common signs of poor sleep quality
1. You fall asleep too fast
Yes, falling asleep too fast can be problematic—despite the assumption that it’d be beneficial to just drift away within seconds. “Falling asleep quickly could be a sign of too little sleep,” says Dr. Rångtell. While you don’t want to have to lay in bed awake for too long, you also don’t want to be so sleep deprived that you fall asleep too quickly and often don’t get high quality sleep, either. “You may perceive that when you finally sleep, you fall asleep fast and sleep quite deep, even if you don’t sleep for enough hours—this is likely because you have built-up sleep debt and thus high sleep pressure.”
A high sleep pressure increases deep sleep, and when we finally get recovery sleep, we may have increased deep sleep and REM sleep as a rebound effect. “The best way to avoid this is to try getting sufficient sleep each night, so you don’t build up sleep debt,” she says.
2. You can’t fall asleep fast enough
Not being able to fall asleep at night is also an issue—there’s that happy medium. “A lower sleep pressure can decrease deep sleep and make it more difficult to fall asleep at a regular bedtime, as well as taking a nap close to bedtime, which lowers our pressure to sleep and makes it more difficult to fall asleep,” says Dr. Rångtell. Consider your bedtime and schedule naps earlier in the day to avoid excess stimulation at night.
3. You Wake Up Often During the Night
“If our sleep is fragmented and we wake up or almost wake up very often, sleep quality can be lower, even if we get enough hours asleep,” says Dr. Rångtell. If sleep is disturbed, you might get too little of some sleep stages or the sleep cycles may become disrupted, resulting in excess fatigue during the day, despite sufficient hours of sleep.
The latest and greatest sleep technology:
4. You’re Chronically Fatigued in the Day
Another sign of poor sleep quality is feeling constantly tired throughout the day, where no matter the sufficient number of hours, you’re still fatigued and ready to get back into bed.
What’s more, it could also impact your mood. In addition to lethargy, if you are moody or irritable, or if you are struggling to focus, you likely have poor sleep quality too. “Your mind and body will feel the effects of poor sleep quality which is why it’s important to schedule enough time for sleep so that you do not run the risk of missing out on the time you need for each sleep stage in the sleep cycle,” says Dr. Rångtell.
How to improve sleep quality
To improve sleep quality, try doing some physical activity during the day, avoiding naps (or scheduling them earlier during the day), practicing relaxation, finding good strategies to deal with stress and emotions, and reducing alcohol and caffeine intake as well as time intake wisely, so not too close to bedtime, for example.
Going outside during the day is helpful, as light is important for your circadian rhythm and helps trigger the sleep-wake cycle. Take lunch outdoors or go for a walk to stretch your legs and break up the workday. “Taking a warm bath or shower in the evening can also make it easier to fall asleep and aid in deep sleep,” says Dr. Rångtell. So, enjoy a nice soak to unwind and get ready for a high quality, restful sleep.
Oh hi! You look like someone who loves free workouts, discounts for cutting-edge wellness brands, and exclusive Well+Good content. Sign up for Well+, our online community of wellness insiders, and unlock your rewards instantly.
Poor sleep quality is associated with poor SRH in individuals with long sleep duration.
Good sleep quality may protect those with long sleep duration from poorer SRH.
SRH in individuals with short sleep duration is largely independent of sleep quality.
Fatigue and sleep quality are pathways linking sleep duration and SRH.
Unhealthy sleep duration, either short or long, is associated with worse health and central subjective dimensions of sleep and health such as fatigue. It has been argued that the link between sleep duration and health may depend on the quality of the slept hours, and on its functional impact (ie, fatigue). The present study therefore assessed whether the relationship between last night’s sleep duration and general self-rated health (SRH) differs as a function of sleep quality, and secondly, whether current fatigue and sleep quality are factors linking sleep duration and SRH.
The present cross-sectional dataset involved 1304 individuals (57% female, Mage = 28.8, range 18–79). Participants completed surveys for general SRH, previous night’s sleep duration and sleep quality, and current fatigue.
