Why Sleep Hygiene Probably Won't Cure Your Insomniaby Martin Reed Patient Advocate
If you talk to your doctor about insomnia or look online for sleep advice, you will likely hear about sleep hygiene. Doctors commonly offer counseling on healthy sleep hygiene as an initial response to insomnia complaints — but there is little evidence to suggest it is an effective insomnia treatment.
What is sleep hygiene?
Put simply, sleep hygiene is a set of recommendations that are intended to promote sleep. Sleep hygiene education involves learning about behaviors and environmental issues that affect sleep and following recommended best practices.
Due to the basic nature of the advice contained in sleep hygiene education, it is a relatively simple intervention to follow and certainly requires far less effort than more robust interventions such as cognitive behavioral therapy for insomnia.
Sleep hygiene is popular since it does not need to be administered in a clinical setting and its components are readily available online and in printed materials. This level of accessibility is particularly helpful for those who are unlikely to seek medical advice for their insomnia.
Does sleep hygiene work?
With that being said, the effectiveness of sleep hygiene as a treatment option for insomnia is not certain. This led researchers to conduct a review of the evidence and findings were published in the journal Sleep Medicine Reviews in 2015.
The typical components of sleep hygiene are listed below, along with the review’s conclusions on their effectiveness.
Sleep hygiene tip: Reduce or avoid caffeine
Since it is a stimulant, it makes sense that consuming too much coffee will harm sleep.
Although the review found large doses of caffeine close to bedtime can disrupt sleep, the effects of lower doses were less consistent. The authors suggested that caffeine abstinence may be more effective for light or intermittent caffeine consumers rather than habitual consumers.
Sleep hygiene tip: Avoid nicotine
Like caffeine, nicotine acts as a stimulant. As a result, sleep hygiene tends to advise against consuming the drug. The review pointed out that habitual nicotine users who suddenly quit are likely to see their sleep get worse in the immediate short term — and there is limited evidence regarding the long term benefits of nicotine abstinence on sleep.
Sleep hygiene tip: Reduce or avoid alcohol
Alcohol is known to disrupt sleep and sleep hygiene tends to encourage either abstinence or avoidance of alcohol close to bedtime. Researchers of the review concluded that for those not dependent on alcohol, even light consumption of alcohol shortly before bed can disrupt sleep — yet the impact of afternoon or early evening alcohol consumption on sleep is not yet fully understood.
Sleep hygiene tip: Get more exercise
The authors of the review determined that research suggests exercise can help reduce sleep disturbance but a number of factors need to be considered (for example, intensity, duration, timing). As a result, the review concluded that there is insufficient evidence to suggest exercise will improve sleep for everyone — particularly since we are all different in terms of age, gender, and fitness levels.
Sleep hygiene tip: Reduce stress
Sleep hygiene often incorporates elements of stress reduction such as encouraging individuals to engage in relaxing activities — usually shortly before bed — to help reduce arousal.
As pointed out by the authors of the review, the perception and influence of stress is highly individual — and a generalized approach risks exacerbating stress and making sleep even worse. Furthermore, since there are a number of different stress management techniques (such as constructive worry, relaxation, and mindfulness), taking a generalized approach makes it difficult to point an individual towards the technique that would be most appropriate for their needs.
Sleep hygiene tip: Noise reduction
It makes sense that excessive nighttime noise can disrupt sleep — and perhaps unsurprisingly, researchers determined that reducing noise in the bedroom is sound advice.
Sleep hygiene tip: Stick to a regular sleep schedule
Sleep hygiene education typically involves encouraging regular (and appropriate) bedtimes and wake times — and the authors of the review concluded that evidence shows there is a clear link between irregular sleep schedules and sleep problems. With that being said, researchers pointed out that studies in this area tend to involve individuals without sleep complaints, so more research is still needed.
Sleep hygiene tip: Avoid naps
Napping during the day can reduce sleep drive, making it harder to fall asleep at night. For this reason, sleep hygiene tends to recommend avoiding naps altogether or restricting them to a maximum of 30 minutes. The review found that there is limited research to support nap avoidance and that additional research is needed in this area.
The effectiveness of sleep hygiene education for insomnia
Although many of the individual components of sleep hygiene appear to be sound, this review found limited evidence to support their effectiveness at improving sleep in the general population.
Perhaps this makes sense. After all, we are all unique individuals and our sleep is affected by a number of different factors — so following generalized sleep hygiene advice may not always be beneficial.
A personalized approach to sleep hygiene education is more likely to be effective — the review pointed to a study in which two out of three insomnia sufferers reported improved sleep after an initial consultation that gave participants personalized sleep hygiene recommendations.
It’s also worth pointing out that changing one sleep hygiene behavior can inadvertently lead to changes in other behaviors. For example, caffeine withdrawal may lead to increased stress and decreased exercise and this can have a negative impact on sleep; avoiding naps may lead to an increase in caffeine consumption, making sleep more difficult — and so on.
In conclusion, sleep hygiene can be helpful — but the advice is generalized, may not apply to everyone, and there is limited evidence to support it as a treatment option for sleep disturbances. It’s worth giving sleep hygiene a try, but if it doesn’t work for you, do not discount the effectiveness of more scientifically proven (and individualized) treatments such as cognitive behavioral therapy.