Trouble sleeping? Sleep hygiene and improving your sleep quality

Have you ever lain in bed, tossing and turning, unable to fall asleep despite being tired? With thoughts racing through your mind, you begin to worry, “Why can’t I fall asleep?” or “How many hours of sleep do I have left?” This might be followed by stress over how little sleep you are getting, and worrying about being tired the next day. A vicious cycle starts and keeps you awake even longer!

A healthy adult typically needs around 7-9 hours of sleep each day. This does not mean that you need to get this amount of sleep every single day; your body is able to catch up on sleep, so if you get less sleep one night, you can compensate with more sleep on another night. Depending on your daily routine however, you may not be able to compensate. If a pattern less sleep continues over some time, daytime sleepiness, irritability, low energy, attention deficits, anxiety, or a depressed mood are more likely to develop.

Insomnia, also known as sleeplessness, is a sleep disorder that involves difficulty falling asleep (called onset insomnia) or staying asleep during the night (called middle-of-the-night insomnia (MOTN), nocturnal awakenings, or sleep maintenance insomnia). 10-30% of adults experience insomnia at one point in their lives, and it is one of the most common symptoms for which people seek medical advice. Acute insomnia can last from one night to a few weeks. It is the most common form of insomnia and usually derives from psychological or physiological stress. Chronic insomnia is defined as having trouble sleeping for at least three nights a week over a month or longer. Insomnia may come and go, with periods of time when a person experiences no sleep difficulties at all. Cognitive behavioral therapy (CBT) and pharmacotherapy are the main treatment options for chronic insomnia.

Many people with insomnia display bad sleep habits. Consequently, the first step in the treatment of insomnia usually consists of sleep hygiene. Sleep hygiene involves habits that help you experience restful sleep.

How does sleep hygiene work?

Most of our bodily processes (such as temperature and brain states) are synchronized to a 24-hour physiological “clock” in the brain, which is called the circadian rhythm. Our sleep-wake-cycle also follows this internal clock. Sleep hygiene implies working together with your body’s clock. Common sleeping problems, such as insomnia, are often caused by bad habits reinforced over time, sometimes years or even decades. By adjusting these habits, you can easily improve your sleep quality. Here are some suggestions:

Sleep schedule

• In order to synchronize your internal “clock”, it helps to wake up and go to bed at the same time every day, even on the weekends. Bedtime and wake time should not differ more than an hour from day to day. Soon, you will find yourself getting sleepy at about the same time every night.
• Go to bed when you feel tired in the evening. According to your internal clock, your body tells you it is ready for sleep.

Sleep environment

• Ensure the bedroom is at the right temperature, not too hot or cold, as that can make it more difficult to fall asleep.
• Make sure the room is dark enough. This facilitates the production and release of the sleep hormone Melatonin.
• Make sure the room is quiet. If there is any disruptive noise you cannot control (such as loud neighbors or cars), try using earplugs.
• Only go to bed if you want to sleep (or be intimate). If you treat your bed like your couch in the living room – for watching TV, talking to friends on the phone or even eating – your mind will associate your bedroom with activity and impede on falling asleep.

Bedtime routine

• Try not to engage in mentally stimulating activities close to bedtime. Use the last hour or so before sleep to relax your mind. This can be achieved by reading a book, listening to soothing music, or taking a bath.
• Avoid watching TV or using smartphones or tablets.

Avoidance of Alcohol, Nicotine and Caffeine

• Caffeine will help you stay awake for four to six hours after intake. Be aware that this might make it difficult to fall asleep.
• Avoid drugs before you go to bed, such as alcohol and cigarettes. Nicotine is a stimulant, which accelerates heart rate and increases blood pressure, so it will keep you awake for longer. Alcohol is a depressant drug, slowing the nervous system. While drinking before bed may help you doze off, the sleep rhythm will be affected. Sleep-wake disturbances are likely to occur. Moreover, you will not feel refreshed and rested in the morning.

Relax your mind

• Insomnia is often caused by worrying. If you have trouble falling asleep due to worrying or racing thoughts, try relaxation techniques, e.g. consciously relax every part of your body, starting with your toes and working up to your scalp. Alternatively, you could think of a restful scene, or shift your attention to the rhythmic rise and fall of your breathing.

• If you are a chronic bedtime worrier, try writing down your thoughts before you go to bed, or schedule a few minutes of ‘worry time’ well before bedtime. If your worries reoccur after getting into bed, remind yourself that you have already done your worrying.

Other suggestions

• Exercise regularly, but not too close to bedtime, as your body needs time to wind down.
• Do not take naps during the day if you experience sleep difficulties at night.
• Do not check the time during the night. This will probably stress you out, making it even harder to find sleep.
• If you cannot fall asleep within a reasonable amount of time, get out of bed and do something else for half an hour or so, such as reading a book.

If you have followed these sleep hygiene suggestions continuously over some time and continue to experience trouble sleeping, contact our Mental Health Department. It is important to identify the cause of your sleep difficulties. If a physical condition is excluded (e.g. restless leg syndrome, chronic pain, or menopause), the existence of a psychological cause may be likely. Insomnia often originates from psychological stress and can be a symptom of mental conditions such as depression or anxiety. Our specialists will aid in assessing and identifying the reasons for your sleep difficulties, and they will provide skills that will help you to cope with or overcome your insomnia.