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Measuring Sleep Efficiency: What Should the Denominator Be?

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  • 1CBTMaine and Director of Somniskills Insomnia Program, Portland, ME.

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The definition of sleep efficiency (SE) is inconsistent, causing confusion. A new definition using the duration of the sleep episode (DSE) is proposed to accurately measure sleep quality.

Keywords:
insomniasleep efficiencytime in bed

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Area of Science:

  • Sleep Science
  • Clinical Research Methodology

Background:

  • Current operational definitions of sleep efficiency (SE) are inconsistent.
  • The denominator used (time in bed) includes non-sleep activities and excludes sleep discontinuity, inaccurately representing SE.
  • This inconsistency poses methodological challenges, particularly in sleep intervention research.

Purpose of the Study:

  • To address the conceptual and methodological confusion surrounding sleep efficiency (SE) definitions.
  • To propose a revised, consistent operational definition of SE that more accurately reflects the construct.
  • To enhance the utility of SE as a measure in sleep research and clinical practice.

Main Methods:

  • Critically analyzed the widely used SE definition (Total Sleep Time / Time in Bed).
  • Proposed an alternative denominator: Duration of the Sleep Episode (DSE).
  • DSE includes sleep onset latency (SOL), total sleep time (TST), time awake after sleep onset (WASO), and time attempting sleep after final awakening (TASAFA).

Main Results:

  • The proposed SE formula is SE = TST / DSE (× 100).
  • DSE can be calculated using standard sleep diaries and the Expanded Consensus Sleep Diary.
  • This revised definition more accurately captures the construct of sleep efficiency.

Conclusions:

  • Adopting a consistent operational definition for SE is crucial for research and clinical practice.
  • The proposed DSE denominator offers a more accurate and methodologically sound measure of sleep efficiency.
  • This refinement has significant implications for insomnia research and treatment.