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Maintaining a balance between mental and physical health is crucial for developing a healthy, reasonable sleep routine, as well as for overall health.Anxiety and stress are well-known for disrupting sleep, leading to various sleep disorders and issues related to sleep. Nonetheless, it’s far easier to observe someone’s physical well-being than to gauge their mental status. This is largely because many of us consider suppressing our feelings and worries as part of behaving like an adult. As a result, obtaining an accurate psychological evaluation can be challenging because the field of mental health is not as precise as the science of the body.

Humans are social creatures and thus susceptible to loneliness – the feeling of being socially abandoned and alone, which often comes with negative interpretations of social scenarios and similar issues. Much like depression (which it is often associated with), loneliness can negatively impact your sleep and can arise from a lack of sleep, which makes it a vicious cycle that leads to more and more daily fatigue and further problems. In this article, we will go over how loneliness and sleep are connected, so you can make informed decisions when seeking medical intervention and following your doctor’s guidelines. Let’s get into it.

Note: If you’re dealing with sleep deprivation regularly, start tracking your sleep as soon as possible. A good sleep journal is crucial in helping your doctor create an accurate diagnosis. Write down when you fall asleep, when you wake up, how often you wake up during the night, how tired you feel in the evening and morning, and every similar piece of information.

How It All Works – A Study Examination

Sleep deprivation is the most common consequence of every sleeping disorder, and it is a constant looming problem in our daily lives in general. It’s incredibly easy to become sleep-deprived, as all it takes is a single night of sub-optimal rest to rack up a considerable amount of “sleep debt” and suffer the consequences of fatigue and excessive daytime sleepiness. Ask any working adult you know about their experiences with daily fatigue, and you may even hear workplace accident horror stories because fatigue affects you in many negative ways, including but not limited to:

• A higher level of irritability, making the fatigued person more irritable, aggressive, and prone to taking risks. Depending on where they are, this can manifest in different ways, the most dangerous ones being during traffic. Their willingness to socialize and tolerate other people drops, which obviously leads to feelings of loneliness.
• Worse awareness of one’s surroundings. When you’re sleep-deprived, it’s harder to detect stimuli and visual cues from the world around you. This is incredibly dangerous for people working in positions that require sharp spatial awareness, such as driving transport vehicles.
• Weaker hand-eye coordination is another common consequence of fatigue. It usually matters when performing delicate work, or work that requires precision, such as surgery.
• It becomes much harder to commit things to memory or remember already known information. Studying is much harder when you’re tired, and it can also be difficult to remember important dates and other things to consider that you would need in a social scenario.
• Fatigued people have difficulty concentrating on tasks. Most math problems or logic puzzles take longer to perform or (in case of time limits) are performed to a lower standard.
• In part due to the above reasons, sleep deprivation and fatigue cause stress and anxiety. It can create a dangerous connection between fatigue and depression, and lead to or link up with feelings of loneliness in a person.

Worst of all, the ways we try to “make up for lost time” and deal with sleep deprivation are not usually healthy. There is a thin line between useful and healthy daytime naps and a ruined sleep schedule that loops the problem back into fatigue, causing escalating health issues.

The part we are most interested in when it comes to sleep deprivation is its social outcome or manifestation. Someone who is irritable, exhausted and unfocused is likely to avoid social interactions and naturally develop a sense of loneliness, especially if the sleep deprivation is chronic or similarly severe. A study was done recently on how sleep deprivation leads to social withdrawal and eventually causes loneliness, and the researchers conducted a handful of exercises to explore this theory. One of the exercises included footage of a person approaching the viewer with a neutral expression on their face.

The subjects were told to press a button when the person gets too close for comfort. This was done with well-rested and sleep-deprived subjects, and the results were clear – sleep-deprived people stopped the recording anywhere between 20-60% earlier than well-rested subjects. It didn’t stop there, either. Brain scans of all involved subjects showcased a different set of patterns between well-rested and fatigued brains. The most important result is that the section of their brain responsible for social interaction was nearly completely inactive when they were under sleep deprivation – but their threat response section was lit up, indicating that exhausted people feel at least mildly threatened by the prospect of social scenarios.

The study didn’t end there. The subjects were asked to rate their own feelings of loneliness, once after having a good rest the previous night, and once while sleep-deprived. Their ratings were much more negative when they were tired, which made sense given the previous results. The next step was recruiting participants via the Amazon Mechanical Turk to view footage of recorded conversations involving the original subjects. The new participants were tasked to rate the subjects based on their level of perceived loneliness and social desirability. The results were clear – sleep-deprived individuals were considered less socially desirable (meaning that the viewers were less interested in interacting with them) than rested ones.

So what does all this mean? It’s quite easy to understand – sleep deprivation makes the person in question much less willing to engage in social interaction because they see other people as a threat, at least to a small extent. Largely because of this, other people are more inclined to consider them socially undesirable or repulsive, which creates a scenario of social isolation and eventually leads to feelings of loneliness. This problem is severe enough that loneliness is considered a public health crisis by experts. A whopping 46% percent of people in the United States experience loneliness either sometimes or always. Not only that but their mortality risk increases by as much as 30%, often depending on other biological factors.

Obviously, not every lonely person is sleep deprived; it’s not a 1-1 correlation. But with how sleep deprivation is creeping into every corner of our society, it may not be far from the truth. Both sleep deprivation and social isolation have negative consequences for your health. Because of this, loneliness is considered a potential contributing factor to a number of sleeping disorders, since it’s closely linked with stress, anxiety, and depression. This means that sleep deprivation and loneliness frequently lead into each other, making it very hard to break out of the vicious cycle and fix your health problems and work performance. It takes a considerable amount of effort to maintain good social relations with people if you’re chronically sleep-deprived, as your desire to interact with them drops, making you less fun to be around. Make sure to contextualize it all properly in your head – being isolated is not normal, and if you sleep poorly, it is a huge reason why you’re feeling lonely. The sooner you can set your schedule straight, the sooner you can fix your social life.

Fixing your sleep schedule is done by a variety of methods. We recommend consulting your doctor about your sleeping problems, as they’re equipped to prescribe methods that will work the best for your specific needs. Not everyone responds to every treatment method optimally, so make sure you know what you’re getting into. A simple bedtime routine or planned physical workouts can drastically reduce sleep onset latency and let you get proper rest, which can alleviate the feelings of loneliness and social anxiety. A diet plan is not only useful for healthy sleep, but it brings a whole host of other benefits when it comes to your physical well-being. A healthy body leads to a healthy mind, so all these small changes to your lifestyle can contribute a lot to a positive mental state. Include relaxation exercises such as yoga, meditation and breathing exercises into the mix if you are still experiencing issues. If you have a sleep disorder (or even suspect you have one), get it checked out by signing up for polysomnography (with your doctor’s approval) and maintain a sleeping journal.

The debate over sleeping with socks on is quite polarizing; individuals are either in favor or vehemently against it, finding themselves either unable to sleep without them or baffled by the thought of wearing socks to bed. This longstanding discussion often elicits strong opinions, so it might be best to steer clear of this topic when with friends or during family gatherings to avoid any heated exchanges.

Socks have until recently been pretty neglected in terms of fashion, they were probably the only part of clothing without any particular innovations or progress, but the wheel of fashion has turned again, and socks are now trending. Basic socks were mostly hidden inside of the shoes, but nowadays socks are designed to be seen and spice the outfit. However, it does not mean that they are gladly seen in bed.

One survey showed that around 44% of Americans think that it is horrible to sleep in socks, 29% have mixed feelings about it, and 28% love it. Regardless of the group you identify yourself with, keep up reading to see what science has to say about this intriguing topic.

A Sleep Inducing Trick?

Those who prefer sleeping with their socks on like to point out that cozy and warm feeling when they go to bed in socks, but is there a scientific explanation or something more behind that? According to the latest news, sleeping with socks might have its advantages.

The thing is, nobody likes the feel of cold feet, not even those who despise the idea of wearing socks in bed. Some people are more sensitive to the cold and feel the slightest temperature drop on their skin, but most of us face cold feet during winter months, and that is not a pleasant experience. Except for that, cold feet can keep us awake and be the cause of many restless nights, because when they are cold, our blood vessels are constricted which causes lower blood circulation. And what is the easiest way to solve that? Wearing socks, of course! The temperature of our body is regulated by the circadian rhythm or internal clock, which controls the timing of our bedtime. During the daytime, the body temperature rises, reaching its peak during the afternoon when we feel most awake, but then as we prepare for sleep the temperature drops from 1 to 2 degrees, and it reaches its lowest point around 4 AM.

Once the cold feet get warmer, our blood vessels will go wider and cause vasodilation, which signals to our brain that it is time for rest. When the blood vessels are open in feet and hands, the heat is spread evenly across the body to prepare it for sleep. Researches have shown that the higher vasodilation in feet and hands will make us fall asleep faster, so maybe that is the reason why people believe that placing a bottle of hot water close to the feet is good for sleep.

Socks in bed may not be the most pleasant thing, but neither is the cold feet. The best materials for socks are natural fibers such as cashmere or merino wool, they will cost you more than the average cotton or polyester socks, but they are worth it. Just be sure that they are not too tight or tick, because if they are they can hinder the blood circulation by constricting the blood vessels, and hinder the proper warming of your feet leaving them semi cold. Socks for sleeping should be medium thickness, and breathable, compression socks should not be worn in bed unless a doctor advised you to do so. Although they are known for enhancing the circulation, compression socks are not meant to be used while you are laying down because then they can block the blood flow.

Why Should I Sleep With Socks On?

The main advantage of sleeping with socks on is the fact that it will heat the feet and induce sleep. If you are not having problems with cold feet, here are some other reasons why you should consider sleeping with socks and how it can be beneficial for you.

• Sock sleepers might not be aware of it, but wearing socks and maintaining temperature regulation helps with the prevention of Raynaud’s syndrome, which is a medical condition that causes our skin to become significantly pale and later even blue, due to the reduced blood flow. Once the blood flow returns, the affected area will become red, and it would feel like it is burning. Those episodes can last briefly, a few minutes, but in more severe cases they can last for hours.
• Socks will nurture the feet during those cold and dry winter months by preventing dryness or cracks, and you can increase the effect by applying some moisturizer before putting your socks on.
• Traditional Chinese medicine recommends wearing socks. They believe that it contributes to the flow of positive energy, circulation and qi energy, while the cold feet would drain the energy out of the body.
• Usually, women who are going through menopause experience occasional hot flashes or flushes, most common symptoms of it include sweating, a sudden intense feeling of warmth all over the body and palpitations. Socks can be very helpful for the body’s temperature regulation during the night by maintaining it around optimal 60 to 67 degrees Fahrenheit.
• If you have a fever, try soaking your socks in apple cider vinegar and wear them, you can also put another dry pair of socks on top of them, it will supposedly help you recover faster.

