Poor Quality Sleep

Poor quality sleep affects millions of people, disrupting daily life and contributing to serious health problems. Understanding what defines poor sleep and how to improve it can make a significant difference in your overall health and wellbeing.

Table of contents

• What is poor quality sleep?
• How common is this condition?
• The difference between sleep deprivation and poor quality sleep
• Understanding sleep quality
• Signs of poor sleep quality
• Effects on health and daily life
• What causes poor quality sleep?
• How much sleep you need
• How to improve your sleep quality
• When to seek professional help

What is poor quality sleep?

Poor quality sleep means you are not getting refreshing, uninterrupted sleep, even if you spend enough hours in bed. Sleep is essential for your body and brain to rest, recover, and perform important functions. When sleep quality is poor, you miss out on the physical, mental, and emotional benefits that good sleep provides^[1].

Sleep deprivation is when you do not get enough sleep. This can be a short-term problem affecting one or a few nights, or it can become a chronic concern lasting weeks or even months. For some people, sleep deprivation happens because they stay awake instead of sleeping. For others, they are still sleeping but are not getting quality sleep, so they still wake up feeling tired^[1].

Getting enough sleep is not just about the number of hours you spend in bed. Quality sleep is an important component of sleep health (overall sleep wellbeing) along with sleep duration, sleep satisfaction, and sleep consistency^[7].

How common is this condition?

Poor quality sleep is very common. Between 50 million to 70 million adults in the United States meet the medical criteria for sleep deprivation at any point in time^[1]. About one-third of Australians are thought to be sleep deprived^[4]. More than one-third of adults in the United States do not get enough sleep, with 14.5% having trouble falling asleep and 17.8% having trouble staying asleep^[5].

Virtually every human being experiences sleep problems at some point in their life. For some people, it is simply a greater or longer-lasting issue, or it happens for a more serious reason^[1].

The difference between sleep deprivation and poor quality sleep

Insomnia (a sleep disorder where you cannot sleep when you try) and sleep deprivation are closely related but are not the same thing. Insomnia is when you are unable to sleep when you try. Sleep deprivation is what happens when you do not give yourself enough time to sleep, do not get enough sleep, or both^[1].

Poor quality sleep can occur even when you spend the recommended amount of time in bed. The quality of your sleep ensures that you get the essential physical, mental, and emotional benefits you need from your rest^[7].

Understanding sleep quality

Most people can rate their sleep as good, bad, or something in between. Sleep quality includes several different elements that you can observe directly or measure with sleep tests^[7].

The four main elements of sleep quality are:

• Sleep latency: how long it takes you to fall asleep
• Awakenings: the number of times you wake up during the night
• Wake after sleep onset: the amount of time you are awake after first falling asleep
• Sleep efficiency: the ratio of time asleep to time lying in bed

Quality sleep means you are getting uninterrupted and refreshing sleep. Getting quality sleep is not just about how many hours you sleep, but how well you sleep^[5].

Signs of poor sleep quality

There are several signs that indicate you may not be getting quality sleep^[9]:

• Daytime sleepiness, which can be caused by a sleep disorder or nighttime behaviors that reduce your sleep duration
• General fatigue, which may occur for months or years but does not include daytime sleepiness
• Increased appetite, which may be caused by hormone imbalances that can lead you to feel hungrier than usual and then less satisfied when you do eat
• Inability to fall asleep, which in many cases is caused by digital devices. The blue light from smartphones and tablets reduces production of melatonin (a hormone crucial to the sleep-wake cycle)
• Frequent trips to the bathroom during the night, a condition known as nocturia, which may be caused by sleep apnea, certain medications, or caffeine
• Nighttime awakenings, which are a common result of alcohol. Although alcohol may help you get to sleep, your body’s overnight processing of the alcohol can lead to waking up, increased snoring, sleep apnea, and nocturia
• Waking up gasping or choking, which may be a symptom of sleep apnea, a condition in which the airway becomes blocked during sleep

Other signs of poor sleep quality include trouble falling asleep, repeatedly waking up during the night, and feeling sleepy or tired even after getting enough sleep^[5].

Effects on health and daily life

Sleep deprivation can have serious effects on your body and mind. When severe or happening over an extended period, it can cause very disruptive symptoms that interfere with even the most routine activities. Long-term sleep deprivation can worsen many major health conditions^[1].

Your body needs sleep to regenerate certain systems and carry out certain processes. Sleep involves different stages, including light sleep, deeper sleep, deepest sleep, and REM sleep (rapid eye movement sleep, when you dream). Research indicates that stage 2 is key in memory storage and learning, while stage 3 is the most important to how your body recovers and maintains itself^[1].

Poor quality sleep can lead to immediate problems including poor concentration, reduced reaction times, altered mood, and lapses in memory. In children, sleep deprivation can affect behavior and school performance^[4].

Getting enough sleep can help you^[5]:

• Get sick less often
• Stay at a healthy weight
• Reduce stress and improve your mood
• Improve your heart health and metabolism
• Lower your risk of chronic conditions like type 2 diabetes, heart disease, high blood pressure, and stroke
• Lessen the risk of motor vehicle crashes and related injury or death
• Improve your attention and memory to better perform daily activities

Chronic sleep deprivation can have a negative impact on brain, metabolic (such as overweight, obesity, diabetes), and immune health^[4]. Not enough sleep or routinely getting broken sleep is linked with seven of the 15 leading causes of death in the United States, including heart disease, cancerous tumors, diseases related to the brain such as stroke and brain aneurysms, accidents, diabetes, sepsis, and high blood pressure^[25].