Results showed the expected inverted U-shaped (ie, quadratic) relation between last night’s sleep duration and SRH and a linear relation between last night’s sleep quality and SRH. However, long sleep duration was only associated with poorer SRH in individuals who also reported poor sleep quality. Further, the quadratic relationship between sleep duration and SRH was partially mediated by fatigue and sleep quality.
The results of this multi-study analysis suggest that SRH is particularly poor in those who slept both long and with poor quality the night before, while good sleep quality may protect those with a long sleep duration from poor SRH. Thus, last night’s long sleep does not seem to be associated with poor subjective health unless it is coupled with poor sleep quality. Furthermore, fatigue and sleep quality are potential pathways linking short and long sleep duration with SRH. Different dimensions of sleep interact in their association with health, and future research will benefit from an integrative approach.
Previous article in issue
Next article in issue
Poor Sleep Has Social Causes and Consequences
Lori M. Hunter
University of Colorado, Boulder
Poor sleep is often considered an individual problem, but it’s also a public health issue. People who have restless nights can cause motor vehicle crashes and workplace mistakes. In addition to these social consequences, poor sleep has social causes such as family and workplace stresses.
Sleep Problems Are Widespread
The Centers for Disease Control and Prevention estimates that anywhere from 50 million to 70 million U.S. adults have sleep disorders or wakefulness disorders (excessive sleepiness during the day). In fact, over a third of adult respondents to a 2009 nationwide study reported less than seven hours of sleep during a typical 24-hour period (seven to nine hours per night are recommended). Young and middle-age adults report less sleep. Among racial and ethnic groups, Black Americans report sleeping few hours.
Sleep deprivation makes even routine daily tasks more difficult. Especially severe, 1,550 deaths and over 40,000 injuries in the United States annually are due to sleepy drivers, according to the National Department of Transportation.
Public Health Costs of Poor Sleep
In addition to the public health costs of traffic accidents, poor sleep reduces labor productivity and can increase costly mistakes at work. Sleep loss and night shift accidents have been partially to blame for dramatic environmental health disasters such as the grounding of the Exxon Valdez oil tanker in Alaska and the chemical plant disaster in Bhopal, India. 1 A strong relationship also exists between medical errors, sleep loss, and shift duration among medical residents, who may be required to work up to 96 hours in a week.
The full economic impact of poor sleep is not known. But even when focusing only on medical care costs, it’s estimated that tens of billions of dollars are spent annually on medications and doctor and hospital visits due to sleep problems. 2
Social Factors and Poor Sleep
While sleep quality can affect work, the reverse is also true: Workplace stress can “follow workers home” and cause restlessness. 3 To shed light on the effect on sleep of workplace stresses, researchers from the University of Michigan’s Population Research Center analyzed data from the nationwide Americans’ Changing Lives study. Results suggest that feeling bothered or frequently upset at work has the strongest effect on sleep, even more so than low job security.
Family relationships also matter for sleep—both immediate family such as spouse and children, and also more distant associations with parents and siblings. Results from the National Survey of Midlife Development in the United States suggest that frequent family tension and inadequate emotional support are strongly associated with troubled sleep. And while social relationships generally promote good health, this is not the case with troubled family relationships. More frequent contact within strained families has negative effects on sleep. 4
Good sleep is required for good health. Public health programs targeted at both workplace and family stressors may reduce troubled sleep. Such efforts could increase labor productivity and reduce workplace accidents and medical care costs.
This article is part of PRB’s CPIPR project, funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Hunter is liaison from the University of Colorado’s Population Center to CPIPR. NICHD-funded researchers highlighted in this article are Sarah Burgard of the University of Michigan Population Research Center and Jennifer Ailshire, formerly with the University of Michigan’s Population Research Center and currently a post-doctoral researcher at the University of Southern California.
Being caught in a cycle of tiredness and sleeplessness can be desperately frustrating. Just one night of broken sleep can leave you feeling out of sorts the next day, impacting your productivity, immunity, and emotional health. Often, poor sleep hygiene is responsible.
