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. Author manuscript; available in PMC: 2023 Jun 1.
Published in final edited form as: J Acad Nutr Diet. 2022 Jan 19;122(6):1182–1195. doi: 10.1016/j.jand.2022.01.007

Diet Composition and Objectively Assessed Sleep Quality: A Narrative Review

Katherine Wilson 1, Marie-Pierre St-Onge 2, Esra Tasali 3
PMCID: PMC9124688  NIHMSID: NIHMS1772505  PMID: 35063665

Abstract

Insufficient sleep is highly prevalent in society and has tremendous negative health consequences. Despite the available treatments, there is continued demand for novel and natural strategies to promote better sleep. Dietary modifications could be a viable new target to improve sleep. A literature review using PubMed was conducted on studies that examined the relationship between diet composition (i.e., macronutrients or special diets) and objectively assessed sleep quality. Twenty human studies (6 observational and 14 interventional) published between 1975 and March 2021 met the eligibility criteria and were included. The amount of dietary carbohydrates and fats was associated with both better and worse sleep quality indices. However, the type of carbohydrate and fat was an important factor in these associations, with diets higher in complex carbohydrates (e.g., fiber) and healthier fats (e.g., unsaturated) being associated with better sleep quality. Diets higher in protein were associated with better sleep quality. In general, diets rich in fiber, fruits, vegetables, and anti-inflammatory nutrients and lower in saturated fat (e.g., Mediterranean diet) were associated with better sleep quality. The connection between diet and sleep quality warrants further investigation. Rigorous interventional studies of longer duration assessing the effects of whole foods, rather than isolated nutrients, under free-living conditions, rather than in a research laboratory setting, as well as mechanistic studies are needed to better understand how dietary patterns relate to sleep quality. Future research could provide insights into whether dietary modifications could be an effective, personalized strategy for improving sleep quality in millions of Americans.

Keywords: diet, sleep quality, slow wave sleep, REM sleep

INTRODUCTION

About one third of Americans suffer from chronic sleep problems1. Moreover, nearly 50% of adults complain of feeling sleepy during the day with many reporting its negative impact on their daily activities2. Poor sleep quality can be due to poor sleep hygiene or sleep disorders such as insomnia or obstructive sleep apnea, which are highly prevalent in modern society3. Individuals who sleep poorly are more likely to fall asleep while driving or be involved in work-related accidents. Poor sleep quality has also been linked to major adverse health consequences including cardiometabolic diseases and neurodegenerative disorders4, 5. Current interventions to improve sleep quality include sleep hygiene recommendations (e.g., dark sleep environment free of electronics, avoiding excessive caffeine intake etc.)6, 7 and/or specific treatments for sleep disorders (e.g., continuous positive airway pressure treatment for obstructive sleep apnea, cognitive behavioral therapy and/or pharmacological sleep aids for insomnia)810. Despite the availability of such interventions, there is a continued demand for novel and natural strategies to promote better sleep quality11, 12. Approximately 80% of individuals using prescription sleep aids report feeling groggy and having concentration difficulties in the day following medication use13, which could account for this demand. Some of the novel and natural strategies of interest to improve sleep, include dietary supplements and foods/beverages14, 15. Like sleep habits, Americans also struggle with maintaining healthy dietary habits. The average American consumes excessive amounts of refined grains, saturated fat, and added sugar16. Unhealthy diet is thought to explain, for the most part, why about two-thirds of American adults are overweight or have obesity today17. Excess weight in turn can lead to poor sleep quality and increase the risk for sleep disorders18, 19.

Sleep quality can be assessed subjectively by self-report or objectively by sleep monitors. Although self-reported sleep measures are commonly used in most epidemiologic and clinical studies, they are prone to over-, or underestimation of sleep as compared to objective assessments. The relationships between diet and sleep were broadly evaluated in two prior reviews20, 21, which included various diets and/or specific food items, and subjective and/or objective sleep outcomes. The present narrative review specifically focuses on how diet composition (i.e., macronutrients or special diets) relates to objectively assessed sleep quality. A narrative review was conducted because the eligible studies that were included were highly diverse with regards to their methodologies, precluding a systematic review. The findings are summarized from observational and interventional studies where healthy individuals or patients with sleep disorders were assessed in their usual home environment or in a research laboratory. Potential mechanisms that may explain how diet affects objective sleep quality and future research directions are also briefly discussed.

METHODS

Search strategy and eligibility criteria

A literature search was conducted using PubMed with a focus on studies with assessments of diet composition and sleep quality in humans. The search was limited to original research published in English between January 1975 and March 2021 and the following search terms were used: diet, sleep, objective, polysomnography, and actigraphy. The search terms were employed in variable order and combinations. In addition, a snowball search was performed using the references of the review article by St-Onge and colleagues20. Following the search, the titles and abstracts of the identified articles were screened for relevance, and where appropriate, the full texts were examined for the inclusion and exclusion criteria (Figure 1). The studies were excluded if they involved children or adolescent populations, or animal models. Since diet macronutrient composition and whole diets were the primary focus of this review, the studies that examined the effects of specific food items (e.g., tart cherry juice, kiwi, fatty fish, milk) on sleep parameters were excluded. The search was limited to objective sleep quality indices22 and the studies that examined the effects of dietary patterns on other specific sleep metrics (e.g., apnea-hypopnea index in obstructive sleep apnea) were excluded. Studies that reported only subjective sleep measures (e.g., sleep diaries, surveys) or had sleep duration as the primary outcome were also excluded. The studies that primarily investigated sleep patterns in the context of meal timing, fasting or the food quantity were excluded. Eligible studies were categorized as observational (e.g., lacking any dietary intervention) or interventional (involving one or more experimental diet given to individuals under free-living or laboratory settings). Original research articles were included in this review if they used, in combination with dietary measures, an objective assessment of sleep either by actigraphy or polysomnography. A total of 20 clinical studies (6 observational and 14 interventional) met the eligibility criteria and were included.

