Commentary on National Sleep Foundation sleep quality recommendations

In this issue of the journal, the National Sleep Foundation presents its first consensus report on sleep quality recommendations. When evaluating an individual's sleep history, we should consider 4 basic sleep components: quantity, quality, timing of sleep, and the individual's state of mind. People usually only focus on the first component, the quantity, or amount of sleep. They may say, “I know I am supposed to get eight hours, but I can only sleep five.” Parents often ask “how much sleep should my child get?” Certainly, there have been many publications making recommendations about the amount of sleep needed for the general population. However, all sleep clinicians know that the amount of sleep is only a part of the bigger picture of sleep health. The quality of sleep is just as important, if not a more important, consideration when evaluating a person's sleep health Measuring sleep quality can be much more difficult to objectively measure than sleep quantity. This difficulty resides in the fact that quality of sleep is a subjective experience. Prior publications have used self-rating as a global indication of an individual's sleep quality. The authors point out that a limitation of relying on self-report is “the loss of consciousness during sleep, which makes us poor self-observers of this particular behavior.” With children, this is more problematic. Parents will describe an infant or young child as a “good sleeper” if the child merely does not disturb the sleep of the parents. Therefore, the characterization of how good of a sleeper a child is will be based, in part, on the quality of the parents' own sleep or their own arousal thresholds. When parents are separated, the same young child may be considered a good sleeper in one home and problematic in the other simply based on the reporting parent's own sleep issues.