Good Sleep Habits: The Real Basics

Good sleep habits are absolutely crucial to maintaining good healthy sleep.  Also they are the rock-bottom foundation for the treatment of any sleep disorder.  No fancy device, drug, or therapy can work well without establishing good sleep habits.  Good sleep habits include:

  1. Regular times for going to bed and awakening. Most important is fixing the rise time, since it is under our control while the sleep time is more elusive.  The body likes regularity, and we violate this rule at our peril.
  2. Maintain the bedroom dark, quiet, and cool.  First do sleep in the bedroom and nowhere else.  Light can interrupt our sleep and keep us awake.  Remove bedroom objects that have small lights.  Noise also disturbs our sleep, even if we don’t notice it.  Conditioning ourselves to sleep with the TV or radio on is a bad habit not a good one. But it can become a habit and therefore we cannot sleep well without them.  A bland background sound (white noise) that is monotonous and does change can be helpful to sleep.  The problem with TV or radio is that it does change in content, mood, and volume and our brains do respond positively or negatively to it.  During sleep onset and the early part of the night our body cools down and awake environmental temperatures can seem too high and disturb us.
  3. Use the bed only for sleep and sex.  It is vitally important to preserve the association (conditioned reflex in psychological jargon) between the bed and sleep or sex.  This association is the major rationale of the advertising industry that, based on this well established principle, spends billions of dollars to sell products or services.  Do not use the bed for working, watching TV, reading, talking business or arguing with your bed partner, writing checks and paying bills, etc.   The association in our brain of bed-sleep must be preserved and kept pure.
  4. Avoid late daytime naps, and have a bedtime routine.  The urge to sleep keeps accumulating during the day and pushes us to sleep. It can be dissipated or diluted by sleeping in the afternoon or the evening, such that when we finally do go to bed the urge is less than normal.  We then cannot go to sleep in a short time and can easily become frustrated, falling into a vicious cycle since these negative feeling prevent relaxation and keep us awake.  Our body also likes rituals at bedtime that reassure us and have meaning while enhancing feelings of security.  These routines sooth and calm us, allowing for the relaxation necessary to sleep.  They can involve a warm bath, reading a book with positive thoughts, etc. while avoiding bad news programs and TV or computer monitors all together.  The problem is that these instruments have very bright lights and what we really want is to dim the lights or lower the brightness beginning an hour or so before we actually go to bed.  Remember when you went to night clubs and the dim light enhanced a romantic atmosphere?
  5. Avoid at night or evening: alcohol, caffeine, and nicotine: Unfortunately a late night capper or alcohol drink is the most commonly used “sleeping pill” in this country.  And yet it is the worst, unless you happen to be a chronic alcoholic, and the addiction mandates daily alcohol to avoid noticeable anxiety and tremors.  For most of us alcohol will sedate us for about 4 hours but will then alert us for the following 4 hours.  In effect, taking alcohol is like driving a car and careening sharply right, with the reaction then being sharply careening left, and then right and then left.  It is difficult then to restore order and keep the car in the center or reach equilibrium.  Alcohol just throws our body and sleep off center and overall makes the situation worse not better.  Caffeine alerts us for at least 4 hours but in many people the effect can last 12 hours or more depending on the amount of caffeine consumed.  For someone who cannot sleep the first order of business is cut down or stop alcohol and caffeine.  If the person cannot then it’s time to take a hard look in the mirror and ask: “Am I addicted and do I need professional help?”  Unfortunately many persons never seriously ask this question and seek help; rather they take more alcohol or caffeine (when sleepless night leads to daytime sleepiness and fatigue) and engage in a vicious cycle.  Also the wrong solution is to take sleeping pills that perpetuate a bad situation and can easily lead to another addiction, since most sleeping pills are habit forming.
  6. Sleep around 7 to 8 hours every night.  My impression is that the majority of persons need 7 to 8 hours of sleep, while a minority needs 6 to 7 hours or 8 to 9 hours.  It is distinctly uncommon to require less than 6 hours or more than 9 hours of sleep. The vast majority of people who sleep routinely less than 6 hours are actually sleep deprived, while the majority that sleep beyond 9 hours actually have an illness.  
  7. Prudent exercise and eating:  Strenuous exercise or big meals just before bedtime should be avoided, though a glass of warm milk can be soothing while moderate exercise in the morning, afternoon, or early evening can increase sleep urgency.  Large fatty meals with alcohol can also lead to reflux, especially if we are overweight, and then we wake up during the night with heartburn, acid in our mouth, or coughing and shortness of breath.
  8. Avoid stressful situations at night.  Again we need a reassuring ritual at night and we need to leave the difficult issues for the day.  Light, sound, touch should all have a soothing and calming effect.  It is only by relaxing that we catch the next wave of sleep, we cannot grab it.  While sleeping pills usually work well in the short run (less than 4 weeks), their effect usually wears off with time, we may become dependent on them, and we may have to bear side effects.
Test: If one truly has good sleep habits then sleep should be similar to that of school age children 5 to 10 years old with spontaneous, regular, and established bedtime and rise times. Also, we would fall asleep after only a short time in bed, and no alarm clock would be necessary to wake us up. For most of us this is a worthy goal to pursue, although we are far from it.  Unfortunately, many of us have actually developed bad sleep habits and justify them with counterproductive rationalizations.

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