V. SLEEP HYGIENE EDUCATION:
Sleep hygiene education appears to be everywhere these days in the form of isolated lists that are often presented as "the"
condensed formula for better sleep. In contrast to presenting only concise "tips-and-tricks", this learning platform has been created precisely because sleep bullet-points do not have the power to effect positive change unless they have been boiled down from a larger context that is specific to the individual. Context matters
. Lists are effective the way that cheat sheets are effective: a condensed cheat sheet works best if it prods important features at the same time that it activates a broader association with where
those select features are important. If isolated from context, their importance is never transferred.
Within CBT-I protocols, sleep hygiene education complements the other therapies and intervention methods. Sleep hygiene
includes general sleep-facilities recommendations, including:
(1) Avoiding stimulants such as caffeine and nicotine
for several hours prior to bedtime. See also the caffeine
link to contextualize the 5 hour half-life of caffeine.
(2) Avoid alchohol around bedtime
because it fragments sleep. See also the Sleep Architecture
section to understand why the REM-suppressing qualities of alcohol are so disruptive.
(3) Exercise regularly.
Exercise timing is also important to ensure that circadian rhythm delays do not interfere with desired sleep onset time. Morning and late afternoon exercise may be beneficial, provided that core body temperature is allowed to be reduced. Late evening exercise is not recommended. See the circadian rhythm
section to learn more about exercise timing and influence.
(4) Allow at least a 1-hour period to unwind
and prepare for sleep. This preparation aligns with a natural inflection point in our circadian rhythm that should occur to assist a sleep onset preparation period.
(5) Keep the bedroom environment
quiet, dark and at a comfortable temperature. Our natural dim light melatonin onset (DLMO) is interrupted with bright light, as is the inflection of a previous late afternoon rise in our circadian rhythm that abruptly turns downward in preparation for sleep to reduce our core body temperature. The bedroom should be between 62 and 68 degrees Fahrenheit to maintain this reduction.
(6) Maintain a regular sleep schedule
to keep your circadian rhythm from drifting.
(7) Remove electronic devices
from the bedroom. Electronic devices
emit enough light to interrupt normal melatonin release. In addition, increased cortical arousal delays sleep onset.Sleep Hygiene is rarely adequate to treat sleep onset difficulties on its own in the absence of a multi-component therapy similar to those available in the form of CBT-I.