SLEEP HYGIENE

What is sleep hygiene?
This is the full range of conditions and behaviors related to sleep that you can generally control. These include your habits, environmental factors, and rituals for sleeping every night. 

Why does sleep hygiene matter?
It is the first place to look for ways to improve one's sleep health. Many problems with sleep can be eradicated by tending to one's own sleep hygiene. Often, doctors will have patients with sleep problems account for their sleep hygiene first through diaries and reports of activities of daily living like eating, alcohol consumption, prescription use, and exercise before they will diagnose and treat these problems. Fixing poor habits can often take care of most patients' sleep problems, or at least reduce their impact significantly on their overall health.

How do my electronic devices impact my ability to sleep?
Electronic devices emit blue spectrum light, which automatically disrupts the function of the pineal gland. The pineal gland, located in the center of the brain, is responsible for melatonin production. It requires the natural dimming of daylight in order to function. Melatonin is the hormone most responsible for sleep. Even 10 minutes spent checking your email at night can have a major impact on your pineal gland's ability to generate melatonin. It is recommended that you turn off electronics with screens one hour before bedtime to allow your brain to generate these natural sleep hormones. Electronics most commonly related to disrupted melatonin production include smartphones, iPads, handheld games and laptops, which are typically backlit.

If you need to read at night to relax, try reading paper books or magazines or tablets with so-called "electronic paper," which does not emit light. A book light with a blue-light filter is a good option if you must read in the dark. 

Sleep hygiene considerations
Consider the following habits and how they can impact the quality and quantity of your sleep.

Time of day when you go to bed or rise
Bedtime should correspond with how sleepy you are. This is because your body generates a "sleep drive" based on how much you have slept previously (including last night's sleep and the day's naps). This buildup of the need to sleep is resolved by going to bed when sleepy.

Rise time, by contrast, should be consistent every morning. This is so that the brain can be reset by the light of the morning sun, an important circadian calibration the human body needs daily.

Pre-sleep rituals
What you do before bed has a major impact on how you will sleep. If you take some time to find ways to relax, such as by reading, listening to calming music, practicing meditation or yogic breathing, or taking a warm (not hot) bath, the odds you will fall asleep easily improve dramatically.

However, if you decide to watch an intense or scary movie before bedtime, or use your electronic devices (see above), or have an emotionally charged conversation with a loved one or find you cannot turn off your brain, you will have difficulty sleeping. These are rituals and habits you can choose or change by your own volition.

Diet and time of last meal
Eating a fat-laden, high-calorie meal at dinner time or right before bed can lead to regular problems with Gastroesophageal Reflux Disease (GERD). Midnight snacks may seem comforting for some, but these can also be problematic for sleep as the digestive system and liver function differently during sleep and may not respond well to calories, protein, and fiber introduced well into the sleep cycle. Try to eat at least two hours before going to bed at night to stave off these digestive issues, which can seriously disturb your sleep patterns and lead to other problems.

Exercise habits
Daily exercise is great for sleeping better, especially if it's done outside in natural daylight and fresh air. However, you don't want too rigorous a session of exercise right before bed. Your body's internal temperature follows a specific pattern during sleep and any exercise-related increase in your internal thermostat at bedtime could lead to undesirable changes in sleep architecture. In addition, exercise can be highly arousing because it stimulates the production of hormones like adrenaline, which generate alertness for as long as two hours after you have exercised.

Regularity of sleep schedule
Sleeping in on weekends always sounds good, and especially if you are up too late on weeknights tending to work or studies. However, though you will want to sleep longer on weekend mornings to make up for lost sleep during the week, you can also inadvertently mess with your sleep schedule in a way that makes it harder to recover when you get back to work on Monday morning, hence the common reference to the "Monday morning hangover." It is better to rise at your usual time on the weekends and then go to bed earlier to make up for that lost sleep in order to recover from sleep debt.

Caffeine, alcohol, and cigarette use and sleep
It goes without saying that consuming caffeine products (coffee, tea, chocolate, cocoa, caffeinated sodas, energy boosters) will overstimulate your system and keep you awake. Put 5 hours between any consumption of caffeine and bedtime for optimal results.

It's also true that alcohol before bedtime, known as "having a nightcap," can also mess with your sleep stages. Alcohol may help some people to fall sleep, but once it is metabolized, the body goes through a withdrawal period which severely disrupts the sleep architecture in such a way that the body cannot get enough deep sleep necessary for optimal health. Besides that, it often means getting out of bed multiple times to use the bathroom.

Nicotine may help some smokers to relax before bed, but cigarettes have a dual effect on the brain; they both stimulate and depress certain areas of the brain. It's advised that smokers have their last cigarette at least 30 minutes before bedtime to avoid this problem. 

