What is Sleep Health?
Written by Lisa Meltzer, the Sleep Science Advisor at Zepp Aura
According to the World Health Organization (WHO), health is not just the absence of disease, but “a state of complete physical, mental and social well-being.”
But what about sleep health?
Research has shown that sleep disorders, deficient sleep duration, and poor sleep quality are associated with negative physical and mental health outcomes. But just like health isn’t simply the absence of disease, sleep health is not simply the absence of a sleep disorder or deficient sleep.
Get ready for the fancy definition of sleep health…
In 2014, Dr. Dan Buysse of the University of Pittsburgh defined sleep health as “a multidimensional pattern of sleep-wakefulness, adapted to individual, social, and environmental demands, that promotes physical and mental well-being. Good sleep health is characterized by subjective satisfaction, appropriate timing, adequate duration, high efficiency, and sustained alertness during waking hours.”
Still with me? That is a lot to consider, so let’s break it down.
“A multidimensional pattern of sleep-wakefulness” means that sleep is not simple. While it would be nice if sleep was as easy as closing your eyes, falling asleep, waking up refreshed, and repeating night after night, the truth is there are a lot of different factors that work together to ensure a good night of sleep. More on that in a moment.
“…adapted to individual, social, and environmental demands” tells us that sleep is part of a complex, inter-connected system that has to consider individual differences (e.g., genetics, age), social demands (e.g., work, children), and environmental conditions (e.g., noise, light). In other words, good sleep health will not be the same for every person or in every situation.
“…that promotes physical and mental well-being.” This one is sort of obvious, good sleep health contributes to your overall physical health, including your energy, weight, and cardiovascular health, and your mental well-being, including your mood.
Now to those different factors…
Dr. Buysse proposed the RU-SATED model as a way to measure your sleep health. The following will briefly discuss each factor to help you understand how to optimize your own sleep health.
R — Regularity of Sleep
In order to help keep your internal clock on schedule, and make sure that you have been awake long enough to feel sleepy at bedtime, it is important to have sleep regularity, or a consistent sleep-wake schedule. Emerging evidence suggests that inconsistent sleep-wake schedules are associated with poorer health outcomes, including cardiometabolic risk factors (e.g., insulin sensitivity, elevated blood pressure) and obesity.
Try This: For a couple weeks, go to bed and wake up around the same time (within about an hour), every single day, including weekends. Okay, easier said than done. But after a couple weeks of sleep regularity you will likely start to notice that it is easier to fall asleep and wake up (sometimes even before your alarm goes off!).
S — Satisfaction with Sleep
Satisfaction with sleep is a subjective variable, which means you are the only one who can determine if your sleep was “good” or “poor.” This variable captures your experience of sleep, which can be influenced by environmental or social contexts. So what makes you satisfied with your sleep? Is it how much sleep you got, whether or not you woke up during the night, and/or how you felt in the morning? Each of these dimensions are important to overall sleep health, but only you can determine what is a “good” night of sleep for you.
Try This: For 1–2 weeks, rate your satisfaction with sleep each morning on a 1 (poor) to 5 (great) scale. See if you can identify any patterns or factors that may be associated with your satisfaction (e.g., weekday vs. weekend, bedtime/wake time, caffeine/alcohol, stress)
A — Alertness/Daytime Sleepiness
Good sleep health should include feeling alert and attentive throughout the day. Daytime sleepiness can result from not getting enough sleep, poor quality sleep, or an underlying sleep disorder. Sleepiness can usually be reversed by improving sleep duration or quality. This is important, because many people mistake fatigue, which is extreme tiredness due to physical or emotional exertion or illness, as sleepiness. Yet fatigue is often not alleviated with sleep, regardless of duration or quality.
Try This: Insufficient sleep duration is the primary culprit for sleepiness, so make sure you are getting enough sleep by having a consistent sleep-wake schedule and healthy sleep habits. If you are still sleepy during the day, consider taking a short nap (no more than 30 minutes) in the early afternoon (usually before 2:00 pm). Longer naps or naps that occur later in the day may interfere with your ability to sleep at night.
T — Timing
Timing is all about when you sleep. For most people, sleep happens at night, with bedtimes between 9:00 pm and midnight. However, our circadian rhythm or internal clock can strongly impact when we are able to fall asleep. People who consider themselves “morning larks” and wake early in the morning are more likely to have an early bedtime, while “night owls” may have a much later bedtime and wake time. That said, sleep timing is heavily influenced by external factors, including what time you have to wake up for work or caring for children.
When sleep timing is consistent (remember regularity?) it will be easier to fall asleep and wake up. But it is also important for your sleep timing to allow you to get enough sleep (see duration below).
Try This: Determine when you have to wake up most days, and then determine how much sleep you need (see duration below). Counting back from that wake time will help you set your bedtime. For example, if you have to wake on weekdays at 6:00 am and you need 8 hours of sleep, set your bedtime for 10:00 pm and your wake time to 6:00 am and stick to it!
E — Efficiency (or Continuity)
Sleep efficiency or continuity is defined by how easy it is to fall asleep and return to sleep. Fun facts
It takes most people 10–20 minutes to fall asleep, but up to 30 minutes is normal.
Waking up during the night is normal. Everyone has brief arousals several times during the night, but usually you go right back to sleep and don’t even realize that you’ve woken up.
What does this mean for sleep health? Don’t panic if it takes you more than a few minutes to fall asleep at bedtime or if you wake up during the night for a few minutes. That said, if you fall asleep the second your head hits the pillow, that is usually a sign of insufficient or poor quality sleep. Also, if it regularly taking you more than 30 minutes to fall asleep at bedtime, or you are awake most nights for more than 30 minutes during the night, you may need to work on other aspects of your sleep health to ensure good sleep efficiency.
Try This: If it is regularly taking you more than 30 minutes to fall asleep at bedtime, consider delaying your bedtime a little to match the time you are falling asleep (e.g., if you try to fall asleep at 10:00 pm, but never fall asleep before 11:00 pm, try moving your bedtime to 10:45 pm). If you still experience difficulty falling asleep and staying asleep, get out of bed and engage in a quiet activity (e.g., reading, playing solitaire with actual cards) until you feel sleepy. Keep in mind, this is hard to do, and must be done consistently to retrain your body to sleep when you are in bed. Otherwise, your body begins to think your bed is a great place for hanging out, thinking, and tossing and turning, but not for sleeping.
D — Duration
Sleep Duration is how many hours of sleep you get every 24 hours. This includes both nighttime and daytime sleep. For most adults, the recommended amount of sleep is 7 to 9 hours. While there are a few people who are truly short sleepers, most people who “get by” on less than 7 hours are doing just that, getting by. They have adapted to the demands that limit their sleep duration (or have fallen victim to the incorrect belief that sleep is for slackers), but they are likely not thriving or achieving optimal health. Similarly, while someone who consistently gets more than 9 hours of sleep per night may be a long sleeper, this could also be a sign of an underlying medical or psychiatric condition that requires additional evaluation and treatment.
Try This: How do you know how much sleep you truly need? Find a week where you don’t have to get up for work or other obligations, and keep a consistent bedtime every single night. Let your body wake up when it is done sleeping. More than likely, the first few nights your body may need to “catch up” on sleep. However, by the end of the week you should be waking up after you’ve gotten enough sleep. This lets you know how much sleep you actually need.
Just like you have to eat and you have to breathe, you have to sleep. So in addition to having a healthy diet and exercising regularly, don’t forget to focus on your sleep health. Yes, this involves some discipline, but the end result is worth it!