Review Regarding the Dietary Interventions for Better Sleep Management

MOCANU Andreea Gabriela1, NICOLAESCU Oana Elena1, BELU Ionela1

1 Pharmacy Department I, University of Medicine and Pharmacy, 2-4 Petru Rares Str., 200349 Craiova, (ROMANIA)



Poor quality sleep has become a major concern in recent years. A number of factors that include diet, lifestyle, and workload have been associated with this problem. Sleep quality may exert a certain effect in a number of health related issues including cardio-metabolic diseases and mental disorders. 

Several strategies have been employed to improve sleep. They include reduction of external stimuli or relaxation strategies such as aromatherapy. Moreover, drug treatment is another highly used option. Studies suggest several dietary interventions that are a good alternative to these solutions. A diet low in various nutrients such as vitamins, minerals and dietary polyphenols is directly associated with poor sleep quality and sleep onset latency. Furthermore, a high consumption of confectionary and energy beverages has also been associated with poor sleep quality. 

Keywords: poor sleep quality, sleep onset latency, insomnia, Mediterranean diet, energy intake, diet, vitamins, hydroxycinnamic acids


Diet and its health impact has been a major focus. Recent studies show a bidirectional relationship between dietary factors and sleeping patterns, namely sleep quality and duration. Worldwide, poor sleep quality has been presented as an extensive public health issue. It has been reported that the average sleep duration has shortened by two hours in the last 40 years due to several factors such as lifestyle, workload and technology [1-3]. 

Sleep quality is assessed in most studies using the Pittsburgh Sleep Quality Index (PSQI) where each individual evaluates sleep duration, sleep efficiency, sleep quality, and sleep onset latency, sleep disturbances, daytime dysfunction and use of sleep medication with a score which ranges from 0 to 3. A high PSQI total score expresses a low sleep quality. Furthermore, other objective measures of sleep such as amount of slow wave sleep or duration of rapid eye movement (REM) sleep may also be used [4,5]. 

According to the National Sleep Foundation an optimal sleep duration is 7-9 hours for adults, aged 26-64 years and 7-8 hours for adults older than 65 years [6].

Sleeping habits are considered to exert a certain effect in a number of health related issues including both cardio-metabolic diseases such as diabetes or obesity and mental disorders. The mechanisms involved in this associations have not been entirely established. They include oxidative stress, inflammation, epigenetic modifications and gut microbiome. Furthermore, sleep deprivation may lead to increased C reactive protein and hypercortisolemia according to several experimental studies [3, 5,7,8].

Research studies show that unhealthy chronic sleeping patterns are linked to cognitive impairment. Moreover, results obtained in animal testing show that a long-term unhealthy sleeping behavior may determine both attenuation of synaptic efficiency and reduction of spine density [7].

Reduction of external stimuli or relaxation strategies such as aromatherapy are employed to improve sleep. Moreover, drug treatment is another highly used option. A number of studies suggest nutritional intervention as a good alternative to these solutions [3]. 

Dietary patterns and sleep quality

It has been reported that both short and long sleepers are more likely to have fewer main meals during the day and skip breakfast compared to subjects with a sleep duration of 7-8 hours [9].

Another study involving sleeping habits in Japanese female workers mentions worse sleep quality when irregular eating or skipping breakfast was involved [4]. 

High caloric intake may be associated with insomnia and poor sleep quality. Also, an increased intake of food per weight may promote longer sleep onset latency (Table 1). It has been suggested that increased ghrelin may play a role in this relationship [10]. Moreover, epidemiologic studies reported that a high total energy intake was consistent in short sleepers (5-6 hours) [6]. 

 Philips et al showed that a diet high in carbohydrates and low in fat leads to reduced sleep onset latency and slow wave sleep. Furthermore, studies suggest that a diet high in fat lowers sleep efficiency and rapid eye movement sleep and increases slow wave sleep [11, 12]. 

Previous studies have also reported that dietary proteins may affect sleep through tryptophan which is transformed into 5 – hydroxytryptophan and then to serotonin. Serotonin is further converted into melatonin which signals the onset of sleep and night time in the body. A study conducted among female Iranian students shows a link between a diet low in proteins, beans, fibers, fruits and short sleep duration [2, 3, 13].

