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Sleep Hygiene

A series of simple guidelines, habits and routines can help ensure a more restful and effective sleep
A series of simple guidelines, habits and routines can help ensure a more restful and effective sleep
Many (although by no means all) sleep disorders can be improved, and in some cases eliminated completely, by a good regime of sleep hygiene. In fact, cognitive behavioural therapy (CBT), the workhorse of most modern approaches to dealing with sleep disorders, consists of two main parts: firstly, convincing a patient that their problems are manageable, and secondly establishing a good system of sleep hygiene.

The following list of simple habits and attitudes can help establish a process of sleep re-education, which is always a preferable first step before considering sedatives or other medications.

There are many medical and counselling websites which deal with sleep disorders in great detail, so this page just describes briefly some simple uncontroversial measures that can safely be taken by anyone. Sleep medicine, the diagnosis and therapy of sleep disturbance and sleep disorders, is now a recognized medical subspecialty in many countries, and it is recommended that anyone who feels they may be suffering from sleep disorder consult a professional for treatment.

  • Only go to bed when you are sleepy. If sleep does not come reasonably quickly - within, say, 20-30 minutes or even less - get up and try again later (try to avoid bright lights while you are up, though).
  • Do not oversleep, as it may leave you feeling unrefreshed and sluggish the next day, as well as confuse your internal biological clock for subsequent nights.
  • Use your bed only for sleep and sex, not for television viewing, telephone calls, work, etc. Try to establish a strong mental association between the bedroom and sleeping.
  • If possible, to try keep your sleep and waking times regular, even on weekends, in an effort to “train” your biological clock. Make sleep a priority, even when time is short.
  • Do not engage in strenuous exercise, heavy meals or a hot bath just before going to bed: all of these activities work to increase body temperature which will make it harder to fall asleep. A lukewarm bath or shower, however, can help relax your muscles and make falling asleep easier.
  • A little moderate exercise, such as an evening stroll, can help you sleep, and more strenuous exercise earlier in the afternoon is also beneficial. But avoid intense exercise too close to bedtime (within 3-4 hours).
  • Make sure your evening meal is not too light and not too heavy, and a good two or three hours before bedtime. High protein foods, and foods containing tyramine (e.g. bacon, ham, pepperoni, eggplant, raspberries, avocado, nuts, soy sauce, red wine), might keep you awake at night, and may be better options for lunchtime. Foods containing tryptophan (e.g. bananas, dates, nut butters, tuna, turkey, yoghurt, milk) and carbohydrates like bread or cereal, on the other hand, may help encourage drowsiness and sleep. As with everything else, a balanced diet with plenty of fresh fruits, vegetables and whole grains will help in the long term.
  • Avoid caffeinated drinks like coffee, tea, cola, “energy” drinks, etc, near bedtime (certainly within 3-5 hours, and preferably much longer than that), and try not to drink too much of anything too late in the day, in order to avoid bathroom trips. A hot milk or herbal tea before bed, however, may help encourage sleep.
  • Avoid other stimulants, such as alcohol or tobacco, before going to bed. Alcohol may help you get to sleep in the first place, but it will disturb your sleep later, preventing you from entering the deeper restorative stages of sleep, and causing you to wake frequently during the night.
  • Relaxing bedtime habits or rituals, such as reading or writing, just before bed can help to relax you and take your mind off any anxieties you might have about sleeping. Bedtime rituals are particularly important for children, especially when they reach the stage, as most do at some point, of resisting bedtime and encountering difficulties falling asleep.
  • Similarly, meditation, relaxation exercises, soothing music or just a period of calm deep breathing before sleep can all help to calm you down and alleviate stress and anxiety.
  • Sleep on a good comfortable mattress which helps you maintain a good sleep posture, and a comfortable pillow that allows for efficient unobstructed breathing and a good neck and spine position during sleep (for more details, see the section on Sleeping Positions).
  • Avoid exposure to bright light (especially blue light) close to bedtime, as it may confuse circadian rhythms and trigger awakening rather than sleeping processes. Try to get regular exposure to outdoor light during the day (in particular, direct sunlight straight after waking can help establish good circadian rhythms).
  • Ensure that the bedroom is not too hot or too cold. Old-fashioned remedies like wearing bed-socks can really help in cold weather, as they slow heat loss to the extremities and so make it easier to fall asleep.
  • Ensure that the bedroom is fully dark (use blackout blinds is necessary), and that it is isolated, as far as possible, from intrusive noises (use earplugs or white noise machines if necessary).
  • Use the bathroom before sleep in order to avoid unnecessary trips to bathroom during the night. If you do have to use the bathroom at night, use the minimum possible amount of light to navigate.
  • If you are having problems sleeping at night, avoid naps during the daytime, as they tend to “borrow” from the next night’s sleep, unless they are very short (10-20 minutes).
  • If you are not sleeping well, avoid watching the clock and do not put mental pressure on yourself or get upset about the situation - you cannot force yourself to sleep, and this can only be counterproductive.
  • Write down any troubling thoughts before bed-time, so that they won’t dwell on them through the night.
  • Melatonin supplements are widely used as sleep aids and are generally harmless, but scientific evidence suggests they provide little or no benefit, except in the case of some specific circadian rhythm sleep disorders.
  • Sedatives should be taken only as a last resort, but they may help to establish a sleep habit if taken as a temporary short-term solution. Avoid long-term use, though, as this can lead to drug dependency and “rebound” insomnia, and may also disturb mood and memory circuits, as well as causing undesirable side effects such as tremors, sleepiness during the day, etc. Some recent research has cast serious doubts on the efficacy of sedatives as sleep aids anyway.