I thought I would share what I know about sleep hygiene. I've had varying degrees of insomnia and hypersomnia for almost 10 years, much of which has been related to depression or periods of hypomania. This is what I have learned from GPs, my current psychiatrist, psychologists, as well as from my training and work as a nurse, my psychology degree, and my own reading on the subject. As always, if you have received different information from your treatment team, follow their advice.
So what is sleep hygiene? I know when I first heard the term I thought it was something to do with having a shower before I went to bed and making sure I had clean sheets! This isn't quite the case. Sleep hygiene is a series of steps that you can undertake to help you get a good night's sleep. It can help people who have problems with sleep onset (falling asleep), sleep maintenance (staying asleep for the whole night) and rising (waking up early and not being able to get back to sleep).
Some of these activities can be undertaken during the day, and others to form a routine before you go to bed. You do not need to do every single activity. What works for some people may not work for others, because everyone is a unique individual and has different lifestyles and personalities.
One last thing to be aware of is that these practices are not likely to work instantly. Unfortunately you need to keep at them, they need to become routine because sleep is very sensitive to conditioning. It may take a couple of weeks before you start to notice a difference, depending on the severity of your sleep problems. And even if you don't have sleep problems, getting into a routine can help you have a more restful and restorative sleep that may give you a little extra bounce during the day.
In the Morning
- It is important to get up at the same time each day, even on the weekends. It can be hard at first, trust me(!) but after some time you will actually start to wake up at this time on your own.
- Having a morning routine can also help with rising at the same time each day. Make your bed, open the curtains and windows (unless you live somewhere with heavily polluted air) to your bedroom. Letting fresh air and light in during the day can help to 'clear the air'.
During the Day
- Exercise. I'm sure everyone knows about the benefits of exercise for health. It helps sleep too. A lot of what I have been reading lately suggests that exercise in the late afternoon or early evening may be the best for sleep. However, I do know some people that feel extremely energised and find that exercise wakes them up. If you fall into this category it may be better to exercise in the earlier parts of the day. Aerobic exercise is always good. But even a gentle stroll in the evening can help. Yoga is wonderful. There are difference practices in yoga, some of which are very active and can get the heart pumping, and others are restorative/relaxing. I try and do a few of the restorative practices before bed.
- Eat three balanced meals a day. Again, this relates to the general health benefits which also can impact upon your sleep.
- If something is stressing you try and take 5 minutes out. Sit somewhere without distraction, outside is great but if you are at work and don't have your own office you can go and lock yourself in a toilet cubicle (I used to to this frequently!). Slow your breathing and take note of the breath. Try and relax each of your muscles, especially those which you feel are holding tension. Afterwards try and tackle the problem.
- For most people avoiding caffeine or sugary drinks would be unthinkable, however try to limit yourself. Remember the more you have, the harder it will be to fall asleep at an appropriate time.
In the Evening
- If the weather is cool close your windows so the room is not too cold by the time you go to bed. You need a moderate temperature, not too hot, not too cold.
- Warming/cooling your bedroom as naturally as possible through appropriate sleep attire and sheets and blankets is preferable to artificial heating or cooling.
- Don't eat a huge dinner. If you are still feeling bloated from dinner when you go to bed, it will be harder to fall asleep and it can affect the quality of sleep.
- Exercise if you can, as per the above comment.
- From dinner time onwards avoid caffeine or sugary food and drinks. This will keep you awake for longer.
In the Hour Before you go to Bed
- Have a warm bath or if that is not possible, a shower. Don't do this immediately before you go to bed. Try and do it at least half an hour before. One of my doctors told me that before you actually fall asleep your body temperature needs to lower slightly. If you get out of the bath or shower your body temperature will be raised so it will take longer for you to fall asleep as you will need to wait for your temperature to lower slightly.
- Start to wind down for the night. Avoid active activities such as most video/computer games, getting into heated debates with others, etc.
- Try and avoid using the computer or watching TV. This one I know can be hard. If you can't do this, try and make your interaction as passive and gentle as possible.
- Play some soothing music. A couple of my favourites are Basia Bulat or Brian Eno.
- If you are getting hungry have a small snack. As above, you do not want that feeling of a heavy or bloated stomach when you go to bed. But if you are hungry it will be difficult to sleep.
- Write in a journal. I find that when I go to bed I think a lot, about anything and everything. So I try and journal most nights to get the thoughts out of my head. This is something that I personally find very helpful.
- Reading can also be helpful. However, if you are like me be careful what you read. I will often find that if I really enjoy a book I will stay awake until I finish it. This is not so helpful!
- Add some lavender essential oil to an oil burner and burn in your room for an hour or so before you sleep. Make sure the solution is dilute and NEVER leave it to burn once you get into bed. Also avoid fragrant oils, they are synthetic and are more likely to give you a headache than help to relax. I would always recommend 100% pure essential oils.
When you go to Bed
- Go to bed at the same time every night. Most adults need 8 hours sleep (children require longer). Time your bed time so this is possible. My psychiatrist seems to like 'bed at 11 and up at 7'. However you need to pick times that will suit your lifestyle. I am struggling with this at the moment but I realise that it can help immensely.
- Have a small bed-time routine. Find something that suits you. Include things such as checking the house is locked, cleaning your teeth, getting changed into pyjamas, turning all the lights out. What ever you choose, do it in the same order each night. Routine is important.
- Make your bedroom as dark as possible. Our bodies are designed to sleep at night, and light can disrupt this. This is often cited as one of the reasons shift workers have problems sleeping.
- When you get in bed play some soothing or relaxing music. I already mentioned that I find Brian Eno helpful (his two albums Ambient 1 and Ambient 2, as well as an EP 'Neroli'.) But it must be something you like. Play it softly. There is also a multitude of relaxation for sleep and hypnosis for sleep albums available. Have a look around and find something that is right for you. You can even get white noise albums.
- If after half an hour you are still awake, try reading for a little while.
- Rearrange your bedroom. Sometimes a shift of furniture can be enough to elicit a change in a bad routine. This may sound a little strange but it was suggested by my psychiatrist.
- Keep your bedroom clean. A clean and tidy room is much easier to relax in than a messy one.
- Only use your bedroom for sleep or sex. Obviously this is a little difficult if you still live at home, or live in shared accommodation. Make the best with what you've got. This also has to do with conditioning your body. It learns that if you are in your bedroom it will be for sleeping so it will begin to relax.
- Remove as many electrical devices from your room as possible. TVs, radios, telephones, electronic picture frames, brightly lit digital clocks, anything and everything! The only device I have is my iPhone. I use it to play music on loud speaker to help with falling asleep, as an alarm, and as a phone in case of emergencies. There is some evidence that suggests that even when electrical devices are off but plugged in, they still emit some signals which may disrupt sleep. And if you are only using your bedroom for sleep and sex, you shouldn't need these in there anyway!
- If you are a shift worker, many of these suggestions will be a little more difficult for you. From what I understand the most important thing is routine. So while you may not be able to go to bed at the same time every night, have a routine of things to do before you go to bed, and try and sleep for the same length of time each night.
I've listed quite a few things here. If you are having sleep troubles I hope you can find something from this that may help you. I am sure there are some things that I have forgotten and other ideas that I have not heard of. If you have any additional suggestions or experiences that you can share please leave them in the comments :)
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