Ketones and Sleep: A Narrative Review of Mechanisms, Preclinical Models, and Human Evidence

This narrative review examines mechanistic, preclinical and human evidence linking ketosis from endogenous sources and from exogenous ketones to sleep architecture, sleep quality and sleep-disordered breathing. It reports that in mice acetoacetate, but not beta-hydroxybutyrate, increased slow-wave activity during NREM sleep, and that human evidence is suggestive but heterogeneous, including improved sleep efficiency with ketone ester ingestion after strenuous evening exercise but not during hypoxia-induced sleep disruption. The ketone concentration range associated with optimal sleep outcomes remains undefined.