Providing good sleep hygiene tips is the first step in helping patients get a good night’s rest.
With 70 million Americans experiencing trouble achieving normal slumber, sleep therapists clearly have their work cut out for them—beginning with providing basic instruction in somnolence hygiene.1
Good sleep hygiene, like its counterpart for the teeth, requires first having handy the right equipment. Here is the short list of items about which patients should be informed:
• Mattress and pillows. It appears that mattress quality can influence the quality of sleep.2 Basically, the older the mattress, the less comfort it can deliver. And the greater the discomfort, the harder it is to avoid a restless night. Moreover, a worn-out mattress can adversely affect body temperature, a factor in sleep inducement.
Comfortable mattresses come in all types: inner spring, foam, fabric, water, air. Quality-crafted mattresses generally last up to 10 years before needing to be replaced.3
Pillows should also be purchased with an eye on comfort and quality construction. If troubled sleepers have allergens, they should be advised to purchase the type of pillowcase that resists collecting dust (and creating a growth environment for dust mites), since a stuffy head, runny nose, or nonstop sneeze-athon only guarantees disrupted sleep.3
• Cooler and hotter. Research suggests that a room that is too hot can cause a person to experience many awakenings during the night. Set the thermostat somewhere between 68° and 72° before bedtime in order to help the body’s deep internal temperature cool to the level necessary for good sleep (which, of course, occurs about 4 hours after the average person nods off).2 The flip side is that a room that is too cold can also interfere with sleep.2
Getting the temperature just right is not always easy in a room where two adults share a bed. One may crave a slight amount of warmth, the other a slight amount of cold. Solutions include use of a dual-control electric blanket (wherein the temperature of each half is independently adjustable) and heavier bedclothes for the partner who prefers to be warmer.2
Also playing a role in the matter of temperature-related comfort is humidity. Heat and high humidity are a miserable combination. Then again, so is high humidity and cold. To bring room humidity down to the right level, recommend the person use a dehumidifier (or, to raise room humidity, a humidifier). Generally, there is too little humidity if the sleeper awakes every day with a sore throat, nose dryness, or nose bleed.2
• Noise and light blockers. The steady hum from the motor of a fan running throughout the night masks sounds that otherwise would keep a person awake. These noises include street traffic, barking dogs, neighbors who play their televisions or stereos loudly at all hours, bed partners who snore, and other audio irritants. But even if it is quiet enough outside to hear a pin drop, the fan motor’s pleasing drone in and off itself makes for an effective lullaby.2
Suppose sound-obscuring white noise will not do the trick. In that case, try earplugs. Meanwhile, patients should be aware that bare wood floors conduct sound, so laying down thick rugs might help dampen the noise, as would heavy curtains or drapes for window coverings (speaking of which, double-pane glass windows also have the capacity to attenuate sound).2
Just as a quiet room is better for sleep than a noisy one, so too a dark room is more conducive to sleep than one that is brightly lit. If heavy curtains or drapes are not practical, light can be shut out by using an eye mask.2
• Light emitters. Exposure to 1 or 2 hours of bright light in the evening can help a too-early riser sleep longer in the morning by making sure his circadian rhythms are in sync. Summer sunlight works best for this purpose in that the sun does not set until around 8 pm or later, depending on latitude and on proximity to the western edge of a time-zone boundary; however, in the winter or on dreary days at other times of the year, exposure to a light box or light visor makes a dandy substitute for natural illumination.2
• Bathtub, shower, or spa. A relaxing soak in hot water is believed to promote easier and deeper sleep by causing core body temperature to drop after the person dries off, thus signaling physiologic readiness for sleep onset. Or it could just be that the soothing properties of heated water ease the aches and pains and emotional tensions responsible for nighttime wakefulness.2
• Exercise equipment. Studies have demonstrated that people who work out may take less time to fall asleep than those who do not, and that a good session with a set of free weights or on a stationary bicycle earlier in the day can result in deeper, more restorative sleep. Timing is everything, however; exercise has an alerting effect and raises core body temperature, which does not fully wane until 5 to 6 hours later, meaning that if the individual exercises just before bed, he can expect difficulty falling asleep.2
• Banned equipment. Certain items should be kept out of the bedroom because of their tendency to agitate, aggravate, or abruptly awaken. These include televisions, work-related computers, personal calculators, and telephones. A lighted alarm clock is fine, as long as it is hidden from view; many people have difficulty falling asleep if they are continually checking the clock and calculating how much time remains before wake-up.3
Do’s and Don’ts
In addition to equipment, sleep hygiene depends on good habits. Your patients should be told, at minimum, the following:
• Avoid caffeine, nicotine, and alcohol close to bedtime. On the list of caffeine-containing products are coffee, tea, cola, cocoa, chocolate, and some prescription and nonprescription drugs. The jolt from caffeine typically lasts 3 to 5 hours, but some people feel its effects for as long as 12 hours.3
Many smokers say they like the sensation of calm a cigarette before bed delivers; however, what they might not fully appreciate is that, as they sleep, they begin to experience some degree of nicotine withdrawal. Fitful sleep can ensue. In other smokers, nicotine produces an effect similar to that of caffeine, keeping them awake and then making it harder to arise in the morning.3
The same is true of liquor. Often, consumers of alcoholic beverages consider their customary nightcap to be a harmless sedative. In reality, alcohol disrupts sleep and produces nighttime awakenings.3
• Restrict intake of liquids prior to bedding down. Too many sips of water promote the need for nighttime trips to the bathroom. Each bathroom visit means one more time that sleep must be interrupted. Of course, frequent need to urinate might not be the result of liquid intake; it can stem from a physiologic disorder or even from mental conditioning.3
• Eat light at night. The final meal or snack of the day should be modestly portioned, somewhat bland, and completed 2 to 3 hours before bedtime. This will allow sufficient time for the digestion process to be well along, since going to bed on a full stomach can create discomfort enough to prevent drifting off.2 Saying no to spicy foods at night helps avoid painful, sleep-busting heartburn.3
On the other hand, an empty stomach at bedtime can be just as bad and cause wakefulness all the same.4 Good bets for the evening menu are a small plate of sliced turkey and a glass of warm milk. Both contain natural sleep-inducer tryptophan.2
• Sleep only when sleepy. Going to bed before one is actually ready for slumber results in the likelihood of lying awake, staring at the ceiling or pounding the pillow for a long while before somnolence takes hold.2
One way to help prevent going to bed wide awake at night is to skip daytime napping; however, some researchers argue that nap avoidance is physiologically hard on the body and contributes to late afternoon loss of energy and attentiveness. Accordingly, if siesta a person must, then it should be limited to a duration of 20 to 30 minutes.2
Rich Smith is a contributing writer for Sleep Review.
1. National Sleep Foundation. Myths and facts about sleep. Available at: [removed]www.sleepfoundation.org/NSAW/pk_sleepfacts.cfm[/removed]. Accessed February 1, 2005.
2. Goldberg JR. Helping yourself to a good night’s sleep. Available at: [removed]http://preview.sleepfoundation.org/publications/goodnights.cfm[/removed]. Accessed February 1, 2005.
3. National Sleep Foundation. Sleep tips. Available at: [removed]www.sleepfoundation.org/sleeptips.cfm[/removed] . Accessed February 1, 2005.
4. Dement WC. How to sleep well. Available at: www.stanford.edu/~dement/howto.html. Accessed on February 1, 2005.