How did your sleep go last night?
The question delves into the core of assessing the quality of your sleep. If you haven’t already, I encourage you to shift your focus away from the number of hours you slept and instead learn to evaluate the excellence of your rest. By exploring various aspects of sleep quality, you’ll find a solid foundation to tackle any sleep-related issues, be it at bedtime, during the night, in the early morning, or throughout the day.
Understood? Sleep quality is essential!
Here’s the catch—you can’t directly measure your own sleep quality. There are no reliable, data-driven, do-it-yourself devices that can analyze the brain waves (EEG waves) inside your head while you sleep. Although such technology is on the horizon, for now, subjective perceptions can guide you in assessing your sleep quality and compensate for the lack of direct data.
To begin, sleep quality is based on the physiological patterns of EEG brain waves, making sleep a physical phenomenon that affects both the mind and body. Regardless of what aspect of your sleep you wish to measure, it’s crucial to consider its connection to brain waves.
A prime example: If you feel tired or sleepy during the day, it’s highly likely that something is disrupting your sleep. A healthy sleeper rarely experiences such tiredness or sleepiness. In most cases, physical disruptions to your brain waves during sleep generate these feelings.
But doesn’t everyone feel tired or sleepy at times during the day? The answer is no. A normal sleeper who consistently experiences high-quality sleep (characterized by normal brain wave patterns) doesn’t report such feelings. Their sleep functions as it should, fully restoring the mind and body.
Could you feel tired or sleepy due to insufficient sleep? Certainly, but the game-changer is recognizing that poor and fragmented sleep often leads to shorter sleep duration. And here’s the twist—bad sleep can also cause some individuals to oversleep. So you might wonder, “Can poor sleep quality harm the brain to the extent that it leads to both insufficient and excessive sleep?” The answer is yes.
So why do many healthcare professionals tend to overlook the obvious connection between chronically degraded sleep quality and daytime tiredness and sleepiness? One theory suggests that the widespread consumption of caffeine in modern society masks these significant daytime symptoms.
In addition to measuring sleepiness and tiredness, it’s important to assess your daytime energy levels. A normal sleeper possesses ample capacity to function. It’s not just the absence of tiredness or sleepiness; they have high energy levels that enable them to accomplish tasks throughout the day. This kind of energy stems from excellent sleep quality, not caffeine. This is not to discredit caffeine, which is arguably the most commonly used treatment for fatigue and mild depression. Caffeine annually prevents numerous accidents, injuries, and deaths on our roads and in workplaces.
Caffeine enhances mental alertness, but for a normal sleeper, mental sharpness naturally emerges without the need for supplements shortly after waking up each morning. Monitoring cognitive functions, especially attention, concentration, and memory, are subtle yet crucial ways to evaluate the quality of your sleep.
To this day, many healthcare professionals mistakenly attribute declining memory to aging. However, when memory declines, one of the first factors to consider should be whether degraded sleep quality is harming your brain.
Scientific literature is filled with remarkable stories of individuals experiencing a significant improvement in cognitive function after treating sleep disorders that had been compromising their sleep quality for years. Throughout my career, I’ve treated thousands of such patients. Attention deficit disorders have been reversed by addressing sleep conditions, and some cases of presumed depression or dementia have shown improvement after targeting sleep quality issues.
Unfortunately, too many individuals with cognitive problems are steered away from a sleep assessment, missing out on valuable opportunities to enhance their executive functioning. These delays in receiving proper care can last for decades, as many healthcare professionals disregard or underestimate the power of good sleep while placing excessive focus on sleep duration.
When measuring sleep quality, we don’t stop at the brain. We now understand that sleep impacts nearly every system in the body, and the primary disruptor of sleep is sleep fragmentation or “sleep frag” for short. Sleep frag refers to the physical signs of not sleeping through the night and not consistently spending adequate time in necessary sleep stages.
Instead, your brain oscillates throughout the night between short periods of wakefulness and sleep, repeating this cycle hundreds of times in a poor sleeper. As a result, they may not experience sufficient deep sleep, which is crucial for recovering from the previous day’s stress and workload.
Scientific research provides precise explanations of how poor sleep quality damages the mind and body. These constant cycles of arousal-sleep-arousal during sleep frag episodes (which are too brief to be consciously perceived) specifically harm blood vessels of all sizes. The inner lining (endothelium) of the vessels, which should efficiently deliver oxygen and nutrients to your tissues while removing waste products, is under attack, leading to impaired blood flow.
