By Victoria Loving, Doctor of Physical Therapy (DPT) at Neurology Solutions
With insomnia and sleep disorders on the rise, medical professionals are beginning to emphasize a multifactorial approach in combination with medical intervention and diagnostics. Sleep hygiene is becoming more and more commonplace and a source of initial treatment, including lifestyle adjustments to cut down on the risk of pharmaceutical side effects and allow greater longevity of improved quality of life for those affected by sleep disorders.
Sleep hygiene refers to implementing and using consistent and ideal sleep habits to optimize one’s circadian rhythms and hormones for greater efficiency and effectiveness of the sleep cycle. Sleep hygiene routines emphasize the importance of “good” sleep habits, including optimizing your day-to-day activities, routines, schedules, and sleep environment. By adjusting and differentiating one’s routine and environment toward more ideal sleep hygiene techniques, you can utilize a variation of operant conditioning to improve your sleep efficiency and reduce sleep disorder-based impairments.
Sleep hygiene practices are an effective tool for retraining and providing long-term benefits with sleep health providing patients with the greatest longevity and quality of sleep across one’s life span. As we age, our capacity and time requirements for sleep steadily decrease from birth to adulthood, effectively transitioning from 12-13 hours of required sleep to 6-8 hours needed per day. As the time spent sleeping decreases, it is pertinent to maximize the benefit and time spent in restful cycles of sleep. Sleep hygiene helps to optimize this allowing you to feel and function at your highest level each day. Patients can utilize various techniques to assist with their sleep hygiene, ranging from environmental setup, routine, daily prep activities, diet changes, etc.
Proper environment setup is crucial to indicate to your body when to begin preparing for sleep and maintaining sleep to maneuver through the sleep cycle and achieve restful stages successfully. Many of us use our bedrooms for entertainment and other activities such as television, reading, surfing the internet, etc. Adding blue light and extra screen time interfere with our body’s natural wind-down process and can delay sleep initiation. Proper set up of your bedroom to allow for only sleep or sex is crucial. By building this association with your bedroom and sleep environment, your body’s natural sleep hormone release will become more efficient and accurate, as well as create a trained response to associate your bedroom and bed with sleep, effectively decreasing any sleep delays or interferences.
Maintaining a proper temperature and dark environment is also beneficial. Eliminating extraneous lights coming through windows or from objects in the room will avoid any distractions or triggers that could interrupt restful sleep. Temperature can also play a factor in disrupting sleep you may not be aware of. It has been shown that temperature around 65-68 degrees Fahrenheit with blankets for warmth creates the most optimal sleep patterns. In addition, ensuring your mattress and bedding are comfortable is important. Having a mattress you prefer with soft sheets and bedding can help facilitate relaxation and optimize sleep.
Consistency and habit formation are key factors in optimizing the effectiveness of sleep hygiene and retraining negative sleep patterns. Insufficient sunlight exposure, low physical activity levels, and excessive napping are common daily routines that can negatively impact sleep. These habits directly affect nighttime sleep preparation, making it challenging to both fall asleep and stay asleep.
By consistently prioritizing your bedtime and wake-up time, your body and brain will naturally regulate the release of sleep hormones, leading to more efficient sleep onset and waking according to your desired schedule. This will lead to you feeling sleepier, falling asleep faster at bedtime, and waking feeling more rested for an easier start and transition throughout your day. It is best practice to utilize an alarm for consistent waking, even on vacations and weekends, to ensure no shift or rapid changes that could affect feeling sleepy or needing naps during the day. While napping can be a great source of relaxation and a refresher during the day, naps are often utilized in such a way that detracts from sleeping through the night. Naps should be kept to less than one hour before 3 pm and used only as necessary.
While creating a daily routine for consistent times to rise and sleep, it is also important to integrate daily habits during waking hours that will benefit and encourage sleep at night. Prioritizing daily exercise of appropriate intensity (strong enough to elevate heart rate and cause you to sweat), you will avoid feeling antsy or high-strung when attempting to sleep. Vigorous exercise should be avoided 2-3 hours before bedtime to ensure proper recovery and relaxation to appropriately prepare to wind down and transition into a restful sleep.
One common challenge faced by individuals who follow a structured sleep and wake routine is difficulty falling asleep, often leading to frustration as they lie in bed. While setting the foundation for your daily sleep routine, it is important not to associate frustration with your bedtime routine. When attempting to sleep, if unable to fall asleep within 20-30 minutes, it is important to get up and transition to a new environment as a “reset” until your body is ready to sleep again. It is crucial to avoid any screens or stimulating blue light, like the television or your cell phone, and you should try reading a book or performing a “boring” task to expedite feeling sleepy, at which point you can re-attempt to fall asleep in bed.
Vitamin D is a crucial partner and trigger for our circadian rhythm, and so often, people do not have the opportunity to get outside each day and fulfill their daily sunlight needs. Even 15-20 minutes of sunlight daily can assist with circadian rhythm and appropriate sleep/wake phases.
The significance of our diet and nutrition, which includes the specific foods and beverages we consume and the timing of our intake, cannot be emphasized enough when it comes to establishing a healthy routine and promoting a night of peaceful sleep. It is common practice for people to utilize various sources of caffeine to help kick start and fuel their day, but is this something we should restrict or time just right so we don’t cut into our body’s ability to rest? Absolutely! Research shows that caffeine after about 3 pm significantly prohibits a restful sleep cycle. It can prolong the time it takes to fall asleep, limit the depth of your sleep cycles, and increase the frequency of disturbances and wake time throughout the night, leaving you groggy, sluggish, and irritable the next day. This often leads to a vicious cycle of refueling with caffeine to make it through the day due to fatigue, which will undoubtedly impact the sleep cycle, contributing to and escalating fatigue and grogginess the next day.
Alcohol is another commonly ingested item that can alter one’s sleep routine and quality. Alcohol has been shown to suppress REM during your initial sleep cycles. It leads to increased wake time and disturbances interrupting subsequent sleep cycles, leaving you fatigued and unrested the next day.
In addition to avoiding caffeine and alcohol late in the day, you should eat a healthy diet. By avoiding high-sugar foods and increasing your fiber intake and an array of Vitamin B, your body’s release and regulation of melatonin is more efficient and accurate, helping you to fall asleep faster, stay asleep throughout the night, and effectively spend more time in the restful phases of sleep leaving you feeling rested and energized for the following day.
The 10, 3, 2, 1, 0 Rule
One helpful way to organize and utilize good sleep hygiene practices is with the 10, 3, 2, 1, 0 rule. This “rule” helps you to remember the ideal cut-off times for alcohol, naps, caffeine, screen time, etc. To allow you to enhance and stick to a steady routine. The 10, 3, 2, 1, 0 sleep rule is as follows:
- Eliminate caffeine 10 hours before sleep
- Cut alcohol 3 hours before bed
- Stop working 2 hours before bed
- Stop screen time 1 hour before bed
- Hit ‘snooze’ 0 times in the morning.
These techniques help to eliminate any variables that could prolong or delay the start of sleep or increase the disturbances throughout the night by limiting the intake with enough time for your body to eliminate them, as well as decrease habits that vary your routine and consistency that lead you to feel more fatigued and sluggish.
Sleep hygiene is not one size fits all technique and often takes a period of trial and error and various strategies to achieve the best results for you. With a wide array of suggestions and lifestyles, it is important to try each technique for several days and keep a log or diary of your attempts to best streamline results and effectively improve sleep for many years to come.