Sleep hygiene is a fairly straightforward concept, but it is one with which a large number of people are unfamiliar (including many physicians). The basic principle of sleep hygiene is optimizing the conditions for sleep. Contrary to many people’s beliefs and to the accepted norms of American society, humans do not have full voluntary control over sleep, as with (at least to a greater extent) eating and voiding. Many would like to believe that sleeping and waking are like a switch, on and off, but this is simply not true. Although maximizing the conditions for sound and restful sleep cannot be fully controlled, it can be encouraged and this is the principle of sleep hygiene.

  • First, sleep should have regular timing. People have many processes that are based on a twenty-four hour clock (more or less), and sleep is one of them. Other physiological aspects of this clock are changes in core body temperature and release of hormones including melatonin, cortisol, and growth hormone. All of these processes can adapt to outside influences (as in changing time zones or during shift work), however these changes occur gradually and rapid alteration in daily schedules are not well tolerated. As such, optimum sleep cannot be attained when awakening at 6 AM on weekdays and noon on weekends.
  • Napping too much can disrupt sleep. If a 4-hour nap is taken until 6 PM, then the person will clearly not be tired at midnight. He will then stay up late, and either need to sleep late in the morning (further disrupting sleep) or will awaken early, possibly taking another nap during the day because of excessive tiredness.
  • The sleep environment should be optimized, physically and mentally, for sleep.
    • Physically the bedroom should be suitably dark and quiet.
    • It should be shielded from distracting noise (traffic, other people who arise earlier, etc).
    • The bed should be comfortable, and the temperature should be optimized.
    • Psychologically, the bedroom, and particularly the bed, should be associated with sleep and not with other (particularly active) activities.
    • People should refrain from activities in their bed other than sleep, particularly stressful activities (doing work, studying, or balancing the checkbook). Sexual activity can be either alerting or relaxing, therefore the timing of this in relation to sleep should be individualized. It is also sometimes necessary to avoid reading or watching television in bed.
  • Get help if you can't sleep in bed. Sleeplessness in bed should be treated. Don't lie in bed and think about not sleeping or by staring at the clock; this tends to make people worry and associate the bed with anxiety. If this happens, get out of bed and do quiet activities. Go back to bed only when sleepy.
  • Monitor outside activities that can influence sleep. Activities that tend to stimulate – particularly exercise – should be avoided late in the day (although exercise earlier in the day generally improves nighttime sleep). Alcohol before bedtime should be avoided because it can result in early morning awakening. Caffeine, chocolate, nicotine, and other stimulants should be avoided late in the day.

While these principles are relatively simple, it is amazing how many people do not think about them. Getting counseling or information about sleep hygiene can make a big difference in the quality of one’s sleep.

 

 

Authored By: 
Carl W. Bazil MD, PhD
Joseph I. Sirven MD
Reviewed By: 
Joseph I. Sirven MD
Patty Obsorne Shafer RN, MN
on: 
Thursday, August 22, 2013