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Sleep Dos & Don'ts

'Sleep Hygiene' Solutions for Better Sleep

By Michael Breus
WebMD Feature

Reviewed By Charlotte Grayson

From having occasional difficulty sleeping to insomnia, there is a lot you can do to get a better night's sleep , feel refreshed when you awake, and remain alert throughout the day. It's called "sleep hygiene" and refers to those practices, habits, and environmental factors that are critically important for sound sleep. And most of it is under your control.

There are four general areas important to sleep hygiene:

  • Our circadian rhythm, or 24-hour cycle
  • Aging
  • Psychological stressors -- those factors can cause difficulty falling asleep and disturb the quality of your sleep
  • Common social or recreational drugs like nicotine, caffeine, and alcohol

Circadian Rhythm

We all have a day-night cycle of about 24 hours called the circadian rhythm. It greatly influences when we sleep and the quantity and the quality of our sleep. The more stable and consistent our circadian rhythm is, the better our sleep. This cycle may be altered by the timing of various factors, including naps, bedtime, exercise, and especially exposure to light (from traveling across time zones to staring at that laptop in bed at night).

Aging

Aging also plays a role in sleep and sleep hygiene. After the age of 40 our sleep patterns change, and we have many more nocturnal awakenings than in our younger years. These awakenings not only directly affect the quality of our sleep, but they also interact with any other condition that may cause arousals or awakenings, like the withdrawal syndrome that occurs after drinking alcohol close to bedtime. The more awakenings we have at night, the more likely we will awaken feeling unrefreshed and unrestored.

Psychological Stressors

Psychological stressors like deadlines, exams, marital conflict, and job crises may prevent us from falling asleep or wake us from sleep throughout the night. It takes time to "turn off" all the noise from the day. No way around it. If you work right up to the time you turn out the lights, or are reviewing all the day's events and planning tomorrow (sound familiar?), you simply cannot just "flip a switch" and drop off to a blissful night's sleep.

One must develop some kind of pre-sleep ritual to break the connection between all the stress and bedtime. This is perhaps even more important for children. These rituals can be as short as 10 minutes or as long as an hour. Some find relief in making a list of all the stressors of the day, along with a plan to deal with them, as it serves to end the day. Combining this with a period of relaxation, perhaps by reading something light, meditating, or taking a hot bath can also help you get better sleep. And don't look at that clock! That tick-tock will tick you off.

Social or Recreational Drugs

Social or recreational drugs like caffeine, nicotine, and alcohol may have a larger impact on your sleep than you realize. Caffeine, which can stay in your system as long as 14 hours, increases the number of times you awaken at night and decreases the total amount of sleep time. This may subsequently affect daytime anxiety and performance. The effects of nicotine are similar to those of caffeine, with a difference being that at low doses, nicotine tends to act as a sedative, while at high doses it causes arousals during sleep.

Alcohol may initially sedate you, making it easier to fall asleep; however, as it is metabolized and cleared from your system during sleep, it causes arousals that can last as long as two to three hours after it has been eliminated. These arousals disturb sleep, often causing intense dreaming, sweating, and headache. Smoking while drinking caffeine and alcohol can interact to affect your sleep dramatically. These sleep disturbances may be most apparent upon awakening, feeling unrefreshed, groggy, or hungover.

It is important to realize that not getting the proper amount of and the best quality sleep may have serious short-term and long-term consequences. Many studies have shown that sleep deprivation adversely affects performance and alertness.

Reducing sleep by as little as one and a half hours for just one night reduces daytime alertness by about one-third. Excessive daytime sleepiness impairs memory and the ability to think and process information, and carries a substantially increased risk of sustaining an occupational injury. Long-term sleep deprivation from sleep disorders like apnea have recently been implicated in high blood pressure, heart attack, and stroke.

All that said, here are some sleep hygiene tips to help you relax, fall asleep, stay asleep, and get better sleep so that you wake up refreshed and alert.

1. Avoid watching TV, eating, and discussing emotional issues in bed. The bed should be used for sleep and sex only. If not, we can associate the bed with other activities and it often becomes difficult to fall asleep.

2. Minimize noise, light, and temperature extremes during sleep with ear plugs, window blinds, or an electric blanket or air conditioner. Even the slightest nighttime noises or luminescent lights can disrupt the quality of your sleep. Try to keep your bedroom at a comfortable temperature -- not too hot (above 75 degrees) or too cold (below 54 degrees).

3. Try not to drink fluids after 8 p.m. This may reduce awakenings due to urination.

4. Avoid naps, but if you do nap, make it no more than about 25 minutes about eight hours after you awake. But if you have problems falling asleep, then no naps for you.

5. Do not expose your self to bright light if you need to get up at night. Use a small night-light instead.

6. Nicotine is a stimulant and should be avoided particularly near bedtime and upon night awakenings. Having a smoke before bed, although it may feel relaxing, is actually putting a stimulant into your bloodstream.

7. Caffeine is also a stimulant and is present in coffee (100-200 mg), soda (50-75 mg), tea (50-75 mg), and various over-the-counter medications. Caffeine should be discontinued at least four to six hours before bedtime. If you consume large amounts of caffeine and you cut your self off too quickly, beware; you may get headaches that could keep you awake.

8. Although alcohol is a depressant and may help you fall asleep, the subsequent metabolism that clears it from your body when you are sleeping causes a withdrawal syndrome. This withdrawal causes awakenings and is often associated with nightmares and sweats.

9. A light snack may be sleep-inducing, but a heavy meal too close to bedtime interferes with sleep. Stay away from protein and stick to carbohydrates or dairy products. Milk contains the amino acid L-tryptophan, which has been shown in research to help people go to sleep. So milk and cookies or crackers (without chocolate) may be useful and taste good as well.

10. Do not exercise vigorously just before bed, if you are the type of person who is aroused by exercise. If this is the case, it may be best to exercise in the morning or afternoon (preferably an aerobic workout, like running or walking).

11. Does your pet sleep with you? This, too, may cause arousals from either allergies or their movements in the bed. Thus, Fido and Kitty may be better off on the floor than on your sheets.

Good sleep hygiene can have a tremendous impact upon getting better sleep. You should wake-up feeling refreshed and alert, and you should generally not feel sleepy during the day. If this is not the case, poor sleep hygiene may be the culprit, but it is very important to consider that you may have an unrecognized sleep disorder. Many, many sleep disorders go unrecognized for years, leading to unnecessary suffering, poor quality of life, accidents, and great expense. Since it is clear how critical sound sleep is to your health and well-being, if you are not sleeping well, see your doctor or a sleep specialist.

Originally published April 1, 2003.
Medicall updated June 29, 2005


SOURCES: Sleep Medicine, Kryger, Meir, et al., Third Edition, 2000. Sleep: "Excessive Daytime Sleepiness and risk of Occupational Injuries in Non-shift Daytime Workers," Vol. no. 3. Sleep: "Dose-response Relationship Between Sleep Duration and Human Psychomotor Vigilance and Subjective Awareness," Vol. 22, No. 2. Sleep: "We Are Chronically Sleep Deprived," Vol. 18 No. 10.

Copyright 2004 Sound Sleep, LLC.

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Last Editorial Review: 6/30/2005 9:16:22 PM