Photo by Aleksandar Cvetanovic via Unsplash

 

What a Good Night’s Sleep Looks (and Feels) Like

 

There is a lot of talk about sleep quality in studies and support resources online, but some may ask, what exactly qualifies as a good night of sleep? This is something many researchers and sleep specialists make repeated references to, but often without elaborating on the qualifications. We all know what sleep quantity refers to, but to better understand sleep quality, doctors and sleep specialists are now providing guidelines to give sleepers a measure of their success. With a third of Americans reporting less than ideal sleep on a regular basis, it is not enough simply to focus on time spent in bed. According to top researchers in the field of sleep science, it is also the nature of your sleep, and whether or not it is fragmented, that ultimately affects how you feel.

Sleep Health

In a report published in the journal Sleep Health in 2017, the National Sleep Foundation’s sleep quality recommendations were outlined to give people some defining characteristics for healthy sleep experiences. In this report, sleep health professionals and study participants recognized four primary indicators of sleep quality: sleep latency, number of awakenings, length of awakenings after sleep onset, and sleep efficiency (defined quantitatively). In specific terms, these criteria can be described as:

  1. Falling asleep in 30 minutes or less when you go to bed
  2. Waking no more than once per night
  3. When waking at night, the episode lasts no more than 20 minutes
  4. Sleeping the majority of the time spent in bed (at least 85 percent of attempted sleep time)

 

Thirty Minutes or Less

Sleep health professionals point to two primary causes of sleep latency problems: Going to bed too early and engaging in stimulating activities at late hours. If you have a sleep disorder such as sleep apnea or insomnia, there will be other causes as well, but these habits will still contribute to latency issues. Of course, the best time for you go to bed depends on your specific chronotype, or your biological clock of circadian rhythms, and this will affect your sensitivity to evening activities as well. If you’re having trouble getting to sleep, these are two things you can address right away: cut out exercise or devices (including TV) before bed, and try another bedtime. In some cases you may simply need to change your schedule to meet your needs. Sleep onset latency (SOL) can be a symptom of more serious problems and should not be ignored.

No More Than Once (or Twice) a Night

Waking on occasion is nothing to be alarmed about, but if it happens regularly, it may be best to consult a physician. Sleep medicine specialists will tell you that waking is more common with age. For adults 65 and older, waking twice a night is usually not a problem. But if you wake often or wake due to some form of discomfort or irritation, it could be a sign of more serious health issues and should be addressed right away.

Falling Back Asleep in 20 Minutes

As with night awakenings, the time spent trying to return to sleep can depend on the household environment, the day’s activities, or any number of factors that influence restfulness on a daily basis. But the NSF’s recommendations suggest that if you have difficulty falling back asleep more than one or two nights a week, this is an indication of sleep problems. Finding yourself waking in the night and staring at the dark ceiling in no fun, and can also be a symptom of underlying conditions, and each of these indicators should receive equal attention when assessing your overall sleep health.

Sleep Time vs. Attempted Sleep Time

This rule basically tells us that bedtime is sleeptime. Some doctors are more strict than others in this regard. In an interview with Health.com, Philip Gehrman, Ph.D., Assistant Professor of Psychiatry at the University of Pennsylvania, told the website’s editor that the bed should be a special place, not an office space. “The bedroom should be for two things only,” the doctor said — “sleep and sex.”

The National Sleep Foundation provides more detailed sleep quality guidelines on their website, sleepfoundation.org.  In one article, titled “What is Healthy Sleep?” a more extensive list of indicators includes optimal hours for your age group, a restorative feeling upon waking, which is highly subjective but also very important, and an absence of sleep disorder symptoms such as heavy snoring, choking, pauses in breathing, or daytime sleepiness. The NSF points out that it is natural for people to have peak energy hours and low alertness at certain times of the day. This is part of our biological clock system, and proper sleep helps to balance these ups and downs according to our nature.

A Good Night’s Sleep with CPAP

While this subject merits a complete article on its own, sleep professionals will tell you that above standards still apply when using a CPAP device. Ideally, PAP therapy will improve sleep over time, but there is always a period of adjustment. How long this period will last depends on the individual, the nature of the syndrome, and the specifics of your device. Some fine tuning is usually required to get the best results and customize the therapy to your specific needs as a patient. Once this is achieved, sleep improvement is expected. The most important thing for CPAP patients is continued use, also referred to as treatment compliance. There is only one way to get used to a change in your daily routine, and that is to make the change a permanent fixture. Ask any veteran CPAP user and you’ll hear the same sentiments. Practice makes perfect.