Figure 1:

Figure 1:

Flow diagram of the literature search and filtering results for a narrative review of the relationship between diet composition and objectively assessed sleep quality.

Objective sleep quality outcomes

An actigraph is a motion-based monitor worn on the wrist that tracks the sleep-wake states and sleep continuity using automated and validated algorithms23. Polysomnography involves recording of electroencephalography via sensors placed on an individual’s head and can identify different stages of sleep. Normal sleep architecture is comprised of non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. NREM sleep stages include N1 and N2 (i.e., “light sleep”) and N3 (i.e., “deep sleep” or “slow wave sleep”). Both slow wave sleep and REM sleep are thought to be restorative and have been implicated in a variety of waking neurobehavioral and physiological functions. Sleep latency is the length of time, in minutes, it takes to transition from wake to sleep. Wake after sleep onset (WASO) is the amount of time, in minutes, spent awake after sleep has been initiated and before final awakening. Sleep efficiency is defined as the percentage of time in bed that is spent asleep. Among adults, optimal (shorter) sleep latency (≤15 minutes), low WASO (<50 minutes), few awakenings (<4 times), high sleep efficiency (≥85%) and adequate durations of slow wave sleep (25% total sleep time) and REM sleep (20–25% total sleep time) are well-recognized indicators of good sleep quality22.

DISCUSSION

Observational studies

The literature search identified six observational studies that have objectively assessed sleep quality (Table 1). All studies had a cross-sectional design with a total sample size of 1,291 individuals. Three2426 were conducted in healthy populations with normal weight or overweight and no sleep complaints, two27, 28 included patients with obesity and obstructive sleep apnea, and one29 involved men with obesity and cardiometabolic disease risk. The majority of studies24, 2729 monitored sleep with a single night in-lab polysomnography, and two studies25, 26 used 7- to 10-days of home actigraphy. Most studies tracked dietary patterns by self-report (i.e., food diaries, validated surveys)24, 25, 2729 with one study using a smartphone application26. Only one study objectively assessed diet by weighing the food in the laboratory24. Both acute (1- to 10-days)24, 26, 27 and long-term (1- to 12-months)25, 28, 29 dietary patterns were evaluated.

Table 1.

Observational studies on the associations between diet composition and objectively assessed sleep quality

Reference, year, country Sample size Study population Study Design Sleep assessment Diet assessment Main findings
Spaeth and colleagues24, 2017, Unites States n=50 29 men and 21 women
Age: 21–50 y
BMIa: 21–28 kg/m2
Cross sectional 1-night in-lab PSGb Weighed food 1 day before and after PSG Higher protein and lower carbohydrate intake ⬄ ↑ REM sleep
Higher fiber intake⬄ ↑ slow wave sleep
Higher sugar intake ⬄ ↑ light sleep
Lower carbohydrate and higher fat intake ⬄ ↓ sleep latency
Cao and colleagues29, 2017, Australia n=784 Men with cardiometabolic disease risk
Age: 35–80 y
BMI: average ~29 kg/m2
Cross sectional 1-night home PSG Food frequency questionnaire over the last 12-month Diets rich in vegetables, fruits, and legumes ⬄ ↓ sleep latency
De Melo and colleagues27, 2018, Brazil n=45 Men with OSAc
Age: 30–55 y
BMI: >30 and <45 kg/m2
Cross sectional 1-night in-lab PSG Food diary for 3 non-consecutive days Higher protein intake ⬄ ↑ sleep efficiency
Lopes and colleagues28, 2019, Brazil n=296 Men and women with OSA
Age: 18–60 y
BMI: average ~31 kg/m2
Cross sectional 1-night in-lab PSG Food frequency questionnaire over the last 12-month Pro-inflammatory diets ⬄ ↑ daytime sleepiness, no significant associations with sleep parameters
Hashimoto and colleagues25, 2019, Japan n=80 Women only
Age: 18–27 y
BMI: average ~20 kg/m2
Cross sectional 7-day home actigraphy Diet history questionnaire during the preceding month Lower protein intake ⬄ ↓ sleep efficiency
Falkenberg and colleagues26, 2020, Australia n=36 Men AFL playersd
Age: average ~23.5 y
BMI: average ~24 kg/m2
Cross sectional 10-day home actigraphy Meal-Logger smartphone application for 10 days Higher protein intake ⬄ ↑ WASOe, ↓ sleep efficiency
Evening protein intake ⬄ ↓ sleep latency
a

BMI = Body Mass Index (weight-to-height ratio, measured in kg/m2)

b

PSG=Polysomnography

c

OSA=Obstructive sleep apnea

d

AFL=Australian Football League players (professional athletes)

e

WASO=wake after sleep onset (periods of wakefulness after a designated sleep onset, measured in minutes)

Carbohydrates and sleep quality:

Only one study by Spaeth and colleagues24 examined the associations between carbohydrate intake and sleep quality metrics. This study involved a total of 50 men and women and showed that lower carbohydrate intake was associated with shorter sleep latency and more REM sleep. The authors reported that beyond the amount of carbohydrate consumed, the quality of carbohydrate may also be relevant for sleep: more fiber intake was associated with greater deep sleep, an association confirmed by St-Onge and colleagues in their interventional study30. Spaeth and colleagues24 also noted that higher sugar intake was associated with more light sleep. Overall, the findings from this single observational study suggest that diets lower in carbohydrates are associated with better sleep quality, particularly if a greater proportion of the carbohydrates in the diet are refined carbohydrates (e.g., white flour products) as opposed to complex, or whole carbohydrates (e.g., whole-grain, etc.).

