Good “Sleep Hygiene” refers to the basic “rules” for good sleep, an essential part of sleep education every patient needs to know:
Try to go to bed and wake up at around the same time. Our sleep-wake patterns are regulated by an internal “clock” which dictates when we feel sleepy. We are usually sleepiest at bedtime, and again sometime in the mid-afternoon. This internal clock runs in an approximately 24 hour cycle, in a regular manner.
People who have good sleep habits are well synchronized with their internal clocks, and fall to sleep and wake up like clockwork. When our lives are in-synch with our internal clocks, we tend to function best. People who routinely vary their sleep-wake times, like shift workers, tend to have poorer quality sleep, and sleep less overall than others. When our daily life schedules are nicely synchronized with our internal clocks, we will naturally sleep better. If we keep changing our bed and wake times, there is desynchronization which is stressful for our bodies, and not conducive to good sleep. If you already have difficulty falling to sleep, do not lie in bed tossing and turning indefinitely, watching the clock. If you keep doing this, your mind and body become “conditioned” to struggle with sleep every night in the same manner, and will associate the bedroom with stress and reinforce the difficulty with sleep.
In order to “break” this conditioning, you should make it a point to get out of bed if you are unable to sleep within 15 to 20 minutes. You should leave the bedroom and go somewhere else to do something relaxing, such as reading, listening to music or watching TV. You should only return to bed when you are sleepy again, however long it takes. You need to develop the reverse conditioning, whereby you associate the bedroom with sleepiness and sleep, so that you will fall asleep readily when you go to bed.
Following on the above, the bedroom should ideally be a place only for sleep and sexual activity. If you have a problem with insomnia, you should not read, watch TV or work in bed. Associating the bed with other types of activities, especially if they are stimulating, will make it harder to fall asleep.
Avoid caffeine and stimulating activities close to bedtime. Caffeine can stay in your body for over 10 hours, and can affect sleep because it is a stimulant. People with problems sleeping should not drink caffeinated beverages from the afternoon or at night. Smoking and alcohol should also be avoided close to bedtime. Stimulating activities such as vigorous exercise, intense work and exciting or violent TV programmes should be avoided close to bedtime. The higher our level of arousal at bedtime, the harder it is to fall asleep. However sleepy and tired we are, this can be counteracted by high levels of arousal.
Long afternoon naps make it difficult for us to fall asleep at night and should be avoided. Our ability to sleep is related to our sleep “drive” which builds throughout the day in proportion to how long we stay awake. So the longer we stay awake, the sleepier we get. If we blunt this drive to sleep by taking a long afternoon nap, we may have difficulty falling asleep at night. People who lack sufficient sleep may benefit from a short nap in the afternoon to refresh them, but those who have difficulty falling asleep in general should avoid daytime naps.
A daily ritual to help us relax at the end of the day is a good lead-up to falling asleep easily. This can take the form of a warm bath, dimming the lights, reading quietly, a relaxing TV programme, soft music or just about any pleasurable activity that is something you look forward to at the end of the day. If we can learn to wind down after a day of stresses, our natural sleep drive which has built up over the day of wakefulness takes over, and allows us to fall asleep.
