Sleep Hygiene

September 27, 2011

Sleep hygiene is an important consideration after underlying causes of sleep disturbance have been addressed from neurological, psychiatric, and medical causes, and acute stressors are not immediate by apparent. Sleep hygiene refers to patterns of behavior and attitudes about sleep for a given person. Probably one of the most significant factors is the misunderstanding that surrounds sleep. There are often significant maladaptive behaviors that can arise when a person develops sleep disturbances. This leads to a negative spiral that tends to exacerbate the symptoms of insomnia. It is imperative at the outset of addressing sleep issues to educate individuals about the natural process of sleep. When pathology has been ruled out, then individuals can be reassured that sleep will occur and this is important to provide relief to the suffering person. Insomnia may undermine an individual’s own sleep. This occurs by factors that are under a given person’s immediate control and issues which require adaptation to external factors or modification of those factors.

Factors under a person’s direct control involve making a choice about what times a person chooses to sleep. It is advisable under most circumstances not to take naps greater than one half hour during the day if one expects to sleep at traditional times at night. Vigorous activities or eating substantially should be avoided close to anticipated times of sleep to alleviate insomnia. Avoidance of stimulants such as caffeine is also important. Forcing yourself to sleep is a common misconception. Going to bed when sleepy and not at arbitrary times needs to be appreciated. The tendency to overcontrol sleep instead of learning to work with an individual’s sleep patterns needs flexibility to avoid anxiety or self-induced stress regarding sleep habits. Treatment needs to be directed toward the development of behaviors and adaptations to sleep patterns that are flexible.

It is important that the effect of external factors on sleep needs to be appreciated and again assist individuals in their ability to negotiate these issues. More challenging issues may indicate a need for psychotherapy. Anticipation of a job or endeavor the next day can contribute to anxiety and may compromise sleep. Recognition of the influence of thoughts on sleep patterns may be enough of an influence to change cognitive behaviors, yet, at other times, psychotherapy may be necessary to be able to adapt to changes required.

Chronic sedative use in the absence of applications of these principles is not only not helpful but is in fact counter productive. In fact, chronic sedative use is usually a sign of underlying issues, as previously mentioned, that have not been addressed.

To summarize, sleep hygiene involves education and techniques of adaptation that reflect appropriate management of factors direct and indirect that affect sleep function. It is critical to understand the multidimensional nature of sleep hygiene to implement it efficaciously.

See Also: Anxiety disorders, Insomnia, Mood disorders, Sleep disorders

Suggested Reading

  • Cartwright, R. D. (1995). Sleep disorders: Diagnosis and treatment. American Journal of Psychiatry, 152, 1659—1663.
  • Cohen, G. D. (1998). Aging to sleep, perchance to dream. American Journal of Geriatric Psychiatry, 6, 93—96.
  • Dupont, R. L. (1999). The secret strength of angels—7 virtues to live by. American Journal of Psychiatry, 156, 2011.
  • Hartmann, E., Baekeland, F., Zwilling, G., & Hoy, P. (1971). Sleep need: How much sleep and what kind? American Journal of Psychiatry, 127, 1001-1008.
  • Hartmann, L. (2001). Sleep in America: National survey results. Psychiatric News, 36, 13-a.
  • Kavanau, J. L. (2000). Sleep, memory maintenance, and mental disorders. Journal of Neuropsychiatry and Clinical Neuroscience, 12, 199-208.
  • Kayumov, L., Rotengerg, V., Buttoo, K., Auch, C., Pandi-Perumal, S. R., & Shapiro, C. M. (2000). Interrelationships between nocturnal sleep, daytime alertness, and sleepiness: Two types of alertness proposed. Journal of Neuropsychiatry and Clinical Neuroscience, 12, 86-90.
  • Morin, C. M., Culbert, J. P., & Schwartz, S. M. (1994). Nonpharmacological interventions for insomnia: A meta-analysis of treatment efficacy. American Journal of Psychiatry, 151, 1172-1180.
  • Noffsinger, S. (1998). Psychiatric aspects of sleep. Psychiatric Service, 49, 1099.
  • Regesteinm, Q. R., & Monk, T. H. (1991). Is the poor sleep of shift workers a disorder? American Journal of Psychiatry, 148, 1487-1493.
  • Schnierow, B. J. (2000). The enchanted world of sleep. American Journal of Psychiatry, 157, 1191.

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