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'''Sleep hygiene''' is the controlling of "all behavioural and environmental factors that precede sleep and may interfere with sleep."<ref>{{cite journal |author=van der Heijden, KB |author2=Smits, MG |author3=Gunning, WB |year=March 2006 |title=Sleep hygiene and actigraphically evaluated sleep characteristics in children with ADHD and chronic sleep onset insomnia |url=http://www.ncbi.nlm.nih.gov/pubmed/16490003 |journal=[[Journal of Sleep Research]] |publisher=[[European Sleep Research Society]] |volume=15 |issue=1 |pages=55-62 |doi= |pmc= |pmid=16490003}}</ref> It is the practice of following guidelines in an attempt to ensure more restful, effective [[sleep]]. This can promote daytime alertness, help to treat or avoid specific kinds of [[sleep disorder]]s,<ref name='icsd'/><ref>{{cite journal|last1=Benca|first1=Ruth M.|title=Diagnosis and Treatment of Chronic Insomnia: A Review|journal=Psychiatric Services|date=1 March 2005|volume=56|issue=3|pages=332|doi=10.1176/appi.ps.56.3.332}}</ref> and prevent the negative consequences of sleep deprivation. Specific sleep hygiene recommendations have become more established and refined over time, but there is variable research support across recommendations. The benefits of practicing sleep hygiene recommendations vary by individual and some special populations have unique additional considerations. Consultation with sleep professionals can facilitate personal application of sleep hygiene recommendations. |
'''Sleep hygiene''' is the controlling of "all behavioural and environmental factors that precede sleep and may interfere with sleep."<ref>{{cite journal |author=van der Heijden, KB |author2=Smits, MG |author3=Gunning, WB |year=March 2006 |title=Sleep hygiene and actigraphically evaluated sleep characteristics in children with ADHD and chronic sleep onset insomnia |url=http://www.ncbi.nlm.nih.gov/pubmed/16490003 |journal=[[Journal of Sleep Research]] |publisher=[[European Sleep Research Society]] |volume=15 |issue=1 |pages=55-62 |doi= |pmc= |pmid=16490003}}</ref> It is the practice of following guidelines in an attempt to ensure more restful, effective [[sleep]]. This can promote daytime alertness, help to treat or avoid specific kinds of [[sleep disorder]]s,<ref name='icsd'/><ref>{{cite journal|last1=Benca|first1=Ruth M.|title=Diagnosis and Treatment of Chronic Insomnia: A Review|journal=Psychiatric Services|date=1 March 2005|volume=56|issue=3|pages=332|doi=10.1176/appi.ps.56.3.332}}</ref> and prevent the negative consequences of sleep deprivation. Specific sleep hygiene recommendations have become more established and refined over time, but there is variable research support across recommendations. The benefits of practicing sleep hygiene recommendations vary by individual and some special populations have unique additional considerations. Consultation with sleep professionals can facilitate personal application of sleep hygiene recommendations. |
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Revision as of 20:21, 12 December 2014
Sleep hygiene is the controlling of "all behavioural and environmental factors that precede sleep and may interfere with sleep."[1] It is the practice of following guidelines in an attempt to ensure more restful, effective sleep. This can promote daytime alertness, help to treat or avoid specific kinds of sleep disorders,[2][3] and prevent the negative consequences of sleep deprivation. Specific sleep hygiene recommendations have become more established and refined over time, but there is variable research support across recommendations. The benefits of practicing sleep hygiene recommendations vary by individual and some special populations have unique additional considerations. Consultation with sleep professionals can facilitate personal application of sleep hygiene recommendations.
