Tools to Optimize Sleep Quality
Don’t be so proud of being able to function on no sleep. In the end it will come back to bite you.
Sleep is one of the key pillars of health. Without adequate sleep and good quality sleep, the body begins to compensate in other ways. We see this in the literature where poor sleep quality increases risk for multiple diseases like diabetes, Alzheimers, cardiovascular disease, weight gain, low testosterone, and irregular cycles for women. If your sleep is not right then don’t expect other body systems to work at their peak.
Step 1 - Use screening tools to identify if your sleep is actually an issue and thread to your health.
Step 2 - Use these same tools to optimize your sleep for performance and longevity.
PSQI - This is a validated questionnaire used in many well-respected academic institutions and clinical trials. It is not specific, in that it does not tell you exactly what is disrupting your sleep but it is a great objective barometer in knowing if your sleep is poor, decent or good. The PSQI is rated on a scale of 0 to 21. The closer to 21 the worse your sleep quality. Anything above 5 is suggestive of poor sleep quality.
Epworth Sleepiness Scale - This survey is not directly assessing your sleep but more about the effects of poor sleep in daytime sleepiness. Daytime sleepiness or dozing off is a strong indicator of poor sleep quality at night. Think of the kid who fell asleep in class because he pulled an all nighter - the Epworth is that but for adults who think their dozing off is normal. Another great tool to see if your fatigue might be related to your sleep. Ideal score is less than 6.
STOP-Bang - Sleep apnea is a silent killer. It is easy to identify sleep apnea (OSA or obstructive sleep apnea) is people who appear to have high risk factors - mostly obese/overweight people. But OSA doesn’t discriminate and can impact relatively healthy and normal body weight individuals too. This questionnaire helps screen for OSA and has caught a ton of hidden cases for me. OSA is a major issue and should be taken seriously. A STOP-Bang score of 3 or more should require additional investigation by a health professional.
Sleep Diary - It may not sound fancy but it is an incredible useful and enlightening tool. Similar to logging food, sleep logging allows us to reflect on our sleep and really think about our night of sleep. It is also a great way to record information on a daily basis so you’re not trying to recall how your sleep was a week ago because in most cases you assume it was just fine. The most important part of the sleep diary is it helps you and your doctor to walk through morning and evening routine which has a significant impact on your sleep quality - essentially your circadian rhythm.
Wearables - Sleep wearables are not absolutely necessary but they are incredibly helpful in getting an objective view of your sleep. Tools like Oura, Whoop, and the Apple Watch can all be helpful in measuring your sleep with metrics like heart rate, heart rate variability (HRV), oxygen saturation (especially important for sleep apnea), temperature, and nighttime movement which is hard to remember or even notice. These devices can also estimate your REM and deep sleep which may not be 100% accurate but are certainly directionally accurate when compared to a polysomnography test (sleep study).
Conclusion
You should be taking your sleep very seriously. It is the one pillar of health that arguably has the most impact on our healthspan and our lifespan. Using these simple tools can help you screen for poor sleep and then move forward in making changes to not only achieve 7-8 hours of sleep a night, but feeling rested and refreshed. If any of these questionnaires are flag please consult with your doctor to work on a plan to identify if additional testing is needed.