Protein and sleep quality:

Three observational studies2527 reported that protein intake is associated with sleep quality. Two studies with highly different sample populations25, 27 found a similar association between protein intake and sleep efficiency. In one study, lower protein intake was associated with low sleep efficiency among men with OSA27. In the other study involving healthy young women, Hashimoto and colleagues25 observed a 12% lower sleep efficiency with a 1.5% lower protein consumption (12.5% versus 14% of energy). Spaeth and colleagues24 observed that healthy men and women who consumed more protein had a greater percentage of REM sleep. In contrast to these studies linking higher protein intake to better sleep quality, Falkenberg and colleagues26 found higher protein consumption associated with lower sleep efficiency, more WASO, and longer sleep latency in healthy professional male athletes. However, the clinical relevance is considered minimal in this study because changes in all sleep quality metrics were less than 1%. The characteristics of participants in this study differed from the participants in the three previous studies24, 25, 27 in some important ways. These participants were athletes who consumed a very high protein diet (25% versus 13–21% of energy25, 27) and their sleep duration averaged ~8 hours per night, compared to ~6 hours per night25, 27. The lack of significant sleep changes found in these athletes is in line with findings from Zhou and colleagues31, that protein intake beyond 20% confers no additional sleep benefits.

Fat and sleep quality:

Prior observational studies with subjectively measured sleep quality32, 33 as well as some interventional studies have shown that the amount, as well as the type of fat in an individual’s diet, are associated with sleep parameters. Among the observational studies with objective sleep measures considered in this article, Spaeth and colleagues24 found that consuming more fat is associated with shorter sleep latency.

Special diets and sleep quality:

In one study of 784 men at risk of cardiometabolic disease, Cao and colleagues29 reported that “healthy diets” promoted shorter sleep latency than “unhealthy diets”. The diets in this study were characterized as “healthy” if they consisted of high amounts of vegetables, fruits, and legumes, and “unhealthy” if they contained more processed meat, red meat, snacks, and fast-food items. Many of the foods included in the healthy diet had anti-inflammatory nutrients, such as antioxidants and omega-3 fatty acids. These foods are characteristics of the Mediterranean diet, which has been associated with improved sleep quality in other epidemiological34, interventional35, 36, and observational studies37, 38. Another observational study by Lopes and colleagues28 assigned foods an inflammatory index based on known inflammatory markers39, and found that the inflammatory potential of one’s diet was associated with greater self-reported daytime sleepiness, but not with any objectively measured sleep parameters among men and women with OSA.

In summary (Table 4), observational studies utilizing objective sleep measures suggest a link between dietary composition and sleep quality. Generally, diets lower in carbohydrates particularly higher in fiber intake, are associated with better sleep quality, (i.e., more deep sleep, more REM sleep and shorter sleep latency). Diets higher (but not very high) in protein are associated with better sleep quality, marked by higher sleep efficiency both in healthy and OSA populations. Current evidence from healthy individuals and OSA patients also supports the notion that healthier diets, higher in fiber, lower in sugar, and diets rich in anti-inflammatory foods, are associated with better sleep quality. Observational studies which employ home polysomnography or actigraphy are useful as they allow for the study of an individual’s habitual dietary patterns, rather than laboratory intakes which can be influenced by various factors (e.g., food availability, type, or amount), while still providing objective sleep data. However, these studies possess some inherent limitations. First, the cross-sectional nature of studies reviewed here does not provide insights on the directionality of the associations between diet and sleep. Second, food data and sleep data were typically not collected sequentially to better interrogate the relationships. Third, dietary assessment was based on self-report in all but one study24, which is subject to bias. Finally, nearly 90% of participants in these studies were men. Given increasingly recognized sex differences in sleep disturbances40, 41, more research is necessary to investigate how diet relates to sleep quality in women.

Interventional studies

The literature search identified 14 studies that have investigated the effects of dietary interventions on objectively-measured sleep quality, of which five4246 were in-field (Table 2) and nine30, 4754 were in-lab (Table 3). The majority included individuals without obesity30, 42, 43, 45, 4749, 5153 and healthy individuals with no sleep complaints30, 4245, 4749, 5154. Only one study examined patients with OSA50 and another one46 included individuals with poor sleep quality at baseline55. All studies had a within-subject design except one46. Most studies provided controlled diets to participants in random order30, 4345, 51, 53, 54. The washout period between dietary interventions varied from 3-days53 to more than 4-weeks54. In total, sleep was measured within a home environment for 150 individuals4246 and in a research laboratory for 142 individuals30, 4754.

Table 2.