Development
The term sleep hygiene was coined in 1977 by psychologist Peter Hauri, who published a list of behaviors intended to promote improved sleep.[4] However, similar concepts are credited to Paolo Mantegazza,[5] who published a related original book in 1864 and to Michael Perlis who wrote an article in the British Medical Journal in 1894.[4] The 1991 publication of the International Classification of Sleep Disorders introduced the diagnostic category Inadequate Sleep Hygiene.[6] Over recent decades, specific sleep hygiene recommendations have been revised and expanded as the medical field has made advancements. For example, while avoiding sleeping pills may have been appropriate in the 1970s, there are now non-habit-forming sleep aids.[4]
Assessment
Trouble sleeping and daytime sleepiness can be indications of poor sleep hygiene or sleep habits. The International Classification of Sleep Disorders-Revised (ICSD-R) states on page 74: "The importance of assessing the contribution of inadequate sleep hygiene in maintaining a preexisting sleep disturbance cannot be overemphasized."[2] In the ICSD-R, the diagnosis inadequate sleep hygiene is classified as an extrinsic sleep disorder, code 307.41-1. To qualify for the diagnosis of inadequate sleep hygiene, an individual must first meet criteria for insomnia, and then exhibit one of the following behaviors:[2]
- napping twice or more per week
- having a variable sleep-wake schedule
- spending excessive time in bed
- exercising shortly before bedtime
- engaging in activities that induce intense emotion shortly before bedtime
- frequently using bed for non-sleep-related activities
- using an uncomfortable bed for sleeping
- creating a bedroom environment that is not conducive to sleep (e.g. too hot or cold)
- engaging in activities that require high concentration shortly before bedtime
- recurrent intense thinking once in bed (e.g. planning or reminiscing)
Practice of sleep hygiene and knowledge of sleep hygiene practices can be assessed with the Sleep Hygiene Index,[7] Sleep Hygiene Awareness and Practice Scale,[8] Sleep Hygiene Practice Scale,[9] or Sleep Hygiene Self-Test.[10] For younger individuals, sleep hygiene can be assessed by the Adolescent Sleep Hygiene Scale or the Children’s Sleep Hygiene Scale.[11]
Aspects of sleep hygiene
Sleep specialists and researchers have created lists of recommendations for improving sleep quality. Clinicians choose which item(s) to recommend for each individual person and counselling is presented as a form of patient education. The recommendations reviewed below are the most commonly cited recommendations by sleep hygiene experts.[4][6]
Establishing a sleep schedule
One set of recommendations that clinicians have established relate to the timing of sleep. As most adults need 7–9 hours of sleep each night,[6] a top recommendation is allowing enough time for sleep. Clinicians will more frequently advise that these hours of sleep are obtained at night instead of through napping, because while naps can be helpful after sleep deprivation, under normal conditions naps may be detrimental to nighttime sleep.[6] Negative effects of napping on sleep and performance have been found to depend on duration and timing, with shorter midday naps being the least disruptive.[4] Modifying a sleep schedule to involve regular sleep-wake times and a minimum of 7 hours of sleep has been associated with improved well-being and alertness during the day. There is also focus on the importance of awakening around the same time every morning and generally having a regular sleep schedule.[12]
Engaging in advisable activities
Sleep hygiene experts have focused on which activities facilitate or inhibit sleep quality, and the timing of those activities throughout the day. Exercise is one of these activities, as people who exercise experience better quality of sleep than those that do not,[13] however, exercising too late in the day can be activating and delay falling asleep.[4] Increasing exposure to bright and natural light during the daytime and avoiding bright light in the hours before bedtime helps promote a normal sleep-wake schedule by aligning a person's circadian rhythm with nature's daily light-dark cycle.[14]
Activities that reduce physiological arousal and cognitive activity promote falling asleep, so engaging in relaxing activities before bedtime is frequently recommended.[12] Conversely, continuing important work activities or planning shortly before bedtime or once in bed has been shown to delay falling asleep.[6] Similarly, good sleep hygiene involves minimizing time spent thinking about worries or anything emotionally upsetting shortly before bedtime.[6] Trying purposefully to fall asleep has been found to induce frustration and further prevent falling asleep,[4] so in these situations a person may be advised to get out of bed and try something else for a brief amount of time.[6]
Generally, for people experiencing difficulties with sleep, spending less time in bed results in deeper and more continuous sleep,[4] therefore clinicians will frequently recommend eliminating use of the bed for any activities except sleep (or sex).