Can Kids Sleep With Socks On?

One thing can lead any debate to the boiling point, and those are the kids, add them in, and it all goes on another level. Parents are sometimes overprotective and worry too much, but when it comes to infants and children, there is no reason why they should not sleep with their socks on, it is only essential that they are made from natural materials and that they are not tight. With kids, it is best to avoid heat socks or any heat inducer such as an electric blanket. A nice warm bath will do the trick and make them sleepy right on time. Socks or no socks, parents should always pay attention to their child to see if it is overheating, sweating or flushing, remove blankets and change their clothes quickly.

Babies are more sensitive so it is important that the layer of clothes which touches their skin is from cotton. Their onesies or socks should not be from wool for example. Not all babies will enjoy the feel of socks on their feet during the night, so parents need to pay attention and not put any unnecessary layer of clothes on their baby. If you notice that the baby’s palms and soles are warm or sweating, remove the socks or booties, sweating and discomfort will make the baby cranky and upset.

Overheating has been recognized as one of the causes of SIDS, which is why parents should never exaggerate with the amount of layer they put on their child, including socks.

Recently, many smart clothing products popped up on the market, and smart socks are one of them. It is claimed that they will monitor baby’s vital signs, but doctors and scientists are warning that there is no actual evidence about the efficiency of these smart devices and that they can cause more harm than benefit.

Side Effects of Wearing Socks While Sleeping

Considering how many people hate wearing socks to bed, there have to be some disadvantages that support their point of view, and that is our next topic.

• If your feet get too hot, they will start sweating inside of socks, which will create a damp environment perfect for any bacterial or fungal infection. If you are already dealing with some type of infection, it is best to avoid wearing socks at night until you solve the problem. Foot hygiene is essential, during the daytime we spend a lot of time in socks, especially athletes or anyone with an active lifestyle, that is why fungus, athletic foot and other kinds of infections are so common. You should never ever go to bed in the same socks you been the whole day, always remove them and wash your feet before bedtime.
• Many believe that while they are sleeping with bare feet, their feet are breathing and there are no chances for any unpleasant odors to occur, which is somewhat true. Sock sleepers should not walk around the house in them because they will pick up dirt and transfer it to bed.
• Overheating because of socks is possible, and it can easily wake us up several times during the night, it is easy to remove them and throw them next to the bed but it causes unnecessary heat waves, and it can be annoying.
• If you have tiles or polished wood floor, socks can cause you to slip and fall in the middle of the night if you wake up to go to the bathroom. This can be particularly dangerous for seniors, as they are more prone to accidents. Older people tend to have problems with blood circulation which is why they usually prefer wearing socks at night, but since with age, their balance is not at its best and any slippery surface is their enemy, they should use socks with rubber anti-slip soles, which will keep them safe on their feet.
• Aesthetics. Now, this may not be a valid reason, but it can be a slight disadvantage. Most couples argue about the socks in bed since usually one of them dispase socks and the other one loves them. They are not the sexiest thing, especially if they have a weird design or if they are not matching, but they are probably the coziest thing to the person who is wearing it, while their partner might not enjoy the touch of socks on their feet.
• Eventually, you will double the number of socks you use, and you will have to wash and dry them more frequently which takes some extra time.

Tips For Anti Sock Sleepers On How To Warm Up Their Feet

Some people fear that wearing socks to bed is unhygienic, they believe that it might cause them to overheat and wake up during the night due to sweaty feet, but others just do not find it comfortable enough. We wear socks for the most of our day, and at night our feet can finally be free to breathe and be bare, so if wearing socks is still not an option for you, do not worry, there are plenty of alternative ways to deal with icy cold feet.

• You can always put some extra layers or the blanket on top of the bottom half of your comforter, that way there will be more heat in that area, and your cold feet will heat up quickly.
• As much as they look gimmicky and funny, heating pads do what they are intended for. Just place them at the foot area of your bed a few minutes before you go to sleep, they will prepare and warm up the place for your feet. These heating pads are widely available, and their price varies from 15$ to 80$, but a more inexpensive alternative is a simple plastic bottle filled up with hot water.
• Wearing some cozy footwear before bedtime such as insulated slippers will maintain the optimal temperature in your feet and help you prepare for your sleep.
• A hot bath or even better, a brief foot bath before bedtime will quickly increase your body temperature and prepare you for snoozing time.

DIY Heat Pad

Filling up the plastic bottle with hot water is a widely spread DIY solution for heat pads; the only downside is that the water will eventually cool down. You need to place it in your bed around 15 minutes before you lay down, so that it will remain warm. But, there is one more highly popular DIY project which is more suitable for today’s topic since it includes socks, and it is called rice socks.

For this DIY project, you will need one pair of socks from natural fibers, and around ½ cup of rice. Simply pour all the rice in one sock and tie a knot at the end, place this sock into the other one and tie its end too. This sock-pad is meant to be heated up in the microwave for 1 to 2 minutes, but keep an eye on it because it can sometimes start to smoke. You will be surprised how long it can retain the heat, and it can be used for your feet, neck, or any other area.

The daily grind often brings with it a considerable amount of stress. Juggling work responsibilities, family commitments, and various other duties can sometimes be overwhelming. This overextension can take a toll on our sleep. It is documented that stress negatively impacts the quality of sleep, which is crucial for every part of our lives. Insufficient sleep can trigger numerous adverse mental and physical conditions, including depression, anxiety, insomnia, diminished concentration, reduced learning capabilities, elevated blood pressure, heart disease, obesity, diabetes, cancer, among others. To counteract this, finding a means to alleviate stress is essential, and yoga could be an effective approach to relax and improve sleep quality. Yoga nidra, or yogic sleep, is a meditation practice accessible to everyone, with many adherents touting its numerous benefits.

What Is Yogic Sleep?

Yoga nidra or yogic sleep is a state of deep relaxation achieved by its practitioner. Its goal is to enter the unconscious mind by entering a state of mind somewhere between wake and sleep. The experience is quite similar to hypnagogia, a dream-like feeling you experience while you are falling asleep. It is very common, and during this time your thoughts look like they are floating around, and you can have mild auditory or visual hallucinations. You might see or hear a certain shape or noise, or maybe your brain is producing a repetitive pattern of signals that you might find interesting. Unlike regular dreams that are usually coherent and you are an active member of them, these sensations are more passive, and you find yourself as an observer. Because of this, some people believe that hypnagogia enhances creativity, and they actively seek to experience it. For instance, Salvador Dali regularly tried to induce it, as he thought it helped his creative process and inspiration.

Yoga Nidra is just like the hypnagogic state, your mind is relaxed, your thoughts are floating around, and you forget about the everyday stressors. Classic meditation requires active involvement and being the master of your focus, which can sometimes be frustrating if you are not able to do so. In contrast, yoga nidra can be practiced by anyone, from children to seniors, it is much easier to master, and it usually involves auditory guidance, so you have something to focus on at all times.

Yogic Sleep vs. Normal Sleep

Some practitioners are claiming great benefits of yoga nidra, and they say that a 45-minute session can be equivalent to 3 hours sleep. There is no objective evidence to support this claim, so don’t think that anything can replace your nightly rest. Go for 7 to 9 hours of sleep each night, but you can incorporate yogic sleep to help you get rid of stress, as that is a part where it has proven benefits. With the regular practice, it can help you get better quality sleep.

Your body and mind are deeply relaxed during the nightly slumber. You are unconscious and most of the time unaware that you are sleeping. In contrast, while you are awake, you are very well aware of everything that is happening around you, and you are receiving and experiencing external stimuli continuously. The goal of yoga nidra is to access the middle of those states, a stage where you are profoundly calm and relaxed, while still maintaining consciousness and being alert to your surroundings.

Parts of your brain are emitting specific patterns of brain waves that can be picked up by the EEG. Betta waves are a characteristic of a wake state, but as you start to relax, your brain waves change as well and shift to alpha state. These waves are usually found on the transition between wake and sleep, but they can also be achieved when you are most relaxed. As you enter light sleep, your brain waves start to slow down, and theta waves are dominant here. Finally, as you reach deep sleep, your brain is producing delta waves, the slowest of them all. What’s interesting about yoga nidra is that the brain scans of those practicing it showed a mixture of specific brain waves for both sleeping and wake state. And this makes sense considering that they are trying to achieve that state between being conscious and asleep.

Benefits of Yoga Nidra

Yoga nidra is meant to evoke the feeling of calm, relaxation, and peacefulness. Ideally, you should feel more grounded and restored after the session. Like meditation, visualization and other kinds of yoga practice, it is a spiritual experience that should bring some benefits to your life. It is supposed to relieve stress and make you feel like you can get easier control of your life by better controlling your emotions and well-being. Sometimes it is enough to just sit back for some time, and ease your mind from going all over the place. You might feel more alert and focused afterward, or the session might leave you feeling like you are more connected to the people and the world around you.

Numerous studies are looking into the benefits of yoga nidra, and the results are mostly positive. One such study from 2012 looked into the impact that yogic sleep had on female subjects experiencing anxiety and depression symptoms due to menstrual disorder. The group of 150 females was randomly divided into two groups. One group practiced yoga nidra, while the control group didn’t, and they wanted to see the effects. The results are that the mild and moderate symptoms of anxiety and depression significantly improved in the group practicing yogic sleep. However, it didn’t have the same observable effect in individuals who suffered from severe symptoms.

Similar findings were observed in a study done one year earlier. After six months of practicing yoga nidra, women were experiencing fewer symptoms of anxiety and depression, and they generally had a more positive outlook on life and also rated their well-being higher.

A 2014 study, researchers wanted to look into how yogic practice affects blood glucose levels and stress in nursing students. One group has taken yogic exercise for 60 minutes weekly, for 12 weeks. It consisted of two parts; the first part was the active yogic exercise, while the second part was relaxation (yoga nidra). The results after 12 weeks were reduced stress, as well as lower blood sugar levels in medical students with yogic intervention.

