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Sleep Hygiene

 
Sleep Hygiene Summary
  1. The room should be free of distractions: No pets and no television. It should be enforced that the bedroom is not a study or family room.
  2. The room should have a comfortable sleeping temperature and noise level. A “white noise machine” may help elicit a relaxation response and lessen external noise effects.
  3. An established bedtime and awakening time must be maintained. This is based on the minimum amount of sleep the patient requires to function.
  4. A “wind-down time” should begin 60-90 minutes before the designated bedtime. This is a time to begin to relax and “let go” of the day’s events.
  5. Some sleep centers advocate at least 40 minutes of strong light exposure after rising.
  6. The patient’s mattress may be an issue. A soft surface is recommended to support the body comfortably.
  7. If the patient wishes to watch television before bedtime, stimulating programming and the news should be avoided. Reading choice should be light, avoiding books that are difficult to put down.
  8. Some experts suggest writing down the care or worries for the day in a journal 45-60 minutes before bedtime. Entries should be brief before detracting from the relaxation time.
  9. Preparation should either be done before the “wind-down time” or put off until the next day.
  10. Deep breathing exercises can be done at bedtime; by focusing on breathing, the patient can draw attention away from distractions, allowing the muscles and mind to relax.
  11. Avoid caffeine, nicotine, and alcohol. The latter may cause drowsiness but will disrupt the sleep cycle.
  12. Physical exertion or exercise can be done at bedtime; by focusing on breathing, the patient can draw attention away from distraction, allowing the muscles and mind to relax.
  13. Daytime naps should be discouraged.
  14. No food ingestion within several hours of sleeping. Eating causes blood flow to be diverted to digestive activities rather than relaxation.
  15. Avoid clock watching. A patient unable to fall asleep within 15-20 minutes of going to bed should get up and engage in relaxation, returning only when feeling sleepy. The goal of this is to avoid the association of tossing and turning, rather than sleeping, within the bedroom.
 
Introduction
Sleep is not merely “time out” from daily life. It is an active state essential for mental and physical restoration. More than 100 million Americans of all ages, however, regularly fail to get a good night’s sleep. Some 84 disorders of sleeping and waking result in diminished quality of life and personal health, and endanger public safety through their contribution to traffic and industrial accidents. These disorders include those leading to problems falling asleep and staying asleep, difficulties staying awake or adhering to a consistent sleep/wake cycle, sleepwalking, bedwetting, nightmares, and other problems that interfere with sleep. Some sleep disorders are potentially fatal.
For most people, falling asleep and staying asleep are parts of a natural process. Good sleepers are likely to have developed certain lifestyles and dietary habits or behaviors-known as sleep hygiene-can have positive effects on sleep before, during, and after time spent in bed. For the most part, sleep hygiene is a matter of common sense, and the techniques suggested here will help most people sleep better.
Stimulants
Caffeine stimulates the brain and interferes with sleep. Coffee, tea, colas, cocoa, chocolate, prescription and nonprescription drugs that contain caffeine should not be taken within three to four hours of bedtime. Although moderate daytime use of caffeine usually does not interfere with sleep at night, heavy or regular use during the day can lead to withdrawal symptoms and to sleep problems at night.
Nicotine is another stimulating drug that interferes with sleep, and nicotine withdrawal can also disrupt sleep through the night. Cigarettes and some drugs contain substantial quantities of nicotine. Smokers, who break the habit, once they overcome the withdrawal effects of the drug, can expect to fall asleep much faster and awake up less during the night.
Alcohol
One of the effects of alcohol is a slowing of brain activity. When taken at bedtime, alcohol may help induce sleep at first, but will disrupt sleep later in the night. A “nightcap” before bed can result in awakenings during the night, nightmares, and early morning headaches. Alcoholic beverages should be avoided within four to six hours of bedtime.
Exercise
Regular exercise helps people sleep better; the benefits of exercise on sleep, however depend on the time of day is undertaken and on your overall fitness level. People who are physically fit should avoid exercising within six hours of bedtime. Exercise in the morning is not likely to affect sleep at night, but the same amount of exercise-if done to close to bedtime-can disrupt sleep. On the other hand, too little exercise and limited activity during the day can also lead to sleeplessness at night. Consult a healthcare provider before beginning an exercise program.
