What is meant by sleep quality? How can it be monitored? And what useful information can be extracted from sleep monitoring? Ginevra Pignata, psychologist and neuroscientist specializing in sleep disorders, and Alberto Cerasari, sports physician and Medical Director of SoLongevity, help us answer these questions and understand how the SoLongevity program works in practice. And also what the added value is of monitoring carried out under expert supervision, compared with what a simple smartphone app can offer.
Test e Riprogrammazione del Sonno
Dr. Pignata, why is a smartphone not enough to measure sleep quality?
“Smartphones are certainly very interesting, they provide potentially useful indications, which, however, will never be as precise and sensitive as those that can be provided by an actigraph, the medical device we use at SoLongevity.
In addition, most smartphone apps are not scientifically validated for assessing sleep disorders. There is also the question of the positioning of the device, which can be imprecise and may lead to incorrect readings. Let’s say that the purposes of a smartphone are different from those of validated medical devices”.
What is an actigraph and what does it measure?
“The actigraph provides us with objective and precise data, allowing us to make an actual clinical assessment. In detail, it contains sensors that allow us to monitor both movements and variations in body temperature. Both of these parameters are correlated not only with the alternation of waking and sleeping states, but also with the different phases that make up the sleep cycle itself.
In addition, the sensors of the actigraph we use at SoLongevity are connected to a machine learning algorithm that has been trained on data obtained through polysomnography, that is, through electroencephalogram monitoring of the brain waves that characterize the various phases of the sleep cycle. This, in essence, allows us to make correlations to extract the same information — or almost — that a polysomnograph provides from the data obtained with the actigraph.
For example, the device we use allows us to monitor sleep latency, that is, the time it takes to fall asleep, but also the alternation of deeper and lighter sleep states, the number and duration of any nighttime awakenings, and total sleep duration. It also allows us to estimate the levels of melatonin present during the day, the hormone that regulates the sleep-wake cycle, to understand whether the patient needs supplementation or not. Among other things, it should be remembered that the device we use is certified class 1 and is registered with the Ministry of Health, so it is a medical device in every respect”.
How does the sleep monitoring phase work?
“The actigraph is essentially a bracelet that is configured at the clinic according to the specific parameters to be monitored. Once placed on the wrist, the patient must wear it continuously for a week, obviously while carrying out all their normal daily activities.
It is a very comfortable device, which has also been validated for comfort and is specifically designed not to disturb either sleep or the activities normally carried out while awake. Wearing it during the day too is necessary to have a complete overview of how the patient’s daily life is actually structured, for example to get an idea of the regularity with which the various activities are carried out, or of how much physical activity they do and at what time of day”.
Sleep disorders are in fact defined as “24-hour disorders”, to emphasize that they do not concern only the hours spent sleeping, and that information on waking hours is also needed to assess them.
What happens after the sleep monitoring period?
“After the monitoring phase and the assessment of the data obtained with the actigraph, we move on to the sleep reprogramming phase. That is, a series of strategies and interventions are proposed to restore a healthy and efficient sleep-wake rhythm, with the aim of improving both the quantity and the quality of rest”.
By “quality of rest” we mean, for example, sleep continuity, latency, which should be less than 30 minutes, and also so-called sleep efficiency, which is the percentage of hours actually spent sleeping out of the total spent in bed. The latter should not be lower than 85%.
What does reprogramming consist of?
“It is not a matter of forcing sleep, because that would not be physiological; rather, we try to rebalance the patient’s biological clock. This is done first of all by explaining some fundamental principles, which may seem obvious but are not always so. For example, some patients describe their bed as their daytime home, in the sense that they carry out all their daily activities from bed or in any case in the bedroom: this is a habit that absolutely must be corrected.
Another important thing is to set times, to try to be regular, and also to create an optimal environment for sleep, for example by adjusting the bedroom temperature. An environment that is too warm, in fact, does not help the physiological cooling the body undergoes as it enters the deeper phases of sleep. It is also essential to eliminate sources of blue light before going to sleep, therefore screens, and to limit exposure as much as possible during the day too. By acting on the screen settings of a PC or phone, for example, it is possible to reduce the blue component of the light emitted.
Another important aspect is nutrition: in addition to avoiding very heavy dinners, SoLongevity’s nutritionists can recommend specific foods that promote digestion and therefore also relaxation and falling asleep. In general, ours is a multidisciplinary approach, involving the collaboration of various experts, each of whom provides their own important contribution”.
Dr. Cerasari, what treatments can patients access following or in parallel with the sleep test?
“First of all, we have diversified the check-ups, starting from one premise: one can work on prevention and enhancement on the one hand, and on a therapeutic front on the other.
In the first case we are talking about people who would like to improve their work or sports performance, for example. In this sense we have developed a pathway that involves working with a multidisciplinary team and undergoing laboratory tests, in order then to integrate and plan tailored enhancement interventions.
The other front concerns pre-pathological or already pathological conditions, genetic-familial predispositions, or the need to manage so-called “cofactors” such as stress, anxiety and sleep disorders. In this case different professionals are also involved: from the neurologist, to the neuroscientist — in the person of Dr. Pignata — to a team of neuropsychologists who deal with cognitive assessment and cognitive training.
Finally, there is the aspect of gender medicine and of conditions typical of women such as menopause. We have therefore diversified the pathways between men and women, with increasingly targeted and personalized offerings”.