A 2016 study looked into the benefits of easing menstrual irregularity symptoms. One hundred women were recruited and divided into two groups, where one practiced yoga nidra for six months, while the other didn’t. The results were consistent with the previous research, the group with the yogic intervention showed improved symptoms of anxiety and depression, women felt more positive about their well-being, and they also had better health and general vitality scores, as well as more balanced hormonal levels. The control group used medications to fight off menstrual symptoms, but they showed no difference at the beginning and after six months of observation. That means that yoga nidra could potentially be used as an alternative to relieving menstrual symptoms, but more valid research is needed to confirm this.

One study looked into effects yogic sleep could have on adolescents. Thirty-six students aged 13-15 had 30-minute sessions three times a week for a month. After that period, participants reported improvement in the feelings of happiness, enthusiasm, being more inspired, alert, active, having more control over negative emotions such as anger, and being more confident.

Keep in mind that all of these studies have certain limitations. They all have small sample sizes, most have undergone some kind of preselection of the participants, and in most of them, all of the subjects were female. Although they do show positive benefits, there needs to be more research done in this area with bigger sample sizes, without the preselection of the candidates, and with the more objective methods of evaluating the results of studies.

How To Practise Yogic Sleep?

If you want to practice yoga nidra by yourself, you can look for the nearby studios or workshops, as it has become quite popular. There is also a ton of videos online if you feel more comfortable doing it at home. You can also try one of the many apps that provide guided meditation including yoga nidra.

This is what a typical yoga nidra session looks like:

1. First, you lay down on your back with your arms stretched beside your body. Be free to use blankets, cushions, or blocks to make yourself as comfortable as possible. Close your eyes.
2. The start of relaxation begins through breathing exercises. You can try the alternate nostril breathing technique, or simply inhaling and exhaling more deeply while holding hands on your chest and belly. While focusing on your breath, your mind and body can slow down and become calmer.
3. Keep in mind that the goal of yoga nidra is to stay alert while achieving a state of deep relaxation, but don’t worry if you fall asleep.
4. Now is to do some recognition of your muscles and body parts. Start from the left side and gradually go to the right. First, move your left pinky toe, then go through your legs, body and all the way to facial muscles. By systematically moving and then relaxing your muscles, you become more grounded, and you allow your body and mind to become calmer. Go through this process as quickly as you can, but don’t force yourself as the goal is to remain calm. You can repeat step 4 as long as you want, and then when you feel relaxed enough, you can proceed to the next stage.
5. Visualize a place that you consider beautiful, and let your senses explore it entirely. For some people, this is a beach with waves hitting the rocks, a beautiful garden with the intense smell of flowers, deep forest with lots of birds chirping, or simply a relaxing campfire in the evening with a sky full of stars.
6. Embrace the surroundings, set a positive affirmation for yourself, and after feeling optimal, slowly come back to your surroundings.

You can take as much time as you need, but it is usually recommended that your sessions last between 20 and 45 minutes to let your body relax fully. You can do these sessions before the bedtime to help you unwind and fall asleep more easily, or you could do them in the morning or any other part of the day when you feel like you have too much on your plate, and need to calm yourself down.

Individuals may face numerous barriers that continuously hinder their ability to achieve restful sleep, impacting their health, day-to-day effectiveness, and overall well-being. Whether it’s unforeseen emergencies that deprive you of sleep for a night or two, sleep conditions that consistently make you feel tired throughout the day and restless at night, or poor lifestyle choices that disrupt your natural sleep cycle, losing sleep can happen for many reasons.

Visiting a doctor is always the best course of action if you identify sleeping problems, no matter how they manifest (i.e., whether you have trouble falling asleep, staying asleep, waking up on time, etc.). Regardless of what type of diagnostic method they opt for, the advice you get will often sound the same, at least partially. A lot of what causes sleeping problems lies in our daily life, and the habits that we adopt almost without noticing. Those habits could include eating unhealthy food, avoiding exercise, spending too much time in front of screens, staying up late to watch films, or any other similar thing. During your examination(s), you are asked questions about your lifestyle that help the doctor determine where you’re making mistakes.

One of the most common suggestions for dealing with sleeping problems of any kind (including those caused by sleep disorders) is to establish a bedtime routine or engage in sleep preparation. In this article, we will go over common sleep preparation practices and tips on how you can help yourself fall asleep without the use of risky prescription medication or over-the-counter solutions. Let’s get into it.

How It All Works

Sleep preparation is a flexible process in that you can customize your routine based on your personal preferences, medical history and a variety of other factors. The only common factor ends up being the time invested into this routine each day. Most doctors suggest starting a bedtime routine about an hour before you get into bed, but that’s only because people’s schedules usually don’t allow more. Ideally, you’d start unwinding around two hours before trying to fall asleep, and slowly remove sources of stimulation that keep you awake.

Cognitive behavioral therapy for insomnia works this way, too. The idea is that a good bedtime routine and some stimulus control helps you make a mental connection between your bed and sleep (and sex). If you can eliminate sleep-destroying habits in the evening and avoid using your bed other than for sleeping and sex, it can reduce your sleep onset latency without you even noticing. Sleep preparation often also comes down to creating a healthy sleep environment that keeps distractions away and improves things such as air circulation and the levels of lighting in the room. We will list off various things you can try to establish a bedtime routine that suits you specifically.

Natural Sleep Aids

If you’re afraid of prescription medication for sleep (and we don’t blame you, it comes with a variety of really unpleasant side-effects), there is a safer alternative you can try – natural sleep aids. Understanding natural sleep aids requires having a solid grasp on how your circadian rhythm works, so we’ll explain it briefly here. The circadian rhythm is maintained by a sort of biological master clock that’s located in your brain stem. This clock uses light receptors to tell the time of day to convince your body to start winding down for the night when the time comes. Many processes in your body depend on this rhythm, and things like appetite, blood sugar regulation, and libido are all easily connected to it. However, there are many ways to disturb your circadian rhythm, which throws your entire body off balance (figuratively) and causes potentially severe health concerns. Once your circadian rhythm is disrupted, it can be very hard to get it back on track without serious discipline (and often help).

For the purposes of sleep, the main process that is hurt by a disrupted rhythm is melatonin production. Melatonin is the hormone that forces you to fall asleep eventually, and its production can be crippled by things like alcohol consumption and excessive caffeine intake, among other factors. Natural sleep aids aim to improve your melatonin production, relieve anxiety and induce relaxation through ingredients such as tart cherry juice (which can and should be consumed on its own if you can find it near you), lemon balm extract and valerian root. Some products just give you a straight shot of melatonin directly, which helps you fall asleep quicker once the effect kicks in.

If you can’t afford these aids, you can rely on more accessible substances to improve your chances of falling asleep quickly. We’ve mentioned tart cherry juice, but milk is probably in your fridge right now, and it can be used as an improvised sleeping aid if you implement it as part of your bedtime routine.

Creating the Ideal Sleeping Environment

Environmental factors in your bedroom or outside your window have a huge influence on how well you can sleep during the night. For example, the difference between noisy traffic outside and perfect silence is massive in the context of falling or staying asleep. While this is the most expensive part of sleep preparation, every penny is worth making sure you can get enough rest to stay healthy and productive at work – appropriate bedroom accessories can “pay for themselves” through this benefit. The first step towards solving problems in your immediate sleeping environment is to identify them. Once you’re aware of what’s damaging your sleep, you can get products that solve those problems for you.

If you have to deal with noise while trying to sleep, no matter where it comes from (i.e., from other rooms or the outside), you want to invest in something that either reduces that noise or drowns it out. White noise machines or bedroom fans are popular options for many people, as we’re often more capable of relaxing when exposed to a consistent source of sound (usually a car engine, bedroom fan whirring, etc.). Keeping a bedroom fan active also helps improve air circulation, which is essential for healthy sleep. A stuffy room can single-handedly cause a headache for some people, so its effects on sleep should not be ignored – and since opening windows might expose your home to burglars, a fan could be the ideal solution.

Speaking of burglars, home security can play an indirect role in hurting your sleep prospects. Feeling like your home is never safe creates a lot of anxiety and stress, which can destroy your sleeping schedule. For this reason, it may be wise to invest in security cameras, door bolts, window bars and similar ways of keeping unwanted guests out. Being prepared for emergencies such as floods and fires can also contribute to a sense of safety and help you relax.

Blue light and electronics interfere with your biological clock by making it confused about the time of day. It is no coincidence that people who watch TV a lot or spend a ton of time in front of smartphones or computer screens tend to have poor sleep quality overall. If you can afford to do so (that is, when you’re not expecting an important call or alarm), turn off your smartphone during the night, or at least place it on the opposite side of the room. The same goes for any personal computers or TV monitors; everything should be turned off for at least an hour before you go to bed if you can help it.

Physical Well-Being and Relaxation

One of the questions you can expect to encounter when you visit a doctor and explain your sleeping problems is related to how much exercise you get. Exercise plays an important role in your body in multiple ways, from muscle development and immunity to improved hormone balance and relaxation during sleeping hours. No matter what’s causing your sleep problems (including a full-blown sleep disorder), the chances are that regular exercise is a great habit to pick up if you want to alleviate the problem. Make sure not to overwork yourself, as this can cause pain for as long as several days, which naturally keeps you from falling asleep easily, even with a top-quality mattress supporting your body. Additionally, avoid any intense exercises in the evening hours, and instead perform them in the morning or early afternoon to avoid putting stress on your body when it needs to unwind.

Exercise isn’t the only option, however. Planning your diet is equally important, as eating sugary, greasy or otherwise unhealthy food is harmful to your sleep onset latency and sleep quality in general. Above all, steer clear of alcohol and coffee in the evening hours – these two substances are listed as contributing factors to a massive number of sleep disorders and similar problems. A light meal in the evening is not a bad idea, as going to bed on an empty stomach doesn’t help you get good rest.

Relaxation techniques are an excellent way to improve your bedtime routine. These include different meditation techniques, breathing exercises, yoga routines, and similar activities. Don’t exert yourself too much, and focus on stretching and relieving pain and pressure from your body. Meditation can also train your mind to create a positive association with your bed, so you can avoid feeling bedtime anxiety. If you’re dealing with back pain, shoulder pain, neck pain or any similar problem, getting a massage is a great idea from time to time. Naturally, you should aim to avoid the pain before it can occur, so invest in a good mattress for your chosen sleeping position and avoid putting a lot of weight on your joints if you don’t have to.

A trip or two each week to the local sauna can do wonders for your body in many ways, and sleep quality is one of them. You don’t have to make it a daily thing, but make sure that you head in one or twice per week for decent results. The increased body heat starts to drop once you leave the sauna, and that effect pairs well with how your body naturally gets colder as it starts to switch to “sleep mode.” Some toxins and metals like mercury also vacate your body primarily through sweat, so a combination of healthy, planned exercise and sauna visits can keep you healthy and ready to doze off in the evening.

