Good Sleep Hygiene: The Real Basics

Good sleep hygiene or 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 wake up 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, particularly as we get older.
  2. Maintain the bedroom dark, quiet, and cool.  First, do your sleeping in the bedroom and nowhere else.  Remove bedroom objects that have small lights.  Light can interrupt our sleep and keep us awake. Noise also disturbs our sleep, even if we don’t notice it at first.  Conditioning ourselves to sleep with the TV or radio on is a bad habit. Once it becomes a habit, we cannot sleep well without it.  A bland background sound (white noise) that is monotonous and does not 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 this.  During sleep onset and the early part of the night, our body cools down; a warm environmental temperature can disturb sleep.
  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 feelings 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 should last at least an hour and can involve a warm bath, reading a book with positive thoughts, etc., while avoiding negative news programs and TV or computer monitors altogether.  The problem is that these items have very bright lights and keep us awake. 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 your addiction dictates some level of daily alcohol consumption).  For the rest of us, alcohol will sedate us for only 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, then right and then left, etc.  It is difficult then to restore an equilibrium and keep the car in the center.  Alcohol throws our body and sleep center off. Overall, it makes the situation worse, not better.  Caffeine poses other problems. It alerts us for at least 4 hours, but in many people this 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 do so, then it’s time for him or her to take a hard look in the mirror and ask: “Am I addicted, and do I need professional help?”  Unfortunately many people never seriously ask this question and seek help; rather, they take more alcohol to fall asleep, or more caffeine to stay awake when sleepless nights leads to daytime sleepiness and fatigue. Thus, they 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. Even worse, their effect wears off over time, and then it's right back to no sleep.
  6. Sleep around 7 to 8 hours every night.  The majority of individuals need 7 to 8 hours of sleep, while a minority needs either 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 who 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. Moderate exercise in the morning, afternoon, or early evening is good, as it can increase sleep urgency. 
  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. 
  9. 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 and consistent bedtime and rise time; an alarm clock is not necessary. This is a worthy goal to pursue, although most adults are far from it. 

Common Sleep Problems

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