Table I. Summary of clinical studies that assess the effects of dietary patterns on sleep quality

Study Food Subjects Key observations
Matsunaga et al. [5] Various food groups, drinks and drugs 124 male subjects, aged 19-29 years Poor sleep quality was associated with higher intake of sugar sweetened beverages and lower intake of fat soluble vitamins and iron
Katagiri et al. [4] Various food groups and drinks 3129 female subjects, aged 34 to 65 years Poor sleep quality was related with a high frequency of energy drink consumption and higher intake of noodle
Godos et al [8] Dietary (poly)phenols 2044 female and male subjects, aged above 18 years Better sleep quality was linked to higher intake of some flavonoid subclasses, lignans and phenolic acids
Jansen et al [14] Dietary patterns 4467 female subjects Higher sleep quality was associated with a fruit and vegetable based dietary pattern in mid-life women
Zuraikat et al [10] Dietary patterns 495 subjects, aged 20 to 76 years Poorer sleep quality was associated with higher food weight and lower unsaturated fat intake
Young et al [9] Dietary behavior 462 female subjects, aged 23 years About 1.00 point higher PSQI scores were observed in subjects who reported drinking one or more high-calorie coffee drinks
Matsuura et al [2] Dietary pattern 1997 subjects (940 men and 1057 women), aged 18-69 years A total of 266 women and 205 men were reported as having moderate to severe insomnia symptoms. Moderate-severe symptoms were observed in men with inadequate intakes of vitamin C, total dietary fiber and zinc.
Yajima et al [15] Comparison between a high carbohydrate and a high fat diet  10 healthy subjects Reduced slow wave sleep was determined by a high carbohydrate diet as opposed to the high fat diet.

Mediterranean diet  

The Mediterranean diet represents the dietary pattern of most people in Southern Italy. This diet is characterized by a high consumption of vegetables, fruits and nuts. Moreover, it includes fish, whole grain cereals and dairy products as the main source of carbohydrates and proteins. The Mediterranean diet is also associated with a moderate intake of alcohol (red wine) and a daily consumption of olive oil [7].

The Mediterranean diet includes foods with a high content of flavonoid subclasses (apigenin), lignans and phenolic acids (hydroxycinnamic acids). These subclasses have been shown to lower oxidative stress, reduce systemic inflammation and express anti-neuro-inflammatory properties. Furthermore, preclinical trials show that molecules such as apigenin are able to prolong sleep duration, decrease locomotor activity and potentiate sleep onset. Moreover, dietary polyphenols have been associated with improved resilience after sleep deprivation [7,8,16,17].

Several studies show that the Mediterranean diet may also benefit patients in the management of several conditions such as diabetes, depression, cardiovascular disorders, obesity and dementia. Epidemiological studies demonstrate that a high consumption of foods rich in hydroxycinnamic acids and flavanones lowers hypertension incidence. It has also been reported that a high adherence to the Mediterranean diet shows beneficial effects in increasing physical function and reducing pain in patients living with rheumatoid arthritis [7,8,18,19,20]. 

Sources that are high in apigenin include parsley, oregano, chamomile, celery and artichokes. Red wine is also a source that contains apigenin. The main sources for hydroxycinnamic acids are apple, pears, cherries, plums, kiwis, blueberries, artichokes, carrots, lettuce, eggplant and wheat [21].


Vitamins such as vitamin A, C, E and beta carotene have an antioxidant effect. Sleep regulation has been associated with oxidative stress, according to previous studies. Moreover, studies have reported an association between poor sleep and lower intakes of alpha tocopherol, beta carotene equivalents, retinol equivalents, vitamin K and vitamin B1. A preclinical trial reported that a vitamin A deficient diet determined lower deep sleep during non-REM sleep in mice. The best sources of alpha tocopherol are seeds, nuts and vegetable oil. In addition, carrots, apricots, sweet potatoes, cantaloupe are rich in beta carotene. Vitamin K sources include fermented soy beans and green leafy vegetables such as kale, spinach, turnip greens and lettuce [5, 22].


Calcium low intake has been linked with difficulty of falling asleep and sleep maintenance issues according to a US study [2].

Low levels of magnesium may determine moderate to severe insomnia symptoms. Magnesium helps in maintaining healthy levels of GABA, thus improving sleep quality. A study conducted on 46 elderly subjects showed that an intake of 500 mg for 8 weeks improved early morning awakening, sleep deficiency, sleep onset latency and sleep duration. Food sources high in magnesium are represented by nuts, seeds, seafood such as salmon and vegetables. Calcium rich foods include tofu, edamame, milk, cheese, yogurt and green leafy vegetables such as broccoli and cabbage [22,23]. 

