Sleep Better Without Pills: What Type of Physical Activity Improves “Sleep Architecture” in Disorders

The researchers conducted a systematic review and network meta-analysis of randomized trials to compare which types and “doses” of exercise best improve key parameters of “sleep architecture” in adults with sleep disorders. Unlike “subjective” sleep quality, this is about objective metrics: sleep efficiency (SE), wakefulness after sleep onset (WASO), and the proportion of deep (slow-wave) sleep (SWS). It turned out that exercise in general does restructure sleep in a healthier direction, and the best combination is moderate-intensity aerobic exercise at the right frequency and duration.

Background of the study

Sleep disorders, from chronic insomnia to obstructive sleep apnea, are widespread and are associated not only with subjective “sleep quality,” but also with objective sleep architecture: sleep efficiency (SE), wakefulness after sleep onset (WASO), and the proportion of slow-wave sleep (SWS). These metrics predict daytime sleepiness, cognitive decline, and cardiometabolic risks, so interest in non-pharmacological ways to improve them is steadily growing. One such way is traditionally considered regular physical activity, which in a number of studies has been associated with higher SE, lower WASO, and an increase in SWS, although the results between studies often diverge due to differences in the design, intensity, and duration of training.

In sleep apnea, physical training demonstrated a moderate reduction in the severity of the disease and an improvement in some sleep parameters even without significant weight loss, which hints at additional mechanisms (strengthening of the respiratory muscles, influence on the autonomic nervous system, etc.). However, the effect on sleep architecture as such has been studied fragmentarily: individual RCTs and meta-analyses have shown an increase in the proportion of N3/SWS with programs longer than 12 weeks, but there have been no unified “recipes” for the type and “dosage” of exercise so far.

In clinical guidelines for chronic insomnia, cognitive behavioral therapy (CBT-I) remains the gold standard, while drugs were considered an option when non-drug approaches were ineffective. Against this background, exercise is a potentially accessible and safe adjuvant to basic therapy, but in order to integrate it into practice, it is necessary to understand which format (aerobic, strength, “mind-body”), what intensity and how many weeks gives the greatest increase in SE/SWS and a decrease in WASO in patients with different sleep disorders.

This is the gap that a new systematic review and network meta-analysis of RCTs in Sleep Medicine addresses: the authors compared different exercise modalities and parameters in adults with sleep disorders, focusing not on self-reports but on objective measures of sleep architecture. This approach allows for ranking exercise options and outlining practical guidelines for clinicians and patients, where exercise becomes not just a “healthy habit,” but a structured intervention with a measurable effect on sleep.

Who checked it and how?

The team analyzed 18 RCTs involving 1,214 adults with various sleep disorders (including insomnia and obstructive sleep apnea). Classical meta-analyses and Bayesian network meta-analysis (NMA) were performed according to uniform protocols, and the robustness of the findings was tested using subgroup analyses. The quality of evidence was assessed using GRADE, and the risk of systematic errors was assessed using Cochrane RoB 2.0. This design allows different training formats (aerobics, strength, mind-body, etc.) to be “brought together in the ring” and their effectiveness ranked.

Main results

In total, the exercises:

• Increases sleep efficiency (SE): mean increase ≈ +2.85 pp (95% CI 0.85-4.84).
• Reduces nocturnal awakenings (WASO): ≈ -10 minutes (95% CI -15.68…-4.64).
• Increases the proportion of deep sleep (SWS): ≈ +2.19 pp (95% CI 0.35-4.03).

And what worked best in terms of type and “dose”?

• For SE and WASO, moderate-intensity aerobic exercise (MIAE) is optimal.
• Increased SWS required more frequent training: ≥ 4 times/week, with the effect being particularly pronounced in people with obstructive sleep apnea (OSA).
• On the timeline, the best changes in SE and WASO were achieved with short programs of 8-12 weeks with 3 sessions/week of 45-60 minutes.

What does this mean in practice?

The researchers’ conclusion is extremely practical: start with moderate-intensity aerobic exercise, and adjust the weekly structure to your goal. If your main goal is to “sleep more soundly and wake up less,” prioritize MIAE 3×/week for 45-60 min for 8-12 weeks. If your goal is to deepen slow-wave sleep, add up to 4 or more sessions per week (especially for OSA, where SWS is often compromised). This is consistent with earlier reviews, where exercise consistently improved sleep quality in patients with insomnia, and formats like walking/jogging, yoga, or tai chi showed the best effects in individual groups.

What "intensity" is considered moderate

A practical guideline for most healthy adults is an activity level that allows short speech but makes singing difficult (target RPE 12-13/20 or ~64-76% of HRmax; exact targets are individualized). Typical examples of MIAE include brisk walking, light jogging, swimming, cycling, and dance classes. If you have concomitant illnesses or OSA, consult a sleep/exercise therapist for an activity plan. (This is general information, not medical advice.)

Mini-guide: how to build a "sleepy" program (with examples)

• If you are awakened by night awakenings (WASO):
  • 3×/week MIAE for 45-60 min (for example, Mon/Wed/Fri brisk walking or cycling), course 8-12 weeks.
  • Adding morning light and a consistent wake-up time enhances the effects of exercise on the circadian rhythm.
• If there is a lack of “depth” sleep (SWS), especially with OSA:
  • Increase frequency to ≥ 4×/week; shorter sessions (30-40 min) are acceptable if the overall week is dense.
  • Monitor your CPAP mask/equipment: The combination of training and proper therapy provides the combined benefits.
• If you're just starting out:
  • Start with 20-30 min MIAE, gradually increasing to 45-60 min; the goal is regularity, not an “ideal” number on the first day.
  • Keep a sleep diary (or tracker) and record SE, WASO, subjective well-being once a week.

Why Exercise Works on Sleep

Aerobic exercise modulates homeostatic sleep pressure (sleepiness accumulation), improves thermoregulation and parasympathetic tone at night, modulate circadian signals via daylight/activity, and reduces behavioral hyperarousal that reinforces insomnia. For OSA, training helps reduce body weight, strengthens respiratory muscles, and may reduce sleep fragmentation, opening a “window” for increased SWS. The new analysis adds quantitative benchmarks for which frequency and duration are particularly productive.

Important limitations

This is a review of RCTs, but heterogeneity in diagnoses, age, training format, and sleep measurement methods remains. Some studies used actigraphy, some used polysomnography; co-interventions (e.g., cognitive behavioral therapy for insomnia) may have differed across samples. Finally, network meta-analysis provides probability rankings rather than a “timeless championship”: individual preferences, availability, and tolerability still matter. Nevertheless, the consensus on the benefits of exercise for sleep disorders is strong and is supported by recent reviews in other journals. PubMedebm.bmj.com

Study source: Wang P., Chen Y., Zhang A., Xie C., Wang K. Comparative efficacy of exercise modalities on sleep architecture in adults with sleep disorders: a systematic review and network meta-analysis of randomized controlled trials. Sleep Medicine. Online ahead of print, July 16, 2025; doi: 10.1016/j.sleep.2025.106680.