What are the recommendations for improving sleep hygiene?

Recommendations for Improving Sleep Hygiene

Good sleep hygiene practices are essential for optimal health and should include maintaining consistent sleep/wake schedules, creating a comfortable sleep environment, limiting time in bed to actual sleep time, and avoiding sleep-disrupting substances and activities before bedtime. 1

Optimal Sleep Duration

• Adults should aim for 7-9 hours of sleep per night for good health, as both short sleep duration (<6 hours) and long sleep duration (>9-10 hours) are associated with adverse health outcomes including increased mortality 1, 2
• Sleep needs vary by age: teenagers need 8-10 hours, young adults and adults need 7-9 hours, and older adults need 7-8 hours 3
• Individual variability exists, but deviating significantly from these recommendations is rare and may indicate underlying health issues 1, 3

Key Sleep Hygiene Recommendations

Sleep Schedule and Environment

• Maintain consistent bedtimes and wake times, including weekends 1
• Create a sleep-conducive environment that is dark, quiet, comfortable, and at an appropriate temperature 1, 4
• Use the bedroom only for sleep and sex; avoid watching television, working, or other stimulating activities in bed 1
• Develop a regular sleep ritual, such as a 30-minute relaxation period before bedtime 1, 4

Behavioral Strategies

• Go to bed only when feeling sleepy 1
• If unable to fall asleep within 20 minutes, leave the bedroom and return only when sleepy 1, 4
• Limit daytime napping to 30 minutes and avoid napping after 2 PM 1, 5
• Consider sleep restriction therapy if spending excessive time in bed not sleeping - limit time in bed to match actual sleep time and gradually increase as sleep efficiency improves 1, 4

Physical Activity and Substances

• Exercise regularly, but avoid heavy exercise within 2 hours of bedtime 1, 5
• Avoid sleep-fragmenting substances near bedtime 1:
  • Caffeine (at least 6 hours before bedtime)
  • Nicotine
  • Alcohol (at least 4 hours before bedtime)
  • Heavy meals
• Limit fluid intake before bedtime to prevent nighttime awakenings 1, 5

Advanced Techniques for Sleep Improvement

Relaxation Techniques

• Progressive muscle relaxation: systematically tensing and relaxing muscle groups 4
• Guided imagery: visualizing peaceful scenes to reduce cognitive arousal 4
• Diaphragmatic breathing: slow, deep breathing to activate the parasympathetic nervous system 4
• Meditation and mindfulness: focusing on the present moment to reduce cognitive arousal 4

Cognitive Behavioral Therapy for Insomnia (CBT-I)

• CBT-I is the first-line treatment for chronic insomnia, combining multiple approaches 1, 6
• Components include sleep restriction/compression, stimulus control, sleep hygiene education, and cognitive therapy 6
• CBT-I has shown sustained effects for up to 2 years in older adults 6
• Online CBT-I programs have shown effectiveness for improving sleep quality 1

Common Pitfalls to Avoid

• Clock-watching at night increases sleep-related anxiety and should be avoided 4
• Sleep restriction should not reduce time in bed to less than 5 hours 4
• Inconsistent implementation of sleep hygiene practices may limit effectiveness 7
• Using electronic devices before bedtime can disrupt circadian rhythms due to blue light exposure 4, 5
• Relying solely on sleep hygiene education without addressing behavioral components may be insufficient 1, 7

Special Considerations

• For older adults, sleep disturbances more commonly manifest as difficulty maintaining sleep rather than difficulty falling asleep 4
• Shift workers should pay special attention to creating a dark, quiet sleep environment and maintaining consistent sleep schedules when possible 1
• Underlying medical conditions or medications that disrupt sleep should be identified and addressed 6