Sleep hygiene is a list of practices that can promote better sleep. There's no formal definition of what these practices are, but you've probably already come across some of them on Google, from friends, or even from your doctor.
- Go to bed only if you feel tired
- Wake up at the same time every day
- Limit naps to 30 minutes
- Use your bed only for sleep and sex
- Avoid caffeine after lunch
- Don't drink alcohol or smoke before bed
- Have tea or a warm bath before bed
- Make your bedroom temperature and lighting comfortable
- Deal with your worries before bed
- Exercise regularly (but not at night)
- Don't use your phone in bed
At first glance, these recommendations may seem reasonable. Since we know that insomnia persists due to behavioral changes, beliefs, and physiology, most people assume that improving sleep hygiene should be the first intervention for insomnia. Indeed, many well-intentioned doctors think this is the right path to follow.
Unfortunately, there are at least 5 major problems that prevent sleep hygiene alone from solving the insomnia problem.
1. There is little scientific evidence that sleep hygiene education alone actually helps people with insomnia.
There is some data suggesting that certain sleep hygiene changes can improve sleep in people with mild sleep problems. But these results have not been consistently found in people with insomnia.
Furthermore, most people with insomnia have already tried most items on this list and the problem persists.
In fact, to give you an idea, when scientists design experiments to test a new treatment for insomnia, they usually offer sleep hygiene interventions to the control group (the group that isn't receiving the actual solution). So you might think, it's helpful to receive a placebo, but is that really what you want?
2. Sleep hygiene recommendations don't tell you which behaviors make the biggest difference.
When implemented properly, many sleep hygiene principles are actually good advice. But how do you know where to start?
For example, the recommendation to "Go to bed only if you feel tired" is the foundation of sleep restriction, a proven therapy for quickly combating insomnia that will be covered in the first week of the program, but you'll see that this idea requires a systematic and specific approach. Vague principles hidden in a long list aren't enough.
3. Sleep hygiene isn't universal.
For example, you've probably read that this recommendation helps many people sleep:
Reading in bed to fall asleep
Although there are reports of people approving of this practice, there are many others who try it and end up spending hours without sleeping. Additionally, as seen in the last session, this is a practice that ends up perpetuating the insomnia condition.
The same goes for caffeine. You've probably read that you shouldn't drink caffeine at night. It seems obvious, right? But it's not that simple. Many people sleep well with a coffee after dinner.
4. Sleep hygiene education can actually backfire and make it harder to sleep
The implicit message behind the many hygiene tips is that there are many things you need to do, think about, remember, and generally work hard at if you want to get a good night's sleep.
So what happens to your body at the end of the day when you should be starting to relax? It thinks: Well, I thought it was time to sleep, but I need to do more than 20 activities now before going to bed, so I'd better go back to active mode.
Making your brain go back to active mode is the best way not to fall asleep.
5. Sleep hygiene education leads people to take sleeping pills.
For nearly a decade, sleep experts have been recommending behavioral therapies as the initial solution for insomnia. For many doctors who aren't sleep specialists, and who are busy with other conditions affecting the patient, a single printed sheet of sleep hygiene recommendations and a few minutes of counseling during the appointment was all they could offer. When that didn't work, escalating care to a sleeping pill was seen as the obvious next step.
Therefore, the sleep hygiene approach ends up backfiring and leads many people to believe that medication is the only solution for insomnia.
As evidenced by scientific research, CBT-I is safer, longer-lasting, and at least as effective as any medication on the market.
Just to conclude, we're not saying that these sleep hygiene tips don't help, we're just saying that alone they won't solve the problem, but if there's something that works for you, great, you can keep applying it, otherwise, let it go!