A comprehensible guide to Sleep Hygiene

When someone hears the term “Sleep Hygiene” for the first time, it’s easy to think it relates more to cleanliness than to healthy sleep habits. In this article, we’ll delve into what sleep hygiene truly encompasses, the factors leading to poor sleep hygiene, and the indicators suggesting your sleep hygiene might need enhancement. Most importantly, we’ll outline actionable steps to actively improve your sleep hygiene—and, as a result, the quality of your sleep. Additionally, we’ll explore the steps to take when, despite doing everything correctly, falling asleep remains a challenge. For further expert advice, consider consulting with a sleep specialist.

What is Sleep Hygiene?

Sleep Hygiene is a term used to describe healthy ‘habits’ and what someone might do to improve their sleep. It is not limited to actions within bed, or in the evening leading up to bedtime; but throughout the entire 24-hour cycle of a day. It encompasses your thoughts, behaviours, actions, and environments that you are subject to and how each of these can improve or negatively impact a good night’s sleep.

What can Cause Poor Sleep Hygiene?

Many different factors can cause you to have a bad night’s sleep. Having a poor routine, or no routine at all, can impact the quality and quantity of sleep you may get. The activities you do, or more importantly, don’t do, can also greatly impact your sleep. The things you eat or where you spend the vast majority of your time in the day can also play a role in sleep. More often than not, it is a combination of lots of small things that, when grouped, play a part in unravelling a good night’s rest.

What Are the Signs that indicate we have Poor Sleep Hygiene?

If you think your sleep is poor or inconsistent, consider whether you have some of the following common signs and symptoms:

Difficulty falling asleep initially, or waking up frequently during the night
You wake up in the morning feeling your sleep was not restful or refreshing
You are starting to feel anxious or worried about the sleep you’re getting
During the day, your concentration is poor and you feel tired and less motivated
You feel irritable, grumpy and your tolerance slips easier than it used to
You find it increasingly difficult to get your work, study or daily chores completed

What can we do to Improve our Sleep Hygiene and our overall sleep?

There are a lot of subtle changes you can make in your daytime and nighttime routine to ultimately improve your sleep. Below is a list of suggestions and some practical changes you can do to improve your sleeping habits.

Light and Darkness

Our relationship to sunlight (and its absence) is one of the main drivers of our Circadian Rhythm, or “Body Clock”. Our Circadian Rhythm is the 24-hour internal clock within our brain that regulates cycles of alertness and sleepiness, and it uses changes in our environment’s light to do this. You may have heard of Melatonin before, this is the hormone the Circadian Rhythm uses to signal these changes.

When we are exposed to light, this suppresses our melatonin. When it starts to get dark (i.e., when the sun sets), our body needs to start increasing melatonin, which in turn tells our brain to start preparing to sleep. Unfortunately, humans have not evolved to deal with the influx of light we experience in the evenings, and our systems have not adjusted.

Here are some practical changes with light/dark to improve our sleep:

Expose yourself to bright “white light” in the morning. Better yet, get outside and bask in the morning sunlight. This will be a large signal to your brain and Circadian Rhythm that you should be awake and will engage in alerting signals in your body.
Expose yourself to sunshine throughout the day. This may be difficult if you’re in an office job and don’t sit near a window. If that’s the case, make sure you get outside during your lunch break and expose yourself to sunlight. If possible, suggest to your work team that you do a ‘walking meeting’ outside so you can get some sunlight exposure (and some exercise to boot).
Actively dim the lights in the evening. At least 2 hours before bedtime, turn off overhead lights or install dimming switches so you can lower the light. Aim for a rich ‘golden’ light similar to candlelight. Ideally, use lamps that are low to the ground.
Avoid screens in the last 2 hours before bed. This is hard for a lot of us, but the “blue light” you get from screens is a powerful suppressor of melatonin. There are filters you can buy to help reduce screen brightness, but they don’t completely remove the problem.
Remove all sources of light in the bedroom. Make sure your bedroom is dark during the hours you are to sleep. Black-out curtains can help with this, or using an eye mask.
Invest in some helpful gadgets. If your environment won’t let you use light and darkness appropriately for sleep, then some great products on the market can help. There are alarm clocks that start emitting a soft glow of light in the minutes before your alarm sounds, to simulate the sun rising. This allows you to naturally wake up with the coming of light; it’s perfect if your alarm goes off and it’s still dark outside. Also, there are light therapy lamps that you can sit in front of in the morning to expose yourself to bright light and make you feel more awake. It may be worth speaking to your sleep professional before using these products to see if they’re appropriate for you.

