Sleep: Part 2 – Getting Quality Sleep

For episode 8, we are revisiting the topic of sleep in order to take a deeper look at sleep quality. Athlytic has some great changes coming with sleep analyisis, and I have been incredibly impressed with how it looks in beta form. For an overall primer on sleep, check out episode 3, which provides a good foundation for this episode.

Analyzing Sleep Quality

Sleep quality has been a hot topic for many years. While it’s obvious we need to ensure we are getting enough quantity of sleep, if our sleep quality is poor, we won’t be getting optimal results. Similarly, you can have the best quality sleep, but if you only get 3 hours, you’re not going to be a happy camper (you’ll be a very sleepy camper, in fact).

Traditionally, we are very poor estimators of our sleep quality. In fact, studies suggest that our own subjective analysis is only ~35% consistent with objective measures of sleep quality (1). While we certainly know how we feel, our subjective understanding of the minutia of sleep quality is lacking. This is why it can be useful to combine that approach with more objective measures with Athlytic.

What components are there?
Over the years, researchers have utilized various methods and analyses to help better understand the components of sleep. This research helps us combine our subjective assessments of how we feel with the objective measures that might explain it. Understanding these, and quantifying these, can help us understand our own sleep patterns a bit better with the goal of improving how well we sleep and ultimately how we feel.

One of the biggest factors in sleep quality is a clear correlate to sleep quantity – sleep efficiency. This represents the amount of time you are actually asleep, compared to the amount of time you are lying in bed or trying to sleep. Factors here include sleep latency (how long it takes to fall asleep), how often you wake up, and how long you wake up. Even when we discount other factors, sleep continuity has been proven to be a reliable metric for overall sleep quality on its own (2).

But we can’t just stop there. Once we know we are getting enough sleep duration, and we are actually asleep throughout it, we can focus on the other aspects of sleep – sleep macrostructure or the sleep stages. Again, circle back to episode 3 for a brief review on sleep stages, but the gist here is that more time in the deeper stages of sleep has been associated with better sleep quality and feeling better the next day (3).

So how can I improve my scores?

This is the million-dollar question! Ultimately, because we all live such unique lives, with different stressors, different schedules, different diets, and different medications it can be difficult to prescribe a one-size-fits-all approach to sleep. (This is why poor sleep can be so difficult to treat and why there really aren’t any great medications for long term sleep changes). 

That said, there are some one-size-fits-all recommendations for what leads to poor sleep. Broadly speaking, poor nutrition, smoking, alcohol use, and lack of exercise significantly impair sleep quality (4,5). On the more difficult to modify side of things, stress, anxiety, and low mood can also play a significant role in sleep quality and architecture (6).

Additionally, research is still ongoing about specifics of diet and supplements to identify potential factors associated with sleep quality. While much more research is needed, there are some good reviews of existing literature (7). One of my favorite findings from this review is the positive association of tart cherries with improved sleep. Tart cherries are a natural source of melatonin (a sleep hormone) and has several studies supporting its helpfulness in sleep. (I, like most physicians, much prefer lifestyle and dietary approaches over medications and supplements when possible.)

For these reasons, using Athlytic’s tagging feature can be a great way to track the impacts of several day-to-day variables and the impact on your sleep. Over time, as more data is collected, Athlytic will display associations between each of these variables and it’s effect on your sleep (both good or bad!)

Conclusions

Sleep is certainly a complex topic with so many different variables and factors. At the end of the day (no-pun intended), it comes down to the time we spend asleep, and the time we spend in each stage of sleep. Of course, I can’t sit here and simply say ‘get better sleep’ because achieving this is often a long-term process and not something that can be done overnight (pun intended). 

Continuing to make steady improvements in our waking lives (healthy diet, consistent exercise, stable sleep routines) can help us improve our sleep quality, and thus help us feel better during the days following. While it’s much easier said than done, by making use of these tools to analyze your individual data, you can create a personalized approach for improvement. So with that – stay active, stay healthy, and sleep well.

Sources and Further Readings:

1. springerprofessional.de [Internet]. Estimation of Sleep Quality by Using Microstructure Profiles. Available from: https://www.springerprofessional.de/en/estimation-of-sleep-quality-by-using-microstructure-profiles/12355116

2. Åkerstedt T, Hume K, Minors D, Waterhouse J. The meaning of good sleep: a longitudinal study of polysomnography and subjective sleep quality. J Sleep Res. 1994;3(3):152–8. 

3. Pierson-Bartel R, Ujma PP. Objective sleep quality predicts subjective sleep ratings. Sci Rep. 2024 Mar 11;14:5943. 

4. Li J, Yao Y shui, Dong Q, Dong Y hai, Liu J juan, Yang L sheng, et al. Characterization and factors associated with sleep quality among rural elderly in China. Arch Gerontol Geriatr. 2013;56(1):237–43. 

5. Cohrs S, Rodenbeck A, Riemann D, Szagun B, Jaehne A, Brinkmeyer J, et al. Impaired sleep quality and sleep duration in smokers-results from the German Multicenter Study on Nicotine Dependence. Addict Biol. 2014 May;19(3):486–96. 

6. Wu CY, Su TP, Fang CL, Yeh Chang M. Sleep quality among community-dwelling elderly people and its demographic, mental, and physical correlates. J Chin Med Assoc JCMA. 2012 Feb;75(2):75–80. 

7. Binks H, E. Vincent G, Gupta C, Irwin C, Khalesi S. Effects of Diet on Sleep: A Narrative Review. Nutrients. 2020 Mar 27;12(4):936.