Consuming certain foods and substances
A number of foods and substances have been found to disturb sleep, due to stimulant effects or disruptive digestive demands. Avoiding nicotine, caffeine (including coffee, energy drinks, soft drinks, tea, chocolate, and some pain relievers), and other stimulants in the hours before bedtime is recommended by most sleep hygiene specialists,[15][16] as these substances activate neurobiological systems that maintain wakefulness.[17] Alcohol near bedtime is frequently discouraged by clinicians, because, although alcohol can induce sleepiness initially, the arousal caused by metabolizing alcohol can disrupt and significantly fragment sleep.[12] Both consumption of a large meal just before bedtime, requiring effort to metabolize it all, and hunger have been associated with disrupted sleep.[4] Therefore for some people that struggle with this, clinicians may recommend eating a light snack before bedtime. Lastly, limiting intake of liquids in the time leading up to bedtime can prevent interrupted sleep due to necessary bathroom breaks.[4]
Creating a comfortable sleep environment
Sleep hygiene experts stress the importance of arranging a sleep environment that is quiet, very dark, and cool. Noises, light, and uncomfortable temperatures have been shown to disrupt continuous sleep.[18][14] Other recommendations that are frequently made, though less studied in research, include the importance of selecting comfortable mattresses, bedding, and pillows,[4] and eliminating a visible bedroom clock, in order to prevent focusing on time passing when trying to fall asleep.[4]
Research controversies
The research behind sleep hygiene is still in the process of development, and currently no two sleep hygiene studies use identical sets of sleep hygiene recommendations.[6] There is an imbalance in the popularity of sleep hygiene recommendations in proportion to the amount of scientific evidence supporting the specific recommendations.[12] The strength of research support varies for each recommendation, with some individual recommendations receiving much more attention than others. Some of the more robustly researched and supported recommendations include the effects of noisy sleep environments, alcohol consumption in the hours before sleep, cognitive demand of pre-bedtime activities, and purposeful attempts to focus on falling asleep.[4] Currently, there is lacking evidence for the effects of certain sleep hygiene recommendations, including the under-established effects of comfortable mattresses, visible bedroom clocks, making a worry list, and limiting liquids.[4] Other recommendations may have a greater research evidence base, but have more complicated findings, such as the effects of napping or exercise. The effects of napping, for example, seem to depend on the length and timing of napping, in conjunction with how much cumulative sleep an individual has had in recent nights, but effects are still variable.[12]
In general, there has been less research on sleep hygiene principles in non-clinical samples.[12]
While the strength of research support is variable for individual recommendations, there is abundant support showing positive sleep outcomes for individuals that use several sleep hygiene recommendations together.[4] Because of this, it is suggested that sleep hygiene recommendations are not to be absolutely and blindly followed as “rules”, but rather explored with each patient to determine which recommendations are beneficial for that particular individual.[4][6]
Special populations with sleep hygiene difficulties
There are specific groups of individuals that due to conditions or circumstances are presented with additional barriers to adequate and good sleep.
