Article ID: WMC002245 ISSN 2046-1690

"Sleep Hygiene" The Gateway for Efficient Sleep: A

Brief Review
Corresponding Author:
Dr. Mohammad Torabi Nami,
MD, PhD Neuroscience, Institute for Cognitive Sciences Studies, Neuroscience Research Center, 4th Floor,
Faculty of Medicine, Shahid Beheshti Medical University, Koodakyar st, Daneshjo Blvd, Evin, Tehran - Iran
(Islamic Republic of)

Submitting Author:
Dr. Mohammad Torabi Nami,
MD, PhD Neuroscience, Institute for Cognitive Sciences Stusies, Neuroscience Research Center, 4th Floor,
Faculty of Medicine, Shahid Beheshti Medical University, Koodakyar st, Daneshjo Blvd, Evin, Tehran - Iran
(Islamic Republic of)

Article ID: WMC002245

Article Type: Review articles
Submitted on:23-Sep-2011, 08:01:47 AM GMT Published on: 23-Sep-2011, 06:50:50 PM GMT
Article URL: http://www.webmedcentral.com/article_view/2245
Subject Categories:BRAIN
Keywords:Sleep hygiene, Insomnia, Recommendations, Behavior
How to cite the article:Torabi Nami M . "Sleep Hygiene" The Gateway for Efficient Sleep: A Brief Review .
WebmedCentral BRAIN 2011;2(9):WMC002245