Interventional in-field studies on the effects of diet composition on objectively assessed sleep quality

Reference, year, country Sample size Study population Sleep assessment Diet intervention Main findings
Kwan and colleagues42, 1986, Great Britain n=6 Women only
Age: 20–23 y
BMIa: 19–24 kg/m2
1-night ambulatory PSG Within subject design, habitual diet followed by LC-HFb diet
7-day LC-HF diet (10% carbohydrate, 70% fat, 20% protein)
vs.
7-day Habitual diet (49% carbohydrate, 38% fat, 13% protein)
LC-HF diet ⇒ ↑ REMc latency.
Lindseth and colleagues43, 2013, United States n=44 Men and women
Age: 18–50 y
BMI: 21–28 kg/m2
4-day actigraphy Within subject design, random order, 2-week washout
4-day HC-LFd diet (56% carbohydrate, 22% fat, 22% protein)
vs.
4-day LC-HF diet (22% carbohydrate, 56% fat, 22% protein)
vs.
4-day HPe diet (22% carbohydrate, 22% fat, 56% protein)
vs.
4-day Control diet (50% carbohydrate, 35% fat, 15% protein)
HC-LF diet ⇒ ↓ sleep latency
HP diet ⇒ ↓ number of awakenings after sleep onset
LC-HF diet ⇒ no significant differences from control
Lindseth and collegueas45, 2016, United States n=36 32 men and 4 women
Age: 18–30 y
BMI: 20–31 kg/m2
4-day actigraphy Within subject design, random order, 2-week washout 4-day HC-LF diet (80% carbohydrate, 10% fat, 10% protein)
Vs.
4-day LC-HF diet (25% carbohydrate, 65% fat, 10% protein)
vs.
4-day HP diet (40% carbohydrate, 15% fat, 45% protein)
vs.
4-day Control diet (50% carbohydrate, 35% fat, 15% protein)
HC-LF diets ⇒ ↓ wake times (epoch counts)
LC-HF diets ⇒ ↓ WASO
High saturated fat⇒ ↑ wake time
High polyunsaturated fat ⇒ ↓ wake time
HP diet ⇒ no significant differences from control
Gwin and colleagues44, 2018, United States n=13 6 men and 7 women
Age: 20–32 y
BMI: 22–30 kg/m2
7-day actigraphy Within subject design, random order, 3- to 7-day washout
7-day HP breakfast (42% carbohydrate, 23% fat, 35% protein)
vs.
7-day no (“skip”) breakfast
HP breakfasts ⇒ no significant effect on sleep quality
Hudson and colleagues46, 2020, United States n=51 Men and women with poor sleepf
Age: 30–69 y
BMI: 25–39 kg/m2
12-week actigraphy Parallel design, 12-week intervention
HP diet (44% carbohydrate, 23% fat, 33% protein) plus 750 kcal/day restriction
vs.
USDAg Recommended healthy protein (50% carbohydrate, 30% fat, 20% protein) plus 750 kcal/day restriction
Caloric restriction and HP diets ⇒ no significant effect on sleep quality
a

BMI = Body Mass Index (weight-to-height ratio, measured in kg/m2

b

LC-HF=Low-carbohydrate/high-fat

c

REM=Rapid eye movement sleep

d

HC-LF=High-carbohydrate/low-fat

e

HP=High protein

f

Poor sleep was defined as Pittsburgh Sleep Quality Index sleep score ≥5

g

USDA= U.S. Department of Agriculture

Table 3.

Interventional in-lab studies on the effects of dietary composition on objectively assessed sleep quality

