Do you wake frequently during the night, have restless sleep, or trouble falling back to sleep after waking? These are signs of poor sleep consolidation—your time spent asleep is fragmented. Though you might spend 8 hours in bed, you may spend only 4 hours sleeping.

Poor sleep has been associated with a broad range of problems including cognitive deficits, weight gain, increased blood pressure and risk of heart disease, poor blood sugar control and diabetes risk, (1) decreased leptin (satiation hormone), (2) increased inflammation, (3) hormone disturbance such as low testosterone, (4) emotional disturbance, (5) (6) and all-cause mortality. (7)

Sleep is intrinsically tied to memory. Both primary sleep stages, slow-wave sleep (SWS) and rapid-eye-movement sleep (REM), are important for optimizing the consolidation of memories and the formation of long-term memory. (8) Disturbed sleep may have a more negative impact on cognition than reduced total sleep time.(9)

Many studies have shown the association between sleep and cognitive function, especially among with the APOE ε4 genotype which is associated with increased risk of heart disease and Alzheimer’s disease (or senile dementia). This genotype also confers a two-fold increased risk of sleep disordered breathing which includes sleep apnea (when breathing repeatedly stops and starts during sleep). (10) People with APOE ε4 that suffer from sleep disordered breathing tend to have poorer performance on cognitive tests. (11)

If you suffer from poor sleep, whether it is due to sleep apnea, sleep disturbances, insufficient sleep, or other reasons, you’re probably far more interested in how to fix it, rather than dwelling on what may be going wrong.

The good news is, improved sleep quality through sleep consolidation (the amount of time sleeping without interruptions) reduces the risk imparted by the APOE ε4 genotype on Alzheimer’s Disease. (12) If you spend a lot of time in bed but not a lot of time sleeping, consider these techniques for a better night’s sleep.

First start with a few sleep basics:

Step 1: Better Sleep Basics

1. Keep a regular sleep schedule by going to sleep at the same time every night and waking at the same time each morning, including on the weekends.
2. Avoid certain stimuli that could interfere with your sleep. For example, avoid exercising within 3 hours of bedtime, avoid looking at screens such as a TV or phone within 2 hours of bedtime (or use blue blocking glasses/apps if you must), avoid caffeine after 2 pm, avoid alcohol 3 hours before bed, and no work-related activity at least 1 hour before bed.
3. Set up the ideal sleep environment by keeping the temperature cool, the room very dark, and a white noise machine or fan.
4. Exercise/stay active. People who are more active tend to sleep better. One study showed that 150 minutes of exercise per week, including walking, can improve sleep quality by 65%.(13)
5. Program your ideal wake time. At your ideal wake time, open the curtains and/or get outside to expose yourself to natural light. If it is still dark outside you may want to consider a light therapy box to turn on while you’re getting ready in the morning such as those by Northern Light Technologies.
6. Keep naps brief. If you nap during the day, keep it to 10-30 minutes. Any longer and it will likely interfere with your sleep during the night.

Once you have basic sleep hygiene down, or are working towards it, you can begin the following sleep consolidation protocol:

Step 2: Sleep Consolidation Protocol

1. Estimate your total sleep time (or use the total sleep time on your Fitbit or other device) and add 15 minutes to this time. For example, you may be in bed for 8 hours but asleep for only about 5 hours, so your total sleep time is 5 hours and your number would be 5 hours and 15 minutes.
2. Set your bedtime for this length of time prior to your waketime. For example, if you need to wake up at 6 am, using 5 hours and 15 minutes from #1, your bedtime would be initially 1:45 am.
3. Use this sleep schedule for 3-4 days before moving your bedtime earlier by 15 minutes.
4. Gradually move your bedtime back by 15 minutes every 3-4 days (1:30 am for several days, 1:15 am for several days, 1:00 am for several days, etc) until you are getting 7-8 hours of consolidated sleep.

Other causes of waking during the night can be addressed with your healthcare practitioner. These may include sleep apnea, heartburn or silent reflux, low blood sugar, anxiety, and more.

