Sleep Hygiene Tips

- Things you can do to promote good sleep
Maintain a regular sleep routine

  • Go to bed at the same time. Wake up at the same time. Ideally, your schedule will remain the same (+/- 20 minutes) every night of the week.

Avoid naps if possible

  • Naps decrease the ‘Sleep Debt’ that is so necessary for easy sleep onset.
  • Each of us needs a certain amount of sleep per 24-hour period. We need that amount, and we don’t need more than that.
  • When we take naps, it decreases the amount of sleep that we need the next night – which may cause sleep fragmentation and diffulty initiating sleep, and may lead to insomnia.  

Don’t stay in bed awake for more than 5-10 minutes.

  • If you find your mind racing, or worrying about not being able to sleep during the middle of the night, get out of bed, and sit in a chair in the dark. Do your mind racing in the chair until you are sleepy, then return to bed. No TV or internet during these periods! That will just stimulate you more than desired.
  • If this happens several times during the night, that is OK. Just maintain your regular wake time, and try to avoid naps.

Don’t watch TV or read in bed.

  • When you watch TV or read in bed, you associate the bed with wakefulness.
  • The bed is reserved for two things – sleep and hanky panky.

Do not drink caffeine inappropriately

  • The effects of caffeine may last for several hours after ingestion. Caffeine can fragment sleep, and cause difficulty initiating sleep. If you drink caffeine, use it only before noon.
  • Remember that soda and tea contain caffeine as well.

Avoid inappropriate substances that interfere with sleep

  • Cigarettes, alcohol, and over-the-counter medications may cause fragmented sleep.

Exercise regularly

  • Exercise before 2 pm every day. Exercise promotes continuous sleep.
  • Avoid rigorous exercise before bedtime. Rigorous exercise circulates endorphins into the body which may cause difficulty initiating sleep.

Have a quiet, comfortable bedroom

  • Set your bedroom thermostat at a comfortable temperature. Generally, a little cooler is better than a little warmer.
  • Turn off the TV and other extraneous noise that may disrupt sleep. Background ‘white noise’ like a fan is OK.
  • If your pets awaken you, keep them outside the bedroom.
  • Your bedroom should be dark. Turn off bright lights.

If you are a ‘clock watcher’ at night, hide the clock.
Have a comfortable pre-bedtime routine

  • A warm bath, shower
  • Meditation, or quiet time

Stimulus Control Therapy

Sleep problems can be related to stressful or disturbing life events such as serious illness, hospitalisation, divorce, death or exams. Once the situation or issues surrounding the event has been resolved sleep usually returns to normal.

Sometimes however, although the original cause of the sleep problem has disappeared the insomnia can remain.

Being unable to sleep may be because an association has developed between going to bed and not sleeping. The bed, bedroom, turning the lights out and attempting to go to sleep has become the stimulus that triggers negative emotions such as frustration and worry. The process of going to bed has developed into an automatic trigger for negative emotions. This is conditioned insomnia.

Can these responses be changed?
YES!
These emotional responses have been learned by frequent association. They can just as easily be unlearned and replaced by new responses. This will make the bed and bedroom become a positive trigger for sleep, ensuring that when you go to bed tired, or wake up during the night you can expect to fall asleep easily. This is what you do…

Step1
Keep your bedroom only for sleep or sexual intimacy. Do not use for activities such as eating, smoking, working or arguing.

Step 2
Wake up and get out of bed at the same time each morning. This includes weekends even when you may stay up later at night than usual. Choose a wake up time that suits your usual circumstances.

Step 3
Go to bed at night only when you feel sleepy, not because of a standard routine. Going to bed before you are sleepy or drowsy is likely to result in a long period of wakefulness in bed.

Step 4
If after going to bed and turning out the light, you do not fall asleep in a reasonably short period of time (approx 15 minutes) get out of bed, go to another room and do something relaxing. When you feel sleepy, go back to bed and give yourself another chance to fall asleep. You should not try hard to fall asleep, as this will only raise your alertness and prevent sleep. Just relax.

Step 5
If again you do not fall asleep quickly, repeat Step 4. Continue this procedure until you fall asleep quickly.

Step 6
Do not nap during the day even after a night of little sleep.

Step 7
Follow the program strictly for several weeks to establish a regular and organized pattern.

