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Cognitive Behavioral Therapy for Insomnia Part 5: Sleep Hygiene

Sleep hygiene promotes good sleep habits.

This is the fifth and final post on the cognitive behavioral approach to treating insomnia. Sleep hygiene involves following simple rules designed to promote better quality sleep so as to enhance daytime functioning.

Poor sleep hygiene relates to a number of habits that can have a detrimental effect on sleep. These are familiar to most people and include drinking coffee late in the day, watching the clock through out a restless night and having a noisy bed room environment.

A number of things that are usually included under the heading of good sleep hygiene are related to avoiding substances that can disrupt sleep, preventing excessive nocturnal mentation that can be arousing and prevent sleep onset, not taking daytime naps as they can decrease nocturnal sleep drive, keeping a regular sleep schedule to promote regular drowsiness and wakefulness, and preventing too much time spent in bed while awake or in low quality sleep. Good sleep hygiene can also include efforts to regularize the circadian (24 hour) schedule and to cope better with nocturnal awakenings.

Rules for Good Sleep

1. Limit evening alcohol to one or two drinks with none after 7 pm. Alcohol initially helps people fall asleep and may deepen sleep. Later, however, as alcohol leaves the body some withdrawal symptoms occur and sleep is fragmented resulting in frequent awakenings and very poor sleep. The more you drink the longer it takes for the alcohol to be metabolized out and the more severe the sleep fragmentation will be.

2. Have no more than 2 cups of coffee a day and none after 2 pm. Caffeine persists in the body for a considerable length of time. Caffeine has a stronger effect of disrupting and fragmenting sleep than of preventing sleep onset from initially occurring. This is why some people will say that the can drink a double espresso with dinner and have no problem falling asleep. The question is how good is their sleep later in the night?

3. Exercise 20 to 30 minutes a day, preferably in the late afternoon, within 3 to 6 hours of bed time. Exercise initially raises body temperature and several hours later there is a compensatory drop in body temperature. It is in the evening as body temperature falls that we become sleepy. If exercise occurs in the late afternoon it will help maximize drowsiness around bed time. Exercise also helps decrease stress, a major inhibitor of sleep.

4. Keep the bed room on the cool side. If the bed room is too warm it will be difficult to cool down so that you can fall asleep. A cool, but not too cold, room will help promote the cooling that makes sleep possible.

5. Try to expose yourself to bright light in the morning. This entrains the circadian or 24 hour clock system. Morning sun or bright light helps you feel more alert in the morning and promotes drowsiness in the evening.

6. Keep the bedroom both quiet and dark. Noise and bright light disrupt our ability to fall asleep. Keeping the bed room noise free and as dark as possible helps natural sleep occur.

7. Orient the clock face away from you. Clock watching can be very disruptive of sleep. This is because of the stress caused by being aware of the slow passage of time during the night. This increases arousal and makes it harder to fall asleep.

8. Have a light complex carbohydrate snack about an hour before bed time. Good examples are cheese and crackers. The snack should be about 100 to 200 calories. Be sure that if you have gastric reflux or diabetes that it is medically advisable to have such a snack. The snack can help prevent hunger that may disrupt sleep later in the night.

9. Avoid drinking liquids after 8 pm. This will help decrease the need for night time visits to the bathroom.

10. Have enough room in bed so as to not be disturbed by a bed partner's movement. As discussed in a previous post, many people are sleeping separately today due to a bed partner's snoring or sleep related movements. Even if these are not an issue, having enough room to spread out and get comfortable is important.

Good sleep hygiene is a central component of an effective cognitive behavioral approach to treating insomnia. It may not, however, always be sufficient to overcome a deeply entrenched sleep problem. Other techniques previously reviewed may be needed, as well as the help of a trained behavioral sleep disorders coach (specialist). With good sleep hygiene most people will be on the way to better sleep, and so to better, more fulfilling daytime functioning.

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