Reference, year, country Sample size Study population Sleep assessment Diet intervention Main findings
Philips and colleagues51, 1975, Great Britain n=8 Young men only
BMIa: normal weight
3-night PSG Within-subject design, random order, 2-week washout
2-day HC-LFb diet (84% carbohydrate, 5% fat, 11% protein) vs.
2-day LC-HFc diet (25% carbohydrate, 56% fat, 19% protein) vs.
2-day Control diet (47% carbohydrate, 43% fat, 10% protein)
HC-LF diet ⇒ ↓ slow wave sleep, ↑ REM sleep
LC-HF diet ⇒ ↑ REM sleepd
Porter and colleagues52, 1981, Great Britain n=6 Young men only
BMI: normal weight
3-night PSG Within-subject design, random order, 3-night washout
3-night Placebo supplemente (0% carbohydrate, 0% fat, 0% protein) vs.
3-night LC-HF supplement (47% carbohydrate, 47% fat, 6%) vs.
3-night HC-LF supplement (72% carbohydrate, 23% fat, 5% protein)
LC-HF supplement⇒ ↑ slow wave sleep
HC-LF supplement⇒ ↑ REM sleep, ↓ light sleep and wake
Driver and colleagues53, 1999, South Africa n=7 Men only
Age: 20–24 y
BMI: average ~23 kg/m2
3-night PSG Within-subject design, random order, 3- to 5-day washout
1-night high-energy dinner
(42% carbohydrate, 37% fat, 21% protein) vs.
1-night average-energy (control) dinner
(61% carbohydrate, 13% fat, 26% protein) vs.
1-night no dinner
No significant effect of dietary intervention on objective sleep quality
Afaghi and colleagues48, 2007, United States n=10 Men only
Age: 18–35 y
BMI: 18.5–25 kg/m2
3-night PSG Within-subject design, random order, 1-week washout
1-night High glycemic load dinner
(90% carbohydrate with glycemic load of 175, 2% fat, 8% protein) vs.
1-night Low glycemic load dinner
(90% carbohydrate with glycemic load of 81, 2% fat, 8% protein =81)
High-GLf dinner ⇒ ↓ sleep latencyg
Afaghi and colleagues47, 2008, United States n=14 Men only
Age: 18–35 y
BMI: average ~23 kg/m2
4-night PSG Within-subject design, HC-LF diet followed by VLCh diet
2-night VLC dinner (1% carbohydrate, 61% fat, 38% protein) vs
3-day HC-LF (control) dinner (72% carbohydrate, 16% fat, 13% protein)
VLC diet ⇒↑ slow wave sleep ↓ REM sleep
Yajima and colleagues49, 2014, Japan n=10 Men only
Age: average ~25 y
BMI: average ~23 kg/m2
2-night PSG Within-subject design, random order, 5 to18-day washout
1-night HC-LF dinner (80% carbohydrate, 10% fat, 10% protein) vs.
1-night LC-HF dinner (12% carbohydrate, 78% fat, 10% protein)
No significant effect of HC-LF or LC-HF dinner on whole night sleep quality
HC-LF dinner ⇒ ↓ slow wave sleep in the first sleep cycle
Trakada and colleagues50, 2014, Greece n=19 Men and women with OSA
Age: 28–69 y
BMI: 27.5-55.9 kg/m2
2-night PSG Within-subject design, light dinner followed by fatty dinner
1-night fatty dinner (20% carbohydrates, 70% fat, 10% protein) vs.
1-night light dinner (49% carbohydrates, 18% fat, 32% protein)
Fatty dinner ⇒ ↑ OSA severity but no significant effect on other sleep parameters
St-Onge and colleagues30, 2016, United States n=27 Men and women
Age: 30–45 y
BMI: 22–26 kg/m2
5-night PSG Within-subject design, random order, 3-week washout
2-day ad libitum diet
(54% carbohydrate, 32% fat with 10% saturated fat, 14% protein) vs.
4-day control diet
(53% carbohydrate, 31% fat with 7.5% saturated fat, 17% protein)
High saturated fat and low fiber⇒ ↑ light sleep ↓ slow wave sleep
Higher sugar and non-sugar/nonfiber carbohydratesi ⇒ ↑ nocturnal arousals
O’Connor and colleagues54, 2018, United States n=41 13 men and 28 women
Age: 25–37 y
BMI: 30–69 kg/m2
5-week actigraphy Within-subject design, random order, ≥4-week washout
5-week Red-Med dietj
(500 g/week of red meat, about 13% total daily protein) vs.
5-week Med-Control dietj
(200 g/week red, about 5% total daily protein)
Higher intake of red meat ⇒ ↓ WASO
a

BMI = Body Mass Index (weight-to-height ratio, measured in kg/m2)

b

HC-LF=High-carbohydrate/low-fat

c

LC-HF=Low-carbohydrate/high-fat

d

The observed increase in REM sleep was not as great as that observed after the HC-LF diet

e

methylcellulose placebo capsule

f

GL = glycemic load

g

↓↓ sleep latency when meals consumed 4-hour before bed compared to1-hour before bed

h

VLC=Very low carbohydrate

i

non-sugar/non-fiber carbohydrates=starches

j

Meals were matched for energy and other macronutrients

Carbohydrates, fat, and sleep quality:

A total of eleven30, 42, 43, 45, 4753 interventional studies manipulated the carbohydrate and fat content of participants’ diets while protein content remained constant. Consequently, high-carbohydrate diets also represent low-fat diets, and vice versa.

The interventional diet with the highest carbohydrate content (90% carbohydrate) was implemented by Afaghi and colleagues48. Researchers manipulated the glycemic load of dinners while preserving the proportion of energy from carbohydrates. Sleep latency was reduced by ~9 minutes after one night of the high-glycemic load (GL 175) dinner compared to a control dinner with low-glycemic load (GL 81). However, as the dinners were tested at both 1-hour and 4-hours before bed, with the latter meal timing proving more effective in shortening sleep latency, the effects of the glycemic load on sleep could have been influenced by meal timing.

Philips and colleagues51 showed that consuming a very high-carbohydrate/very low-fat diet (84% carbohydrate and 5% fat) for 4 days reduced slow wave sleep in healthy young men by ~18 minutes while REM sleep increased by 33 minutes when compared to a control diet (47% carbohydrate and 43% fat). A decrease in slow wave sleep was also observed, though only in the first sleep cycle, by Yajima and colleagues49 in 10 young men who were provided with a high-carbohydrate/low-fat diet (80% carbohydrate and 10% fat) for one night compared to a very low-carbohydrate/high-fat diet (12% carbohydrate and 78% fat). The researchers also reported that consuming fewer carbohydrates and more fat reduced REM sleep by ~8 minutes across all sleep cycles.

Lindseth and colleagues45 implemented a unique design involving both in-field and in-lab study periods to test high-carbohydrate, high-fat, and high-protein diets. A total of 44 men and women consumed meals in a supervised, laboratory cafeteria setting while continuing daily activities in their usual home environment, and their sleep was measured using wrist actigraphy. Researchers found a reduction in WASO for participants on the high-carbohydrate/low-fat diet (80% carbohydrate and 10% fat) compared to the control diet (50% carbohydrate and 35% fat). However, a decrease in WASO was also observed when participants were given the low-carbohydrate/high-fat diet (25% carbohydrate and 65% fat), which could potentially be explained by the type of fat being consumed, given that a decrease in WASO was also found in participants with a higher polyunsaturated fat intake (≥35% daily fat intake) compared to saturated fat.