Regularity

Going to bed at the same time, and getting up at the same time every day is what we mean by being “regular” with your sleep timings. Throughout the week, it is common for people’s bedtimes to change from day to day. Unfortunately, this can have a negative impact in the quality of our sleep. As adults, we should be aiming to get between 7-9 hours of sleep per night. For most of us, our busy work schedules, nighttime routines and social calendars play a role in affecting our sleep regularity and the amount of sleep we ultimately get. Here are some ways you can help improve your sleep regularity:

Plan to be in bed long enough to get your 7-9 hours of sleep. Think about what time you get up, subtract the amount of time you want to sleep for (8 hours is a good place to start if you’re unsure), factor in about 15 minutes (the time it takes to fall asleep), and that is your new bedtime. Make sure you get into bed each night by that time in order to get the amount of sleep, your body so desperately needs.
Set an alarm to start your bedtime routine. If you constantly stay up later than you should, then it might be worthwhile setting a reminder to get ready for bed. Your bedtime routine may involve cleaning your teeth, washing your face and putting your pyjamas on. If you know this takes about 15 minutes, then set your alarm for 15 minutes before bedtime to prompt you to start the routine on time.
You can’t “make up for it” on the weekends. Short sleeping yourself during the week, then having a long sleep in on the weekends doesn’t work. It’s not how good sleep works. So make sure you’re getting the total amount of sleep time you need every night, and don’t rely on your weekends to restore balance.

Temperature

Ideally, the temperature of your bedroom should be about 18 degrees Celsius. Temperature plays an important role in our sleep in two major ways:

Together with a decrease in light, a drop in temperature is one of the body’s natural ‘queues’ to start increasing the hormone melatonin. As mentioned before, melatonin doesn’t make you sleepy exactly, it’s what signals the brain to tell it that it needs to start preparing for sleep. We also need to drop our core body temperature in order to go from light sleep, to deep sleep. If you ever think about those nights you’ve tried to sleep in a hot room, you will remember how restless you felt and how difficult it was to get to sleep. Now compare that to nights where you may have slept in the mountains with the window open – it probably wasn’t that fresh mountain air, but the fact that it was much cooler than you were used to.

Now before you start to argue that you hate being cold in bed, let me be clear: I don’t want you to be cold in bed, but to be breathing in cold air. This cold air will enter your lungs and help drop your core temperature as you enter sleep. Don’t be shivering in bed, have that warm blanket of duvet and be snuggled and comfortable.

If you’re not sure whether you’re too warm in bed, then consider the following scenarios: Does it feel nice when you flip the pillow to the cooler side? Does it feel nice when you roll over to the cooler side of the bed and haven’t warmed it with your body? Do you always feel the need to stick one leg out of the blankets? If you’ve answered yes to these, you may be too warm in bed.

So here are some practical ways you can cool your bedroom environment:

Never turn on the heating in your bedroom. If your bedroom is very cold at night, then add an extra blanket to the bed instead.
Open the window and keep your bedroom door closed. That way, you’ll be breathing in the cool night air without making the rest of your home cold.
Get a fan or air-conditioner. If you live in a warm climate and the room is still hot with the window open, then it might be time to use artificial means to cool your room.
Have a cold shower before bed. Not only will you feel fresh, but you’re already helping by cooling your body, and you’ll trap less warmth in the sheets.
Have a hot shower/bath about 2 hours before bedtime. This sounds counterproductive, but having a hot shower 2 hours before bedtime will help, as your body has been in a state of cooling down in the two hours before sleep.

Keep it Quiet

In a perfect world, we like it to be quiet during the night when we’re trying to sleep. Our body has a system in place that still hears all the noises in the night and then assesses whether or not this is an expected noise or if it’s an unexpected noise. If you’ve ever lived next to a train line, or on a busy road, then you can attest to this: the first few nights, the noise constantly woke you up, but after a week or so, you didn’t even register the noise anymore. This is because your brain learned it was an expected noise during the night, and didn’t wake you up. This is why, we generally sleep poorly in a new environment (like a hotel) in the first few nights.

If you however, live in an environment where there are a lot of unexpected noises happening often, then here are some practical ways you can help cope with that:

Use hearing protection. There are a lot of different hearing/ear plugs on the market that can help block out those unwanted sounds. Find one that you feel comfortable wearing (especially if you’re a side sleeper).
Turn your phone on silent. Those little text messages and alerts need to be muted, your Instagram likes can wait until morning. If you’re worried about emergency phone calls, then that’s something you can adjust in the settings, but make sure every other ‘ping’ sound is turned off after a certain time.
Play white noise. White noise can help ‘drown out’ other noises from registering in the night. There are a lot of different ways to play white noise, whether you get a special machine that plays it, or you play it through your smart device. Just be aware that if you’re using your phone, you need to switch off any alerts that may pop up.

