Nine rules of sleep hygiene

Nine rules of sleep hygiene

1. Do not go to bed until you are drowsy.

Most insomniacs go to bed before they are sleepy in an attempt to catch up on lost sleep time and to relieve their sense of tiredness and fatigue. However, typically, when they go to bed they don’t sleep, but worry about issues in their daily lives and, in particular, their anticipated poor sleep ahead. This worry causes emotional arousal that prevents the passive sleep process from occurring.

Some insomniacs have difficulty distinguishing between fatigue and drowsiness, and may need help in making the distinction between these two states, so that they will go to bed when “sleepy-tired” rather than when fatigued. Delaying going to bed until drowsy not only increases the chances of falling asleep, but also strengthens the association between bed and sleepiness (rather than bed and wakefulness, as it is for most insomniacs).

2. Get up at the same time each morning, including weekends.

Insomniacs should always place the alarm clock away from the bed so that the sleeper must get up to turn it off. Maintaining a reasonably early awakening time is one of the important time cues for the 24-hour circadian sleep-wake rhythm. Breaking this rule causes sleep disruption in both good and poor sleepers.

The common experience of “Sunday night insomnia, Monday morning blues” is caused by ignoring this rule. The sleeper goes to bed at progressively later times during the weekend, and sleeps in the following morning. By Sunday night, the adapted circadian rhythm is expecting to begin the sleep period beginning at, say, 1:00 am and end at 9:00 am. However, on Sunday night the sleeper wants to go to sleep at 11:00 pm and awaken for work at 7:00 but is unable to fall asleep until the reset time of 1:00 am. Thus, he or she awakens, relatively sleep deprived, at 7:00 with “the blues.”

3. Do not take naps.

Napping disrupts the sleep-wake cycle, particularly if the nap occurs more than 10 hours after the major sleep period. Most insomniacs nap at irregular times, causing further disruption of the sleep-wake cycle. Problem sleepers should eliminate this behaviour and substitute gentle exercise instead.

The remaining rules concern lifestyle measures and the sleeping environment.

4. Reduce or eliminate the use of alcohol.

Do not drink alcohol later than 2 hours before bedtime.

5. Reduce or eliminate the use of caffeine.

Do not consume caffeine after about 4:00 pm.

6. Reduce or eliminate the use of nicotine.

Do not smoke within 4 hours of your bedtime.

7. Exercise regularly.

Try to avoid strenuous physical exertion after 6:00 pm.

8. Eat a light carbohydrate snack.

A snack such as crackers and milk may help promote sleep in those who tend to eat most in the second half of the day.

9. Adjust the sleep environment.

Your environment should be comfortably warm (or cool), with minimal levels of light and noise.

Jon Fleming, MD, in association with the MediResource Clinical Team

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