Sleep Hygiene Summary
- 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.
- 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.
- An established bedtime and awakening time must be maintained. This is based on the minimum amount of sleep the patient requires to function.
- 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.
- Some sleep centers advocate at least 40 minutes of strong light exposure after rising.
- The patient’s mattress may be an issue. A soft surface is recommended to support the body comfortably.
- 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.
- 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.
- Preparation should either be done before the “wind-down time” or put off until the next day.
- 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.
- Avoid caffeine, nicotine, and alcohol. The latter may cause drowsiness but will disrupt the sleep cycle.
- 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.
- Daytime naps should be discouraged.
- No food ingestion within several hours of sleeping. Eating causes blood flow to be diverted to digestive activities rather than relaxation.
- 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
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
Exercise
Environment
Diet
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
Designating “Worry Time”
Summary