Fortunately, there’s plenty you can do when rest feels unattainable. Here, we outline some of the reasons why you might be feeling tired, along with helpful suggestions on how to improve sleep hygiene.
Why am I feeling so tired?
Sleep experts generally agree that good sleep hygiene leads to good sleep, and poor sleep hygiene leads to poor sleep. That’s why sleep hygiene is increasingly seen as a key component of public health strategy to mitigate the risks associated with poor sleep 1 .
Healthy habit-forming is a fundamental component of human wellbeing – and this is the basis on which sleep hygiene is built 2 . Originally developed to treat mild to moderate insomnia, sleep hygiene involves cultivating healthy daily habits, following a nightly routine, sticking to a consistent sleep schedule, and optimising your bedroom to enhance your sleep quality and better your overall health 3 .
The central premise of sleep hygiene – adjusting the environment and habits to improve sleep – is universal for everyone. However, precisely what rituals to follow daily and nightly may vary from person to person.
What are the signs of poor sleep hygiene?
The following signs may indicate that you could improve your sleep hygiene: 4
Delayed sleep onset (struggling to fall asleep)
Frequent sleep disturbances
Excessive daytime sleepiness
Lack of consistency in sleep quality or quantity
Updated September 8, 2022
Our editorial process includes extensive measures to verify accuracy, provide clarity on complex topics, and present factual information. Read more.
We regularly update our articles to include the latest research, expand coverage, and add new information as it becomes available.
When people think of healthy sleep, they often think of getting a certain amount of sleep every night. This is referred to as sleep quantity. While sleep quantity is definitely important, it is not the only factor in getting a good night’s sleep.
Just as important—and perhaps even more important—is sleep quality. This means regularly getting healthy, consistent sleep that allows your body to go through all of the restorative processes that are necessary to maintain our overall health.
What Is Sleep Quantity?
Sleep quantity refers to how many hours of sleep you get each night. According to the Centers for Disease Control and Prevention, the average person’s sleep needs are:
- Newborns (0-3 Months): 14-17 hours per 24 hours
- Infants (4-12 Months): 12-16 hours (including naps) per 24 hours
- Toddlers (1-2 Years): 11-14 hours (including naps) per 24 hours
- Preschoolers (3-5 Years): 10-13 hours (including naps) per 24 hours
- School-Age Children (6-12 Years): 9-12 hours per 24 hours
- Teenagers (13-18 Years): 8-10 hours per 24 hours
- Adults (18-60 Years): 7-9 hours per night
- Adults (61-64 Years): 7-9 hours per night
- Adults (65+ Years): 7-8 hours per night
These guidelines are generalized, and there are people who need more or less sleep than the amount recommended for their age group. However, even considering exceptions to the rule, there are many people in the United States who regularly don’t get the amount of sleep that they need. In fact, it is estimated that 50 to 70 million Americans suffer from some form of sleep loss, and approximately 35.2% of American adults report regularly sleeping less than the required seven hours a night.
What Is Sleep Quality?
Sleep quality refers to how well you sleep. Sleep quantity is one aspect of sleep quality, but it is not the entire picture. Other standards for high-quality sleep include:
- Sleep Onset Latency: Sleep onset latency means how quickly and easily you can fall asleep. Most people are able to fall asleep within 20 minutes of going to bed.
- Sleep Continuity: This is your ability to stay asleep once you fall asleep. High-quality sleep is continuous. Disrupted sleep at night is associated with less refreshing sleep overall.
- Sleep Efficiency: Sleep efficiency means how much time you spend sleeping versus how much time you spend trying to sleep. Some researchers consider spending at least 85% of your total time in bed trying to sleep as a minimum benchmark for sleep quality.
- Sleep Timing: Timing refers to when you sleep in a given 24-hour period. Our circadian rhythm dictates our internal clock and makes us feel alert at certain times (usually daytime) and sleepy at other times (usually nighttime). High-quality sleep is in line with the body’s circadian rhythms. This means sleeping and waking at the same times every day.