Environment
A comfortable bed in a dark, quiet room is the best setting for a good night’s sleep. Some people seem to adjust easily to changes in sleep environment, but others (such as insomniacs and elderly) can be easily disturbed by small changes in sleep surroundings. When excessive light is a problem, blackout curtains and spot lighting can be helpful. Noise problems can be alleviated with the use of background sound (“white noise”) of earplugs.
Diet
Eating a full meal shortly before bedtime can interfere with the ability to fall asleep and stay asleep, as can heavy meals eaten at any time of day of foods that cause indigestion. A light snack at bedtime, however, can promote sleep. Milk and other dairy products, which contain the natural sleep-promoting substance tryptophan, are especially good as bedtime snacks.
Decreasing the time awake in bed
Stress contributes too many sleep problems. People who have trouble sleeping sometimes begin to rely on certain strategies-such as regular napping, excessive use of caffeine, use of alcoholic beverages at bedtime, working at night, and sleeping at irregular hours-to help adapt to a disturbed sleep schedule. After the source of stress that led to the sleep problem is eliminated, these behaviors can sometime cause sleep problems to continue. A cycle repeated difficulty in falling asleep develops, and tension and a fear of sleeplessness can result. The bedroom itself can come to be associated with unsuccessful attempts to sleep with tension and anxiety. Some people who have trouble sleeping will begin sleeping on a sofa or in a chair because they are no longer able to sleep in the bedroom. This phenomenon, termed conditioning, may respond to one of two treatment techniques: stimulus control and sleep restriction.
Stimulus control attempts to reestablish the connection between sleep and the bedroom. This is done by reducing the amount of time spent lying awake in bed. The principles of good hygiene and stimulus control are often used together to relieve sleeplessness.
Sleep Restriction works by reducing the amount of time spent in bed to the estimated time period spent actually sleeping. Sleep restriction techniques, which can be learned from a sleep specialist. Include recording the time you spend asleep each day for one to two weeks. The amount of time spent in bed is then restricted to the time actually sleeping. As sleep quality improves, the sleep schedule is adjusted as appropriate. Sleep restriction prescribes a specific amount of sleep but not a mandatory time period in bed. Stimulus control and sleep hygiene guidelines may be used in combinations with sleep restriction.
Clock watching should be avoided by people experiencing sleep problems, especially those with insomnia. It can be helpful to set the alarm for the desired morning arise time, and then hide the clock and watches in a dresser drawer across the room. Most people experiencing sleep problems sleep best when time pressures are relieved.
Managing Stress
As mentioned earlier, the stress that stems from common life situations often contributes to sleep problems. A relaxing activity around bedtime can help relieve tension and encourage sleep. Consciously attempting to clarify problems and formulate solutions can have a positive effect on sleep quality. Talking with a trusted friend or colleague to “air out” troubling issues can be helpful. Relaxation exercises, medication, biofeedback, and hypnosis, are sometime beneficial in controlling sleep problems. These techniques should be learned from a psychologist, physician, or other healthcare professional.
Designating “Worry Time”
Another technique that can be helpful is to designate a particular time for worry. This time is dedicated to sorting out problems and coming up with solutions. On 3x5 cards, write down each of your worries as it comes to mind (one worry per card). These worries can range from the mundane (needing to call someone in the morning or remembering an anniversary) to the serious (financial concerns or problems with a relationship). When all worries have been written down, sort the cards into three to five piles according to the priority of the worry. While not all worries will have easy solutions, even small progress in remedying a worry can yield helpful results. The morning after recording your worries, review the worry cards and begin to work on resolving the worries you’ve identified.
Summary
Good sleep hygiene will improve the sleep of many people. Stimulus control and sleep restriction strategies, although they are challenging techniques to master, improve the likelihood of a successful outcome. If sleeplessness persists after four to six weeks of modifying sleep and daytime habits as described earlier, it’s time to consider seeking help from a professional healthcare provider or an expert in sleep disorders.