From the Guidelines
Sleep hygiene practices should not be used as a single-component therapy for treating insomnia, but rather as part of a comprehensive treatment approach, such as Cognitive Behavioral Therapy for Insomnia (CBT-I), which is the recommended treatment of choice for chronic insomnia disorder. According to the American Academy of Sleep Medicine clinical practice guideline 1, CBT-I is a multicomponent intervention that includes sleep restriction therapy, stimulus control, and cognitive therapy, and has the most evidence available in the literature. While sleep hygiene is not recommended as a standalone treatment, certain common-sense principles of sleep hygiene, such as avoiding excessive caffeine or alcohol, may be helpful in a comprehensive treatment approach.
Some key sleep hygiene practices that can be incorporated into a comprehensive treatment approach include:
- Maintaining a consistent sleep schedule
- Creating a relaxing bedtime routine
- Making the bedroom comfortable, dark, quiet, and cool
- Avoiding screens and electronic devices before bedtime
- Limiting caffeine and alcohol close to bedtime
- Engaging in regular exercise, but not too close to bedtime
It's essential to note that these practices should be used in conjunction with evidence-based treatments, such as CBT-I, and not as a replacement for them. Clinicians should discuss different treatment options with their patients and allocate time and resources to delivering interventions with the best evidence, such as CBT-I 1. By prioritizing evidence-based treatments and incorporating sleep hygiene practices into a comprehensive approach, patients with insomnia disorder can experience gradual improvements in insomnia symptoms and durable benefits beyond the end of treatment.
From the Research
Sleep Hygiene Recommendations
To improve sleep quality, several recommendations can be made based on existing research:
- Achieving 7 to 9 hours of sleep per night 2
- Maintaining a consistent sleep/wake schedule 2
- Establishing a regular bedtime routine 2
- Engaging in regular exercise 2
- Adopting a contemplative practice 2
- Avoiding substances that can disrupt sleep, such as:
Cognitive Behavioral Therapy for Insomnia
Cognitive behavioral therapy for insomnia (CBT-I) has been shown to be an effective treatment for insomnia:
- CBT-I has superior effectiveness to benzodiazepine and non-benzodiazepine drugs in the long term 3
- CBT-I can improve psychological outcomes 3
- CBT-I is effective for treating insomnia when compared with medications, and its effects may be more durable than medications 3
- Long-term maintenance of therapeutic gains associated with CBT-I has been documented, with insomnia remission rates ranging from 44% to 74% at the 12- and 24-month follow-ups 4
Melatonin and Zolpidem
Research on melatonin and zolpidem has yielded the following findings:
- Melatonin 5 mg alone improved daytime sleep without impairing memory and vigilance 5
- Zolpidem 20 mg plus melatonin 0 mg enhanced daytime sleep, but memory and vigilance were impaired 5
- Prolonged-release melatonin (PR-M) did not impair psychomotor functions, memory recall, and driving skills in healthy middle-aged and elderly volunteers 6
- Zolpidem significantly impaired psychomotor and driving performance, and early memory recall, and these impairments were exacerbated with PR-M co-administration 6