Sleep Hygiene

Some studies show that good “sleep hygiene” can be at least as effective as medications for long-term treatment of insomnia.  This page covers the most common forms of sleep hygiene that people practice.

 

Behavioral Changes

 

  1. Exercise- People who exercise regularly (30 minutes of exercise 5-6 days per week, heart rate at least 110) have been shown to have less sleep problems.  It is best to exercise six or more hours before planning on going to bed.
  2. Diet – Avoid any caffeinated products after noon.  Also, spicy foods and large dinners tend to interfere with sleep onset.  Finally, avoid high-calorie, high sugar content foods 3-4 hours before bed.  A warm glass of milk does sometimes help in feeling sleepy.
  3. Alcohol use – Alcohol helps with sleep induction but results in early awakening with difficulty falling back asleep.  It also inhibits deep sleep cycles, which is where the body gets the most benefit from sleep.
  4. Light – The best environment for sleep is for the room to be as dark as possible.  Some people prefer a small night light and this can be experimented with.  f.lux is an app that eliminates “blue light” from computer or smart phone screens.   This minimizes the effect that these devices have on disrupting Melatonin.
  5. Noise – White noise may be helpful, and may drown out external street noise, noise from neighbors, other parts of the house, etc.  You can buy white noise machines on-line at http://www.marpac.com.
  6. Temperature – Make sure the room and bedding are not too hot or cold.
  7. Music – Lots of people feel that they fall asleep easier with music.  This is may be true, but having music on may ultimately interfere with sleep as it may wake a person up.  Generally quiet, classical music without lyrics is the most relaxing.
  8. TV – This is similar to music.  People may fall asleep with the TV on, but ultimately the noise and light from the TV interfere with deep sleep cycles and can wake a person up.
  9. Napping – People with insomnia (difficulty initiating or maintaining sleep that causes impairment in function for more than one month) should avoid napping at all.  Short naps otherwise (10-20 minutes can be restorative) can be taken during the day.
  10. Biofeedback can help with relaxation and with a sensation of warming to the skin.  The body likes to have a cool core temperature a bit warmer skin temperature for sleep.
  11. If you are not asleep within 20-30 minutes of laying down, get out of bed.  You can read in a dim light that is behind you.  Read something boring and go right back to bed once you feel sleepy.
  12. Keep sleep and wake cycles as regular as possible.
  13. Cognitive strategies include writing anything down you are worried about so it is on paper and not in your head.   Also retrain your focus on the comfort of your bed, get away from thinking about not being asleep.  Remind yourself that “it is not the end of the world if I am not asleep right now; I will survive if I don’t get great sleep tonight.”

 

Sleep Restriction

 

  1. Sleep restriction involves a strict schedule of bedtimes and rising times.  This can be difficult because it takes discipline to change sleep and wake times and stick to them, but ultimately, the “sleepdrive” is increased through partial sleep deprivation.
  2. Most people require around 7-8 hours of sleep, but this various greatly.  You should set your bedtimes so that you get whatever your optimum amount of sleep is.
  3. Naps should be avoided if you have insonmnia (see above).   If you need a nap it should be kept under 30 minutes.
  4. After the sleep/wake cycle is reset, which may take two to three weeks, there is usually significant improvement in sleep.

 

Stimulus Control

 

  1. The goal of stimulus control is to break associations between the sleep environment and wakefulness by staying in bed or in the bedroom only when sleepy or asleep.
  2. A person practicing stimulus control would not engage in any activities incompatible with sleep while in the bedroom.  This includes work issues, watching TV, and laying in bed while wide awake.
  3. It is hard to do, but if you are awake and not feeling tired, it is helpful to get out of bed and read a boring or low-key book or engage in another relaxing activity until you feel tired.
  4. Drinking a glass of warm milk may help you feel sleepy.

 

Cognitive Therapy

 

  1. In this practice, you engage with your therapist to identify, challenge and replace beliefs and fears about sleep or the loss of sleep with realistic expectations regarding sleep and daytime function.
  2. Generally a few sessions are required to help train how to do this, but once you understand the process, it can be continued without the therapist.

 

Progressive Relaxation

  1. A person engaging in progressive relaxation learns how to recognize and control muscular tension through audio tapes or CD’s.
  2. This technique requires practice as well.
  3. The following is a web-page with a nice description of the technique:
  4. http://www.umm.edu/sleep/relax_tech.html.  This site also reviews sleep hygiene and has other good information on sleep.
-->