Porter and colleagues52 reported an increase in REM sleep by ~10 minutes with a relatively high-carbohydrate/low-fat bedtime supplement (snack; 72% carbohydrate and 23% fat) as compared to a relatively low-carbohydrate/high-fat supplement (47% carbohydrate and 47% fat) given to a small sample of 6 young men. The low-carbohydrate/high-fat supplement also increased deep sleep by ~11–15 minutes when compared to either the high-carbohydrate/low-fat supplement or the zero-carbohydrate/zero-fat/zero-protein placebo supplement.

Another study by Lindseth and colleagues43 combining in-field and in-lab periods showed reduced sleep latency by ~5 minutes when participants consumed a high-carbohydrate/low-fat diet (56% carbohydrate and 22% fat) compared to a control diet (50% carbohydrate and 35% fat). Their low-carbohydrate/high-fat diet (22% carbohydrate and 56% fat) elicited no significant changes in sleep parameters relative to the control.

St-Onge and colleagues30 showed that saturated fat specifically may cause worse sleep quality. Higher saturated fat intakes among 27 healthy adults (7.5% versus 10% of energy), resulted in less slow wave sleep by ~ 5 minutes and longer sleep latency by ~12 minutes. This finding is of particular interest, because 10% of energy from saturated fat is still within the USDA’s recommended range56. However, it is estimated that the average American consumes nearly 12% of their total daily energy in the form of saturated fat16. Therefore, these detrimental effects of saturated fat on sleep quality are likely to be even more pronounced in a real-world setting than evidenced in this laboratory study.

Notably, the study by St-Onge and colleagues30 assessed the impact of self-determined dietary intakes on sleep, and therefore was more representative of usual intakes than the other studies included in this review. Researchers controlled participants intake for 4-days (53% carbohydrate, 31% fat, and 17% protein) then measured participants’ ad libitum eating for one day, where average intakes comprised 54% carbohydrate, 32% fat and 14% protein. Participants who consumed more fiber had more slow wave sleep and fewer arousals from sleep. Nocturnal arousals were higher in participants consuming more sugar and more non-sugar/non-fiber carbohydrates (e.g., starches). These findings indicate that consuming lower quality carbohydrates negatively impacts sleep quality.

The most extreme manipulation to participants’ carbohydrate and fat intake was by Afaghi and colleagues47. They showed that 3-days of very low-carbohydrate/high-fat meals (<1% carbohydrate and 61% fat) compared to 2-days of high-carbohydrate/low-fat meals (72% carbohydrate and 16% fat) increased slow wave sleep by ~15 minutes and decreased REM sleep by ~15 minutes.

Protein and sleep quality:

The associations seen between protein intake and sleep quality in observational studies24, 25, 27 were mostly supported by evidence from interventional studies. In a study done by Hudson and colleagues46 investigating 51 men and women reporting poor sleep, consuming more protein (33% versus 20% of energy) within a 12-week weight-loss diet plan (750 kcal/day restriction) caused a slight improvement in sleep efficiency of 1%. Other interventional studies have found protein intake to reduce WASO: Lindseth and colleagues43 found that 4-days of a high-protein diet (56% protein) reduced WASO in healthy adults when compared to the control diet (15% protein). Similarly, Gwin and colleagues44 found that total sleep time, but not WASO, decreased by 36 minutes in young adults consuming a high-protein (35% protein) breakfast compared to those who skipped breakfast. However, the sleep efficiency after sleep initiation was almost identical between high-protein and control conditions in this study, suggesting that the reduction in sleep time was not detrimental to overall sleep quality.

Special diets and sleep quality:

Some interventional studies tested extremes of dietary macronutrient profiles with the intention of mimicking a specific dietary regimen. For example, Afaghi and colleagues47 designed their low-carbohydrate/high-fat/high-protein experimental meals to reflect the Atkins diet and found that this dietary pattern increased deep sleep. Other studies did not include such major dietary modifications in their design. O’Connor and colleagues54 studied 41 men and women undergoing Mediterranean-style diets that varied in their amount of lean, unprocessed red meat, for a period of 12-weeks. Their so-called “Red-Med diet” provided 13% of total daily protein from beef or pork, while the “Control-Med” diet provided only 5% of total daily protein from these animal sources, and more protein from poultry and legumes. Otherwise, these two special diets were very similar, reflected a typical Mediterranean style diet, and had macronutrient proportions within a range more likely to be seen in the diets of free-living adult populations. The only sleep quality metric that differed between the two diets was WASO, which decreased by 4 minutes under the Red-Med diet. Future interventional studies of extended duration might prove useful in understanding the effects of diet on sleep quality in free-living populations, where individuals maintain dietary habits over longer periods of time.

In summary (Table 4), interventional studies are useful to indicate directionality to the relationships between diet and sleep quality. The current evidence suggest that very high- and high-carbohydrate/low-fat diets reduce sleep latency43, and WASO45, and increase REM sleep51, 52 but reduce deep sleep49, 51. By contrast, lower-carbohydrate/higher-fat diets reduce REM sleep42, 47, 49 and increase deep sleep47, 52. In the only interventional study that involved patients with OSA, fatty dinner increased disease severity, but no significant effect was observed on other sleep quality parameters. Interventional data also suggests that consuming more protein could improve sleep quality by decreasing WASO43, but whether protein influences other sleep indices requires further study. The two special diets considered here (Atkins-like47 and Mediterranean54) appear to promote better sleep quality by increasing deep sleep and reducing nightly waking, respectively. Differences in findings between studies reported above could result from multiple factors, including the type of control diets employed and attention to quality of carbohydrates and fats. Overall, studies show that improvements in sleep are observed when carbohydrates and fat are of good nutritional quality (non-refined carbohydrates and fiber and unsaturated fats).