Choosing the perfect bed or mattress can really take a bite out of your wallet and patience. Land on the wrong one? Brace yourself for a merry-go-round of trying, returning, and hunting down that dreamy sleep buddy. Every year, the pile of options for where to lay your head just keeps getting mountain-high, with brand-spanking-new and snazzy mattresses popping up like mushrooms. But here’s a nugget of wisdom: sometimes, the golden ticket to a blissful night’s sleep isn’t zooming ahead but taking a leaf out of history books or peeping over the fence at how folks in other corners of the globe catch their Zs. Keep your eyes peeled here; you’re about to uncover some sleep secrets so snug and cozy, they’ll make you question everything you thought you knew about catching those all-important winks. Why stick around? Because everyone deserves to know the key to a sweeter slumber.

Sleeping on the floor is definitely not something done by a majority of people, at least in the United States. However, a lot of countries treat sleeping on the floor as a part of their tradition, something their ancestors would do by default. People who are interested in sleeping on the floor often receive support and advice from people of these cultures, whether directly or indirectly. Those of you wishing to adopt this sleeping habit probably have a series of questions about long-term health consequences and potential benefits. This is where we come in – this article was made to provide as much information as possible about floor sleeping to help people decide whether they want to change it up in their sleeping routine or potentially save money they would normally have spent on a new bed. Let’s get into it.

The Effect of Floor Sleeping on Your Body

As you might imagine, sleeping on the floor wasn’t a matter of choice back in ancient times. The benefits we got from sleeping on the floor had much more to do with survival and pain avoidance than with our quality of life or cultural experience. The sleeping positions used by men and women of old times, especially nomadic people, were more oriented towards helping the sleeper detect threats, whether it’s through a good sightline (assuming they wake up) or ears that aren’t pressed against anything for optimal hearing. Additionally, these people had to deal with potential heat loss and general comfort-related obstacles, and their sleeping positions functioned as a way of alleviating these problems.

One of the main elements of any sleeping position is pain relief, which is mainly associated with comfort and healthy posture. No matter how healthy or ill you are, there is always an optimal way to position yourself during sleep if you want to avoid back or neck pain or relieve existing back pain. Every mattress out there is designed to support and comfort a specific target demographic, usually relative to their sleeping position. Sleeping on the floor is a bit different, though. It’s less about adapting your sleeping surface to your body – it’s often the other way around.

Sleep experts that have extensive knowledge when it comes to sleeping on the floor tend to agree that one of the main benefits is the neutral back posture you’re essentially forced into. Spine alignment is something you would hear about during mattress hunting as well, as it plays a crucial role in avoiding many health-related concerns in the long run. The spine is the anchor for your nervous system, so any defects or bad posture habits can potentially affect many other systems in your body. For this reason, mattresses are often “aimed” at people who sleep in a specific position, since they can engineer the firmness to support the spine perfectly in that position. When you’re sleeping on the floor, your back and ribcage position themselves properly, without any real input on your end. This has clear health benefits, including a more comfortable rest. Another idea is that soft sleeping surfaces tend to limit the person’s movement as their body is “sucked into” the mattress. This movement is considered essential for maintaining a healthy sleeping posture and getting enough deep sleep.

However, there are reasons as to why everyone doesn’t sleep on the floor regularly. Most of these reasons stem from habits formed during upbringing, but there are many theories about floor sleeping that circulate in medical communities. One such theory claims that sleeping on the floor can cause harm to your joins over time, especially if your sleeping position doesn’t change very often. The idea is because the floor doesn’t budge under you while you sleep, almost all the weight is placed directly onto your joints – which isn’t a good thing. It doesn’t have any drawbacks if you do short-term floor sleeping (which can be a technique for dealing with back pain, and thus is temporarily done by certain people), but the risk increases over time.

This theory comes into direct conflict with an idea proposed by Michael Tetley in a study about instinctive sleeping postures. According to this study, certain sleep positions when a person is sleeping on the floor can help “fix” joints that aren’t functioning properly. It’s hard to imagine that floor sleeping simultaneously helps and hurts your joints, which brings us to an important fact to consider when researching this topic for yourself. You see, there hasn’t been enough research on the topic of floor sleeping for us to make any guarantees about how it all works. As a result, a lot of these theories remain just that – theories, and hypotheses, with patient testimonies and educated guesses being the most concrete hints to work with.

Who Should Avoid Sleeping on the Floor?

Because the floor is the hardest surface you can sleep on, it is not ideal for everyone. Some conditions prevent people from getting any real benefit from sleeping on the floor and can cause such a choice to carry increased risks. While the prospect of floor sleeping can be tempting from a cultural standpoint, the main focus is still the health, and some groups of people simply shouldn’t ever sleep on the floor if they can help it. Here’s a list of factors that make sleeping on the floor a bad idea:

–          Cold sleepers are one of the main groups that should avoid sleeping on the floor. Heat rises, which means that the floor is often the coldest part of any room – especially rooms without carpets. People who already get cold during the night need to invest extra resources in creating a good sleeping environment on their floor, especially if it’s hardwood during the colder seasons. If you still wish to sleep on the floor, make sure you have warm sleeping clothes and heat-preserving bedding to avoid health risks.

–          People with back pain or other problems that prevent them from efficiently standing up and sitting down whenever they want to are another demographic that should avoid floor sleeping. Falls can cause serious injuries no matter how old the person is, so people who would need assistance to stand up aren’t suitable for sleeping on the floor.

–          Older adults tend to experience the above-mentioned back pain, but other symptoms of aging can also make it hard to justify sleeping on the floor. They have thinner skin, and tend to have less muscle and fat overall, which exposes their joints to much more strain than usual. As a result, they take falls very poorly, and they will almost always find it very uncomfortable to sleep on the floor, even with some soft bedding arrangements like a comfortable sleeping bag.

As a rule, if you have any condition that affects your joints, muscles or causes physical discomfort of any kind during the night, make sure you consult your primary care physician before attempting to sleep on the floor. Let them know what you’re trying to achieve because their advice is crucial when it comes to arranging a floor sleeping plan. Worst case scenario, they may talk you out of the idea, but it’s for your own good. Not everyone should sleep on the floor, and a doctor will be able to tell you whether it’s a suitable sleeping habit for you specifically. If none of these risk factors are present, and you get your doctor’s approval, you can go ahead and think about how to set things up.

How Does One Sleep on the Floor?

As with many things in life, preparation is key. Because sleeping on the floor comes with potential risks and drawbacks, you shouldn’t rush into it blindly. There are steps you can take to ensure your floor sleeping is as comfortable as it can be, and minimize the chances of joint pain, back pain or neck pain in the long run. While you will have to invest some money to cover things like sleeping bag pads and similar comfort-improving articles, it’s worth every penny. Besides, the total cost of all these things is still nowhere near what a high-quality mattress would cost, so your wallet probably won’t take a huge hit.

Before making any purchase, you should examine your sleeping habits – specifically, your preferred sleeping position(s). Knowing this lets you plan ahead for relieving specific pressure points and purchasing adequate bedding. Here’s a list of sleeping positions and how you can improve your comfort depending on which ones you prefer:

–          Side sleeping is the most common sleeping position by far, and depending on your habits, you may either curl up in something resembling a fetal position or stretch your limbs out. Normally (i.e., when sleeping on a mattress that supports you properly), side sleeping comes with many health benefits such as improved brain function and blood circulation, or back pain relief. However, sleeping on the floor complicates matters a bit. Because there is no “give” when you sleep on the floor, your entire body weight ends up resting on one side of your body, specifically your shoulder, calf, and hip. This isn’t good for your joints and general comfort levels, so side sleepers are advised to seek out soft and flexible padding to put underneath themselves while sleeping. This approach lets your spine achieve proper alignment, and lets you reap the standard benefits of side sleeping in general.

–          Back sleeping takes second place when it comes to popularity, but it tends to be the preferred position for those who like to sleep on the floor because there are no spine alignment issues and pressure points that bear a huge burden when it comes to your body weight. However, this doesn’t mean that back sleeping is without its share of problems. People who snore or deal with sleep apnea are advised to avoid this sleeping position unless they’re connected to a CPAP machine. The one part of your body that sustains any significant pressure during back sleeping is your lower back, so you may want to put a pillow under your knees to alleviate potential lower back pain.

–          Stomach sleeping is not recommended in almost any situation, and this applies to floor sleeping as well. Simply put, the downsides are not worth risking, and the main way to prevent neck pain and joint compression is to use pillows under your body, which can be uncomfortable to sleep on in general, leading to greatly increased sleep onset latency. If possible, try to change your sleeping position to something else, or avoid floor sleeping altogether.

Creating a comfortable sleeping surface isn’t very difficult, but the sweet spot varies from person to person, which makes it hard to give specific advice. Browse your local stores and check online storefronts for products where you’re given ample testing time. Nothing is worse than being stuck with an uncomfortable piece of bedding equipment you specifically purchased for comfort. You want to look into various floor mats (such as tatami mats), as they are known to provide refuge from the cold, especially during colder seasons when your floor is uncomfortable to even walk on without socks. Mattress toppers and sleeping bag pads provide similar benefits, usually adding cushioning and comfort to alleviate the uncompromising firmness of the floor. If all else fails, a high-quality blanket (or five, so you can wash them without running out) does wonders in helping you sleep comfortably. Shop smart, and don’t hesitate to return uncomfortable products.

Engaging in sex is an excellent way to alleviate stress. Elevated stress levels can seriously disrupt your sleep patterns, making it crucial to discover activities that help you unwind. One effective method is sex, during which your body produces hormones that induce feelings of happiness. This hormonal surge floods your brain with endorphins and oxytocin, serving as both analgesics and mood lifters. Such hormonal release can serve as an effective remedy for stress and anxiety. Continue reading to learn more about how sex influences your sleep quality.

The Effect on Men

Men tend to go to sleep immediately after sex, without any cuddling or kissing. Women often get frustrated by this, but there is a biological reason for this situation. After sex, men get a surge of all the feel-good hormones coursing in their bodies. However, they also get a rush of hormone prolactin – a protein hormone that promotes lactation, controls many behavioral processes and plays a role in homeostasis. It is also linked to sexual satisfaction and the “refractory period” that men have after orgasming. The levels of prolactin are even higher when you sleep, so the surge is what causes men to feel sleepy after sex.