Sleep hygiene has become a central component of treatment for insomnia.[19] Individuals with insomnia have difficulty with falling and staying asleep and the use of sleep hygiene recommendations has been shown to reduce or eliminate the symptoms of insomnia. Specific sleep disorders may require additional treatment approaches. Continuing difficulties with sleep may require additional assistance from healthcare providers.[20]
College students have been identified as being at risk of engaging in poor sleep hygiene and also of being unaware of how the resulting sleep deprivation affects them.[21] In general, because of irregular weekly schedules and the campus environment, college students are more likely to have variable sleep-wake schedules across the week, take naps, drink caffeine and/or alcohol near bedtime, and sleep in disruptive sleeping environments.[21] Because of this, it is important to have sleep hygiene education on college campuses.[21]
Similarly, shift workers have difficulty maintaining a healthy sleep-wake schedule due to irregular job hours.[22] Shift workers need to be strategic about napping and drinking caffeine, as these practices may be necessary for work productivity and safety, but should be timed carefully. Because shift workers may need to sleep while other individuals are awake, additional sleeping environment changes should include reducing disturbances by turning off phones and posting signs on bedroom doors to inform others when they are sleeping.[22]
Due to symptoms of low mood and energy, individuals with depression may be likely to have behaviors that are counter to good sleep hygiene, such as taking naps during the day, consuming alcohol near bedtime, and consuming large amounts of caffeine during the day.[23] In addition to sleep hygiene education, bright light therapy is a particularly useful treatment approach for individuals with depression. Not only can bright light therapy help establish a more normal sleep-wake schedule, but it also has been shown to be effective for treating depression directly, especially when related to seasonal affective disorder [24]
Individuals with any type of breathing difficulties – due to asthma or allergies – may need to make special changes to their bedroom environment. Difficulties with breathing while sleeping reduce ability to stay asleep and to get restful sleep;[25][26] it is therefore important to consider how to reduce allergy or asthma triggers. This might include purchasing hypoallergenic bedding, not allowing pets in the bedroom, using de-humidifiers, and especially avoiding exercise in the hours before bedtime.
Individuals who experience physical pain – chronic or situational – have to be particularly careful about consumption of medications and substances.[27] Many pain-relieving substances – ibuprofen, intense pain killers, alcohol – have chemical effects that can induce either sleepiness or wakefulness, and therefore individuals managing pain should consider the timing of these medications.
Results of poor sleep hygiene
Knowledge of sleep hygiene practices has been found to relate to actual sleep hygiene practices, which ultimately relates to quantity and quality of one’s sleep,[21] and this holds true for those with and without sleeping disorders.[9] Sleep hygiene is associated with subjective sleepiness and actual sleep deprivation across cultures.[7][28] There are correspondingly a number of detrimental consequences of such sleep deprivation and poor sleep quality. Cognitively, sleep deprivation has been associated with diminished logical reasoning abilities, slower reaction time, decreased attention and concentration, difficulties with memory, decreased work efficiency, and high rates of mistakes and omissions.[29][30] Emotionally, restricted sleep has been associated with high levels of perceived stress, increased irritability, and decreased motivation.[29][30] Physically, sleep deprivation has been associated with weakened muscles, disrupted visual perception, increased appetite, and weakened immune system.[29] Sleep hygiene practices that prevent sleep deprivation can correspondingly reduce these negative consequences.
Counseling and resources
Clinicians who advise sleep hygiene strategies for individuals and families have lists of suggestions which may include advice about timing of sleep and food intake in relationship to it, exercise, sleeping environment, etc. Which items are suggested for which people are selected by the clinician, depending on knowledge of the individual situation; the counselling is presented as a form of patient education. Re-education involves a combination of advice about homeostatic, adaptive and circadian aspects of sleep control, how to avoid sleep deprivation, and how to respond to unwanted awakenings from sleep if these occur.[31] As the second edition of the ICSD (ICSD2, 2005) points out, the "sleep disruptive effects of poor sleep hygiene are often obvious to others, but the patients show little insight into this fact."[32]
As sleep hygiene has become more popular, a number of sleep hygiene resources have been made available online to the public. The websites of the National Sleep Foundation and the Division of Sleep Medicine at Harvard Medical School have published tips for sleep hygiene, instructional videos, sleep hygiene self-assessments, poll statistics on sleep hygiene, and tools to find sleep professionals.
See also
References
- ^ van der Heijden, KB; Smits, MG; Gunning, WB (March 2006). "Sleep hygiene and actigraphically evaluated sleep characteristics in children with ADHD and chronic sleep onset insomnia". Journal of Sleep Research. 15 (1). European Sleep Research Society: 55–62. PMID 16490003.