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"Sleep Hygiene" The Gateway for Efficient Sleep: A
Brief Review
Author(s): Torabi Nami M
Abstract
Sleep hygiene comprises series of considerations by
which quality and efficiency of one’s sleep can be
positively affected. Since 1998 the American academy
of sleep medicine recommended some practice
parameters which could be of help not only as solid
recommendations to be followed but also as real
supplements to other therapies including medications
and cognitive behavioural therapies for a variety of
sleep disorders, mainly insomnia. Based on these
recommendations four components guide practice of
good sleep hygiene. These include change in behavior,
environment, diet and exercise. In this brief review we
mean to outline these points which should be well
managed and controlled so that to maximize the
response to conventional therapeutic measures for
various sleep disorders, mainly insomnia.
Review
Understanding sleep hygiene
Sleep hygiene refers to simple recommendations that
may improve the length and the quality of sleep by
modification of habits, behaviors, and environmental
conditions. Common complains that suggest poor
sleep hygiene are disturbed sleep excessive daytime
sleepiness, increased sleep latency, and nocturnal
awakenings. Watching late night television, surfing the
internet, late night use of computer, smoking, alcohol
or coffee drinking around bedtime contribute to poor
sleep hygiene (1). Occupational stress, irregular sleep
habits and poorly controlled medical and psychiatric
conditions add to poor sleep hygiene. Sleep hygiene
practice improves the quality and quantity of sleep and
restores a natural sleep wake cycle in synchrony with
the circadian rhythm(1-5). A few basic physiologic
principles underlie the sleep hygiene
recommendations. Sleep hygiene is not only a solitary
intervention but also supplants other therapies like
medications and cognitive behavior therapy (2-4). It
also continues to maintain over time the therapeutic
benefits obtained by the other therapies (5). Many
clinical studies have demonstrated a better quality of
sleep when compared against pharmacological
therapy (2-6).
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The practical aspects of sleep hygiene
According to American academy of sleep medicine
four components guide practice of good sleep hygiene.
These include change in behavior, environment, diet
and exercise (1,2).
Behavior and sleep
1. It requires a regular sleep schedule in terms of bed
and wake-up time daily, regardless of the day of the
week. Variable sleep and wake times offsets the
circadian rhythm and result in insomnia or sleepiness
during the night and the day respectively. The situation
is worse in shift workers and travelers across time
zones. The body system rhythms fail to match rapid
changes in the environment causing disruption of the
homeostasis (1,5,8).
2. A pre-sleep routine to wind down and relax is
helpful in inducing sleep. Engaging in a fixed routine
prepares the mind and body for sleep (1,2).
3. Trying hard to fall asleep invariably drives sleep
away. It is based on the principle of the paradoxical
intention (1,2,5).
4. It is advisable to avoid Sleep deprivation during the
night. It causes a rise in the stress hormone levels
increasing the wakefulness (1,5,8).
5. Bed should be used for sleep only and it should be
approached only when drowsy. It is easy to condition
the brain to identify the bed to be a place to relax and
sleep (1,2).
6. Lying down in bed awake for longer than 10 to 20
minutes without falling asleep or continuing to rest in
bed after awakening must be avoided. If awake for
10-20 minutes it is better to get up and leave the
bedroom. Engaging in mellow, non-exciting activity is
more conducive to sleep (1,5,8).
7. The power nap for less than 30 minutes may be
refreshing. Longer naps cause sleep inertia and more
sleepiness after awakening from the nap. Napping
offsets the circadian rhythm (1,2).
8. The racing mind or inability to stop brain from
thinking is example of anxiety disorder that must be
addressed to ensure good sleep. The stress related to
such anxiety releases corticotropin-releasing hormone
(CRH) and triggers a chain reaction leading to the
release of cortisol and other stress hormones. The
high levels of cortical and ACTH increase
wakefulness (8).
Proper sleep environment
1. Bedroom should be dark. For the shift workers who
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sleep during the daytime the bright lights should be
avoided to maintain melatonin levels in the brain (1,2).
2. The temperature in the bedroom should be
comfortable as uncomfortably warm environment
disrupts sleep (1).
3. The sound levels need to be controlled to minimize
loud sounds. Ear plugs or “white noise” machines
minimize loud noises (1).
4. Dust mites and other allergens induce nasal
mucosal congestion, sneezing, sniffling and coughing
disrupting the sleep (1,2).
Diet and sleep
1. Caffeine 6-8 hours before sleep may disrupt the
sleep architecture. Any caffeinated product will have
the similar effect. According to the American academy
of sleep medicine caffeine should be used with a
strategic plan to prevent daytime sleepiness. Caffeine
antagonizes the adenosine receptors and therefore
the somnogenic effect of the higher adenosine
concentrations (1,6,8).
2. Alcohol is best avoided 3-5 hours before sleep.
Alcohol is a central nervous system depressant. It is a
muscle relaxant and affects the respiratory system's
ability to keep the airways open during the inspiration.
In addition it disrupts the sleep architecture and
increases the arousal threshold, a defense mechanism
against obstructive sleep apnea that restores the
airway patency (1,5).
3. Nicotine by its stimulatory effect on serotoninergic
neurons in the brain disrupts sleep. Normally,
serotoninergic fibers fire rapidly during wake state,
decrease firing in slow wave sleep, and then become
nearly quiet during rapid eye movement (REM) sleep.
Nicotine causes the serotoninergic fibers to continue
firing at a higher-than-normal rate during sleep
maintaining the wakefulness (1,2).
Exercise and sleep
1. Regular exercise for 20 to 30 minutes 3-4 times a
week is recommended. Exercise promotes a regular
sleep-wake schedule and improves quality of sleep
(1,7). Exercise increases the amount of deep, delta
sleep that is considered the restorative sleep (2,6,7).
2. Heavy exercise should be avoided before sleep as it
raises the body temperature and disrupts the
sleep-wake cycle. Heavy exercise releases
epinephrine, a hormone that creates a sense of
happiness and excitement (1).
Conclusion(s)
It is important to recognize the limitations of the sleep
hygiene therapy. In most instances it is considered a
more supportive form of therapy. Patient's medical and
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psychiatric co-morbid conditions should be well
managed and controlled for obtaining the maximum
benefits from the practice of sleep hygiene.
Abbreviation(s)
ACTH: Adrenocorticotropic Hormone
CRH: Corticotropin Releasing Hormone
REM: Rapid Eye Movement
References
1. Blake DD, Gomez MH. A scale for assessing sleep
hygiene preliminary data. Psychol Rep. 1998; 83:
1175-8.
2. Chesson AL Jr, Anderson WM, Littner M, et a1:
Practice parameters for the non-pharmacologic
treatment for chronic insomnia: an American
Academy of Sleep Medicine report. Sleep 1999;
22:1128-33.
3. Morin CM, Culbert JD, Schwartz SM:
Non-pharmacological intervention for insomnia:
meta-analysis of treatment efficacy. Am J Psychiatry
1994; 151: 1172-80.
4. Morin CM, Hauri PJ, Espie CA, Spielman AJ, et al:
Non-pharmacologic treatment of chronic insomnia:
an American Academy of Sleep Medicine review.
Sleep 1999; 22:1134-56.
5. Jefferson CD, Drake CL, Scofield HM, Myers E,
McClure T, Roehrs T, Roth T: Sleep Hygiene
6. Stepanski EJ, Wyatt JK: Use of sleep hygiene in
the treatment of insomnia. Sleep Medicine Reviews
2003; 7(3): 215-225.
7. Pao-Hui C , Hung-Yu K, Ke-Hsin C: Sleep Hygiene
Education: Efficacy on Sleep Quality in Working
Women. Journal of Nursing Research 2010; 18(4):
283-9.
8. Lyne J, Quinlivan L, Byrne CA, Malone K, Walsh C :
Sleep Hygiene Use in a Psychiatry Outpatient Setting.
Irish Medical Journal 2011; 104(2): 49-50.
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