- Alertness During Waking Hours: Another indicator of quality sleep is your body’s ability to maintain wakefulness during the day, which includes being able to stay awake, as well as being able to function with your full cognitive and physical capacity.
- Sleep Satisfaction: Satisfaction is measured by how well-rested you feel both upon waking and throughout the day.
What Gets in the Way of High-Quality Sleep?
There are a number of things that can get in the way of a person’s sleep quantity and sleep quality.
Sometimes, the problem is an underlying medical issue. This may be a sleep disorder such as insomnia or sleep apnea, or a psychiatric condition such as depression, anxiety, or bipolar disorder.
In addition, there are many other conditions that interfere with healthy sleep, either as a primary symptom (like Parkinson’s and Alzheimer’s) or as an effect of symptoms like chronic pain, indigestion, or the need to urinate frequently. These conditions can be both the cause and the effect of sleep deprivation, meaning patients sometimes get caught up in a vicious cycle where a condition causes sleep loss, and sleep loss then aggravates the condition and causes more sleep loss.
Sleep quantity and quality can also be negatively affected by factors like having infants or young children at home, working a night shift, and dealing with stress. Additionally, recent studies have suggested that sleep quality and quantity may also be reduced by the impact of technology on our lives. This includes developments such as the extension of work time into the evening, as well as being increasingly plugged into the 24-hour digital world through various devices.
What Are the Harms of Poor Sleep Quality?
Poor sleep can have serious health consequences both in the short term and the long term. It may increase your risk of developing concerns such as:
- Cognitive, memory, and performance deficits
- Increased stress and irritability
- Depression and anxiety
- Hypertension, high cholesterol, heart disease, and stroke
- Weight gain and obesity
- Immune system issues
- Diabetes and insulin resistance
How Can You Improve Sleep Quantity and Quality?
Though chronic sleep deprivation is problematic, the great news is that there are many ways to improve both the quality and quantity of your sleep. Steps you can take to get better, healthier sleep include:
- Addressing Underlying Issues: If you believe you may have a medical issue that is impacting your sleep, you should discuss it with your doctor as soon as possible. Many of the most common medically-induced sleep issues are treatable.
- Make Lifestyle Changes: While certain parts of your life may be harder to change than others, there are a few steps you can take that are likely within your power and may drastically improve your sleep. Getting regular exercise has been shown to improve sleep, as has cutting out cigarettes, alcohol, and caffeine in the hours before bed.
- Invest in Your Sleep Environment: Most people underestimate the importance of their sleep environment. Though everyone has their own preferences, people generally tend to get the best sleep in dark, quiet, comfortable environments. Make sure your mattress and bedding are comfortable, and consider investing in new ones if they aren’t. If you find yourself interrupted by noise or light from outside, consider ear plugs or blackout shades.
- Go Screen-Free: Though it may seem daunting to disconnect, studies have shown that bedtime phone use is associated with poor sleep. Using phones and other devices in bed also makes it more likely that you may lose track of time and can delay your actual bedtime significantly.
- Practice Sleep Hygiene: Sleep hygiene means incorporating behaviors into your life that promote healthy sleep. This includes some of the suggestions mentioned above, in addition to practices like having a nightly routine, maintaining the same bedtime whenever possible and winding down in the hour before bed with a relaxing activity like reading, taking a bath, or meditating.
As always, knowledge is power. The more you know about sleep quantity, sleep quality, and sleep health in general, the more tools you have to improve your sleep.
CAMH study the first to objectively measure sleep patterns on a large scale in people with mental illness compared to the general population
- Mental illness associated with poor sleep quality according to largest study of its kind
- By Centre for Addiction and Mental Health
TORONTO, October 12, 2021 – People who have been diagnosed with a mental illness are more likely to have poor sleep quality compared to the general population, according to the largest study of its kind ever conducted.
,” has just been published in the journal PLOS Medicine.
“The differences in sleep patterns indicated worse sleep quality for participants with a previous diagnosis of mental illness, including waking up more often and for longer periods of time,” said senior author Dr. Shreejoy Tripathy, an Independent Scientist at CAMH’s Krembil Centre for Neuroinformatics. He also emphasized that gauging the quality of sleep was just as important as measuring the total amount with regard to its impact on mental health.
