Behaviors that help promote sound sleep
For most people, falling asleep and staying asleep are parts of a natural process. Good sleepers are likely to have developed certain lifestyle and dietary habits that promote sound sleep. These habits or behaviors – known as sleep hygiene – can have positive effects on sleep before, during, and after time spent in bed. For the most part, sleep hygiene is a matter of common sense, and the techniques suggested below will help most people sleep better.
Caffeine stimulates the brain and interferes with sleep. Coffee, tea, colas, cocoa, chocolate, and prescription and nonprescription drugs that contain caffeine should not be taken within three to four hours of bedtime. Although moderate daytime use of caffeine usually does not interfere with sleep at night, heavy or regular use during the day can lead to withdrawal symptoms and to sleep problems at night.
Nicotine is another stimulating drug that interferes with sleep, and nicotine withdrawal can also disrupt sleep throughout the night. Cigarettes and some drugs contain substantial quantities of nicotine. Smokers, who break the habit, once they overcome the withdrawal effects of the drug, can expect to fall asleep faster and wake up less during the night.
One of the effects of alcohol is a slowing of brain activity. When taken at bedtime, alcohol may help induce sleep at first, but will disrupt sleep later in the night. A “nightcap” before bed can result in awakenings during the night, nightmares, and early morning headaches. Alcoholic beverages should be avoided within four to six hours of bedtime.
Regular exercise helps people sleep better; the benefits of exercise on sleep, however, depend on the time of day it is undertaken and on your overall fitness level. People who are physically fit should avoid exercising within six hours of bedtime. Exercise in the morning is not likely to affect sleep at night, but the same amount of exercise – if done too close to bedtime – can disrupt sleep. On the other hand, too little exercise and limited activity during the day can also lead to sleeplessness at night. Consult a healthcare professional before beginning an exercise program.
A comfortable bed in a dark, quiet room is the best setting for a good night’s sleep. Some people seem to adjust easily to changes in sleep environment, but others (such as insomniacs and the elderly) can be easily disturbed by small changes in sleep surroundings. When excessive light is a problem, blackout curtains and spot lighting can be helpful. Noise problems can be alleviated with the use of background sound (“White Noise”) or earplugs.
Eating a full meal shortly before bedtime can interfere with the ability to fall asleep and stay asleep, as can heavy meals eaten at any time of day or foods that cause indigestion. A light snack at bedtime, however, can promote sleep. Milk and other dairy products, which contain the natural sleep – promoting substance tryptophan, are especially good as bedtime snacks.
Decreasing Time Awake in Bed
Stress contributes too many sleep problems. People who have trouble sleeping sometimes begin to rely on certain strategies – such as regular napping, excessive use of caffeine, use of alcoholic beverages at bedtime, working at night, and sleeping at irregular times – to help adapt to a disturbed sleep schedule. After the source of stress that led to the sleep problem is eliminated, these behaviors can sometimes cause sleep problems to continue. A cycle of repeated difficulty in falling asleep develops, and tension and a fear of sleeplessness can result. The bedroom itself can come to be associated with unsuccessful attempts to sleep and with tension and anxiety. Some people who have trouble sleeping will begin sleeping on a sofa or in a chair because they are no longer able to sleep in the bedroom. This phenomenon, termed conditioning, may respond to one of two treatment techniques: stimulus control and sleep restriction.
Stimulus control attempts to reestablish the connection between sleep and the bedroom. Reducing the amount of time spent lying awake in bed does this. The principles of good sleep hygiene and stimulus control are often used together to relieve sleeplessness.
Sleep restriction works by reducing the amount of time spent in bed to the estimated time period spent actually sleeping. Sleep restriction techniques, which can be learned from a sleep specialist, include recording the time you spend in bed and the time you spend asleep each day for one to two weeks. The amount of time spent in bed is then restricted to the time spent actually sleeping. As sleep quality improves, the sleep schedule is adjusted as appropriate. Sleep restriction prescribes a specific amount of sleep but not a mandatory time period in bed. Stimulus control and sleep hygiene guidelines may be used in combination with sleep restriction.
People experiencing sleep problems, especially those with insomnia, should avoid clock-watching. It can be helpful to set the alarm for the desired morning arise time, and then hide the clock and watches in a dresser drawer across the room. Most people experiencing sleep problems sleep best when time pressures are relieved.
As mentioned earlier, the stress that stems from common life situations often contributes to sleep problems. A relaxing activity around bedtime can help relieve tension and encourage sleep. Consciously attempting to clarify problems and formulate solutions can have a positive effect on sleep quality. Talking with a trusted friend or colleague to “air out” troubling issues can be helpful. Relaxation exercises, meditation, biofeedback, and hypnosis are sometimes beneficial in controlling sleep problems. These techniques should be learned from a psychologist, physician, or other healthcare professional.
Designating “Worry Time”
Another technique that can be helpful is to designate a particular time for worry. This time is dedicated to sorting out problems and coming up with possible solutions. Set aside 30 minutes in the evening to sit alone and undisturbed. On 3 x 5 cards, write down each of your worries as it comes to mind (one worry per card). These worries can range from the mundane (needing to call someone in the morning or remembering an anniversary) to the serious (financial concerns or problems with a relationship).
When all worries have been written down, sort the cards into three to five piles according to the priority of the worry. Next, look at each card and formulate a possible solution to that worry. While not all worries will have easy solutions, even small progress in remedying a worry can yield helpful results. The morning after recording your worries, review the worry cards and begin to work on resolving the worries you’ve identified.
Good sleep hygiene will improve the sleep of many people (see Table 2 at the back of this booklet). Stimulus control and sleep restriction strategies, although they are challenging techniques to master, improve the likelihood of a successful outcome. If sleeplessness persists after four to six weeks of modifying sleep and daytime habits as described earlier, it’s time to consider seeking professional help from a healthcare professional or an expert in sleep disorders.
Instructions for stimulus control management for sleep problems
1. Try to sleep only when you are drowsy.
2. If you are unable to fall asleep or stay asleep, leave your bedroom and engage in a quiet activity elsewhere. Do not permit your self to fall asleep outside the bedroom. Return to bed when – and only when-you are sleepy. Repeat this process as often as necessary throughout the night.
3. Maintain a regular arise time, even on days off work and on weekends.
4. Use your bedroom only for sleep and sex.
5. Avoid napping during the daytime. If daytime sleepiness becomes overwhelming, limit nap time to a single nap of less than 1 hour, no later than 3 p.m.
Sleep hygiene instructions
1. Avoid caffeine within four to six hours of bedtime.
2. Avoid the use of nicotine close to bedtime or during the night.
3. Do not drink alcoholic beverages within four to six hours of bedtime.
4. While a light snack before bedtime can help promote sound sleep, avoid large meals.
5. Avoid strenuous exercise within 6 hours of bedtime.
6. Minimize light, noise, and extremes in temperature in the bedroom.