The Effect on Women

Women also get a surge of prolactin after an orgasm. A study conducted on healthy women showed estrogen levels increase during sexual stimulation, and another study has proved that higher estrogen levels positively affect sleep quality. Other studies of women during sexual stimulation discovered that the areas responsible for alertness and anxiety (the hippocampus and the amygdala) have a decrease in activity. This means that sexual activity will turn off the parts of the brain that cause you to feel stressed and anxious, ensuring you sleep like a baby.

How Does Sleep Improve Sex?

There are many links between sleep and sex. Having sex can help you fall asleep, and excellent sleep quality can boost your libido. Researchers have found that sleep deprivation can impact your sex life. Being too tired for sex cause many problems for couples.

Multiple studies have been done to find the link between these two. A study that examined women in their twenties showed that those who had more sleep at night had a greater sexual desire. They also had better arousal during sex. And women who got more sleep on a regular basis also had an increased sexual desire. By also examining women between 50 and 79, researchers noticed that less than 7 hours of sleep lowered sexual satisfaction. This also showed that poor sleep is among many factors that can affect the woman’s sex drive in menopause. Short sleep has an impact on almost every aspect of our health, and sexual health is definitely not an exception.

Depression and anxiety, as side effects of sleep deprivation and insomnia, take a toll on your sex life. The body gets stressed from lack of sleep and causes the brain to stop making sex hormones like testosterone and estrogen, and instead, starts producing stress hormones like cortisol. Cortisol is a hormone made by the adrenal glands – the organs on your kidneys, and it is the body’s main stress hormone. By working with different parts of your brain, it can take control of your mood, fear, and motivation. This hormone shift leads to a decreased sex drive, lower fertility, and even erectile dysfunction.

Apart from sleep deprivation, sleep disorders can impact your sex life. Men that have sleep apnea can also have erectile dysfunction (ED), but the connection between these two is not yet clear. Some hypothesize that sleep deprivation can be the cause of that link, while others suggest that the condition itself is causing certain bodily responses that cause erectile dysfunction. One thing is sure, if the sleep apnea interrupts your sleep, it will affect your testosterone levels, and that can reduce your libido or cause erection issues. Additionally, erectile dysfunction is very stressful, and it can cause sleep deprivation as well. However, men that get treatment for their sleep apnea or any other sleep disorder often have an improvement in their sex lives.

This is more prevalent in women due to the effects of pregnancy, menstruation, menopause, and postpartum lifestyle can have on sleep. These situations can cause many sleep disorders, and cause sleep deprivation. In many cases, women’s sex drive is decreased due to stress, depression or fatigue.

Chemicals and Hormones Released During Sex

Like we mentioned before, sleep deprivation can severely impact your sex life, but in the same way, sex can help you sleep better (which will improve your sex life). Researchers found that in many cases sex before sleep can help improve the sleep quality. After you have an orgasm, your body releases hormones that will relax you and your brain will get feelings of tranquility. The endorphins that are released during sex help relieve anxiety and minimize stress. During sex, your body also releases oxytocin, also known as the love hormone. This hormone causes many pleasant effects on the body and mind, including cueing relaxation. Oxytocin for women is known as the cuddle hormone, and it is the reason women want to cuddle after an orgasm. And it also reduces stress. Apart from these, the body releases dopamine. Dopamine is a neurotransmitter that causes feelings of pleasure, plays a significant role in the brain’s center for reward. For men, the release of prolactin and serotonin makes it difficult to have intercourse again but instead makes it easier to have a nap.

These hormones do not make you feel sleepy themselves, but they do provide you with a relaxing and happy feeling that makes it easy for you to fall asleep. Many studies have been conducted on this particular topic.

A study done by Queensland University focused on the relationship between sleep and sexual climax. It showed that more than 60 percent of the individuals that had their sexual climax before bed had better sleep quality.

How to Sleep Better and Have More Sex

For those of you who are stuck in a routine with bad sleep and no sex, some things can help you break that routine.

To make sure your body is ready for sex, it would be best to follow the guidelines from the National Sleep Foundation. According to these guidelines you need to sleep at least seven to eight hours per night. Depending on your sleep habits you can plan on sleeping for more than eight hours each night, just be careful not to overdo and make sure you go along with your circadian rhythm. If you do not feel rested when you wake up, you probably need more sleep. If you are not feeling rested, you might not be able or have the will to have sex.

Keeping good sleep hygiene is vital for both your sleep and sex life. Maintaining good sleep hygiene involves following a sleep routine that will provide structure to your rest. Having good sleep hygiene is an excellent way to treat any sleep-related problem. The best way to fix your sleep and sex problems is to have a comfortable bedroom environment that is reserved just for snoozing and sex. And nothing can impose on that environment. To do that, you need to put away any electronic devices you might have. Any mobile phone, tablet, laptop, iPad and other similar devices need to be far away from your bed. Along with that,  watching TV or doing work in bed are activities that you really need to avoid in order to prevent your brain from creating associations to these things instead of rest. The idea is to reserve your bed just for slumber and nothing else, and electronic devices are known for inhibiting sleep and intimacy. And don’t forget to keep the bedroom cool, dark, and quiet.

You also need to limit the consumption of caffeine, alcohol, nicotine, or other stimulants during the night. Additionally, you might want to consider getting some exercise. At least thirty minutes of exercise during the day can help you fall asleep naturally.

As you have seen throughout the article, sexual health and sleep quality are linked together. Sex or simply orgasms help you snooze better at night, and a good night of rest improves your sex life. Having an active sex life will not impose on your sleep, but getting an adequate amount of sleep is necessary for your body to be able to have sex. Enough rest will make sure you have the needed stamina and energy for sex, and it will also allow the proper hormone regulation for both your daily activities and your sex life.

Disorders related to breathing during sleep can partially or fully block a person’s airway, leading to several serious issues such as decreased oxygen levels in the blood, elevated blood pressure, and even heart attacks or strokes. These conditions vary in severity, encompassing obstructive sleep apnea, central and mixed sleep apnea, and sleep-related hypoventilation, among others. The most prevalent of these, the obstructive sleep apnea (OSA), affects roughly 20% of men and 9% of women in the United States, marking a significant rise from the estimated 3% in the 1990s. Factors contributing to this increase include higher rates of obesity and asthma, increased pollution, and improvements in diagnostic techniques, notably the refinement of polysomnography towards the late 20th century. Polysomnography, which tracks respiratory airflow and other breathing-related functions during sleep, has become an essential tool for diagnosing this disorder. It also monitors the heart rhythm, brain activity, and eye movements, among other parameters.

Several options exist for treating OSA, the most widespread and efficient one involving a CPAP machine. This choice has been proven time and time again as the most effective and remains a go-to option in most circumstances unless it isn’t adhered to for a period long enough to work. Many people find CPAP uncomfortable and stop using it as soon as their OSA starts to feel better. As a result, the disorder symptoms return in full swing, and a recent study highlights this as the main reason for hospital readmissions among OSA patients. Before we get into the study, we will review OSA and CPAP treatments for some context and clarification first.

Obstructive Sleep Apnea (OSA)

OSA is frequently accompanied by loud snoring, interrupted by periods when the airflow is reduced or blocked. This is followed by choking or gasping for air which usually wakes up the person, but only for a brief moment before they resume sleep. Depending on how often this happens, OSA can be:

• Mild – the episode happens 5-14 times every hour
• Moderate – the incident occurs 15-30 times every hour
• Severe – the event occurs over 30 times every hour

Everybody is at a lower or higher risk of developing OSA, depending on some contributing factors such as:

• Weight. High blood pressure, heart disease, and diabetes are all linked to obesity and known to increase your chance for developing OSA as well.
• Neck size – over 17 inches for men, and over 16 inches for women increase the risk of OSA.
• Age. The older you are, the more chances you have at developing OSA, at least until you hit 60. Statistically, the incidence rate drops after that age.
• Sex. Men are at least two times more likely to develop OSA than women, possibly due to their higher obesity rates and larger neck dimensions.
• Allergies and asthma both increase the risk because of more sensitive airways, increased mucus production and congestion.
• Family history. The exact predisposing genetic factor isn’t known yet, but its existence is evident, given that you are more likely to experience OSA if you have a relative who suffers it, too.
• Retrognathia, meaning that your lower jaw is smaller than the upper one.
• Narrow airways. These sometimes naturally “happen,” perhaps due to a larger than average tongue or enlarged tonsils.

Treatments usually consist of some lifestyle changes and some specialty therapy with machines like CPAP (more about that in a bit).

Lifestyle changes include:

• Weight loss – beneficial for everybody whose BMI is outside of the optimal.
• Switching sleeping positions from back to the side, preferably left, as this aligns the organs and the spine properly while reducing snoring and airway obstruction.
• Avoiding opioids such as alcohol, pills, cigarettes, etc.
• Managing secondary conditions if they are present – asthma or allergies, GI issues or another medical condition.
• Nasal sprays if congestion is what disrupts the breathing.

CPAP therapy

Continuous positive air pressure (CPAP) is a type of PAP treatment most suitable for OSA and some other breathing conditions. It is a machine that is put next to a patient’s bed, connected to a mask they’re supposed to put on at bedtime via a hose. The treatment lasts the entire night. The machine humidifies the air and provides it with high pressure directly into the mask, hence the name. This enables the patient’s airways to remain open, or reduces their obstruction and improves their sleep quality. The duration of this treatment and the specific settings on the CPAP machine depend on the doctor’s prescription based on the severity of your OSA and your overall health. For example, if you have OSA but also some gastrointestinal issue that causes acid reflux, CPAP therapy is not the best option – the air will sometimes stray and pass through the esophagus which is already weak enough, thus exacerbating acid reflux.

Nonadherence to CPAP associated with increased 30-day hospital readmissions

Specialists sought out to discover the effect of nonadherence to CPAP on hospital readmissions expecting to get the general overview of the situation so they conducted this study including 345 patients at the VA Long Beach Medical Center that satisfied the criteria (they were diagnosed with OSA, hospitalized at some point or another from January 2007 to December 2015 and prescribed CPAP therapy). Out of that number, 183 people adhered to their CPAP therapy while 162 didn’t. The purpose of the study was to establish the effect of nonadherence in terms of all-cause, cardiovascular-cause and pulmonary-cause hospital readmissions within thirty days after the initial, index admission discharge from the hospital. Excluded were patients without records of adherence to CPAP therapy and polysomnography to confirm OSA, those who passed away in the hospital during index admission and those transferred to another facility within the same day of index admission.

