Improving Sleep Hygiene and Insomnia by Melissa Edelmayer, LISW-S, LICDC

Obtaining healthy sleep is important for both physical and mental health. It can also improve productivity and overall quality of life. Everyone, from children to older adults, can benefit from practicing good sleep habits.

Your behaviors during the day, and especially before bedtime, can have major impact on your sleep. They can promote healthy sleep or contribute to sleeplessness. Your daily routines – what you eat and drink, the medications you take, how you schedule your days and how you choose to spend your evenings - can significantly impact your quality of sleep. Even a few slight adjustments can, in some cases, mean the difference between sound sleep and a restless night. Completing a two-week sleep diary can help you understand how your routines affect your sleep.

The term "sleep hygiene” refers to a series of healthy sleep habits that can improve your ability to fall asleep and stay asleep. These habits are a cornerstone of cognitive behavioral therapy for insomnia, the most effective long-term treatment for people with chronic insomnia. CBT can help you address the thoughts and behaviors that prevent you from sleeping well. It also includes techniques for stress reduction, relaxation and sleep schedule management.

Insomnia is a common sleep disorder that can make it hard to fall asleep, hard to stay asleep, or cause you to wake up too early and not be able to get back to sleep. Cognitive behavioral therapy for insomnia, sometimes called CBT-I, is an effective treatment for chronic sleep problems and is usually recommended as the first line of treatment.

​Most cases of insomnia are related to poor sleep habits, depression, anxiety, lack of exercise, chronic illness, or certain medications. Symptoms may include difficulty falling or staying asleep and not feeling well-rested. Treatment for insomnia consists of improving sleep habits (see tips above), behavior therapy, and identifying and treating underlying causes. Sleeping pills may also be used, but should be monitored for side effects.

Cognitive behavioral therapy for insomnia is a structured program that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. Unlike sleeping pills, CBT-I helps you overcome the underlying causes of your sleep problems.

How does cognitive behavioral therapy for insomnia work?

The cognitive part of CBT-I teaches you to recognize and change beliefs that affect your ability to sleep. This type of therapy can help you control or eliminate negative thoughts and worries that keep you awake. The behavioral part of CBT-I helps you develop good sleep habits and avoid behaviors that keep you from sleeping well. Depending on your needs, your sleep therapist may recommend some of these CBT-I techniques:

• * Stimulus control therapy. This method helps remove factors that condition your mind to resist sleep. For example, you might be coached to set a consistent bedtime and wake time and avoid naps, use the bed only for sleep and sex, and leave the bedroom if you can't go to sleep within 20 minutes, only returning when you're sleepy.
• * Sleep restriction. Lying in bed when you're awake can become a habit that leads to poor sleep. This treatment reduces the time you spend in bed, causing partial sleep deprivation, which makes you more tired the next night. Once your sleep has improved, your time in bed is gradually increased.
• * Sleep hygiene. This method of therapy involves changing basic lifestyle habits that influence sleep, such as smoking or drinking too much caffeine late in the day, drinking too much alcohol, or not getting regular exercise. It also includes tips that help you sleep better, such as ways to wind down an hour or two before bedtime.
• * Sleep environment improvement. This offers ways that you can create a comfortable sleep environment, such as keeping your bedroom quiet, dark and cool, not having a TV in the bedroom, and hiding the clock from view.
• * Relaxation training. This method helps you calm your mind and body. Approaches include meditation, imagery, muscle relaxation and others.
• * Remaining passively awake. Also called paradoxical intention, this involves avoiding any effort to fall asleep. Paradoxically, worrying that you can't sleep can actually keep you awake. Letting go of this worry can help you relax and make it easier to fall asleep.
• * Biofeedback. This method allows you to observe biological signs such as heart rate and muscle tension and shows you how to adjust them. Your sleep specialist may have you take a biofeedback device home to record your daily patterns. This information can help identify patterns that affect sleep.

The most effective treatment approach may combine several of these methods. If you are struggling with poor sleep or insomnia, talk to your prescriber or therapist today.

Four Quick Sleep Tips:

If you have difficulty sleeping or want to improve your sleep, try following these four tips to establish healthy sleep habits. Talk to your doctor if your sleep problem persists even after trying these tips.

[1] Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
[2] Set a bedtime that is early enough for you to get at least 7 hours of sleep.
[3] Don’t go to bed unless you are sleepy. If you don’t fall asleep after 20 minutes, get out of bed.
[4] Try an herbal supplement like Valerian root. This over-the-counter supplement is sometimes helpful for the treatment of insomnia. 
[5] Establish a relaxing bedtime routine. A regular nightly routine helps the body recognize that it is bedtime. This could include taking warm shower or bath, reading a book, or light stretches. When possible, try to avoid emotionally upsetting conversations and activities before attempting to sleep.
Use your bed only for sleep and sex.

Additional Sleep Advice:

Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature. Mattress and pillows should be comfortable. The bedroom should be cool – between 60 and 67 degrees – for optimal sleep. Bright light from lamps, cell phone and TV screens can make it difficult to fall asleep, so turn those light off or adjust them when possible. Consider using blackout curtains, eye shades, ear plugs, "white noise" machines, humidifiers, fans and other devices that can make the bedroom more relaxing.

Limit exposure to bright light in the evenings, and be sure to get adequate exposure to natural light during the day. This is particularly important for individuals who may not venture outside frequently. Exposure to sunlight during the day, as well as darkness at night, helps to maintain a healthy sleep-wake cycle.
Turn off electronic devices at least 30 minutes before bedtime.

Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack. Heavy or rich foods, fatty or fried meals, spicy dishes, citrus fruits, and carbonated drinks can trigger indigestion for some people. When this occurs close to bedtime, it can lead to painful heartburn that disrupts sleep.

Exercise regularly and maintain a healthy diet. As little as 10 minutes of aerobic exercise, such as walking or cycling, can drastically improve nighttime sleep quality. For the best night’s sleep, most people should avoid strenuous workouts close to bedtime. However, the effect of intense nighttime exercise on sleep differs from person to person, so find out what works best for you. Avoid consuming caffeine in the late afternoon or evening. On a similar note, avoid consuming alcohol and reduce your fluid intake before bedtime.

Many poor sleepers simply need help relaxing. If you're a habitual insomniac and trying to get to sleep just makes you more anxious and awake, try these alternative choices to help reduce your worry about sleep while relaxing your body and mind. Breathing exercises can promote relaxation.

Here's a routine you can do anywhere, anytime:
   * Exhale completely through your mouth.
   * Inhale through your nose to a count of four.
   * Hold your breath for a count of seven.
   * Exhale through your mouth for a count of eight.
   * Repeat the cycle three times.

In addition, meditation, yoga, and biofeedback may reduce tension and promote better sleep. Visualization or guided imagery, during which you hold a peaceful image in your mind before bedtime, can also be an effective path to relaxation. You can learn learn more about these techniques from your prescriber or therapist.

If you wake up at night and can't go back to sleep, remain quiet and relaxed. Even normal sleep can be punctuated by periods of restlessness or even waking. Be patient; sleep usually returns. Remember, a few nights of poor sleep do no long-term harm. Even if you toss and turn trying to get to sleep, you are probably getting more periods of sleep than you think.