Trace minerals

A lower intake of both iron and zinc has been related to poor sleep quality. A study conducted on Japanese subjects reported that participants with moderate to severe insomnia symptoms had a considerably lower intake of zinc and iron compared to those with no insomnia symptoms. Furthermore, sleep quality in patients with iron deficiency anemia is reportedly lower. This may be determined by the implication of iron in the dopamine system, which plays a role in sleep regulation.  Seafood and vegetables, specifically spinach, sweet potatoes, kale, have a high content of iron. Meat and shellfish are excellent sources of zinc [2,5].

High caloric beverages and confectionary

High calorie coffee drinks consumption determined a longer sleep latency in a US study that included young adult women, aged 23. Another study conducted on Thai students showed that drinking one stimulant drink per week will increase the possibility of poor sleep quality by 50%. Furthermore, a high PSQI score was linked to the consumption of caffeinated beverages, alcohol and energy drinks [9]. Moreover, a high intake of soda and soft drinks may determine a shorter sleep duration, according to a Korean study [24]. Matsunaga et al determined that a higher intake of sugar-sweetened beverages leads to poor sleep quality [5]. This has all been confirmed by Katagiri et al who also mentions that high confectionary intake lowers sleep quality in Japanese women [4]. 


Diet is highly linked to sleep quality and sleep onset, with studies showing a bidirectional relationship between them. Moreover, sleep quality and duration may play a certain role in cardio-metabolic diseases and mental disorders. Dietary carbohydrates, proteins and fat all exert a certain effect in sleep quality and sleep onset latency.  

A high adherence to the Mediterranean diet not only improves sleep quality by prolonging sleep duration and potentiating sleep onset, but it may also help in the management of several conditions such as cardiovascular disorders, diabetes, depression and metabolic disorders such as obesity. Furthermore, the Mediterranean diet is high in polyphenols, which have been shown to lower oxidative stress, reduce systemic inflammation and express anti-neuro-inflammatory properties.

A diet low in vitamins that include alpha tocopherol, beta carotene equivalents, retinol equivalents, vitamin K and minerals such as calcium, magnesium, zinc and iron has been associated with poor sleep in a number of studies. Furthermore consumption of caffeinated beverages, alcohol and energy drinks has been reported to determine poor sleep quality.

Thus, a balanced diet with a high intake of micronutrients and a low intake of both confectionary and energy beverages may promote better sleep quality. 

Author Contributions: All authors have equally contributed to the work reported.