All-cause readmissions include cardiovascular and pulmonary-cause, as well as other cause readmissions such as renal, urologic, gastrointestinal, neurologic, psychiatric, infection, etc.

Cardiovascular-cause readmissions refer to those of congestive heart failure, coronary syndrome, arrhythmia, peripheral cardiovascular disease, and some others.

Pulmonary-cause readmissions were due to pulmonary hypertension, asthma, hypoxia, obesity hypoventilation, pulmonary embolism, and interstitial lung disease.

The average age of the patients from the adherent group was 66.3 years, and 62.3 in the nonadherent group. This, along with the patients’ sex, BMI, race, environment, and home conditions, the overall state of health and medical history was taken into account before measuring the results. Although the CPAP adherent group was older on average, the expected increase, especially in cardiovascular-cause of readmission, wasn’t apparent. The incidence rate both for all-cause and cardiovascular-cause readmissions was significantly higher in the nonadherent group, and their stay in the hospital was slightly longer, too.

Results

The study confirmed an existing hypothesis that not sticking with your CPAP treatment plan is more likely to get you back into the hospital.

The cardiovascular causes were due to atrial fibrillation (29.0%), myocardial ischemia (22.5%), and congestive heart failure (19.3%), and to no surprise, because these are often the result of frequent apnea episodes and hypoxemia, both of which are neutralized with CPAP therapy.

The pulmonary-related readmissions were also higher among the nonadherent group, but not as much as initially expected, and not of significance to this study.

All-cause readmission unrelated to the two causes mentioned was mostly urologic (10.7%), infection (8.0%), and psychiatric (5.3%). Specialists are just starting to take a closer look into these factors and their association with OSA and sleep in general.

Limitations and critique

Although its significance is notable if only as a single study, this work has faced a couple of flaws from the start and they are worth mentioning for clarification and readjustments for future studies.

For starters, it was conducted in a Veterans Affairs Medical Center, which is a specific target group and not as general as one would hope for a study of this sort. People from this subject group were predominantly white, male, have a lower income, have a history of substance abuse or have a second existing chronic condition. Cause-consequence effect wasn’t completely transparent either, as with most studies. One can’t be sure that CPAP nonadherence was the reason for a future event, only that the event was more likely to happen to people from the nonadherent group, although researchers did include many other contributing factors.

Further, most of the patients who didn’t make the criteria for this study were excluded because of the lack of sleep clinic follow-up within a year after the first hospitalization.  That excludes their results as well, whether they continued the prescribed CPAP therapy or not.

Lastly, because of its small dimensions, the study might have missed some patterns, while some of the patterns noticed could have proved irrelevant on a larger subject group. For this reason, the study remains more a stepping stone for future research, than a sole authoritative source of information.

When it comes to laying the foundation for good sleep, there are several factors you need to consider and tackle. It’s common knowledge how much of an impact a new mattress can have, the necessity for frequent replacements, or how the right pillow has fixed someone’s neck issues, among other things. If you’re relocating, dealing with ongoing problems, or just keen on exploring this topic, you might find yourself swamped by a flood of information and products that were previously off your radar. The variety is vast, ranging from standard bed frames to memory foam mattresses, not to mention countless other specialized products. With so much to sift through, the decision-making process can feel overwhelming initially. Considering how ubiquitous these items are, it’s understandable to think that they’re essential for you too.

People are not wrong to recommend a lot of these items; a comfortable, sensibly designed and uncluttered environment is essential for establishing and maintaining healthy sleep. But the question might have already crossed your mind – what do you need out of all these things to achieve that goal? Do you even need a pillow?

The question you should be asking instead is, does your sleeping position require a pillow for support? Because the answer mainly depends on whether you are a side, back or stomach sleeper, as each of these positions aligns the body differently and needs a different type of support, or rather, support in a different area. A pillow is sometimes necessary, but sometimes does more damage than good.

We will cover sleeping positions one by one in a second to explain what we mean and offer a couple of possible answers.

Side Sleeping

The universally favorite position occurs in three common forms:

• Fetal position, curled-up position, with arms in front or under the pillow, and legs bent in the knees. This position is twice as prevalent in women than men and is reported in 41% of people.
• Log position, featuring straight, stretched out legs and arms naturally falling as if the person was standing up. 15% of people sleep in this position.
• Yearner position, similar to the log, except here the arms are reaching forward. 13% of people reported sleeping like this.

Sleeping on your side is beneficial for a number of reasons: it prevents sleep apnea, snoring, and acid reflux while keeping the spine aligned with ease. This position is therefore optimal for people with gastrointestinal issues or chronic back pain, as well as pregnant women.

However, the downsides include potential face wrinkling and shallow breathing, although the latter applies only to people who sleep in the fetal position. By pulling the knees too high up, or tilting the head downwards, you are restricting your diaphragm which makes it harder to take deep breaths. Other than this, people who have arthritis also tend to have more issues the tighter they are curled up. Luckily, both of these matters can easily be solved if one only remembers to stretch out a bit more than usual.

Do Side Sleepers Need a Pillow?

The answer, in this case, is: absolutely yes, side sleepers without a dilemma need a good pillow. While sleeping on your side (especially left side) is considered the healthiest way to position yourself, without a combination of proper mattress and pillow support, that claim is out of the window. Without a pillow, your head will pull your neck downwards and out of alignment from the rest of your body, and sleeping on your shoulder is another bad idea – you’re likely to wake up with a numb arm, which is even worse because only one side will be affected.

What side sleepers need is a good contouring mattress that allows the pressure points of your body to sink in, and a thick pillow to lift your head to match the rest of your body. Consider either a cervical pillow or a memory foam pillow, which will have a higher loft right below your neck, and lower under your head.

Beware of pillows that are too thick though, as they will tilt your head upwards and cause issues with your back and neck. A pillow too soft will have the same effect as no pillow at all, so choose wisely and try out different kinds to gain some perspective. The good way to start would be to simply measure the distance from your head to your shoulders, then work your way from there.

Besides the pillow for your head, you might benefit from keeping a thin pillow between your knees to relieve some of the pressure from your hips and keep the spine straight.

What to consider when choosing a pillow as a side sleeper:

• Material. The variety is more abundant than one might initially think. Down pillows (filled with geese feathers) are durable, adjustable and lightweight, but not very allergy-friendly, affordable, and often aren’t supportive enough for side sleepers. Down alternatives have a shorter lifespan but are less allergenic. Latex pillows provide good support and keep cool during sleep, but the thickness isn’t adjustable. The list goes on and on; you will have some homework to do before you even get to shopping.
• Thickness. Side sleepers prefer the thickest pillows of the bunch, but that doesn’t mean the super-thick pillow will fit you in particular. Remember that your head shouldn’t be angled in any direction.
• Price. Depending on the characteristics mentioned above, pillow prices can be very expensive or really cheap. But as you just saw, the most expensive ones (usually down pillows) don’t automatically tick all the boxes when it comes to your specific needs. Good quality pillows can be found in all categories, and it all comes down to finding an option that works for you – that might as well be a cheap polyester pillow, as long as you aren’t compromising something important to fit into the budget.
• Firmness. Firm pillows are appropriate for side sleepers. They provide the necessary support and don’t flatten out as soon as softer pillows. It is especially remarkable if you are overweight, as your head would otherwise easily sink into the pillow and the whole point of having one would be lost.

Back Sleeping

About 8% of people sleep in savasana or soldier position (arms are down, legs either both straight or one bent), while only around 5% sleep in the so-called “starfish” position, with their arms above the head. Back sleeping is good for preventing neck pain along with the wrinkling that comes from side sleeping (as it keeps the face open). It also prevents acid reflux. It is not difficult to keep the body in a straight line in this position either. However, back sleeping is known to worsen sleep apnea and snoring (which can directly decrease the quality and duration of one’s sleep), as well as cause lower back pain, if not done correctly. We are just about to address that, too.

Do Back Sleepers Need a Pillow?

Once again, yes. Not as firm a yes as in the case of side sleepers, because there are some pillow-free scenarios that could potentially work for back sleepers. Don’t insist on it though, because the number one option definitely includes a pillow, and here’s why:

Back sleepers naturally have gaps between their neck and the mattress and under the lower part of their spine when laying on a firm or innerspring mattress. The lower back gap can be addressed with the help of contouring or memory foam mattresses, as these allow one’s hips to dig a little deeper and straighten the spine. However, the issue with the neck remains, and this is where the pillow comes into play. If you were to sleep without one, your head would dig into the mattress and leave the uncomfortable room, whereas a big, thick pillow would be the opposite extreme as your head would be forced forward and into your chest. Both scenarios could result in next-day pain or stiffness which could easily be avoided by finding the comfortable middle ground.

A thinner, contouring pillow might be the answer here. It will fill the space as needed, but won’t awkwardly angle your head, ensuring good posture and sound sleep. There are plenty of such options to check out between cervical pillows, pillows with built-in neck support, or rounded pillows similar to those one might bring along to a flight or train ride.

Aside from that, a second, small pillow could be positioned under the knees, much like what side sleepers might use as well, to help lessen the pressure from the lower back. Additionally, another good option for back sleepers would be to place the pillow under the lumbar spine to minimize the back strain.

Things to consider when choosing a pillow as a back sleeper:

• Shape – The most common type of pillows has a full or flat surface and a neutral effect on your body, whereas a contoured pillow might be more suitable for people with back or neck pain as they are elevated right below the neck.
• Price – The range of different models’ prices is wide enough to suit everybody’s needs, just be sure to research them beforehand and not settle for low quality because of the low price. In the end, that money will be wasted, and you will have to find another pillow as your problems won’t be solved. Investing a bit in the start will pay off more in the longer run.
• Thickness – Back sleepers tend to go for pillows around 3 inches thick on average. Do feel free to suit yourself though, as other factors like shoulder width, head size, and weight are also important to consider. Having a pillow that’s a bit thinner or thicker might feel more comfortable, and that is not a bad thing. Don’t follow the general rule blindly – it is just the average, after all.

Stomach Sleeping

With the single benefit of preventing sleep apnea and snoring, sleeping on your stomach compromises just about everything else. The cons include face wrinkling, breast sag, neck and back pain, pressure on joints and muscles, as well as the misalignment of one’s spine. As the center of your weight is located in your core, when you sleep on your stomach, it sinks into the bed and creates pressure on the rest of your body. This discomfort causes stomach sleepers to change positions more often during sleep, resulting in a reduced overall quality of sleep for over 7% of people who sleep in this way.

Do Stomach Sleepers Need a Pillow?