- ^ a b c The International Classification of Sleep Disorders, Revised 2001.
- ^ Benca, Ruth M. (1 March 2005). "Diagnosis and Treatment of Chronic Insomnia: A Review". Psychiatric Services. 56 (3): 332. doi:10.1176/appi.ps.56.3.332.
- ^ a b c d e f g h i j k l m n o p Hauri., P. (2011). Sleep/wake lifestyle modifications: Sleep hygiene. In Barkoukis TR, Matheson JK, Ferber R, Doghramji K, eds. Therapy in Sleep Medicine. Elsevier Saunders, Philadelphia, PA. pg 151-160
- ^ Gigli, Gian Luigi; Valente, Mariarosaria (30 June 2012). "Should the definition of "sleep hygiene" be antedated of a century? A historical note based on an old book by Paolo Mantegazza, rediscovered". Neurological Sciences. 34 (5): 755–760. doi:10.1007/s10072-012-1140-8.
- ^ a b c d e f g h i Stepanski, Edward J; Wyatt, James K (June 2003). "Use of sleep hygiene in the treatment of insomnia". Sleep Medicine Reviews. 7 (3): 215–225. doi:10.1053/smrv.2001.0246.
- ^ a b Mastin, D. F., Bryson, J., & Corwyn, R. (2006). Assessment of sleep hygiene using the Sleep Hygiene Index. Journal of behavioral medicine, 29(3), 223-227.
- ^ Lacks, P., & Rotert, M. (1986). Knowledge and practice of sleep hygiene techniques in insomniacs and good sleepers. Behaviour research and therapy, 24(3), 365-368.
- ^ a b Yang CM, Lin SC, Hsu SC, Cheng CP. Maladaptive sleep hygiene practices in good sleepers and patients with insomnia. J Health Psychol 2010;15:147–55
- ^ Blake DD, Gomez MH: A scale for assessing sleep hygiene: Preliminary data. Psychol Rep 1998, 83:1175-1178.
- ^ Lewandowski, A. S.; Toliver-Sokol, M.; Palermo, T. M. (11 January 2011). "Evidence-Based Review of Subjective Pediatric Sleep Measures". Journal of Pediatric Psychology. 36 (7): 780–793. doi:10.1093/jpepsy/jsq119.
- ^ a b c d e f Irish, Leah A.; Kline, Christopher E.; Gunn, Heather E.; Buysse, Daniel J.; Hall, Martica H. (October 2014). "The role of sleep hygiene in promoting public health: A review of empirical evidence". Sleep Medicine Reviews. doi:10.1016/j.smrv.2014.10.001.
- ^ Driver, Helen S.; Taylor, Sheila R. (August 2000). "Exercise and sleep". Sleep Medicine Reviews. 4 (4): 387–402. doi:10.1053/smrv.2000.0110.
- ^ a b Czeisler, C. A.; Gooley, J. J. (January 2007). "Sleep and Circadian Rhythms in Humans". Cold Spring Harbor Symposia on Quantitative Biology. 72 (1): 579–597. doi:10.1101/sqb.2007.72.064.
- ^ Sin, Celia WM; Ho, Jacqueline SC; Chung, Joanne WY (January 2009). "Systematic review on the effectiveness of caffeine abstinence on the quality of sleep". Journal of Clinical Nursing. 18 (1): 13–21. doi:10.1111/j.1365-2702.2008.02375.x.
- ^ Jaehne, Andreas; Loessl, Barbara; Bárkai, Zsuzsanna; Riemann, Dieter; Hornyak, Magdolna (October 2009). "Effects of nicotine on sleep during consumption, withdrawal and replacement therapy". Sleep Medicine Reviews. 13 (5): 363–377. doi:10.1016/j.smrv.2008.12.003.