Table 4.

Summary of current evidence on diet composition and objectively assessed sleep quality

Sleep quality indices Dietary factors associated with better sleepa Dietary factors associated with worse sleepb
Observational studies Interventional Studies Observational studies Interventional Studies
Deep Sleep High fiber intake24 High fiber intake30
Low carbohydrate diet52
Very lowc carbohydrate diet47
Highd carbohydrate diet49
Very highe carbohydrate diet51
High saturated fat intake30
REM Sleep High protein diet24
Low carbohydrate diet24
High carbohydrate diet52
Very high carbohydrate diet51
Low carbohydrate diet42
Very low carbohydrate diet47
High fat diet49
WASO High carbohydrate diet43, 45
High fat diet45
High protein diet43
Mediterranean dietf 54
Very high protein dietg 26 High sugar intake30
SOL Low carbohydrate diet24
High fat diet24
High vegetable, fruit, and legume intake29
High carbohydrate diet43
High-GI-carbohydrate intake48
Very high protein diet26
High saturated fat intake30
SE High protein diet46 Low protein diet25, 27
Very high protein diet26
a

Better sleep refers to more deep sleep, more rapid eye movement (REM) sleep, less wake after sleep onset (WASO), shorter sleep onset latency (SOL), and higher sleep efficiency (SE).

b

Worse sleep refers to less deep sleep, less REM sleep, more WASO, longer SOL, and lower SE.

c

The very low carbohydrate diet employed by Afaghi and colleagues47 was Atkins-like, with <1% carbohydrate content.

d

High carbohydrate diets had a carbohydrate content of 51–80%

e

Very high carbohydrate diets had a carbohydrate content >80%

f

Mediterranean style diet, but with red meat

g

A 25% protein intake in professional athletes.

Potential mechanisms for the influence of diet on sleep quality

The underlying mechanisms for the impact of diet on sleep quality are largely unknown, although multiple pathways have been postulated. An amino-acid, tryptophan (Trp), specifically its ratio relative to large neutral amino acids (LNAA) in the blood, appears to be a potential mediator in the connection between diet and sleep. Tryptophan is a precursor of the synthesis of the serotonin neurotransmitter and melatonin hormone, which are both integral to sleep-wake regulation. Researchers25, 48, 52 have proposed that diets that increase the Trp:LNAA ratio allow for greater synthesis of these sleep promoting factors. When Trp levels are increased, the amino acid can surpass other LNAA for transport across the blood-brain-barrier (BBB)21. Once across, Trp is converted to serotonin which in turn regulates sleep-wake. Higher carbohydrate meals are thought to increase the amount of Trp in the blood relative to other LNAA by promoting the uptake of LNAAs into skeletal muscle through an insulin mediated mechanism57. This effectively elevates the Trp:LNAA ratio and allows more Trp transport across the BBB for serotonin synthesis. There is also evidence that high-protein meals could promote sleep quality by increasing levels of plasma Trp, but only if the protein ingested does not also increase plasma levels of other LNAAs58. Zhou and colleagues31 found no difference in plasma Trp:LNAA ratio between diets containing 10%, 20% and 30% protein, and attributed this to an increase in both Trp and LNAA. Thus, it seems that a balanced diet with protein and carbohydrates, or consuming specific Trp-rich foods (e.g., beans, eggs), is most effective in improving sleep quality through Trp-mediated mechanisms. It is accepted that the effects of Trp on sleep-wake patterns depend on its transport across the BBB, and thus its levels relative to other LNAA. Yet, Trp is also converted to melatonin, via serotonin, in the pineal gland, which resides outside the BBB. Thus, the production of melatonin in the pineal gland should not be influenced by any transport competition between Trp and other LNAA across the BBB, and rather should respond directly to plasma concentrations of Trp59. More research is needed to elucidate the potential role of Trp in sleep quality as a precursor to serotonin and melatonin syntheses through BBB-dependent or -independent mechanisms.

Other humoral factors have also been postulated as mediators of improved sleep quality after certain diets. Growth hormone is primarily released during slow wave sleep, and its secretion is suppressed by carbohydrates. This has led researchers51 to suggest that very high-carbohydrate meals might reduce slow wave sleep via alterations in growth hormone. Ghrelin, an appetite stimulating hormone has been postulated as a sleep-promoting factor60. Ghrelin levels normally rise preceding a meal or during a prolonged fast, and fatty foods can further elevate ghrelin levels61. Aside from its role in energy balance, one study concluded that ghrelin was a sleep-promoting factor after observing that hourly administration of ghrelin (from 2200–0100 hours) to healthy adult men increased their deep sleep by 17 minutes62. Cholecystokinin (CCK) release is stimulated by fat intake and has been shown to promote slow wave sleep in animal models63, 64. This has not been confirmed in humans, however, there is evidence65 supporting associations between subjective feelings of sleepiness and higher CCK.

Additionally, there are Trp-independent mechanisms which invoke one’s diet for sleep promotion. Healthier diets, consisting of greater proportions of plant foods (fruits, vegetables, grains, seeds, legumes) and vegetable oils, could be associated with improved sleep quality via the synthesis and secretion of serotonin and melatonin25, 66, 67. These foods also provide exogenous serotonin and melatonin and contain higher levels of fiber. These foods promote tissue repair and brain restoration; and since there is empirical evidence68 that these processes occur during slow wave sleep, a healthy diet could encourage the body to extend its time in this sleep stage.