Interestingly, when you sleep poorly, the brain sends mixed signals to blood vessels due to the nonstop arousal-sleep-arousal cycles. These signals cause excessive contractions and dilations in the vessel walls throughout your circulatory system (i.e., the heart pumping blood to every part of your body). This disrupted vessel function, known as endothelial dysfunction, results in abnormal blood flow.
To make matters worse, endothelial dysfunction has two accomplices that create a toxic combination, intensifying the assault on your blood vessels—all starting with sleep fragmentation. Pro-inflammatory biomolecules and oxidative stress release harmful substances that directly attack the inner lining of the vessels. Sleep-related breathing disorders produce the most severe oxidative stress, which can be equivalent to smoking a pack of cigarettes a day in some cases.
This trio of abnormal physiological changes is well-documented in hypertension research. According to several sleep researchers, changes in the inner linings of multiple blood vessels indicate the earliest phase of high blood pressure. And this is just the beginning.
If poor sleep quality persists for years or decades, as is unfortunately the case for many individuals, these circulatory changes can do more than aggravate hypertension. They can contribute to serious diseases involving damage to the coronary arteries and trigger cardiovascular conditions such as heart attacks, heart rhythm disturbances, heart failure, strokes, and heart valve damage.
These are significant health issues, and we’ve only scratched the surface. Having a serious sleep disorder is akin to experiencing a severe case of depression or diabetes, or both. However, poor sleep is more insidious because it’s challenging to perceive the extent of the damage occurring.
Speaking of which, sleep disorders worsen both diabetes and depression. Therefore, a useful benchmark for sleep quality is to assess whether your current medications are effectively treating other medical and mental health conditions as expected.
Regrettably, the mental health population experiences the largest epidemic of untreated sleep disorders, yet the treatment for most individuals often revolves around more and more medication. However, this narrow approach provides an opportunity to evaluate your sleep quality. For instance, if you’re taking sleeping pills, antidepressants, or anti-anxiety medication and continue to have poor sleep, the lack of improvement indicates that something else is at play in your brain waves during sleep.
The best assumption is that your sleep is not responding well to the drugs. Similarly, if medications are ineffective in treating anxiety, depression, or PTSD, the lack of progress may indicate another underlying factor. Poor sleep should be considered in the face of ineffective medication, and this often involves multiple trials of drugs—an all-too-common occurrence in the realm of psychotropic prescriptions.
Unfortunately, the majority of professionals in psychiatry and psychology tend to focus on prescribing more pills or increasing therapy sessions without considering non-drug sleep therapies. In one particularly concerning scenario, mounting evidence suggests a strong connection between sleep-related breathing disorders and PTSD.
Most cases of PTSD are treated with medication or psychotherapy, yet a surprisingly large proportion of trauma patients also suffer from undiagnosed and untreated sleep apnea. This condition impairs brain function and exacerbates PTSD through the toxic combination generated by the arousal-sleep-arousal cycle. However, the vast majority of mental health professionals receive no training to accurately screen for this prevalent condition.
There are other notable health issues—some quite surprising. When you wake up at night to use the bathroom, it often indicates a specific cause of sleep fragmentation that triggers your kidneys to produce excessive urine. If kidney function declines without an obvious cause, poor sleep quality may be a contributing factor.
When your immune system weakens, making you more susceptible to respiratory infections, poor sleep quality is likely involved. And when you notice that cuts or injuries take longer to heal than expected, it’s crucial to evaluate your sleep quality.
Need more convincing? Poor sleep quality is linked to various pain syndromes, both physical and emotional. Nearly all fibromyalgia patients experience sleep fragmentation caused by sleep-related breathing problems. Poor sleep quality interferes with overall pain management and often leads to increased reliance on pain medication.
Furthermore, poor sleep quality is associated with major issues concerning insomnia and nightmares, exacerbating these conditions and leading affected individuals to consume excessive alcohol or abuse drugs as a means to address them. Lastly, poor sleep quality can potentially contribute to accidental overdoses or suicide attempts, sometimes resulting in fatal outcomes.
For reasons not yet fully understood, only a minority of individuals are fortunate enough to experience genuinely normal sleep. The rest of us could greatly benefit from personalized treatments aimed at reversing our poor sleep quality and achieving the healthiest and potentially life-saving slumber possible.