We have finally reached the one case in which an individual might actually benefit from not using a pillow. Sleeping on your stomach is generally viewed as the worst sleeping position for your health. This is largely because of the inevitable curving of your neck which steps out of alignment with the rest of your body. Along with the neck and head problems, additional issues can arise if a stomach sleeper uses a mattress that is too soft or too firm – either the pressure points of their body will sink even lower, or their back and shoulders will be pushed too far out and distort the straight line.

Experts often recommend you sleep without a pillow in this case. For some people, though, sleeping without a pillow can seem strange, as we’ve become so accustomed to having at least one, if not more of them on our beds. If you feel this way, simply buying the thinnest pillow you can find isn’t guaranteed to provide optimal results.

If you do opt for purchasing one, we’ve listed some features to look for below. Additionally, whether you end up sleeping with or without a pillow, putting a second, thin pillow below your hips can also prove beneficial when sleeping on your stomach.

Things to consider when choosing a pillow as a stomach sleeper:

• Thickness – Between 2-5 inches is the preferred pillow thickness of most stomach sleepers. This, of course, also depends on an individual’s weight, shoulder width and so forth, but a pillow thicker than five inches is considered unsuitable here.
• Price – If you are on a budget, it’s useful information to keep in mind here as well that real down models are typically the most expensive types, while polyester pillows are the cheapest. Before you go shopping, figure out a maximum you are okay with spending and do some research on types of pillows to know what you want.
• Moldability – Because of the frequent position switching and the general discomfort of sleeping on your stomach, this is a key characteristic to consider. If a pillow can’t re-shape efficiently to attend to your needs, it’s a clear sign to avoid it and keep searching. Your head should be in a neutral position, facing forward or downwards, like it would be were you standing up. The curved shape of the pillow, similar to the kind you would lie on while being massaged, might prove useful as it will leave some space between your face and the bed, making breathing easier.

In conclusion, there’s a reason that pillows are so wide-spread, as sleeping without one is a bad idea most of the time. Establishing a proper support for your body during sleep might not seem like such an important thing until chronic back pain or a stiff neck changes your mind, but let’s not wait for that to happen – the urgency of the necessary switch in mattresses or pillows will only rush you and potentially make you settle for less.

Are they even real? ― that’s probably the initial thought that crosses people’s minds. And for good reason. Apart from common symptoms like feeling tired and having a decreased ability to focus, there doesn’t seem to be much more evidence to base opinions on. Indeed, the precise workings of sleep remain a bit of a puzzle, even for researchers. Sleep disorders, such as insomnia, often lack a specific root cause. Narcolepsy is somewhat less mysterious but remains baffling. Hypersomnia, and Insufficient Sleep Syndrome, in particular, usually have believable explanations. Generally, they are associated with an individual’s personal choices, behavior, and lifestyle. Yet, these conditions are often acknowledged as symptoms and, once linked with some observable disorder, as syndromes― but the exact causes behind them remain a mystery.

Have you ever tried your hand at guessing why you couldn’t get a good shut-eye the night before some appointment? Why does your headache even if you had? Maybe you’ve written it off as ‘stress,’ ‘anxiety’ or something else, caused by anticipation. Well, you might as well be correct, but the exact problem  ― what caused this negative bodily reaction ― is a probably a tad bit more complex. Going through regular and irregular routines, our sleep-adjustment changes and modifies itself in turn. But what in our body brings this change about? What is it? That’s precisely the overarching question we’d like to share with you.

What Their Discovery Entails

Experts all around the world would relish the chance to get to the bottom of this problem. More than anything else, it would provide a coherent set of measurables. Once measured and ascertained, this problem would be reduced to something more quantifiable. We would have a clearer picture of the exact graphs and numbers behind our sleep and sleeping schedule. And this alone should prove a great impetus to aspiring chemists and doctors. Ideally, the discovery of such a biomarker would give us insight into:

1. The relationship between bodily functions and the quality and quantity of sleep
2. The way certain sleep disorders function in regard to the presence/absence of particular biomarkers
3. Finally, how we might effectively manage these biomarkers and even get the better of them in the long run

Plainly put, these biomarkers would indicate with great precision the many variables involved with sleep. They would show us people’s personal propensity to sleep and the mechanisms behind sleep disorders. Perhaps, but only perhaps, we would even have a glimpse into the anthropological history of  such a mundane activity. The answer is, you’ll have noticed, really of great importance, scientifically. But it is also tremendously important to every non-specialist and us as its repercussions affect that great third part of our lives ― our convalescence in dreamland.

Since a good deal of life is indeed spent dozing off, one way or another, wouldn’t it be nice if we knew why we had to sleep? If that’s asking far too much, then it would be undoubtedly handy if we at least knew what causes it. Is it not true that all mysteries are made to be unraveled. If not that, then at least pondered. It does affect both our memory and mental, as well as physical well-being, after all. And so finding, or coming close to finding sleep biomarkers, might not be just a scientific adventure, chemicals, brains and all that jazz. It might also be a deeply human search for the meaning of our nocturnal and diurnal visitations into dreams. Still, better not get ahead of ourselves!

Sleep Biomarkers, Sleep Disorders and Sleep Debt

Quite a few articles in recent years have shown a correlation between sleep or lack thereof, and the multitude of effects it can have on us. From our daily jobs to personal relationships, and from physical consequences to mental health, it does seem to be one of the pressing issues of the modern world. More and more, in fact. Not knowing how to manage one’s sleep can lead to loneliness, social withdrawal, ill health, and so on. Hence, resolving the issue of sleep biomarkers is fast becoming, if it has not already become, an urgent matter. The pace of life is such that one simply has to optimize one’s sleep or, sadly, suffer the consequences. This is why we’d like to draw attention to this. For the everyman, it could make all the difference between a quality life and one of just ‘getting by’  ― getting by tired, baggy-eyed and wretched.

More to the point, the human body is, needless to say, a complex organism. The intricacies of its many biomarkers and their relationship can be hard to pinpoint. How many times have you felt something ― a back-pain or a headache ― and been unable to specify its cause? Science tells us there are usually several. The same, in all probability, holds true for anything that bothers or enhances our ability to sleep. One thing leads to the next and back again. Many conditions, whatever they are, exist in a sort of link. For example, some studies have shown parallels between ADHD and sleep disorders. Other such cases abound and show us a profound interconnectedness between one facet of our body and another. And this is where we encounter a major problem ― in this vast matrix of cause-and-effect, how are we to determine what is primary and what secondary? Well, no objective methods have been as yet employed on a large scale to give a satisfactory answer. But this is just some food for thought. Raising awareness of this issue is but the first step to solving it, especially in this technology-dominated age. And on that point, it might be wise to consider how tech influences our biorhythm. It is of such profound importance to modern society that it just cannot be overlooked. Indeed, the developments in technical sciences have added yet another layer on top of this. Our biorhythm is less and less in tune with the ‘natural’ world and more and more ‘online.’ For better or worse, this certainly makes finding select biomarkers that much more difficult.

In any case, it can be safely assumed that sleep disorders and abnormalities must have something to do with their putative biomarkers. More often than not, however, they can also be misleading in regards to biomarkers of sleep per se. For example, biomarkers for sleep debt status showed little overlap with previously identified biomarkers for circadian phase. Biomarkers for acute and chronic sleep loss also showed little overlap. We can see, then, that even amongst themselves, sleep disorder biomarkers can diverge into separate categories. If it’s like that regarding relatively similar biomarkers, then we can only imagine how subtle the one we’re searching for is!

In (Re)Search of the Elusive Sleep Biomarkers

So far, there has been experimental research conducted in order to identify the chemical basis of sleep. How? This is done mostly by analyzing subjects in instances of sleep deprivation and chronic sleep restriction or sleep reduction. The samples taken are usually blood, urine, and saliva. And though the nature of these tests is a bit of a hit-and-miss affair, some facts can at least be established.  This study shows several things. Firstly, a change in metabolism has been observed in both humans and non-human animals, as well as certain changes in the bloodstream. Whether this is indicative of a biomarker is questionable. Still more promising, however, is the usual saliva test which has shown reduced mRNA encoding amylase in sleep-deprived patients. This, again, may be a useful signal for showing us the culprit. And many other tests ― the so-called multivariate tests ― have been performed to that end.  These have so far been used to detect biomarkers for cancer and dementia, for example. So they show some promise, despite the rather more complex nature of the biomarkers we’re talking about.

The main problem with this is the very nature of sleep. It is an emergent property of the brain that takes over when enough cortical columns go to sleep. There is not a point in time in which all ‘shut down’ ― some are always active. Thus the presence or absence of certain chemicals in the blood/saliva is simply not precise enough to determine, by itself, whether a person is asleep, or even sleepy. And even if handled with greater precision, this method still sorely lacks the ability to specify what the trigger was. So the specific biomarker again eludes us.

An even more perplexing issue emerges, however, when we take into consideration variable daily sleep. It is become all the more common, especially for younger people, to have flexible sleeping schedules. This is, technically speaking, unhealthy. Not only that, but it appears that it can further muddle the precise nature of the underlying sleep biomarkers. Apparently, changing your sleeping schedule can shift the balance of bodily and sensory secretions. However, bluntly put, it is most noticeable when going to bed later than usual. This is as apparent from changes in body temperature and specific inflammatory functions. From this, we see that sleep variability is associated with a biomarker strongly influenced by sleep and circadian regulations. So we can see the change, yet again, and what set off at least one biomarker ― the one showing a shift in sleeping behavior. Alas, though it may exist, no study has yet shown us what it is exactly. Who knows? It might even be that it’s not a single biomarker, a sole culprit. Perhaps it is. But then again, it just as well might be a whole array of processes that bring sleep about. After all, there is so much we don’t know about it. Besides the peripheral knowledge of what influences sleeping, the question still stands open.

Sleep or Sleepiness Biomarkers?

Could it all be a mistake? ― would be the appropriate punchline. Well, not quite. But I would draw your attention this anyway. Namely, what’s been so far neglected is the rather significant difference between sleep and sleepiness. And, of course, the difference between their biomarkers. That is if they even correspond on a one-to-one basis. A die-hard skeptic may also ask, ‘Do they correspond at all?’ In certain points, sleepiness and actual sleep are assuredly linked, however tentative that bond may be. But as to whether one leads to the other  ― well, let’s get down to that.

All of us yawn, and most of us yawn when other people yawn. It is also one of the most socially-recognized cues that one is tired. The latter has little scientific backing, though. Still, this is what most people would conjure up when asked what they thought was a prototypical sign of sleepiness. And the relationship between sleep and sleepiness is just as deceptive as this. This is why I’ve mentioned yawning, as a sort of symbol for this divide.