The Science of Proper Sleep

It should be noted that quality sleep, and the physiological conditions which produce a ‘good night’s sleep,’ are not completely understood. It is not unusual, for example, for those who report poor or inadequate sleep to show relatively normal physiological sleep patterns. We know that feelings of restoration after sleep are linked to sleep architecture, which represents the stages or patterns of a person’s sleep cycle, including rapid eye movement (REM) and non-rapid eye movement (NREM) sleep. While sleep architecture includes our moments of waking as well as the various sleep stages we go through, we do not know exactly how these patterns translate into restful, restorative sleep experiences. As a result, good sleep is usually defined by its quantity and its consequences, such as our daily energy reserves, and how well our bodies and minds perform during daytime tasks. The NSF’s recommendations reflect this knowledge with simple guidelines that are easily understood and assessed.

Sleep Assessment Tools

For more in-depth assessments of sleep quality, standardized tools are used to determine the roots of dissatisfaction or possible disorder symptoms. The Pittsburgh Sleep Quality Index, created by Dr. Daniel J. Buysse and his team of researchers at the University of Pittsburgh in the late 1980s, is today the gold standard measure of subjective sleep quality. Written as a questionnaire, the PSQI does a good job of establishing data points for a number of parameters over periods of time. Another questionnaire, the Epworth Sleepiness Scale, was created in 1991 to provide a shorter, more summarized list of measurements. And for objective assessments, polysomnography (PSG), and to an extent, actigraphy, are used most frequently in sleep research to measure and provide records of physiological states during sleep. While polysomnograms require a lab environment to record a range of biophysiological data, actigraphy devices can be attached to a patient’s wrist or ankle to record breathing and movement over a span of several nights. In future research, sleep specialists will use these tools to better understand the relationship between sleep architecture and sleep quality. This would mean that more precise measurements of sleep quality could be observed, taking into account the duration, efficiency, and proper staging or cycling of the various levels of sleep and their corresponding functions.

And What About Dreams?

Many ask about the role of dreams in the quality of sleep, for example, whether pleasant dreams result in good sleep, or vise versa. Often, this can result in a ‘which came first?’ debate, but the relationship is reciprocal. While dreams do have purposes beyond our current understanding, we do know that they tend to reflect our state of mind, mood, and recent experiences. If we’re having good, healthy sleep, our dreams are likely to reflect that reality. Despite how it may feel, though, dreams don’t necessarily affect sleep architecture in major ways, but they can contribute to sleep latency, especially if they are recurring or end in fearful awakenings. When this occurs, it is very often a sign of some psychological concern that should be addressed. People tend to think that nightmares are normal, but they’re only normal on occasion, and with minor emotional consequences. More problematic night terrors are indicative of a sleep disorder, or something more.

The guidelines listed here are simply a starting point, but if problems persist, professional help should be sought. Everyone deserves good sleep on a regular basis, and good dreams to go with it, but an unrested life leads far too often to unrested sleep. If this is the case for you, get yourself tested, treated, and rested as soon as possible.

 

Sources

Centers for Disease Control and Prevention – https://www.cdc.gov/sleep/about_sleep/how_much_sleep.html

Health – https://www.health.com/mind-body/how-to-get-more-energy-chronotype

———. – https://www.health.com/sleep/good-sleep-guidelines

Pittsburgh Sleep Quality Index – https://www.sleep.pitt.edu/research/ewExternalFiles/PSQI%20Instrument.pdf

Psychiatry Research – https://www.ncbi.nlm.nih.gov/pubmed/2748771

National Sleep Foundation – https://www.sleepfoundation.org/press-release/what-good-quality-sleep

Web MD – https://www.webmd.com/sleep-disorders/guide/sleep-101

Sleep Health – https://www.sleephealthjournal.org/article/S2352-7218(16)30130-9/abstract

Sleep Review – http://www.sleepreviewmag.com/2016/12/in-touch-with-chronotype-breus/

Very Well Health – https://www.verywellhealth.com/sleep-latency-3014920