“The relationship between sleep and mental health is bi-directional,” said lead author Dr. Michael Wainberg, a postdoctoral researcher at the Krembil Centre for Neuroinformatics. “Poor sleep contributes to poor mental health and poor mental health contributes to poor sleep. Sleep pattern differences were a feature of all mental illnesses we studied regardless of diagnosis.”
The study was based on data collected from 89,205 participants in the United Kingdom who agreed to wear an accelerometer on their wrist that tracked body movement 24 hours a day for seven days. They also consented to having their data stored in a digital biobank for research purposes. The authors used computational algorithms—including machine learning—to summarize this vast amount of data into ten metrics, including bedtime, wake time, naps and the longest duration of uninterrupted sleep. They then compared these metrics between participants who had received a previous diagnosis of mental illness in their lifetime and those who had not.
“We know that up to 80 per cent of people with mental health disorders can have problems with falling asleep, staying asleep or waking up earlier than they intended,” said CAMH psychiatrist and sleep disorder specialist Dr. Michael Mak. “We know that sleep disturbances cause a great burden to society, including an economic one. And we know that treatments that improve sleep quality, whether it is therapy or some types of medication, can improve mental health outcomes.”
This is the first large-scale transdiagnostic study of objectively measured sleep and mental health, and the study’s unique methodology allowed for sleep monitoring to be conducted in each individual’s natural home sleep environment rather than in a laboratory setting.
“Until now nobody has looked at objectively measured sleep in the context of mental illness at quite this scale before,” said Dr. Tripathy. “Part of why we wanted to do this study is that with the emergence of smartphones and wearables, we have access to data streams that we never had before.”
The Krembil Centre for Neuroinformatics is currently developing a patient data biobank similar to the one in the UK that was used for this study. The core goal of the CAMH BrainHealth Databank is to use patient data, including the use of wearables outside of a hospital setting, to deliver improved, personalized mental health care in the present, while also accelerating future clinical research, discovery and innovation.
About The Centre for Addiction and Mental Health (CAMH)
CAMH is Canada’s largest mental health and addiction teaching hospital and a world leading research centre in this field. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental illness and addiction. CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre. For more information, please follow @CAMHnews
- Download citation
- Full Article
- Figures & data
- Reprints & Permissions
- Get access /doi/full/10.1080/13548506.2021.1874440?needAccess=true
Poor sleep quality might be a potentially modifiable predictor of prognosis in patients with coronary heart disease (CHD). Anxiety and depression symptoms are highly prevalent in these patients. Whether anxiety and depression symptoms are risk factors for poor sleep quality in Chinese patients with CHD is unclear. This study is intended to examine the prevalence of poor sleep quality in Chinese patients with CHD and its associations with anxiety and depression symptoms, and to explore whether sex, obesity and CHD type modify these associations. Three hundred and forty-eight participants were included. The Pittsburgh Sleep Quality Index (PSQI, >7 was defined as poor sleep quality) and Hospital Anxiety and Depression Scale (HADS) were used to assess sleep quality and psychological symptoms. 47.1% of the participants had poor sleep quality. Logistic regression analysis showed that poor sleep quality was independently associated with anxiety and depression symptoms adjusting for demographic and clinical factors. However, adjusted for anxiety symptoms, poor sleep quality was no longer associated with depression symptoms. Subgroup and interaction analysis showed that poor sleep quality was associated with markedly higher HADS anxiety and depression scores among patients with stable angina than those with acute coronary syndrome (ACS). These findings suggest that poor sleep quality was associated with both anxiety and depression symptoms in Chinese patients with CHD. However, in the case of concurrent anxiety and depression, anxiety was the main related factor of a high prevalence of poor sleep quality. The association between poor sleep quality and psychological symptoms was influenced by CHD type.
The authors thank the patients with CHD who volunteered to participate in this study. We also thank all the staff in the cardiovascular departments of the studied hospitals for their assistance to ensure the conduction of this study.