This information is not intended to be construed as medical advice or to diagnose or treat any disease. Please consult with your healthcare practitioner for any medical concerns you may have.

Works Cited

1. Sleep duration as a risk factor for cardiovascular disease – a review of the recent literature. Na6gai, M, Hoshide, S and Kario, K. 1, s.l. : Curr Cardiol Rev, 2010, Vol. 6, pp. 54-61.
2. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. Taheri, S, et al. 3, s.l. : PLos Med, 2004, Vol. 1, p. e62.
3. Sleep loss and inflammation. Mullington, JM, et al. 5, s.l. : Best Pract Res Clin Endocrinol Metab, 2010, Vol. 24, pp. 775-784.
4. The relationship between sleep disorders and testosterone in men. Wittert, G. 2, s.l. : Asian J Androl, 2014, Vol. 16, pp. 262-5.
5. Effects of sleep deprivation on cognition. Killgore, WD. 2010, Prog Brain Res, Vol. 185, pp. 105-29.
6. The emotional brain and sleep: an intimate relationship. Vandekerckhove, M and Cludydts, R. 4, s.l. : Sleep Med Rev, 2010, Vol. 14, pp. 219-26.
7. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Cappuccio, FP, et al. 5, s.l. : Sleep, 2010, Vol. 33, pp. 585-592.
8. System consolidation of memory during sleep. Born, J and Wilhem, I. 2, s.l. : Psychol Res, 2012, Vol. 76, pp. 192-203.
9. Sleep duration as a risk factor for cardiovascular disease – a review of the recent literature. Na6gai, M, Hoshide, S and Kario, K. 1, s.l. : Curr Cardiol Rev, 2010, Vol. 6, pp. 54-61.
10. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. Taheri, S, et al. 3, s.l. : PLos Med, 2004, Vol. 1, p. e62.
11. Sleep loss and inflammation. Mullington, JM, et al. 5, s.l. : Best Pract Res Clin Endocrinol Metab, 2010, Vol. 24, pp. 775-784.
12. The relationship between sleep disorders and testosterone in men. Wittert, G. 2, s.l. : Asian J Androl, 2014, Vol. 16, pp. 262-5.
13. Effects of sleep deprivation on cognition. Killgore, WD. 2010, Prog Brain Res, Vol. 185, pp. 105-29.
14. The emotional brain and sleep: an intimate relationship. Vandekerckhove, M and Cludydts, R. 4, s.l. : Sleep Med Rev, 2010, Vol. 14, pp. 219-26.
15. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Cappuccio, FP, et al. 5, s.l. : Sleep, 2010, Vol. 33, pp. 585-592.
16. System consolidation of memory during sleep. Born, J and Wilhem, I. 2, s.l. : Psychol Res, 2012, Vol. 76, pp. 192-203.
17. Poor sleep is associated with impaired cognitive function in older women: the stuyd of osteoporotic fractures. Blackwell, T, et al. 4, s.l. : J Gerntol A Biol Sci Med Sci, 2006, Vol. 61, pp. 405-10.
18. APOE 4 is associated with obstructive sleep apnea. Gottlieb, DJ, et al. s.l. : Neurology, 2004, Vol. 63, pp. 664-668.
19. Association of Sleep Disordered Breathing and Cognitive Deficit in APOE ε4 Carriers. Nikodemova, M, et al. 6, s.l. : Sleep, 2013, Vol. 36, pp. 873-880.
20. Sleep Modifies the Relation of APOE to the Risk of Alzheimer Disease and Neurofibrillary Tangle Pathology. Lim, ASP, et al. 12, s.l. : JAMA Neurol, 2013, Vol. 70. 10.1001/jamaneurol.2013.4215.
21. Association between objectively-measured physical activity and sleep, NHANES 2005–2006. Loprinzi, PD and Cardinal, BJ. 2, s.l. : Mental Health and Physical Activity, 2011, Vol. 4, pp. 65-69.