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How to Improve Sleep Efficiency for More Restful Nights

Written by Dr. Michael Ruscio, DC on April 21, 2025

Written by Dr. Michael Ruscio, DC on April 21, 2025 — Reviewed by Hannah Wright

• What Is Sleep Efficiency?|
• Signs of Low Sleep Efficiency|
• Tracking Sleep Efficiency|
• Increasing Sleep Efficiency|

Sleep isn’t just rest—it’s one of the most powerful tools we have for maintaining a healthy body and mind. While we’re asleep, our brains clear out waste products that could otherwise build up and become toxic. Sleep also helps reduce inflammation and oxidative stress, both of which are linked to chronic disease. 

It’s no wonder, then, that regularly sleeping less than 6 hours or more than 9 hours is linked to reduced brain volume and a decline in cognitive abilities like memory, reaction time, and problem solving 1. Simply put, the quality and quantity of your sleep may shape the quality of your life.

What Is Sleep Efficiency?

To understand sleep efficiency, we first need to understand what sleep quality is. Sleep quality is how satisfied you feel with your overall sleep experience. It includes four main parts 2: 

• How efficiently you sleep (sleep efficiency)
• How long it takes you to fall asleep (sleep latency)
• How long you sleep (sleep duration)
• How often you wake up during the night (wake after sleep onset)

Sleep efficiency is a measure of how much time you actually spend asleep compared to the total time you’re in bed. Total time in bed includes the time it takes to fall asleep, any time you wake up during the night, and the time you spend trying to fall back asleep after waking up for the last time. 

The sleep efficiency equation looks like this 3:

• (Time spent sleeping) ÷ (Total time spent in bed) x 100 = Sleep efficiency %

A higher sleep efficiency score means you’re getting more restful sleep while you’re in bed. For example, 7.5 hours spent sleeping during 9 hours in bed would get a sleep efficiency score of about 83%. 

Calculating your sleep efficiency provides a clearer idea of how well you’re sleeping, and tracking it allows you to see your progress as you improve your sleep. 

What’s the Difference Between Sleep Latency & Sleep Efficiency?

Sleep latency refers to how long it takes you to fall asleep after getting into bed. A shorter sleep latency means you fall asleep quickly, while a longer one may indicate you have a hard time winding down.

In contrast, sleep efficiency is the percentage of time you actually sleep during the total time you spend in bed. If your sleep efficiency is high, you spend most of your time in bed actually sleeping. If it’s low, it means you wake up often or otherwise spend a lot of time awake.

Let’s take a more detailed look at sleep efficiency, how it changes as we age, signs of low sleep efficiency, and the best ways to increase it. 

What Causes Poor Sleep Efficiency?

One thing researchers know for sure is that aging can affect sleep efficiency. As we get older, sleep efficiency decreases, causing more frequent wake-ups and lighter sleep 3. 

Although other factors besides age almost certainly have an effect on sleep efficiency, researchers have yet to uncover them. Meanwhile, we know that many factors can affect your sleep—and we can presume they also affect sleep efficiency. For example:

• Stress & Anxiety – Increased cortisol levels can make it harder to fall and stay asleep.
  
• Poor Sleep Environment – Noise, light, feeling too warm or too cold, and uncomfortable bedding can reduce sleep quality.
  
• Irregular Sleep Schedule – Going to bed and waking up at different times can disrupt your circadian rhythm.
  
• Too Much Screen Time – Blue light from phones, laptops, and TVs may suppress melatonin production, delaying sleep onset. 
• Caffeine & Alcohol – Caffeine can keep you alert, while alcohol may cause fragmented sleep.
  
• Medical Conditions – Sleep apnea, restless leg syndrome, and other health issues can lead to disrupted sleep.
  
• Medications – Certain medications, such as stimulants (like Adderall or Ritalin for ADHD) or diuretics (like hydrochlorothiazide or furosemide for heart problems), can interfere with sleep patterns.
  
