There are several topics that seem to come up with patient after patient and I find myself making the same suggestions over and over again. One of these topics is sleep hygiene.
Simply stated, sleep hygiene is a way to describe your behaviors and habits related to sleep. There are several types of insomnia including delayed sleep onset, middle insomnia or frequent awakenings, and early morning awakenings. Though improving sleep hygiene can help with all three of these subtypes, change will be most dramatic with delayed onset or trouble falling asleep when you want to.
Sleep hygiene is all about rules, behavior change and “stimulus control.” Though I am rarely directive with my patients, when it comes to sleep hygiene I explain a set of rules they should follow if they want to be able to fall asleep quicker. Here they are:
- Use your bed for sleep and sex only. Don’t read, do work , play on your phone or watch TV in bed. This is all about stimulus control: you want your body to react to the stimulus of being in bed by getting tired and falling asleep. If you like to read before bedtime, sit in a chair next to your bed or, even better, do so in another room.
- Set rigid bedtimes and wake-times. Be reasonable and calculate out the number of hours of sleep you do best with. Note: more is not always better; most people tend to function best with approximately 7-8 hours of good quality sleep per night. Set these times and stick with them, even on weekends, at least in the beginning of your sleep hygiene training.
- Set a rigid pre-bedtime routine. For example, before you fall asleep you probably want to wash your face and brush your teeth. Some people like to take out the next day’s outfit the night before. Make time to include saying your goodnights to your loved ones, engaging in prayer, doing your evening reading or whatever. After you’ve listed all your pre-bedtime activities, write them out in the order you want to do them each night, estimate the start time prior to when you want to fall asleep and then stick with this rigid schedule. Again, this is all about stimulus control.
- This one is tough: If you’re not asleep within about 20 minutes or so, get out of bed and do something boring. Don’t read a good novel, watch an engaging movie or pay your bills. Instead do something mundane and boring like reading the user manual for your refrigerator. When you’re eyes get tired, get back in bed and start over. Once again, we’re focused on stimulus control: you are trying to get your body used to only sleeping (or having sex) when in bed.
- If you have tons of thoughts that run through your head as you’re trying to get to sleep, have a notepad and pen (and maybe a small flashlight) next to your bed. Roll over, write down those important thoughts and then let them go; you no longer have to try to remember them because they’re written down.
- Some people find that over-the-counter Melatonin is helpful if they take it about 30 minutes or so before bedtime. Unlike some other medications, Melatonin is not habit-forming.
- Taking a very hot soaking bath immediately before getting into bed (i.e., the last pre-bedtime activity) can help “jumpstart” the process of falling asleep. The theory behind this is that a very hot bath will raise your core body temperature a bit. Then, when you get out of the bath and into bed, your core temperature will drop, and this is the jumpstart because when you fall asleep your core body temperature automatically drops a little.
- No screens before bedtime. Recent research has demonstrated that the frequency of light emitted from televisions, laptops and handheld devices are neurologically stimulating and can make it much harder to relax and fall asleep.
- Start exercising on a regular basis, but try to do so earlier in the day. Don’t do any strenuous activity within a couple hours of bedtime.
- Eliminate caffeine from your diet. If you can’t do that, start to cut back by drinking half caffeinated and half decaffeinated drinks. No caffeine at all after lunch time.
- Don’t have a big dinner and don’t snack after dinner. Eat your bigger meals earlier in the day.
- Learn to do relaxation training. Now, the point of relaxation training is not generally to get you to sleep, but it surely doesn’t hurt. Most people find that progressive muscle relaxation and guided imagery are the best when they’re trying to fall asleep.
- Instead of having the television or music on when you’re trying to get to sleep, turn off those stimulating sounds and muffle out distracting sounds with a white noise machine or a regular fan. The “wooshing” sound of the fan masks other sounds and is not stimulating like music or the news.
- No naps. Though for some people naps can be quite rejuvenating, they alter your sleep-wake cycle and can delay sleep onset significantly. Cut naps out of your routine.
- Remember that your sleeping difficulties didn’t just start over night; you’ve probably been dealing with them for quite some time. Even if you follow every tip on this list it’ll still probably take a little while before you’re able to get to sleep quickly. With consistent efforts however, you should be able to improve your sleep within a few weeks or sooner.
- Speak with a psychologist, physician or other healthcare professional if you have questions or additional concerns.