Nap habits
Naps can be extremely useful for children as they transition from intensely different sleeping patterns at birth to the sleep-wake cycles of adults. Naps are also useful for the elderly and for the chronically ill to combat fatigue. However, napping during the day for people who are otherwise healthy can interfere with their sleep drive. "Make up" naps, every once in a while, to pay off some sleep debt recently acquired from an "all-nighter," aren't necessarily bad as long as they don't become habitual. Nor are naps taken intentionally to prepare for anticipated sleep deprivation (as is the case for night shift workers). And if you are extremely fatigued, taking a quick cat nap of 10-20 minutes can keep you from risking dangerous judgments or behavior on the job, at home or behind the wheel of a car. Just don't get into the habit of napping and you'll be okay.

Use of sleep aids
It's always important to remember the following with regard to using over-the-counter (OTC) medications to help with sleep:
  • Nutritional and "natural" OTC sleep aids are still drugs with potential side effects.
  • Nutritional and "natural" OTC sleep aids may interfere or interact negatively with your current prescribed or OTC medications. Please consult a pharmacist before using them to make sure you don't do more harm than good.
  • Melatonin is generally recognized as safe, but most sleep health professionals disagree on its most effective dosage. Also, because melatonin is used to enhance circadian influences on sleep, its timing with the earth's light-dark cycles, as well as your nighttime behaviors, will influence how effective it is. Taking melatonin, then sitting at your computer for an hour answering email right before you go to bed, is not going to work, for instance.
There are all kinds of pharmaceutical drug classes that can be consulted when looking for the right aid for sleep, including anxiolytics, stimulants, antidepressants, antipsychotics, antihistamines, hypnotics, narcotics, nonbarbiturate sedatives, barbiturates, opiates, anticonvulsants and dopamine agonists. These can be very powerful and dangerous when taken with other medications. However, the medications prescribed for sleep have become much safer and less addictive than those previously prescribed in the past. Consult with your doctor and your pharmacist before taking any of these medications to ensure they are the best, safest option for improving your sleep.

For more detailed information about prescription drugs and their impact on sleep, click here.

Stress management
Often, the trouble with sleeping comes from daily stress that remains unresolved over time. Meditation as a relaxation technique can be useful for helping to achieve healthy sleep. Practicing yoga or yogic breathing can also help with relaxation, as can using complementary therapies like steam rooms, massage, hot tubs, or art therapy. Seeking help from a therapist, who can give you tools for dealing with the stress of life can lead to improvements in better sleep overall. This can be achieved through cognitive behavior therapy, which has been shown to be an effective solution for insomnia.

Use of bedroom outside of sleeping/sex
If you have an office in your bedroom, or a TV, or a computer, you might find you live at odds with these distracting activities when it comes to getting quality sleep. It is recommended that your sleeping space be used only for sleeping and intimacy as a way to avoid this problem.

Environmental impacts (comfort, light, noise)

  • Obviously, you are not going to sleep well if your bed is too hard or too soft, or if your pillow gives you allergies. 
  • Keeping your room clear of clutter, painting it a relaxing color, and decorating it softly are all ways to make it a more comfortable space conducive to sleep. 
  • It's especially helpful to keep pets and children out of the bedroom if their presence is disruptive to your sleep. 
  • Room temperature should also be even: too warm a room can prevent certain phases of sleep from occurring, as your body temperature normally decreases over the course of the night and should be allowed to do so. Having multiple blankets to add and subtract for comfort is highly recommended, as are ceiling fans for summer sleeping. A room that is too cold may make it impossible to fall asleep, so make sure you dress accordingly if you find yourself in this situation.
  • If there's a lot of atmospheric light in your bedroom, try to find a way to change the situation by using window treatments, room darkening shades, or blinds, or an eye mask. Turn your alarm clockwith its glowing numbersaway from you so that you can't see it at night; you don't need to know what time it is while you are sleeping anyway! 
  • Exposure in your bedroom can also dictate how easily you get up in the morning. If you have a bright eastern or southern window that's not blocked by buildings and trees, you will want to find ways to darken it so the sun doesn't wake you up too early. If you have a dark northern or western window, you may wish to go without window treatments at all.
  • If there's ambient noise in your room, do what you can to shut it down. Ask your neighbors to be quiet; teach your kids and train your pets to respect quiet time at night. Don't listen to talk radio or stimulating music at night; though it can be soothing for some, it can also guarantee that you will be distracted or charged up at a time when you should be relaxing. White noise machines and the sounds emitted from a fan are helpful to block out noise you can't control. If you find the sound of crickets or frogs outside your window relaxing, by all means, crack your windows. If your partner snores, try wearing ear plugs.