Finally, research has been accumulated over the past several years implicating a potential role of gut microbiome in sleep69. For example, one study70 has found that high microbiome diversity (e.g., a broad range of bacteria presence in gut) is correlated with better sleep efficiency, greater total sleep time, and less WASO. While individuals’ gut microbiota is highly personalized, there is evidence that dietary habits and patterns can cause both transient and long-term changes to an individual’s microbiota: fiber and fat content of the diet appear closely linked to changes in microbiota species, with high-fiber diets promoting and high-fat diets diminishing diversity71. This notion is in line with the evidence suggesting that diets higher in fiber and lower in fat can promote better sleep quality. More research72 may reveal microbiome as a potential target along with dietary manipulation to improve sleep quality.

SUMMARY AND FUTURE DIRECTIONS

In summary, the current evidence from observational and interventional studies suggests that healthier diets and good, objectively assessed sleep quality occur concurrently (Table 4). High (i.e., carbohydrate content >50% and < 80%) and very-high (i.e., carbohydrate content > 80%) carbohydrate diets are associated with poorer sleep quality marked by less deep sleep. However, consuming more carbohydrates is also associated with better sleep quality (i.e., more REM sleep, less WASO, and shorter SOL). Notably, carbohydrate quality (e.g., the proportion of complex versus simple carbohydrates in one’s diet) also matters in sleep quality. Consuming more fiber is associated with better sleep quality, (i.e., more deep sleep), while high sugar intakes are associated with worse sleep quality (i.e., more WASO). Similarly, fat quality is also an important consideration for sleep quality. While consuming more saturated fat is associated with poorer sleep quality, marked by less deep sleep and longer SOL, consuming healthier fats (e.g., polyunsaturated fat) is associated with better sleep quality denoted by less WASO and shorter SOL. Diets higher in protein are associated with better sleep quality, (i.e., more REM sleep, higher sleep efficiency and less WASO). When overall diet, rather than discrete macronutrients, is considered, those rich in fiber, fruits and vegetables, anti-inflammatory nutrients, and lower in sugar and saturated fat are associated with better sleep quality. Of note, three studies that were included in this review27, 28, 50 studied patients with OSA, and future research is needed to rigorously examine the effects of diet composition on objective sleep quality in OSA patients and other populations with sleep disorders. In a recent narrative review, Binks and colleagues21 examined the link between diet and sleep in healthy individuals focusing primarily on foods items and dietary supplements. The authors also briefly discussed the effects of macronutrients on subjective and objective sleep parameters referencing some studies30, 43, 45, 4749, 53 that were included in the current review and have reached similar conclusions. Notably, the current narrative review has additional studies2429, 42, 44, 46, 5052, 54 and greatly expands the discussion on the effects of macronutrient composition of diet on objective sleep quality both in healthy individuals and patients with sleep disorders. Food timing, circadian rhythms and chrononutrition are increasingly recognized as key aspects of dietary patterns, and more research exploring how these aspects of eating behaviors affect sleep quality is warranted73.

The beneficial impact of diet on objectively assessed sleep quality metrics (e.g., 5 up to 12-minute improvement in sleep latency) evidenced in the interventional studies reviewed here, could be viewed as minimal or of little clinical significance. However, it is important to note that these effects sizes are comparable to, if not exceeding, those achieved through sleep-enhancing medications74. Thus, there is a need for rigorous research in real-life settings to investigate whether dietary modification could be an alternative non-pharmacological approach for sleep improvement. Indeed, this narrative review uncovered important gaps in knowledge on the connection between diet and sleep quality that warrant further investigation. Most published interventional studies focused on extreme experimental diets, which would not be sustainable in real-life. While these laboratory studies provided insights into the associations between dietary macronutrients and objective sleep quality, they cannot inform about how diets impact objective sleep quality while individuals are living in their natural home environment. Therefore, interventional studies using whole-food diets under free-living conditions are needed to better understand how dietary patterns that align with public health recommendations influence to sleep quality. More research is also needed to elucidate the underlying biological pathways for the connections between diet and sleep quality. A better understanding of the connection between diet and sleep quality at a population level is important and can pave the way for personalized dietary interventions as a viable option to promote better sleep quality. While waiting for more evidence from future research on how diet composition relates to sleep quality, dietitians, and other healthcare providers should continue to encourage their patients to practice healthy dietary habits and educate the public on the multitude of potential benefits to maintaining a healthy diet.

RESEARCH SNAPSHOT.

Research Question:

How does diet composition relate to sleep quality assessed by objective tests?

Key Findings:

Observational studies utilizing objective sleep measures suggest that higher quality diets (e.g., higher in fiber and protein, rich in fruits and vegetables, and lower in saturated fats) are mostly associated with better sleep quality. Interventional studies indicate that higher quality diets improve objective sleep quality indices including deep sleep, REM sleep, sleep efficiency, sleep latency, and wake after sleep onset.

Funding/financial disclosure:

MPS: R35HL155670, R01HL142648, R01HL128226, and AHA 16SFRN27950012; and ET: R01 DK120312-001A1 and R01HL146127-01

Conflict of interest disclosure:

MPS has received consulting fees from PepsiCo and Nestle and grant from the National Dairy Council

Footnotes

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