• Lack of Physical Activity – Regular exercise promotes better sleep, whereas a sedentary lifestyle can contribute to poor sleep efficiency.

As you can see, many factors may affect sleep efficiency. Addressing these issues can help improve your overall sleep quality.

What Is a Good Sleep Efficiency Score? 

When it comes to sleep efficiency, the higher, the better. If you fell asleep as soon as your head hit the pillow and didn’t wake up for a full eight hours, that would be 100% sleep efficiency.

That’s next to impossible for most people, so we want to aim for the next best thing. 

A normal sleep efficiency score for adults is 85–89% 4. I would consider anything above 90% very healthy.

Here are some sleep efficiency scores for reference. Where might you fall on an average night of sleep?

Sleep efficiency below 85% is considered poor. Some research suggests that consistently having sleep efficiency below 80% may increase the risk of dementia and death in older adults 1 5,  but if you’re at 85% or above, you don’t need to worry 4.

Signs You May Have Low Sleep Efficiency

Of course, having sleep disorders like insomnia and sleep disruptions throughout the night (such as with a newborn) will likely compromise your sleep efficiency. 

But there can be subtler signs of low sleep efficiency that are easy to miss. For example, snoring or restricted breathing can seriously impact sleep quality and probably efficiency, but many people aren’t even aware they have these issues. 

Waking up feeling tired and daytime sleepiness are also signs of poor sleep quality and may suggest that you’re experiencing sleep disruptions you don’t recall. 

How to Track Your Sleep Efficiency

Polysomnography (PSG): Sleep Testing

Understanding your sleep efficiency starts with accurate tracking. The gold standard for sleep analysis is polysomnography (PSG)—a clinical sleep study that measures multiple physiological signals, including:

• Brain waves
• Breathing patterns and oxygen levels
• Heart rate and muscular activity
• Eye movements and body position

However, PSG requires an overnight stay in a sleep clinic, where unfamiliar surroundings and monitoring equipment can affect your sleep quality. For a more practical approach, at-home consumer sleep trackers (CSTs) offer an accessible alternative.

At-Home Sleep Trackers: Ranked by Science

Research comparing sleep trackers with PSG (sleep testing) shows that their accuracy varies, but certain devices perform well in specific sleep metrics. One study analyzed 11 popular CSTs, including 6:

• Wearables like Oura Ring 3, Fitbit Sense 2, and Apple Watch 8
• Nearables like Withings Sleep Tracking Mat and Amazon Halo Rise
• Airables like SleepScore, SleepRoutine, and Pillow 

Since you’re here, you may be considering getting a sleep tracker. Let’s break down what the study found so you can make the most informed decision. 

Each device was evaluated across several key metrics to determine its accuracy in tracking different aspects of sleep:

• Wakefulness: How accurately the device detects when you’re actually awake during the night
• REM Sleep: The device’s ability to identify REM (rapid eye movement) sleep, which is important for memory and emotional regulation
• Deep Sleep: Detection of slow-wave sleep, the most physically restorative stage
• Sleep Latency: How well the device estimates how long it takes you to fall asleep
• Sleep Efficiency: The percentage of bedtime actually spent sleeping

Devices that performed well across multiple areas were ranked higher overall.

Top-Ranked Devices

SleepRoutine (Airable)

SleepRoutine outperformed other devices in detecting wakefulness, REM, and sleep latency. Its ability to provide accurate sleep-stage tracking without requiring wearables makes it a top contender for those seeking precise data without additional devices.

Oura Ring 3 (Wearable)

The Oura Ring consistently provided strong performance in tracking sleep-wake cycles, heart rate variability, and deep sleep. It stands out as a user-friendly, unobtrusive wearable for those looking to gain actionable insights into their sleep without the bulk of a larger device.

Mid-Tier Devices

Galaxy Watch 5 (Wearable)

The Galaxy Watch 5 performed well in sleep efficiency and deep sleep but did not consistently track other metrics as accurately as the top-tier options. Still, it’s a solid option for Android users looking for a smartwatch that also monitors sleep.

