Study: Good Sleep Makes Other Health Habits Easier to Follow
For some people, there is simply nothing better than a good night’s sleep. Unfortunately, it doesn’t happen nearly as often as most of us would like. Between rising inflation and a global pandemic that left few untouched in some way, stress levels are at an all-time high for many people, and convincing them that a good night’s sleep is both necessary and achievable can feel like trying to score Taylor Swift concert tickets: utterly impossible.
But is it really? Or do many people sabotage themselves with bad habits (put down the phone!) or avoid taking the time to invest in sleep hygiene? Perhaps they simply aren’t convinced that an extra hour or so of sleep is enough to make a difference, especially when it leaves them with less time to do all the other things that have to get done.
While knowledge doesn’t always translate into action, helping your clients understand that good sleep can make all other health habits easier to stick to could be an effective approach for convincing them that sleep is, in fact, a cornerstone of good health and wellness. To that end, the results of a new study presented earlier this year at the American Heart Association’s Epidemiology, Prevention, Lifestyle and Cardiometabolic Health Scientific Sessions in Boston, Mass., offers some important insights worth sharing with your clients.
Researchers recruited 125 adults (average age 50 years old, 91% female, 81% white, body mass index of 27 to 44 kg/m2) who had overweight or obesity to participate in a 12-month weight-loss program. One of the goals was to use the data to determine if good sleep health was related to how well participants adhered to the range of lifestyle modifications they were given as part of the program.
The participants’ sleep habits were measured at the beginning of the program and at six and 12 months through patient questionnaires, a sleep diary and seven-day readings from a wrist-worn device that recorded sleep, waking activity and rest. These measures were used to score each participant as “good” or “poor” on six measures of sleep: regularity, satisfaction, alertness, timing, efficiency (the percentage of time spent asleep while in bed) and duration. A composite sleep health score of 0 to 6 was calculated for each participant, with one point for each “good” measure of sleep health, meaning that higher scores indicated better levels of sleep health.
The next step was to determine how well participants followed the recommendations of the weight-loss program. This was measured by how often they attended group intervention sessions, how often they were within 85 to 115% of their daily caloric intake goals, and their daily amount of moderate or vigorous physical activity (it was expected to increase over the duration of the study). Participants had an average sleep health score of 4.5 out of 6 at all three measurement checkpoints. They self-reported their caloric intake each day using a phone app and their physical-activity levels were tracked by an accelerometer they wore at the waist for one week at a time at the start of the study, at six months and at 12 months.
After adjusting the sleep health scores for age, gender, race and whether the individual shared a bed with a partner, the researchers found that better sleep health was associated with higher rates of attendance at group intervention sessions, adherence to caloric intake goals and improvement in time spent performing moderate- to vigorous-intensity physical activity. Here are some additional findings:
- Participants attended 79% of group sessions in the first six months and 62% of group sessions in the second six months.
- Participants met their daily caloric intake goals on 36% of days in the first six months and 21% in the second six months.
- Participants increased their total daily time spent in moderate- to vigorous-intensity activity by 8.7 minutes in the first six months. However, their total time spent being physically active decreased by 3.7 minutes in the second six months.
The decrease in group session attendance, meeting of caloric intake goals and in time spent in moderate- to vigorous-intensity activity in the second six months was expected, explains Christopher E. Kline, PhD, coauthor of the study and an associate professor in the department of health and human development at the University of Pittsburgh. “As one continues in a long-term behavioral weight-loss intervention, it’s normal for the adherence to weight-loss behaviors to decrease.”
While the researchers had hypothesized that sleep would be associated with lifestyle modification, according to Dr. Kline they didn’t expect to see an association between sleep health and all three of the study’s measures of lifestyle modification. “Although we did not intervene on sleep health in this study, these results suggest that optimizing sleep may lead to better lifestyle modification adherence,” he says.
It’s important to note that this study wasn’t without limitations. For example, it didn’t incorporate any intervention to help participants improve their sleep. Additionally, the participants were not recruited for their sleep health characteristics and did, in fact, have relatively good sleep health at the start of the study. The sample was also primarily white and female, so it is unclear whether these results are generalizable to more diverse populations.
What the Research Means to Health and Exercise Professionals
There’s no getting around it: Sleep is crucial to good health. In fact, you might even consider it the foundation upon which all other health habits are based, as it may have the power to help people stick with their other goals, especially if weight loss is one of them.
“Focusing on obtaining good sleep—seven to nine hours at night with a regular wake time along with waking refreshed and being alert throughout the day—may be an important behavior that helps people stick with their physical-activity and dietary-modification goals,” argues Dr. Kline. “A previous study of ours reported that better sleep health was associated with a significantly greater loss of body weight and fat among participants in a year-long, behavioral weight-loss program.”
According to Dr. Michael A. Grandner, PhD, MTR, director of the Sleep and Heath Research Program at the University of Arizona and director of the Behavioral Sleep Medicine Clinic at the Banner-University Medical Center in Tucson, Ariz., more than 100 studies have linked sleep health to weight gain and obesity, but this current study shows “how sleep isn’t just tied to weight itself, it’s tied to the things we’re doing to help manage our own weight,” explains Dr. Grandner. “This could be because sleep impacts the things that drive hunger and cravings, your metabolism and your ability to regulate metabolism and the ability to make healthy choices in general. Studies like this really go to show that all these things are connected, and sometimes sleep is the thing that we can start taking control over that can help open doors to other avenues of health.”
Of course, greater weight control is not the only reason to urge your clients to get more sleep. Much like being physically active, the wide-ranging benefits of sufficient sleep are becoming more widely known and accepted—and even championed. For example, improving sleep health can help improve cardiovascular health, and it is now a key component of the American Heart Association’s Life’s Essential 8. Getting healthy sleep was added in 2022 as the eighth component of optimal cardiovascular health, which also includes eating healthy food, being physically active, not smoking, getting enough sleep, maintaining a healthy weight, controlling cholesterol, managing blood sugar levels and managing blood pressure levels. Cardiovascular disease claims more lives each year in the U.S. than all forms of cancer and chronic lower respiratory disease combined, according to the 2023 Statistical Update from the American Heart Association.
In the video below, Sabrena Jo, PhD, ACE’s Senior Director of Science and Research, talks about the current study and offers some guidance on how to talk to your clients about their sleep habits and where to go for more information on how to improve their sleep hygiene. You can also offer them the following tips:
- Stick to a sleep schedule. Go to bed and wake up at the same time each day, even on weekends. This helps the body get into a regular sleep-wake rhythm.
- Create a relaxing bedtime routine. Do something calming in the hour or two before bed, such as reading a book, taking a bath or listening to soothing music. Avoid watching TV or using electronic devices in the hour before bed, as the blue light emitted from these devices can interfere with sleep.
- Keep the bedroom dark, quiet and cool. Darkness helps the body produce melatonin, a hormone that promotes sleep, and silence can make it easier to fall asleep. Additionally, cool temperatures (around 60 to 67º F or 15.6 to 19.4º C) are considered ideal for sleep.
- Avoid caffeine and alcohol before bed. Caffeine can stay in the body’s system for hours and make it difficult to fall asleep. Alcohol may help some people fall asleep faster, but it can disrupt sleep later in the night.
- Get regular exercise. Exercise can help improve sleep quality and reduce the incidence of insomnia. However, avoid exercising too close to bedtime, as this can make it harder to fall asleep.
Finally, if your client continues to have trouble sleeping despite following these tips, it may be a good idea for them see a doctor to rule out any underlying medical conditions.