What will happen?
At first, it will probably take several times out of bed before you fall asleep quickly. The result will be less sleep than usual resulting in a build-up of sleepiness over the first few days. This will help you to fall asleep more quickly after a few nights. The more experiences you have of falling asleep quickly after turning out the lights, the stronger the influence your bed and bedroom will have to trigger sleep rather than wakefulness. Gradually, over several days or weeks, you will fall asleep on few attempts. You will also notice that you get sleepy earlier in the night and will gradually gain more sleep. For a while you will experience more sleepiness than you do now. The length of treatment required before positive results will depend on how long you have experienced your sleep problem. However, if you follow the instructions for the stimulus control technique it will work quickly and its effects will be long term. Once your sleep pattern has improved and your bed and sleep routine has returned, you should not stop using this therapy. If you want to have an occasional sleep-in remember this may delay you falling asleep that night. Remember it is important not to have long periods awake in bed especially if you start to feel worried or frustrated. It may be beneficial to consider the promotion of good sleep habits (see Sleep: Facts & Hygiene). These minor lifestyle changes can be included into your day, night and bedtime routine and can help you develop a good ongoing sleep pattern.

Dr. Spielman at Columbia Presbyterian in New York may have pioneered a new, effective treatment called sleep restriction therapy. Within a month, his insomniacs were sleeping a good seven hours, and they reported that the quality of their sleep was much improved.

Retraining Your Body
Sleep deprivation therapy is based on the idea that your body has learned how to get along without sleep. Whether this was caused by circadian rhythms, trauma or bad habits when you were young, good evidence shows that you can retrain your body to sleep again. The bad news: It's not easy and it takes a few weeks. The good news: You've probably suffered worse, and it only takes a few weeks.

The Downside of Sleeping Pills

One of the hardest things you may have to do before trying sleep deprivation therapy is make sure you're off sleeping pills. If you've been on sleeping pills before, you know they don't really help with long term sleep problems, they don't increase sleep duration, and they are highly addictive. "The only effect sleeping pills have," says sleep expert Dr. Kripke at UCSD, "is they make you feel good about not being able to sleep." Sleeping pills will harm any chance of retraining your body to know when to sleep and how to stay asleep.

Step 1: Find your minimum sleep threshold

Almost all of us can get a little bit of sleep each night, even if it is for only a few hours. Use the mood tracker to keep a daily log of your sleep times. The mood tracker is also great for identifying foods, activities or events that disrupt sleep. Once you have determined the average minimum amount of time you are able to sleep, move to step 2.*

Step 2: Go without sleep all day

By depriving your body of sleep for a 24-hour period, your body builds up endogenous sleep inducing chemicals that increase your desire and ability to sleep. Staying completely awake also disrupts your 'learned' sleep cycle, and is similar to holding down the restart button on your computer. Sleep fasting reboots your internal sleep computer.

Step 3: Use your minimum sleep time to allow yourself to sleep
Only sleep for that amount of time, even if you could sleep in more. Also, subtract the time you are able to sleep from the time you usually wake up or want to get up, and set this as your subjective bedtime. For example, if you wake up at 6:00am, and your minimum sleep threshold is 3 hours, then stay awake until 3:00 am before going to sleep. Remember to get up at 6:00 even though you may want to sleep in.

Step 4: Use specialized bright light to reinforce your new wake schedule
This is one of the most important steps to sleep deprivation therapy. Bright light is the most powerful regulator of the sleep wake cycle. Using light will help reset a normal sleep/wake pattern, and trying sleep deprivation therapy without bright light is not nearly as successful. Using light for approximately ½ hour upon awakening is sufficient to regulate the sleep/wake cycle.
Step 5: Gradually increase minimum sleep threshold
This is one of the most important steps, because if you jump back too quickly into trying to sleep all night, you'll lose any benefit you gained up to this point. The idea here is to only add 15 minutes of sleep per night until you start having trouble sleeping again. For example, on night one, you go to sleep at 3:00 am and get up at 6:00 am. Night two, you go to sleep at 2:45 am and get up again at 6:00 am (Always keep the same waking schedule). Let's say that by night six, you're going to sleep at 1:30, but now you start having trouble sleeping. Go back to where you are able to sleep solid and stay there a few days before trying to add more time.

Step 6: Don't nap!
Napping can disrupt your circadian rhythm and hurt your ability to sleep again when you need to. When you nap during the day, you teach your body to sleep when it shouldn't, and then it can't sleep when you really need to. If you suffer from chronic insomnia, you should never try to nap again, it's that important. If you feel tired during the day, use your light box or get out in the sunshine and exercise until the drowsiness is gone, but don't give in to napping.
Sleep deprivation therapy works with most chronic sleep suffers. It may not bring back the elusive 8 hours of sleep but it will most likely add a couple of hours of needed sleep. As one sleep sufferer said, "If I could even get another half hour, that would be paradise." Remember, as with all disorders, you should talk with your doctor or sleep specialist when considering any treatment.