The authors have no conflicts of interest to disclose.
Notes on contributors
This article has been republished with minor changes. These changes do not impact the academic content of the article.
- Find this author on Google Scholar
- Find this author on PubMed
- Search for this author on this site
- Find this author on Google Scholar
- Find this author on PubMed
- Search for this author on this site
- Find this author on Google Scholar
- Find this author on PubMed
- Search for this author on this site
- Find this author on Google Scholar
- Find this author on PubMed
- Search for this author on this site
- Info & Metrics
Background University students are likely to have poor sleep quality and fatigue, affecting academic and psychological well-being.
Aims and Objectives To assess if and how sleep quality and fatigue are affected in university students of different Tertiary Institutions during an academic exam period and to identify possible associated factors.
Methods A Web-based survey was completed by 517 students of 20 different Tertiary Institutions (response rate 83.7%), containing questions about demographics, sleep habits, exercise habits, caffeine, tobacco and alcohol use, subjective sleep quality (using the Pittsburgh Sleep Quality Index – PSQI) and fatigue (Fatigue severity scale – FSS) at the beginning of the semester and on examination period.
Results The study group consisted of 328 (63.4%) females and 189 (36.6%) males with mean age 21.3±2.5 years. PSQI global and FSS scores were significantly elevated at exam period compared to pre-exam period (5.9±2.7 vs 5.4±2.5, p
There is no doubt that technology improves our daily lives. It has advanced medicine, industry, and so much more. Technology is a source of income for some, entertainment for others, and automation for many more. But, what your patients may not know about technology is that it could be ruining their good night’s sleep.
Most people today go to bed with their cell phone, tablet, laptop, or television to keep them company. Unfortunately, the result of that can be a long night of wakefulness prompted by the light from these devices along with the stimulating mental activity required to play games, watch movies, or take care of last-minute work-related emails before turning in.
There’s also the risk that they’ll become wrapped up in what they’re doing and continue long past the time they’d normally go to sleep. All these things combine to leave your patients getting less sleep than they’re accustomed to and far less than they need.
Subscribe to the AAST Blog to receive a free copy of our PAP Titration Guide.
Bright Light from Devices
The Sleep Health Foundation reports that the bright light from mobile phones, tablets, computers, and televisions blocks the release of the sleep hormone, melatonin, after only 1.5 hours of using technology in the evening .
Why is melatonin so important?
Melatonin is the hormone that signals the brain that it is time to sleep. The absorption of bright light through the eyes delays the release of melatonin, making it more difficult for people to fall asleep.
This exposure to light results in increased alertness in brain waves and improved results on mental performance tests. Follow that with reports of people feeling less sleepy after using their devices for an hour and a half, and there is cause for concern. The alarming discovery from this study, though, is that after five nights of exposure to bright lights from mobile devices, the natural body clock can be delayed that same 1.5 hours.
The effects of nighttime electronics use are even greater with children and teens , according to the National Sleep Foundation, with adolescents who text at night experiencing greater instances of daytime sleepiness. Unfortunately, increasing academic demands and busy social calendars make it difficult for students to complete their homework earlier in the day, requiring computer and tablet (since many schools utilize iPads for students) usage later into the night.
How can your patients decrease these effects on their own sleep?
As a sleep technologist, there are things you can do to encourage more sleep-positive changes in your patients’ daily routines. These include discontinuing screen use two hours before the time they want to go to bed at night.
For those who must use technology at night – for school or work – suggest that your patients download an app to switch their screens from blue light, which is brighter, to softer pink colors. Some devices have this option as a built-in feature.
Increased Alertness/Stimulation from Technology Activity
When patients begin to unwind for the day, it generally signals the brain that it is time to go into sleep mode . This is especially true if they have a normal bedtime routine (take a shower, brush their teeth, put on sleep clothes, etc.).
However, when they include screen time during this critical “unwinding” period, they’re filling their minds with information, knowledge, and thoughts. It could lead to information overload by loading their minds with information the brain must process before allowing them to sleep.