  1. Pot, G. (2017). Sleep and dietary habits in the urban environment: the role of chrono-nutrition. Proceedings of the Nutrition Society 77(3), pp. 189-198.
  2. Matsuura, N., Saito, A., Takahashi, O., Rahman, M., Tajima, R., Mabashi-Asazuma, H. (2020).  Associations between nutritional adequacy and insomnia symptoms in Japanese men and women aged 18–69 years: a cross-sectional study. Sleep Health 6(2), pp. 197-204.
  3. Sutanto, C., Wang, M., Tan, D., Kim, J. (2020). Association of sleep quality and macronutrient distribution: a systematic review and meta-regression. Nutrients 12(1), pp. 126.
  4. Katagiri, R., Asakura, K., Kobayashi, S., Suga, H., Sasaki, S. (2014). Low intake of vegetables, high intake of confectionary, and unhealthy eating habits are associated with poor sleep quality among middleaged female Japanese workers. Journal of Occupational Health 56(5), pp. 359-368.
  5. Matsunaga, T., Nishikawa, K., Adachi, T., Yasuda, K. (2020). Associations between dietary consumption and sleep quality in young Japanese males. Sleep and Breathing. [published online ahead of print]
  6. Dashti, H., Scheer, F., Jacques, P., Lamon-Fava, S., Ordovás, J. (2015). Short sleep duration and dietary intake: epidemiologic evidence, mechanisms, and health implications. Advances in Nutrition 6(6), pp. 648-659.
  7. Godos, J., Castellano, S., Marranzano, M. (2019). Adherence to a Mediterranean dietary pattern is associated with higher quality of life in a cohort of Italian adults. Nutrients 11(5), pp. 981.
  8. Godos, J., Ferri, R., Castellano, S., Angelino, D., Mena, P., Del Rio, D. (2020). Specific Dietary (Poly)phenols Are Associated with Sleep Quality in a Cohort of Italian Adults. Nutrients 12(5), pp. 1226.
  9. Young, D., Sidell, M., Grandner, M., Koebnick, C., Troxel, W. (2020). Dietary behaviors and poor sleep quality among young adult women: watch that sugary caffeine!. Sleep Health 6(2), pp. 214-219.
  10. Zuraikat, F., Makarem, N., Liao, M., StOnge, M., Aggarwal, B. (2020). Measures of poor sleep quality are associated with higher energy intake and poor diet quality in a diverse sample of women from the go red for women strategically focused research network. Journal of the American Heart Association 9(4).
  11. Phillips, F., Crisp, A., Mcguinness, B., Kalucy, E., Chen, C., Koval, J.  (1975). Isocaloric diet changes and electroencephalographic sleep. The Lancet 306(7938), pp. 723-725.
  12. St-Onge, M., Mikic, A., Pietrolungo, C. (2016). Effects of Diet on Sleep Quality. Advances in Nutrition 7(5), pp. 938-949.
  13. Haghighatdoost, F., Karimi, G., Esmaillzadeh, A., Azadbakht, L. (2012). Sleep deprivation is associated with lower diet quality indices and higher rate of general and central obesity among young female students in Iran. Nutrition 28(11-12), pp. 1146e1150. 
  14. Jansen, E., Stern, D., Monge, A., O’Brien, L., Lajous, M., Peterson, K. (2020). Healthier dietary patterns are associated with better sleep quality among mid-life Mexican women. Journal of Clinical Sleep Medicine [published online ahead of print]
  15. Yajima, K., Seya, T., Iwayama, K., Hibi, M., Hari, S., Nakashima, Y., Ogata, H., Omi, N., Satoh, M., Tokuyama, K. (2014). Effects of nutrient composition of dinner on sleep architecture and energy metabolism during sleep. J Nutr Sci Vitaminol (Tokyo) 60(2), pp. 114–121
  16. Ciulu-Costinescu, F., Chifiriuc, M.C., Popa, M., Bleotu, C., Neamtu, J., Averis, L.M.E., Bubulica, M.V., Simionescu, A., Aldea, I.M., Belu, I. (2015). Screening of polyphenol content and in vitro studies of antioxidant, antibacterial and cytotoxic activities of Capsicum Annuum extracts. Revista de Chimie 66, pp. 1261-1266
  17. Rotaru, L., Varut, R., Banicioiu Covei, M., Costache, I., Novac, M., Nicolaescu, O., Florescu, C., Petrica, A., Kostici, R., Ciobanu, D. (2018). Determination of Antioxidant Components and Activity of Tamarix ramosissima Comparative with Vaccinium myrtillus on Streptozotocin-diabetic Mice. Revista de Chimie 69(7), pp.1860-1865.
  18. Forsyth, C., Kouvari, M., D’Cunha, N., Georgousopoulou, E., Panagiotakos, D., Mellor, D. (2017). The effects of the Mediterranean diet on rheumatoid arthritis prevention and treatment: a systematic review of human prospective studies. Rheumatology International 38(5), pp. 737-747.
  19. Dărmănescu, D., Mihele, D., Dogaru E., Cocu, F. (2010). Experimental evaluation of some biochemical parameters after administration of fatty acids ethanolamides from extra virgin olive oil in rats. Farmacia 58(2), pp. 228-236
  20. Neguț, C., Pintilie, L., Tănase, C., Udeanu, D.I., Drăghici, C., Munteanu, C., Moroșan, E. (2018). Oleic acid amides with potential pharmacological effects in the overweight treatment. Revista de Chimie 69(5), pp. 790-794
  21. El-Seedi, H., El-Said, A., Khalifa, S., Göransson, U., Bohlin, L., Borg-Karlson, A. (2012). Biosynthesis, natural sources, dietary intake, pharmacokinetic properties, and biological activities of hydroxycinnamic acids. Journal of Agricultural and Food Chemistry 60(44), pp. 10877-10895.
  22. Daneshzad, E., Keshavarz, S., Qorbani, M., Larijani, B., Azadbakht, L. (2020). Dietary total antioxidant capacity and its association with sleep, stress, anxiety, and depression score: A cross-sectional study among diabetic women. Clinical Nutrition ESPEN 37, pp. 187-194.
  23. Rondanelli, M., Opizzi, A., Monteferrario, F., Antoniello, N., Manni, R., Klersy, C. (2011). The effect of melatonin, magnesium, and zinc on primary insomnia in long-term care facility residents in Italy: a double-blind, placebo-controlled clinical trial. Journal of the American Geriatrics Society 59(1), pp. 82-90.
  24. Min, C., Kim, H.J., Park, I.S. (2018). The association between sleep duration, sleep quality, and food consumption in adolescents: A cross-sectional study using the Korea Youth Risk Behavior Web-based Survey. BMJ Open 8, pp. e022848.