Droopy-eyes, on the other hand, is a quite clear indication of one’s fatigue. You can be as dopey when utterly tired as when you’ve had an excellent meal (and a lot of it). In the first case, if one is genuinely exhausted after a long day, this might be indicative of a biomarker playing its part. But is it the sleep biomarker, and is it possible to differentiate it from the others? In the second case, we might be tempted to say that the lack of blood supply to the brain is responsible. And partially it is. But how then to separate this biomarker of a metabolic function, i.e., digestion, from another that is, nonetheless, noticed by us through the same symptoms — droopy eyes, in this case.

Conclusion

The precise sleep biomarker or biomarkers remain an enigma. But a less puzzling one, we would like to think. To wrap this up, we do hope this article has offered its readers some good food for thought (from which you won’t get droopy eyes!) and stimulated them to think about the role sleep plays in their own lives.

When it comes to diagnosing sleep-related issues, Polysomnography, commonly referred to as PSG, is considered the gold standard. It’s only fitting that it leads the discussion in an article about such monitoring devices. PSG is renowned for its capability to identify indicators of a range of sleep disorders, from the less severe to the more serious conditions, including obstructive sleep apnea, periodic limb movement disorder, and narcolepsy, among others. This has made it extremely popular and widely used worldwide. Polysomnography tracks several different functions that take place during a person’s sleep:

Eye movements via electrooculography (EOG);

Brain activity via electroencephalography (EEG);

Heart rhythms via electrocardiography (ECG);

Muscle movements via electromyography (EMG).

Besides these aspects, PSG frequently measures blood oxygen levels, respiratory airflow, and includes video or audio recordings to detect patient’s body movements and snoring.

This study is performed in a laboratory during the night, or at a customized time window to accommodate the patient’s usual bedtime circumstances (useful for people with circadian rhythm disorders who sleep at different times of day or night compared to the average nightly bedtime), and its results are reviewed by a licensed professional.

Despite its wide utility, PSG’s high cost and the mere inconvenience a lab sleepover poses for the patients have prompted the discoveries and development of many novel devices similar in purpose, but versatile in logistic aspects and indications of use. Many of them carry potential clinical value, but the particular interest among the audience has arisen for at-home sleep monitoring gadgets. Hence will they also be the focus of our attention in this article.

Devices for Sleep Monitoring at Home

Although the idea is relatively new, home-based sleep monitors are already quite a few, and the numbers are only expected to grow. They mostly target breathing abnormalities and circadian rhythm deviations; most are worn somewhere on the individual’s body, and some aren’t even initially meant for sleep scanning purposes, but their targeted aspects may also be sleep-informative. The devices we will discuss in some depth can be categorized into the following categories, depending on the way they work:

• Monitoring based on brain activity
• Monitoring based on autonomic signals
• Bed-based monitoring
• Monitors based on body movements
• Devices with “accidental” sleep-monitoring properties, or other devices

Sleep Monitoring Based on Brain Activity Signals – ZEO

This exemplary device works via a headband that is intended to be worn during sleep. It detects electroencephalogram (EEG), electrooculogram (EOG) and electromyogram (EMG) signals through the night and transfers them to an iPhone or similar receiver station for analysis.

Zeo was evaluated in research where healthy adult subjects underwent polysomnography while also wearing the headband. The results showed around 75% of overall matching between the screenings from PSG and Zeo. Such a study wasn’t conducted on patients with diagnosed sleep disorders, so the accuracy of Zeo monitoring isn’t known – the possible effects of medication, as well as opioids like caffeine, cigarettes or alcohol on Zeo’s precision,  aren’t yet explored. Still, the device may be useful to have in a sleep disorder-free household if only to keep track of one’s general state.

Sleep Monitoring Based on Autonomic Signals – M1

A representative model in this category is M1 (SleepImage). Working via a patch containing a wire electrode that one wears on their chest, along with a small processing unit, this device records ECG signals, actigraphy, and the person’s body position. A limitation established with this model is the fact that some people don’t have a typical response to ECG – such is the case with patients experiencing autonomic dysfunction and some types of arrhythmia.

Bed-Based Sleep Monitors

EarlySense Mattress is indicated to be placed under one’s mattress to measure snoring, coughing, heart rate, respiration, and body movement.

Air Cushion is a pressure-sensitive thin cushion that you are supposed to put on top of your mattress. It measures heart rhythm, snoring, respiratory airflow and movements you make during sleep. Compared to PSG screenings, wake and NREM stages are accurately scanned by the Air Cushion the majority of the time, while REM was correctly displayed only about 38% of the time.

Home Health Station (TERVA) is a more complex system that screens and shows heart rhythm, respiratory airflow, blood pressure, body movements and even contains a diary for subjective entries of the individual who is only to position this station somewhere in their house. It has been shown to provide accurate results for sleep-wake differentiating and also was able to record a significantly increased disordered breathing rate in sleep apnea patients versus the people who don’t have this disorder.

SleepMinder is a sleep monitor placed above and near the bed, preferably in the radius of less than a meter away. It works by measuring movements through a radiofrequency monitor and is estimated to recognize slow wave sleep in 96% of the cases, although it has some issues with identifying REM and NREM sleep phases. Much like other movement-measuring devices, SleepMinder overestimates the amount of time a person spends asleep, which makes sense seeing as how one usually stays still while first attempting to fall asleep.

Touch-Free Life Care (TLC) is a wireless data transmitting system that works via a device placed below one’s mattress. It screens heart and respiratory rate as well as one’s activity during sleep but requires a more careful examination and validation from experts.

Other Devices

This category includes many gadgets that weren’t initially intended for sleep surveillance like SmartShirt or Zio. SmartShirt is a T-shirt that has sensors in the cotton material which track heart rhythm, body movement and one’s temperature in real-time. Zio is a gadget designed to scan cardiac arrhythmias and heart rate via a patch with two electrodes intended to be worn on one’s chest for up to 14 days.

Device Hardware and Software Issues

For an at-home sleep surveillance method to work, it needs to live up to certain standards. Cost and convenience are two essential factors to keep in mind, as patients could simply undertake PSG if these two didn’t present as difficulties. A device that is to be worn by a person needs to be light in weight and comfortable to a degree to ensure they won’t be reluctant to keep using it after the initial time. Further, the software needs to provide information in a form that anybody could understand with minimum guidance. If a person is to receive their results in a complicated, technical language, they will get discouraged from using the device or misinterpret the feedback it provided. Clarity is key with such sensitive information.

Combining the Objective and Subjective

Doctors are used to complementing PSG with a sleep diary to make up for the personal angle that PSG lacks. Not only does the sleep log make sure patients don’t forget to mention an important medical event, but its two or three weeks minimum duration creates enough of a chance for a visible pattern to form. Potential circumstantial events that would have been confusing in a single-day model can thus easily be spotted and disregarded. This harmonious combination should be the aim of all home-based sleep monitoring systems. The setting in the patient’s home would automatically eliminate the sterile atmosphere encountered during a lab sleepover while keeping track of specific bodily functions and their fluctuations. On top of that, a sleep log provided as a second part of the procedure would cover for the personal outlook moment, and the whole system would be able to last as long as necessary to eliminate “accidentals” and leave only real, contributing factors.

Of course, such an ideal mechanism remains out of reach so far but is a goal in mind for the development of future tools and devices.

How Do We Measure “Normal”?

By now, everybody knows the rule of thumb that adults need an average of eight hours of sleep per night in order to function to their best ability. Uninterrupted, quality sleep is what we are all going for, but measuring how long a person has been asleep, or how long they spent in various stages per night isn’t enough to tell whether their sleep is normal, let alone optimal. The tendency of researchers to combine the total of time one had spent in each stage during sleep and view them as blocks to compare amongst one another is still present and often harmful. Such a practice disregards the importance of the number of transitions between phases and their order, which can very well be the indicator that something is wrong and help with diagnosing a sleep disorder. For instance, patients with sleep apnea tend to rush through sleep stages and switch between them many times during the night. However, the total amount of time the person cumulatively spent in each phase will summarize to the same amount as that of healthy sleep and their apnea, characterized by fragmented sleep, might pass under the radar.

Furthermore, many medications and stimulants have been shown to interfere with and even suppress some sleep phases (REM and slow wave most commonly). Other factors like a person’s age, overall health state, other present conditions, immediate environment, etc. must all be taken into account as well to neutralize the otherwise out of context results, but these variables have their own dimensions, and it’s their average that’s used as the reference.

To summarize, perfectly correct algorithms don’t exist, and we can only get so close to calculating exact measurements of optimal sleep. Experience-based predictions and statistics are all we’ve really got in our arsenal when faced with such issues.

Device Validation

All measuring devices are evaluated based on how they compare to the “golden standard” which is PSG. Although the best we’ve got at the moment, PSG itself scores about 85% when it comes to precision and reliability, which automatically affects the validity of other devices measured against it.

Other than that, all of these devices simply register the events in one’s body, but don’t necessarily indicate as to why they might occur, or take into account the influence of another present condition or external factors such as age, sex, body mass index (BMI) and so forth.

Most of these devices measure relatively correctly the time spent awake and asleep but have issues distinguishing between exact stages, the REM stage being particularly tricky. A generally accepted time frame of stage duration is thirty consecutive seconds. If a monitor measures intervals as longer or shorter than that, the results might present differently, and comparison to PSG will be more difficult.

Finally, it is crucial to note that these devices get developed faster than specialists are able to test them thoroughly and validate them. Using a monitoring device at home can be helpful for an individual to grasp some basic knowledge about what goes on in their sleep, experiment with their routine and potentially notice when something goes downhill, but these gadgets, in reality, are as efficient as a weight scale or a thermometer (but less accurate). They are by no means intended to replace sleep clinic appointments, studies, and diagnostic procedures! Even if there were a home-based sleep screening system as sophisticated as PSG, sleep specialists would be the ones to review and analyze the collected data, diagnose patients and plan any future action.

The verdict on at-home sleep tracking systems is that, albeit more lazy and practical, they aren’t to be overestimated and used without consultation with professionals. Most of the gadgets one comes across on internet platforms haven’t yet been validated, so patients need to be cautious and responsible. If you suspect an issue, reach out to a sleep doctor. Not only are they trained to know all the problems related to the individual aspects of diagnostic criteria you may have only heard of, but they will also know how best to combine them in order to take the most advantage of them, all in your benefit.