Google Pixel Watch (Wearable)

The Pixel Watch performed strongly in deep sleep and sleep efficiency but lacked the overall consistency of top performers in wakefulness and REM detection. It offers a sleek design and works well within the Google ecosystem but isn’t the most reliable for in-depth sleep tracking.

Fitbit Sense 2 (Wearable)

The Fitbit Sense 2 delivered reliable sleep tracking with a particular strength in sleep stages and oxygen levels. However, its deep sleep tracking was less accurate compared to the best performers, and it may not offer the most precise data for users seeking detailed sleep insights.

Apple Watch 8 (Wearable)

While the Apple Watch 8 offers a comprehensive health suite and tracks sleep, its performance in sleep latency and wakefulness was less consistent. It’s a solid option for those already in the Apple ecosystem, but it’s not the best choice for highly accurate sleep data.

Lower-Ranked Devices

Pillow (Airable)

Pillow consistently ranked among the least accurate in several key areas, including wakefulness and REM sleep detection. While it’s easy to use with an iOS app, it doesn’t provide the reliable insights needed for users who are serious about tracking sleep.

Google Nest Hub 2 (Nearable)
The Google Nest Hub 2 is a contactless device that integrates well with other Google smart home products, but it underperformed significantly in tracking wakefulness and REM. It’s a convenient option for casual users, but its sleep tracking is far from precise.

Amazon Halo Rise (Nearable)
The Halo Rise offers a hands-off sleep tracking experience but struggles with REM detection and other key metrics. While it can work well for users seeking general trends, it’s not the most reliable for detailed sleep analysis.

While consumer devices won’t match the precision of a lab-based sleep study, this ranking helps highlight which options come closest in scientific rigor. Of course, budget and user-friendliness also play a role. Taking those factors into account, here are our top picks for at-home sleep trackers:

Best Ways to Increase Sleep Efficiency

If your baseline sleep efficiency score is lower than you’d like, how can you go about improving it? 

Here’s a quick overview of the most helpful treatments in sleep medicine, according to high-quality research: 

• Cognitive behavioral therapy for insomnia (CBT-I), in person and online 7
• Exercise 8
• Acupuncture 9
• Positional therapy and oral appliances like CPAP (for obstructive sleep apnea) 10
• Listening to calming music at bedtime 9 
• Taking a warm bath before bed 11

Developing the following good sleep habits can also help you get better sleep and regulate your circadian rhythm (which has health benefits beyond feeling well rested):

• Wind down your activity at least an hour before bed.
• Dim the lights at night.
• Put yourself on a sleep schedule with a regular lights-off and wake-up time.
• Keep a sleep diary each day to track your progress. 

Though less well-researched, other promising treatments for better sleep overall include:

• Using bluelight-blocking glasses in the hours before bed 12
• Lemon balm supplements 13
• Tryptophan supplements 14
• Cooler air temperature (like 60–68℉) 15
• N-acetylcysteine supplements (for obstructive sleep apnea) 16

As a quick note, treatments that did not improve adults’ sleep efficiency in high-quality studies include:

• Melatonin 17 (despite improving sleep disorders and time to fall asleep, melatonin may not have the same effect on sleep efficiency) 
• Omega-3 fatty acids 18
• Trazodone 19

Take Steps to Improve Your Sleep Quality

Sleep efficiency can be one marker we may be tempted to fixate on, possibly to our detriment overall. Sleep health is critical, but the difference between 97% efficiency and 99% is too small to worry about. 

If you want to know more about my first-hand experience, I did a full episode of Dr. Ruscio Radio on my journey to sleep optimization, including the testing I did and the misleading advice I received along the way. 

You can also contact us at the Ruscio Institute for Functional Medicine for one-on-one guidance regarding how to improve inconsistent or poor sleep.

The Ruscio Institute has developed a range of high-quality formulations to help our clients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you. The information on DrRuscio.com is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.