Cognitive Therapy

Cognitive therapy simply means correcting a few misconceptions about the nature of sleep. Here are some of the more common misconceptions people have about sleep, along with the facts.

When I don't sleep at night, I must sleep during the morning or nap.
Actually, if you have a bad night or two, trying to make up for it in the day may simply make the problem worse. Continue your daily routine. Go to bed at a reasonable bedtime. Many people get into a cycle where they sleep during the day, can't sleep at night (no wonder) and then sleep during the day again.

If I spend enough time in bed eventually I'll feel rested.
Wrong! Rest is fine, but it is not the same as sleep. If you really can't sleep, then seek help.

I've lost the ability to sleep.
No one really loses the ability to sleep. Not being able to fall asleep is due to influences that have nothing to do with the ability to sleep.

My insomnia is due to aging.
This is a common misconception. Older people actually require the same amount of sleep as younger people (adults). However, due to inactivity, depression, medication, or illness, many older people sleep during the day. This naturally reduces the time that they sleep at night. In addition, many older people shift their biorhythm so they fall asleep earlier and get up earlier. There is nothing wrong with this per se unless the person continues to try to go to bed late. Then they may end up sleep depriving themselves. Older people usually require the same amount of sleep as when they were younger, but they may end up distributing sleep during the day and night rather then consolidating sleep at night.

My insomnia is due to a biochemical imbalance.
When you don't know, just use the words "chemical imbalance." There are a hundred different reasons for insomnia. It is the job of the doctor and the patient to figure out what the root cause is and deal with it in an appropriate manner.

I must have (7, 8 or whatever) hours of sleep.
Actually, the requirements for sleep differ greatly between individuals. Some people do fine on 5 hours a night, and some require 8 to 9 hours a night. If you get five hours, but aren't sleepy during the day and are functioning just fine, then don't worry about it. If you need more sleep, then arrange your sleep schedule appropriately.

I should be able to fall asleep like...
Since sleeping habits differ between individuals, do not compare yourself to someone else. Some people are champion sleepers, and some have always had some difficulty falling asleep (often they call themselves light sleepers). You need to deal with how you are and not put yourself up to someone else's standard.

When I can't sleep, I must try harder.
Lying in bed "trying hard" to sleep is usually the best way to stay awake. The idea is to relax, control your thoughts and allow yourself to fall asleep.

Relaxation
Dozens of scientific studies have proven that the relaxation is an effective treatment for insomnia.

How Does Relaxation Improve Sleep
When practiced during the day, relaxation response counters daily stress responses. This reduces the likelihood that stress hormones will be elevated at night.

When practiced at bedtime or after an awakening, relaxation response helps turn off negative sleep thoughts, quiet the mind, and relax the body.

Relaxation response elicits a brain-wave pattern similar to Stage 1 sleep, the transition state between waking and sleeping. Thus, by practicing the relaxation at bedtime or after a nighttime awakening, it is easier to enter Stage 1 sleep and then to Stage 2, deep sleep, and dream sleep ultimately.
People who practice relaxation fall back to sleep faster. They sleep longer and they have a better quality of sleep (deep sleep). They are more rested in the morning. Gradually, they develop a greater sense of control over their mind and sleep. Thus, although the relaxation by itself may not cure insomnia, it has a significant positive effect on sleep for most insomniacs.

How To Achieve Relaxation
There are two main techniques to elicit relaxation.
1. Progressive Relaxation by Jacobson
2. Relaxation response by Benson
Both of these techniques are effective in eliciting relaxation. Which method you use depends on personal preferences and what makes you more comfortable.

Progressive Relaxation
One of the most popular and easy-to-use methods to relax is by progressive relaxation. The key to progressive relaxation is to become aware of tension and its corresponding state, relaxation, in each of the body's muscles. Once you are aware of the difference, you can learn to relax muscles one at a time until gradually your whole body is ready to drift away into restful sleep.

How To Elicit Relaxation Using Relaxation Response

Begin with the muscles in your face, such as those that move your eyebrows. Contract the muscles with gentle force for one to two seconds, and then relax. Don't stop breathing while you tense the muscles. Some people find it helpful to count their breaths.