What causes poor quality sleep?

There are many factors that can cause individuals to sleep poorly. It is important to consider both the quantity and quality of sleep, as poor quality sleep can also result in sleep deprivation. Factors that impair the quality of sleep include things that wake a person up, prevent falling asleep, and things that disrupt normal sleep cycling^[4].

Common causes include:

Lifestyle behaviors: Busy schedules, anxiety, and technology can all get in the way of good sleep. The blue light from electronic devices stops sleep by reducing melatonin production. Consuming caffeine, alcohol, or nicotine close to bedtime can interfere with sleep. Alcohol can make you sleepy initially, but after a few hours it becomes stimulating and may cause you to awaken and have difficulty falling back to sleep^[12].

Environmental factors: Noise, light, and room temperature can all affect sleep quality. A sleep environment that is not quiet, dark, and cool can make it harder to get quality sleep^[13].

Sleep disorders: Some people may have health conditions that prevent them from getting enough quality sleep, no matter how hard they try. Common sleep disorders include insomnia, restless legs syndrome, narcolepsy, and sleep apnea^[5].

Mental health: Common mental health problems like anxiety and depression can often underpin sleep problems. Where this is the case, a combination approach to treating the mental health problem and sleep problem together is often the most effective^[8].

How much sleep you need

The amount of sleep you need varies depending on your age and individual needs. The recommended daily hours of sleep change as you age^[5]:

• Newborns (0 to 3 months): 14 to 17 hours
• Infants (4 to 12 months): 12 to 16 hours, including naps
• Toddlers (1 to 2 years): 11 to 14 hours, including naps
• Preschool (3 to 5 years): 10 to 13 hours, including naps
• School age (6 to 12 years): 9 to 12 hours
• Teens (13 to 17 years): 8 to 10 hours
• Adults (18 to 60 years): 7 or more hours
• Adults (61 to 64 years): 7 to 9 hours
• Adults (65 years and older): 7 to 8 hours

While these hours are recommended, adults who are receiving slightly more or less may still be achieving healthy and adequate sleep. Some people can cope very well with much less and some need much more every night. Many aspects of sleep are genetically determined^[4].

How to improve your sleep quality

Better sleep habits, sometimes called sleep hygiene, can help you get a good night’s sleep. Following healthy sleep recommendations and making small lifestyle adjustments can improve sleep quality^[11].

Create a sleep-friendly environment:

• Keep your bedroom quiet, relaxing, and at a cool temperature (around 65 to 68 degrees Fahrenheit)
• Reduce or mask noise with heavy curtains, rugs, or white noise machines
• Minimize light with light-blocking curtains or shades
• Replace your mattress and pillows if they are worn or uncomfortable
• Only use the bedroom for sleep and intimacy
• Keep electronic devices and work-related items in another room^[22]

Establish a consistent sleep schedule:

• Go to bed and get up at the same time every day, including weekends
• Set aside no more than eight hours for sleep
• Being consistent reinforces your body’s sleep-wake cycle
• If you do not fall asleep within about 20 minutes of going to bed, leave your bedroom and do something relaxing^[12]

Create a relaxing bedtime routine:

• Reserve an hour before bedtime to wind down away from stressful activities
• Turn off electronic devices at least 30 minutes to two hours before bed
• Try reading, listening to soft music, taking a hot bath, or sleep meditation
• Avoid electronic devices at least an hour before bed, as mobiles, tablets, and computers all throw out blue light that stops sleep^[13]

Pay attention to what you eat and drink:

• Avoid large meals within a couple of hours of bedtime
• Avoid caffeine in the afternoon or evening
• Avoid alcohol before bedtime
• Avoid nicotine, as it is a stimulant that can interfere with nighttime sleep^[12]

Stay physically active:

• Get regular physical exercise during the daytime, at least five to six hours before going to bed
• Exercising close to bedtime can make it harder to fall asleep
• Avoid anything too energetic in the 90 minutes before bedtime if you find it stops you from sleeping^[13]

Manage stress and worry:

• If you often lie awake worrying, set aside time before bed to make a to-do list for the next day
• Talk to someone you trust or write in a notebook about your concerns
• Try mindfulness techniques or meditation to help manage worries^[13]

Do not force sleep: If you are lying awake unable to sleep, do not try to force it. If you cannot sleep, get up and sit in a comfortable place and do something relaxing, like reading a book or listening to quiet music. Only go back to bed when you feel sleepier^[13].

When to seek professional help

Talk to your healthcare provider if you regularly have problems sleeping or notice signs or symptoms of common sleep disorders. Your provider can run tests, including sleep studies, to determine if you have a sleep disorder^[5].

Your healthcare provider may ask you to keep a sleep diary to better understand what is going on. Your sleep diary should include when you go to bed, wake up during the night, wake up in the morning, take naps, exercise, drink alcohol or caffeinated drinks, and take medications^[5].

For people with long-term insomnia, psychological approaches are useful because they can encourage you to establish good sleep patterns and develop a healthy, positive mental outlook about sleep. One of the most widely used and successful therapies is Cognitive Behavioral Therapy or CBT. The cognitive part of CBT teaches you to look for and change beliefs that affect your ability to sleep. The behavioral part helps you develop good sleep habits and avoid behaviors that keep you from sleeping well^[15].

Sleep medication is commonly used but may have negative side effects and is not recommended in the long-term. Psychological approaches and lifestyle changes are generally the first treatment recommended^[8].