Prevent

Sleep Hygiene

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Sleep Hygiene, Insomnia Nonpharmacologic Management

  • See Also
  1. Insomnia
  2. Cognitive Behavioral Therapy for Insomnia (CBT-I)
  • Indications
  1. Insomnia
  • Efficacy
  1. Allow 2-4 weeks to see results
  2. For transient Insomnia, Sleep Hygiene improvements will likely offer benefit
  3. For chronic Insomnia, Sleep Hygiene is best practiced in combination with Cognitive Behavioral Therapy for Insomnia
    1. Sleep Hygiene education alone has poor efficacy for chronic Insomnia
    2. Chung (2018) Fam Pract 35(4): 365-75 [PubMed]
  • Protocol
  • Establish a regular sleep schedule
  1. Go to bed at same time each night
  2. Get up at same time each day
  3. Avoid "sleeping-in" on Sunday morning
  • Protocol
  • Cut down time in bed (if not asleep, get up)
  1. Avoid trying to force yourself to sleep
  2. Use your bed only for sleep and sex
  3. Do not read or watch Television in bed
  • Protocol
  • Make the bedroom comfortable
  1. Keep Temperature in your bedroom comfortable (cooler Temperatures are typically better for sleep)
  2. Keep bedroom quiet when sleeping
    1. Consider ear plugs (silicon)
  3. Keep bedroom dark enough
    1. Use dark blinds or wear an eye mask if needed
  • Protocol
  • Relax at bedtime
  1. See Relaxation Technique
  2. Relax each Muscle group individually
    1. Begin with your feet
    2. Work toward your head
  3. Deal with your worries before bedtime
    1. Set aside a worry time for 30 minutes earlier
  4. Listen to relaxation tapes
    1. Classical Music or Nature sounds
  5. Imagine a tranquil scene (e.g. waterfall or beach)
  6. Back Massage
    1. Gentle 5-minute back rub prior to bedtime
  • Protocol
  • Perform measures to make you tired at bedtime
  1. Get regular Exercise each day (6 hours before bed is ideal)
    1. Regular Exercise improves sleep
      1. Effect may be delayed 2 months
      2. King (1997) JAMA 277:32-7 [PubMed]
    2. Tai Chi improved sleep in older adults
      1. Li F (2004) J Am Geriatr Soc 52:892-900 [PubMed]
  2. Take medications only as directed
  3. Eat a light bedtime snack or warm drink
    1. Warm milk
    2. Warm herbal tea (non-caffeinated)
  • Protocol
  • Special Therapy Measures
  1. See Sleep Restriction Therapy
  2. See Sleep Stimulus Control
  • Protocol
  • Things to avoid
  1. Do not Exercise within 90 minutes of bedtime
  2. No overstimulating activities just before bed
    1. No competitive games before bedtime
    2. No exciting Television programs before bedtime
  3. Avoid Nicotine (Tobacco, Vaping) after 4 pm
  4. Avoid Caffeine after lunchtime or after 4 pm (caffeine Half-Life exceeds 4 hours)
    1. Avoid chocolate
    2. Avoid coffee, tea, or soda
  5. Do not eat a heavy meal within 2 hours of bedtime
  6. Avoid excessive fluids immediately before bedtime
  7. Avoid Alcohol for 4 to 6 hours before bedtime
    1. Do not use Alcohol to induce sleep (worsens Insomnia)
  8. Do not take someone else's sleeping pills
  9. Do not look at the clock when awakening
    1. Avoid staring at the clock when unable to get back to sleep (see Sleep Stimulus Control)
  10. Do not turn on light when getting up to use bathroom
  • References
  1. Holder (2022) Am Fam Physician 105(4): 397-405 [PubMed]