Sleep Education & Hygiene

Goal

To be able to better understand sleep and implement sleep hygiene strategies

Sleep Education (Edinger & Carney, pp. 11-12, 15-16)

Oftentimes people wonder how many hours of sleep they need each night. Generally speaking, there is no one amount of sleep that “fits” everyone. Most normal adults sleep 6 to 8 hours per night. However, some people need only 3 or 4 hours, whereas others require 10 to 12 hours. People, like many animals, have powerful internal “clocks” that affect their behavior and bodily functioning. The “body clock” works in roughly a 24-hour period and produces 24-hour cycles in such things as digestion, body temperature, and the sleep-wake pattern. Work schedules, meal times, and other activities work together with our body clocks to help us keep a stable sleep-wake pattern. However, significant changes in our sleep-wake schedule can interfere with our ability to sleep normally, such as jet lag.

In addition to our body clock, getting older usually leads to changes in our sleep. As we age, we tend to spend more time awake in bed and less time in the deepest parts of sleep. Because sleep becomes more “shallow” and broken as we age, we may notice a decrease in the quality of our sleep as we grow older. Although these changes set the stage for the development of sleep problems, they do not guarantee such problems. However, because of these changes, it is probably unrealistic to expect that you will again have the type of sleep you enjoyed at a much younger age than you are now.

Many people who have sleep problems try to compensate for lost sleep by taking naps, going to bed early, or sleeping in. Doing these things, however, will likely make your sleep problems worse. In fact, these habits are usually the opposite of what needs to be done to improve sleep. It is important to remain awake through each day in order to build up enough sleep drive to produce a full night’s sleep. You do not need to worry a great deal about lost sleep nor should you actively try to recover lost sleep. Needless worry and attempts to recover lost sleep will only worsen your sleep problem.

Sleep Hygiene (Edinger & Carney, pp. 17-20, 24-25)

Sleep problems are bothersome and often disruptive-reducing quality of life and one’s sense of well-being. They can also adversely affect mood, reduce performance at work, and increase risk for injury during routine tasks (e.g., driving) that require normal alertness. Given these considerations, it is no wonder that many, if not most, people who suffer from sleep problems develop some sort of strategy to cope with their difficulties and minimize the impact their sleep problems have on daily routines.

Your sleep habits and general attitude and approach toward sleep play crucial and deciding roles in determining how well or poorly you sleep most nights. Consistent, good quality sleep occurs when there is a strong sleep drive and a consistent sleep-wake schedule in place.

In order to overcome your sleep problems, you need to follow a regimen designed to reduce bedtime arousal, increase your sleep drive, and stabilize your sleep schedule so that your body’s sleep system can work at its best without inference from you. As a first step toward achieving this goal, you need to make sure that you are sufficiently relaxed and ready for bed when you choose to retire each night. To enhance the chances of being ready for sleep when you enter bed, you should try to build in some time to relax in some way prior to bed so that you establish a “buffer” between your active day and your more passive sleep process. During this buffer time, avoid mentally or physically stimulating activities that could increase your alertness. In Lesson 3, you will learn specific relaxation strategies.

Here are sleep hygiene tips along with an explanation about why each tip is important for improving sleep:

Select a standard rising time
In order to develop a stable sleep pattern, it is important that you choose a standard rising time and stick to it every day regardless of how much sleep you actually get on any given night. You can create the type of sleep problem that occurs in jet lag by varying your wake-up time from day to day. If you set your alarm for a standard wake-up time, you will soon notice that you usually will become sleepy at about the right time each evening to allow you to get the sleep you need.

Get out of bed when you can’t sleep
If after 20 minutes of trying to fall asleep you find yourself still awake, get out of bed. Long periods of being awake in bed usually lead to tossing and turning, becoming frustrated, or worrying about not sleeping-making it more difficult to fall asleep. If you lie in bed awake for long periods, you are training yourself to be awake in bed. Instead, get up, go to another room, and only return to bed when you feel sleepy enough to fall asleep quickly.

Use the bed only for sleeping
While in bed, you should avoid doing things that you do when you are awake. Do not read, watch TV, eat, study, use the phone, or do other things that require you to be awake while you are in bed. If you avoid these activities while in bed, your bed will eventually become a place where it is easy to go to sleep and stay asleep. Sexual activity is the only exception to this rule.