These cognitive exercises of filling the brain and processing the information are outstanding throughout the day. But when patients are getting ready to go to sleep, it’s mentally jolting – sort of like drinking an energy drink or an espresso would be.
Stimulation from technological devices can be active or passive. Passive stimulation comes in the form of listening to music, reading e-books, and watching television shows or movies. Active stimulation occurs when using interactive devices that change what takes place on the screen according to user input. The Sleep Judge warns that both types of stimulation are still stimulation and can disrupt sleep substantially .
The recommended solution you can share with your patients is to stop using all screens two hours before going to bed, but also taking things one step further by removing all devices from the bedroom. Encourage patients to try this for one week to see what a difference it makes in their ability to fall asleep and their overall sleep quality.
Activity Absorption & Extra Distractions
Patients who use screens before going to sleep are dealing with the ultimate sleep distraction. It’s too easy to get lost in what’s taking place on the screen.
“One more chapter” becomes finishing an entire book.
“One more level” turns into another hour of hunting orcs in a favorite game.
“One more episode” becomes finishing a season from their favorite streaming services.
“One more text” becomes an all-night comfort session when a friend needs a shoulder.
“One more email” becomes a late-night work session to iron out problems with a presentation.
One more minute – when it comes to screen time at night – can easily turn into several hours if patients aren’t careful. When patients keep their minds absorbed in these “one more” activities, it tricks their brains into believing they should remain awake.
That is only part of the problem, though. Due to the fact that everyone is now connected at all hours of the day or night, people are more likely to wake up during the night as the result of a message or notification received.
Whether they realize it or not, your patients are “tuned in” to the sounds their devices make – even when they are set to vibrate. Sleep.org reports that sleeping with electronic devices results in nearly an hour’s worth of difference in sleep among kids between the ages of six and 17 when compared to children who do not sleep with electronic devices.
What can you recommend to combat this?
Suggest that patients turn their phones to silent rather than vibrate, or simply remove the devices from their bedrooms altogether. For those who rely on mobile devices for an alarm clock, suggest that they consider switching to a nightstand clock instead.
The bottom line is that sleeping with electronic devices within arm’s reach can be a distraction just as much as using these devices too close to bedtime. Suggesting that patients remove these devices, and the temptation they bring, can help them enjoy more sleep throughout the night along with improved sleep quality.
The AAST is committed to providing you with key information to help you advance your career and serve your patients better with articles like these. Please subscribe today to stay up-to-date with the latest information and resources, and to get your free copy of AASM PAP Titration Guidelines: What You Need to Know , as our thanks to you.
Table of Contents
- What Is Sleep Deprivation?
- Health Effects Of Sleep Deprivation
- Treatments For Sleep Deprivation
Sleep deprivation—defined as less than seven hours of shut eye per night for adults—impacts up to one-third of American adults  One in Three Adults Don’t Get Enough Sleep. Centers for Disease Control and Prevention. Accessed 7/15/2021. . And even more teenagers suffer from lack of sleep. Over 57% of middle schoolers and more than 72% of high schoolers don’t get enough sleep on school nights, according to the Centers for Disease Control and Prevention (CDC)  Sleep in Middle and High School Students. Centers for Disease Control and Prevention. Accessed 7/12/2021. .
The health consequences of not getting enough sleep can be immediate and long-term, according to the National Institutes of Health. Sleep deficiency can interfere with work, school, driving and social functioning. The ability to learn, focus and react, can also be affected. It can also lead to feelings of frustration, crankiness or anxiety, and potentially even cause long-term health damage. And, according to research, sleep deprivation is a worsening problem.
Because Sleep Support
What Is Sleep Deprivation?
Sleep deprivation refers to the failure to get the recommended sleep as defined by the National Sleep Foundation, according to Janet Hilbert, M.D., a sleep expert at Yale Medicine in New Haven, Connecticut. How much sleep someone needs is age-dependent.
For American adults ages 18 and older, the National Sleep Foundation recommends seven to nine hours of uninterrupted sleep, while other age ranges need the following amounts of shut-eye:
|Age||Sleep Amount Recommended|
|0 – 3 months||14 – 17 hours|
|4 – 11 months||12 – 15 hours|
|1 – 2 years||11 – 14 hours|
|3 – 5 years||10 – 13 hours|
|6 – 13 years||9 – 11 hours|
|14 – 17 years||8 – 10 hours|
|18 – 64 years||7 – 9 hours|
|65 and older||7 – 8 hours|
There are two types of sleep deprivation: total and partial limitation. “Acute total sleep deprivation is the absence of any sleep at all for a limited time, such as pulling an all-nighter on one night to get work done,” says Dr. Hilbert. More often, people experience chronic partial sleep deprivation, which is chronically achieving less sleep than you need for optimal performance. An example might be only getting 5 hours of sleep on weeknights when the recommendation for adults is 7 to 9 hours nightly.
In the real world (as opposed to research), most sleep deprivation is partial. “People can only go without any sleep at all for short periods before they experience an intense need to sleep.” Dr. Hilbert says.
Studies on sleep deprivation are done on research subjects under different conditions. Sometimes, the subjects are brought into a laboratory and not allowed to sleep at all for up to a few days (this is acute total sleep deprivation). Other times, research subjects are allowed to sleep for short periods on each night of the study so the studies can be carried out longer (this is chronic partial sleep deprivation).
However, time is just one of the factors that can impact sleep deprivation. Quality of sleep is another component, says Darren P. Mareiniss, M.D., an assistant professor of emergency medicine at Sidney Kimmel Medical College, Thomas Jefferson University in Philadelphia, Pennsylvania. For example, if someone is experiencing decreased REM sleep or frequent arousals, they can still suffer from sleep deprivation even if they’re getting the recommended hours.
Causes Of Sleep Deprivation
Causes of sleep deprivation are varied.
Chronic Difficulty Falling or Staying Asleep
While everyone struggles to fall or stay asleep on occasion, Dr. Hilbert explains that certain factors can lead to chronic sleep deprivation. They include sleep disorders such as insomnia, sleep apnea, restless legs syndrome and circadian rhythm sleep disorders. Medical conditions, including symptomatic congestive heart failure, poorly controlled asthma, anxiety and depression can also contribute to a sleep deficiency. And the use of certain medications or substances, including steroids, stimulants, caffeine and alcohol can also negatively impact sleep.
Shift Worker Syndrome
Shift worker syndrome, a disorder that results from disrupting the normal night and day circadian rhythm in the body, can negatively affect sleep quality and quantity, according to Dr. Mareiniss. “Patients with shift worker syndrome [circadian rhythm disorder] typically sleep during the day and work nights,” he says. “This disrupts the normal wake cycle of the body and can result in sleep deprivation.” Patients may not be able to sleep at night due to the disruption, leading to sleep deprivation.
Lack of Opportunity or Time to Sleep
A common culprit of sleep deprivation is a lack of sleep opportunity or an “insufficient time allotted for sleep,” says Dr. Hilbert. This can be the result of a demanding work or school schedule or tending to a baby or young children.
Lack of Sleep Awareness
Some people don’t get enough sleep simply because it isn’t a goal, says Dr. Hilbert. This can be the result of not thinking about sleep or maladaptive habits limiting sleep. A few examples of this would be variable sleep scheduling, which is an irregular sleep/wake cycle.
An example of variable sleep scheduling might be someone who has a sleep schedule of 10 p.m. to 6 a.m. on weekdays because he needs to get up for work, but a sleep schedule of 1 a.m. to 9 a.m. on Friday and Saturday nights, says Dr. Hilbert.
“On Sunday nights, when he tries to go to bed at 10 p.m., he is not ready to fall asleep, but he still needs to get up at 6 a.m., so he starts the week off with less than the amount of sleep he needs,” she says. “Having a three-hour time difference between weekday and weekend sleep schedules is like flying from New York to California and back every weekend.”
Social behavior which results in jet lag-type symptoms has been termed “social jet lag.”