Repeat a few times, then move on to the other muscles, such as those in the center of your face that control your nose and upper lip, and those that control the comers of your mouth.
Tense and relax the muscles of the jaw and neck.
Move on to the upper arms, the lower arms, and each finger of the hands. 
Now work on the parts of the body below such as the chest, the abdomen, the buttocks, the thighs, the calves, and finally the feet.
Repeat this exercise two more times, for a total of about forty-five minutes of relaxation time. In most cases, you won't be able to complete too many whole cycles, because you'll have relaxed yourself to sleep! When you feel you've learned how to relax your arms, repeat the procedure with other muscles-legs, chest, abdomen, and face. Each time, you begin by tensing the muscles, holding the tension, and then relaxing.
Once you have mastered this technique of relaxation, you'll be able to go straight to the relaxation mode. You'll be able to identify where you're tense and allow yourself to relax. 
Since it is hard to remember the sequence of relaxation when you are trying to relax and sleep, a better alternative is to make a tape that guides you through the process. There are many tapes available that are professionally made or you can record one yourself. Make sure you give plenty of gaps (preferably interspersed with relaxing music) so that you can go through it without having to rewind or fast forward the tape.

Learning to Elicit the Relaxation Response
Step 1: Relax the muscles throughout the body
Lie down or sit comfortably. Close your eyes. Feel relaxation gradually spread throughout your body.
Some people start with the head and feel relaxation spread to the toes. Others find it easier to start with the feet and feel relaxation rise to the head. Again choose whichever makes you comfortable.

You may feel warmth, heaviness, tingling, or floating as signs of relaxation. Some people may feel nothing specific.
Step 2: Establish a relaxed breathing pattern
When relaxed or sleeping, we breathe with the abdomen. This is the most relaxing to the body because carbon dioxide is expelled and oxygen inhaled efficiently. When we feel stressed, our breathing pattern changes to short, shallow, regular chest breaths, or we hold our breath. This type of breathing is not effective in inhaling oxygen and exhaling carbon dioxide. This further stresses the body. Since waste products were not removed during the breathing out, they build up in the bloodstream and we feel more anxious.
So, it is important that we learn how to breathe deeply. You can learn more about breathing in Holisticonline.com yoga infocenter. Yoga has an entire section called pranayama that deals with the science of breathing.

Related Topic: Breathing Exercises

Step 3: Direct your attention from everyday thoughts by using a mental focusing device that is neutral and repetitive
For many choosing a word and repeating it may help to keep their attention away from day to day problems. Transcendental meditation gives a personal mantra. You can, however, choose a word that may have special meaning to you such as peace, "Jesus love me", one, or relax. You can also use the rise and fall of the abdomen as you breathe. Some find it easier if they count or say the word with the breath. Others repeat a word silently with each exhalation.
You can choose a visual image of an enjoyable, relaxing place as the mental focusing device. Examples are:

  . A favorite vacation spot
  . A place you create

 

. A beach, a meadow, or mountain

 

. A place in a book, magazine, or movie

 

. Floating on a cloud

When eliciting the relaxation response, assume a passive attitude. Let relaxation happen at its own pace. Don't "force" to relax. Don't worry about whether relaxation is occurring. If distracting thoughts occur, disregard them and return attention to the mental focusing device. 

Practicing Relaxation Response
It is useful to make a relaxation tape so that you can follow the step-by-step instructions on the tape. You can make one yourself or buy one made professionally.
Play the tape and follow the instructions. Close your eyes and mentally repeat them. Relax.
Relaxation - Enjoying the Moment
When people first elicit the relaxation, they often experience physical relaxation: the muscles relax, breathing and heart rate slow. Others notice novel sensations such as heaviness, warmth, tingling, or even floating. Many find it difficult to quiet the mind, which wanders from thought to thought as if it has a life of its own. With practice, the ability to quiet the mind and focus attention improves. Thoughts begin to slow and pleasantly drift.
During deep relaxation, you may feel that you are not really awake or asleep. You may begin to lose awareness of surroundings, thoughts, or the mental focusing device and enter a state similar to Stage I sleep. If attention drifts back to everyday thoughts, return to the mental focusing device until the mind quiets again.
Initially, feelings of relaxation from the relaxation response may last only a short time. However, in a few weeks, the body adjusts to the relaxation. The stress hormones become less reactive and the effects of the relaxation begin to "carry over" and extend throughout the day. As stress is reduced, you sleep better. 
Making Relaxation as Part of Your Daily Life
You need to practice relaxation almost daily to obtain significant benefits from it. 
The more consistently the relaxation is practiced, the greater the benefits for sleep, health, and daily life.
Here are some guidelines you can use.

 
  • Allot ten to twenty minutes per day for the relaxation. Most people simply can't relax and quiet the mind in less time. As more experience is gained, relaxation occurs more quickly.

 

  • Practice relaxation in a comfortable position and in a quiet place where you will not be disturbed.

 

  • Experiment to find the time of day that works best for you. Then designate that time as regular relaxation time.