Don’t worry, plan, or problem solve in bed
Do not worry, mull over your problems, plan future events, or do other thinking while in bed. These activities are bad mental habits. If your mind seems to be racing or you can’t seem to shut off your thoughts, get up and go to another room until you can return to bed without this thinking interrupting your sleep. If this disruptive thinking occurs frequently, you may find it helpful to routinely set aside a time early each evening to do the thinking, problem solving, and planning you need to do.

Avoid daytime napping
You should avoid all daytime napping. Sleeping during the day partially satisfies your sleep needs and, thus, will weaken your sleep drive at night.

Avoid excessive time in bed
In general, you should go to bed when you feel sleepy. However, you should not go to bed so early that you find yourself spending far more time in bed each night than you need for If you spend too much time in bed, you may actually make your sleep problem worse.

Limit caffeine & alcohol
Caffeine is a stimulant that may make it harder for you to sleep well at night. You should also know that caffeine stays in your system for several hours after you consume it. Limit your caffeine to the equivalent of no more than three cups of coffee per day and do not consume caffeine in the late afternoon or evening hours. Alcoholic beverages may make you drowsy and fall asleep more easily. However, alcohol usually causes sleep to be much more broken and far less refreshing than normal. Try to avoid drinking alcohol in the evening or using it as a sleep aid.

Exercise regularly
Try some regular moderate exercise such as walking, swimming, or bike riding. Improving your fitness level will likely improve the quality of your sleep.

Try a light bedtime snack such as milk, peanut butter, or cheese
These foods contain chemicals that your body uses to produce sleep. As a result, this type of bedtime snack may actually bring on drowsiness.

Keep your bedroom quiet and dark
Noise and even dim light may interrupt or shorten your sleep. You can block out unwanted noise by wearing earplugs, running a fan, or using a so-called “white noise” machine that is specifically designed to screen sleep-disruptive sounds. If possible, eliminate the use of night-lights and consider using dark shades in your bedroom so that unwanted light does not awaken you too early in the morning.

Keep your bedroom cool
Make sure the temperature in your bedroom is comfortable. Generally speaking, temperatures much above 75 degrees Fahrenheit cause unwanted wake-ups from sleep. During hot weather, use an air conditioner to control the temperature in your bedroom.

Determining Time in Bed Exercise (Edinger & Carney, pp. 20-21)

Instructions: It is important that you allot enough time for sleep each night but not too much time. The amount of time you schedule for yourself in bed each night should fit your own individual sleep needs. In order to determine how much time you should stay in bed, you will need to review your completed sleep logs from Lesson 1. Calculate your average total sleep time (ATST) by checking your sleep logs and figuring out how much time you actually spend asleep each night. Do not take into account the many minutes you spend tossing and turning or staring at the ceiling. We are talking about actual time spent asleep. Then, use the following formula to determine the ideal amount of time you should remain in bed each night:

Time in Bed (TIB) = Average Total Sleep Time (ATST) + 30 minutes

Once you have calculated your ideal TIB, use it to choose a standard wake-up time and earliest bedtime. For example, if you decide that you want to get up each morning at 7 AM, but your recommended TIB equals 6 hours, this means that your earliest bedtime would be 1 AM. For some people a sleep schedule with a 1 AM bedtime and 7 AM rising time may seem ideal. Others may decide it is probably not a good idea to go to bed this late. There is room for flexibility. Whatever the exact TIB you derive from your sleep log calculations, use your discretion when selecting the bed and rising times that fit with this amount of TIB. Once you have identified the schedule that seems most acceptable to you, record it in the table below. It is very important that you try to stick to these times as closely and as consistently as possible. This is an important step toward overcoming your sleep problems.

My standard rising time is _______________

My standard bedtime is _______________

You should try this sleep-wake schedule for at least 2 weeks while you follow the rest of the sleep improvement strategies discussed. Once you have done so for a minimum of 2 weeks, you should examine how well you are sleeping at night and how tired or alert you are feeling in the daytime. If you are sleeping well most nights and are as alert as you would like to be in the daytime, then you probably don’t need to make changes to your TIB. However, if you find you are sleeping well at night, but feeling tired most days, you should try increasing your time in bed (TIB) at night gradually by 15 minutes per week until you find the right amount of time. If you notice an increase in the amount of time you are awake in bed each night, it may indicate that you have increased your time in bed at night too much.

Tip: If you routinely take more than 30 minutes to fall asleep or you are routinely awake for more than 30 minutes during the night, you probably should reduce the amount of time you spend in bed each night. You also should consider decreasing your time in bed if you find that you routinely awaken more than 30 minutes before you plan to.

Next Step

For more sleep hygiene suggestions, watch this video: