Sleep Hygiene

Original Editor - Romy Hageman
Top Contributors - Romy Hageman and Carina Therese Magtibay

Introduction[edit | edit source]

Sleep disturbances, including insomnia, sleep apnea, circadian rhythm disorders, or disruptions caused by lifestyle factors, environmental influences, or underlying medical conditions, can have a considerable impact on health and may worsen both medical and psychiatric conditions[1]. The most effective approach for sustained improvement in sleep quality involves adopting proper sleep hygiene practices, which entail modifying behaviours and habits related to sleep[1]. Sleep hygiene is a range of behaviours and environmental factors designed to promote restful and high-quality sleep, without the need for medication[2]. During sleep hygiene education, patients are instructed on how to develop healthy sleep habits and are motivated to adhere to a set of guidelines aimed at enhancing their sleep quality. Sleep hygiene strategies offer a simple, and inexpensive way for individuals to improve their sleep.

While current guidelines do not recommend sleep hygiene as a standalone therapy for insomnia, it is frequently used as a control condition in randomized trials of cognitive behavioural treatments[3]. Sleep hygiene practices might be particularly beneficial for certain people, such as adolescents, young adults, and workers, as they can enhance daily performance[4][5][6][7]. Individuals under the age of 65, who are good sleepers may also derive more benefits from sleep hygiene compared to those with insomnia[8]. However, the effectiveness of sleep hygiene in individuals over 65, regardless of their sleep quality, remains uncertain[9]. Nevertheless, when combined with behavioral sleep interventions, sleep hygiene can help alleviate symptoms of insomnia[2]. Sleep hygiene awareness alone does not guarantee improved sleep quality.

Importance of Sleep Hygiene[edit | edit source]

Sleep problems are becoming increasingly concerning for global public health, as inadequate sleep is linked to deficiencies in motivation, emotion, and cognitive function, along with a heightened risk for severe conditions such as diabetes, cardiovascular disease, and cancer, as well as all-cause mortality, even when symptoms fall below the threshold for clinical sleep disorders[10][11][12].

Sleep-related factors, including going to bed later on weekdays, experiencing difficulties maintaining sleep, arousal disorders, negative emotions at bedtime, and inconsistent sleep schedules, are found to be independently linked to heightened mental health issues[13]. Daytime sleepiness increases the risk of harm at work or at home, contributes to car accidents, and reduces overall productivity[14].

Common Sleep Hygiene Practices[edit | edit source]

Recommendations to improve sleep include:

  • Achieving 7 to 9 hours of sleep[1].
  • Maintaining a consistent sleep/wake schedule[1][15].
  • A regular bedtime routine[1].
  • Engaging in regular exercise[1][16][17].
  • Avoiding many substances late in the day: caffeine, alcohol, and heavy meals are associated with fragmented poor-quality sleep[1][15][16].
  • Avoiding nicotine: smoking disrupts the sleep[15][16].
  • Managing stress: stress is associated with impaired sleep[16].
  • Reducing bedroom noise: noise increases arousal[16].

Sleep Hygiene for different age groups[edit | edit source]

Infants, toddlers, and preschool-age children[edit | edit source]

Establishing healthy sleep patterns and effectively managing sleep issues can be achieved through sleep-promoting parenting practices, commonly known as ''good sleep hygiene''[18]. Quality sleep, especially during the night, promotes full daytime alertness[19][20].

Sleep hygiene recommendations:

  • Consistent routines play a crucial role in maintaining good sleep hygiene, particularly through regular sleep schedules and pre-sleep routines. For young children, routines offer a sense of predictability and security, aiding in smoother transitions between activities while also helping to moderate impulsivity and enhance self-regulation[18]. Additionally, routines are thought to contribute to overall family well-being by reducing conflicts between caregivers and children[18]. The presence of a regular bedtime routine has been linked to improve sleep, influencing factors such as sleep latency (time taken to fall asleep) and the frequency of night waking in infants and toddlers[21].
    • Bedtime routines serve as external cues signaling the approach of sleep and help children mentally prepare for bedtime by offering predictability and a calming environment.
    • It is recommended to initiate a regular bedtime routine by around the age of 6 months[18]. These routines should be relatively brief, lasting no more than 30-45 minutes, and consist of a set of relaxing activities performed before bedtime each day[18]. Examples include a warm bath, reading stories, and singing lullabies[22].
  • After engaging in calming pre-bedtime activities, children should be provided with a comfortable sleep environment characterized by a calm, quiet, dark, and warm atmosphere, without the presence of a TV[23].
  • Regular bedtimes, naptimes, and wake times help to synchronize sleep and wake cycles with the circadian rhythm. Naptimes should be timed correctly, making sure naps are not too late in the afternoon. This could make children less sleepy when it is bedtime[24].
  • During the waking times of a child, they should be exposed to bright lights in the morning and encouraged to have regular exercise during the day.
  • They should avoid stimulating activities and foods near sleep times.
  • Parents should make sure to avoid sugar and caffeine prior to bedtime[25].
  • Children should avoid screen time before bed, particularly with violent content[26].

School-age children[edit | edit source]

A lot of school-age children experience parent-reported sleep problems[27][28]. This can affect their academic performances, as well as their behavior and health[27][28][29]. Consistent bedtimes, bedtime routines and use of electronic devices are associated with sleep problems[30].

Sleep hygiene recommendations:

  • Consistent bedtimes on school and non-school nights[27][31].
  • Limiting media use before bedtime[27][30][31][32].
  • No TV in the bedroom[30][33].
  • Sufficient after-school leisure-time physical activity[31][32].
  • Healthy nutrition and not eating meals just before bedtime[31].
  • Eliminate exciting activities just before bedtime[34].

Adolescents[edit | edit source]

Many adolescents frequently sleep less than they need over an extended period, leading to chronic sleep deprivation. They prefer to go to bed later and waking up much later than adults or children[35]. Adolescents with good sleep hygiene tend to go to bed earlier, have a shorter sleep latency, and a longer sleep duration[36]. Studies have shown that the sleep of adolescents can be positively changed by sleep hygiene training[37][38]. Adolescents may choose to keep their phones nearby at night to maintain their perceived connection with social media and to avoid distress induced by FOMO (Fear Of Missing Out)[39]. This may impact their sleep.

Sleep hygiene recommendations:

  • Caffeine: caffeine peaks approximately 30 minutes after drinking, and the half-life of a single dose is 3 - 7 hours. The half-life of caffeine increases with age, meaning the substance remains active for a longer period in older adults[40]. Adolescent boys drink soda and energy drinks more frequently than girls[41].
  • Reducing evening technology / computer use before bedtime[35][36].
  • Avoiding artificial light exposure before bed[36][42].
  • Establishing a parent-set bedtime[36].
  • Reducing hot beverage intake (tea and chocolate) before bedtime[35].

Students[edit | edit source]

Students are often recognized for not getting enough sleep during the week and compensating with longer hours of sleep on the weekends[43][15]. In fact, the sleep schedules of students are so inconsistent that twice as many students as individuals in the general population exhibit symptoms consistent with delayed sleep phase syndrome. This is characterized by increasingly later wake-up times on non-work or non-school days, resulting in suboptimal job and academic performance and excessive sleepines during the week[43]. Students often choose to maintain contact with friends and family on social media, rather than prioritizing enough sleep[44]. 50% of college students experience daytime sleepiness, and 70% experience insufficient sleep[45].

Sleep hygiene recommendations:

  • Maintaining a consistent sleep-wake schedule[43].
  • Avoiding going to bed thirsty or hungry[43][46].
  • Reducing worry before falling asleep[43].
  • Reducing environmental noise (which can be challenging, especially in university dormitories) by using earplugs[43].
  • Paying attention to the campus environment: using strategies to enhance relaxation, and using the dorms only for sleeping (not for eating or socializing)[47].
  • Avoiding strenuous exercise before bedtime[46].
  • Avoiding caffeinated drinks, nicotine, and alcohol within four hours of bedtime[46].
  • Setting time to relax before sleeping[46].

Adults[edit | edit source]

Poor sleep quality is common in adults. Sleep quality has a positive association with awareness of sleep hygiene practices about sleep medication use, consistent wake-up times, and exercising in the afternoon or early evening[48].

Sleep hygiene recommendations:

  • Eating regular meals[49].
  • Avoiding nightcaps, nicotine, and caffeine[49][50][51].
  • Maintaining a healthy body weight[49].
  • Getting light exposure in the morning[49].
  • Avoiding blue light in the evening[49], put away all electronics 1-2 hours before bedtime[50], not using media/ social media in the bedroom[52][53][54].
  • Eating enough vegetables[49].
  • Maintaining a regular sleep schedule[50][54].
  • Reduce light and noise in the bedroom[50][54].
  • Go to bed when sleepy, try not to force sleep[50].
  • Establish a bedtime routine[50].
  • Try to reduce stress[50][51][54][55][56].
  • Make sure to exercise each day[50][51].
  • Avoiding daytime naps[51].
  • Maintaining strict work-home life boundaries[57].
  • Opening windows and doors for ventilation[58].

Elderly[edit | edit source]

The elderly experience a decline in sleep efficiency, leading to more frequent nocturnal awakenings and difficulties in returning to sleep[59][60]. They often struggle with both falling asleep and maintaining sleep due to frequent awakenings. They spend more time in the lighter fases of sleep than in deep sleep[61]. Practicing good sleep hygiene may help enhance sleep[62][63][64][65].

Sleep hygiene recommendations:

  • Setting up a regular wake and sleep schedule every day[65][66] .
  • Only being in bed when sleeping and sleepy[65][66].
  • Keeping the bedroom environment optimal[67]:
    • Sleeping with dark lighting[66][67].
    • Comfortable bedroom temperatures[66] : below 24 degrees Celcius / 75 degrees Fahrenheit[67].
    • Avoiding noises[65][66][67].
    • Sleeping in a clean bedroom[66].
    • Do not keep a clock in view of the bed[65].
  • Limiting stress and making the mind and body calm[66]:
    • With relaxation exercises[63] .
    • With yoga and stretching exercises[63].
    • Foot bath and massaging using aromatic oils[63].
    • Taking a warm evening shower[66].
  • Meals and drinks:
    • Eating regularly every day, but not too much before bedtime[66]. A light snack when hungry before bed is ok[65][67].
    • Limiting coffee and other caffeinated drinks (green tea, cola, chocolate) before bedtime[65][66][68][67].
    • Limiting fluid intake before bedtime to reduce the frequency of needing to urinate in the night[67].
    • Avoid alcohol as this causes fragmented sleep[65][67].
  • No smoking before bedtime[66][67].
  • Regular exercising in the morning[66][67][69], but avoiding it too close before bedtime[65][68].

Athletes[edit | edit source]

Elite athletes consistently obtain less total sleep compared to non-athletes[70]. This trend persists across various sport disciplines, including individual versus team sports and strenght versus endurance sports[70]. Olympic athletes often fall short of the traditional 8-hour sleep recommendation and typically sleep for 6.5-6.8 hours[70][71]. There are several reasons for this. Athletes typically adhere to rigorous and strict training schedules, have travel obligations, and may experience time zone changes due to competitions and events. Some athletes are exposed to bright lights during a match, which may impact their sleep[72]. Additionally, athletes may underestimate the significance of sleep, prioritizing other aspects of their mandatory training over rest and recovery[71].

Athletes could benefit from enhancing their sleep hygiene practices[73][74][75]. By implementing regular routines and creating an optimal sleep environment, athletes can train and improve their sleep quality. While it may not be feasible for athletes to adopt all sleep hygiene recommendations, they should strive to incorporate as many as possible to optimize this crucial aspect of physical recovery and performance[71]. Sleep hygiene strategies could be used during off days to promote restorative sleep[72].

Sleep hygiene recommendations:

  • Avoiding blue light from screens before bed[71][76].
  • Following a regular bedtime and wake time routine on off days[72][75].
  • On off days, athletes should get some light exercise (walking, cycling) to promote sleep without inducing extra fatique and/or muscle soreness[72].
  • Get bright, natural light in the morning[71][76].
  • Not using the snooze button[71][76].
  • If a computer must be used in the evenig, install a color-adjusting and blue light reducing software or use blue-light blocking glasses[71][76].
  • Use meditation[71][72][76].
  • Higher carbohydrate intake at night can improve sleep, as well as high protein meals[71][76][72][77].
  • Consuming high-electrolyte fluids[72].
  • Magnesium supplements[71][76].
  • Don't fall asleep to the TV[71][76].
  • Don't drink too much before bedtime[71][76].
  • Cooling your body temperature may improve sleep[71][76].
  • Checking the mattress. It could be old and contain allergens[71][76].
  • Reduce external stressors[71][76].
  • Using recovery strategies aimed at reducing muscle soreness (cold water, compression, massage)[72][78].
  • Create a low-light, cool sleep environment[72].
  • Use brief naps (5-30 min)[72].

References[edit | edit source]

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  70. ↑ 70.0 70.1 70.2 Lastella M, Roach GC, Halson SL, Sargent C. Slaap/wake behaviours of elite athletes from individual and team sports. European Journal of Sport Science. 2015; 15(2): 94-100
  71. ↑ 71.00 71.01 71.02 71.03 71.04 71.05 71.06 71.07 71.08 71.09 71.10 71.11 71.12 71.13 71.14 Vitale KC, Owens R, Hopkins SR, Malhotra A. Sleep Hygiene for Optimizing Recovery in Athletes: Review and Recommendations. International Journal of Sports Medicine. 2019; 40(8): 535-543
  72. ↑ 72.0 72.1 72.2 72.3 72.4 72.5 72.6 72.7 72.8 72.9 Nédélec M, Halson S, Delecroix B, Abaidia A-E, Ahmaidi S, Dupont G. Sleep Hygiene and Recovery Strategies in Elite Soccer Players. Sports Medicine. 2015; 45(11): 1547-1559
  73. ↑ O'Donnell S, Driller MW. Sleep-hygiene education improves sleep indices in elite female athletes. International Journal of Exercise Science. 2017; 10(4): 522-530
  74. ↑ Fullagar H, Skorski S, Duffield R, Meyer T. The effect of an acute sleep hygiene strategy following a late-night soccer match on recovery of players. Chronobiology International. 2016; 33(5): 490-505
  75. ↑ 75.0 75.1 Caia J, Scott TJ, Halson SL, Kelly VG. The influence of sleep hygiene education on sleep in professional rugby league athletes. Sleep Health. 2018; 4(4): 364-368
  76. ↑ 76.00 76.01 76.02 76.03 76.04 76.05 76.06 76.07 76.08 76.09 76.10 76.11 Halson S. Sleep in elite athletes and nutritional interventions to enhance sleep. Sports Medicine. 2014; 44: 13-23
  77. ↑ Res PT, Groen B, Pennings B. Protein ingestion before sleep improves postexercise overnight recovery. Medical Science of Sports and Exercise. 2012; 44(8): 1560-9
  78. ↑ Duffield R, Murphy A, Kellert A, Reid M. Recovery from repeated on-court tennis sessions: combining cold-water immersion, compression, and sleep recovery interventions. International Journal of Sports Physiology and Performance. 2014; 9(2): 273-82
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