- ^ Boutrel, B., & Koob, G. F. (2004). What keeps us awake: the neuropharmacology of stimulants and wakefulness-promoting medications.SLEEP-NEW YORK THEN WESTCHESTER-, 27, 1181-1194.
- ^ Xie, Hui; Kang, Jian; Mills, Gary H (2009). "Clinical review: The impact of noise on patients' sleep and the effectiveness of noise reduction strategies in intensive care units". Critical Care. 13 (2): 208. doi:10.1186/cc7154.
{{cite journal}}
: CS1 maint: unflagged free DOI (link) - ^ Jacobs, Gregg D.; Pace-Schott, EF; Stickgold, R; Otto, MW (2004). "Cognitive Behavior Therapy and Pharmacotherapy for Insomnia: A Randomized Controlled Trial and Direct Comparison". Archives of Internal Medicine 164 (17): 1888–96.
- ^ Running on Empty: Fatigue and Healthcare Professionals: The Consequences of Inadequate Sleep. NIOSH: Workplace Safety and Health, August 2, 2012
- ^ a b c d Brown, Franklin C.; Buboltz, Walter C.; Soper, Barlow (January 2002). "Relationship of Sleep Hygiene Awareness, Sleep Hygiene Practices, and Sleep Quality in University Students". Behavioral Medicine. 28 (1): 33–38. doi:10.1080/08964280209596396.
- ^ a b Åkerstedt, T. (1998). Shift work and disturbed sleep/wakefulness. Sleep Medicine Reviews, 2(2), 117-128.
- ^ Doghramji, K. (2003). Treatment strategies for sleep disturbance in patients with depression. Journal of Clinical Psychiatry, 64, 24-29.
- ^ Loving RT, Kripke DF, Shuchter SR. Bright light augments antidepressant effects of medication and wake therapy. “Depress Anxiety” 2002;16:1–3
- ^ Léger, D., Annesi-Maesano, I., Carat, F., Rugina, M., Chanal, I., Pribil, C., ... & Bousquet, J. (2006). Allergic rhinitis and its consequences on quality of sleep: an unexplored area. Archives of internal medicine, 166(16), 1744-1748.
- ^ Vir, R., Bhagat, R., & Shah, A. (1997). Sleep disturbances in clinically stable young asthmatic adults. Annals of Allergy, Asthma & Immunology, 79(3), 251-255.
- ^ Lavigne, G. (2003). Sleep and Pain. “sleepmatters”
- ^ LeBourgeois, M. K., Giannotti, F., Cortesi, F., Wolfson, A. R., & Harsh, J. (2005). The relationship between reported sleep quality and sleep hygiene in Italian and American adolescents. Pediatrics, 115(Supplement 1), 257-265.
- ^ a b c Orzeł-Gryglewska, Jolanta (1 January 2010). "Consequences of sleep deprivation". International Journal of Occupational Medicine and Environmental Health. 23 (1). doi:10.2478/v10001-010-0004-9.
- ^ a b Banks, S; Dinges, DF (15 August 2007). "Behavioral and physiological consequences of sleep restriction". Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. 3 (5): 519–28. PMID 17803017.
- ^ Tamar Shochat and Sonia Ancoli-Israel (2007). "Sleep hygiene". Nature of Sleep and its Disorders. Armenian Medical Network. Retrieved 2007-09-19.
- ^ International Classification of Sleep Disorders. 2005. ISBN 0-9657220-2-3.
Further reading
- Hauri., P. (2011). Chapter 11. Sleep/wake lifestyle modifications: Sleep hygiene. In Barkoukis TR, Matheson JK, Ferber R, Doghramji K, eds. Therapy in Sleep Medicine. Elsevier Saunders, Philadelphia, PA. pg 151-160.
- Irish, L. A., Kline, C. E., Gunn, H. E., Buysse, D. J., & Hall, M. H. (2014). The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep medicine reviews.