Caffeine and Alcohol

Caffeine (often in the form of tea or coffee) is something that most of us partake in during the day. One of the things caffeine does is block the chemical in our brain that makes us feel sleepy. It doesn’t stop it from being there, but it stops it from telling your brain it’s sleepy. That is a big misconception about caffeine, it doesn’t ‘give you energy’, just merely blocks you from feeling sleepy. But caffeine stays in our system for a long time, and it can take several hours to process just a single cup of coffee. This processing time can also slow as we age. So your afternoon caffeinated drink could still be blocking your sleepy driver once bedtime approaches.

Alcohol works as a depressant, which means it slows down the functioning of your brain. Alcohol (and other drugs in that category) will unfortunately greatly affect the quality of your sleep. It will make it very difficult to enter the deeper stages of your sleep and can fragment your sleep time, which means you have a lot more small ‘awakenings’ during the night. It is universally agreed upon within the sleep medicine community that alcohol can be severely detrimental to your sleep.

Here are some practical suggestions to help improve your sleep:

Have no more than 2 caffeinated beverages per day. This will ensure your caffeine load isn’t too much for your body to process before bedtime.
Avoid caffeine after lunch. This gives your body plenty of time to process the caffeine before bedtime.
De-caff still has caffeine in it. There is a lot less caffeine in decaffeinated items, but there is still some. Try instead UN-caffeinated teas and coffees in the later part of the day.
Look for unexpected caffeine. There is caffeine in a lot of things that we might not realise, so it’s important to read the label of anything we consume. Soft drinks and sodas, as well as chocolate, are two examples of high-caffeinated products.
Reduce alcohol intake. Try to have more alcohol free days in your week than days with alcohol consumption. Try to stick to the recommended safe daily intake for adults. Avoid binge drinking.

Exercise

We all know that exercise greatly improves our health, but it also has huge benefits for our sleep. When we are more physically active as a regular part of our routine, sleep quality improves. Regular exercise also reduces the number of times we wake up at night and helps us fall asleep faster at the beginning of the night.

In terms of what exercise is best for sleep? Well, it depends on what you want to improve. Studies have looked at the type of exercise, the frequency, and the timing in relation to sleep, and one thing is always concluded: SOMETHING is better than NOTHING. Doing any form of exercise will have a positive impact on your sleep when compared to inactivity, so find something you enjoy!

Not only is it important to exercise, but it is also important to move a lot in your day. Sitting down all day does us no favours and when you have a desk job, this can make it difficult.

Here are some practical ways to help increase your exercise and daily movement to benefit your sleep:

Find something you enjoy, not just endure. The key to a good and sustainable exercise routine is often how much you enjoy doing it. So if you find the exercise you’re doing a chore, then you may need to change it up to find something better.
Aim for a daily goal of 10,000 steps. This is considered our daily minimum step count, which we should all be aiming for. If you find this difficult to achieve, then try introducing a lunchtime walk, parking further away from work, walking to work, or introducing an evening stroll at the end of your day. If your workplace allows it, suggest a walking meeting. If you’re working from home, think about walking on a treadmill or riding an exercise bike during long meetings.
Mix it up. Your workout routine shouldn’t be the same every time you exercise. Doing some cardio as well as weight training or even introducing a team sport can add some variety. Changing the intensity (high intensity, short duration versus low intensity, long duration) can help achieve different health and sleep outcomes.
Avoid exercising 2 hours before bedtime. You can exercise at any time of your day that suits you, but if you do it two hours before bedtime, then your core body temperature may not have had time to completely cool down. As mentioned before, temperature plays a major role in our sleep, so make sure you’re not still warm from your workout as you get into bed.

Diet and Eating for Sleep

We need a lot of different vitamins and minerals to maintain good sleep health, and having a healthy and varied diet is important to ensure we are meeting our body’s needs. But some of our diet practices could also be impacting our sleep more than we realise, so here are a few practical suggestions to help improve our sleep:

Avoid Caffeine and Alcohol in the evening. As mentioned earlier, caffeine and alcohol have a direct negative impact on our sleep quality, so making sure they’re out of our system by bedtime will help.
Avoid foods you know disagree with you. Is there a food you love, but that doesn’t love you? Does spicy food give you indigestion? Does dairy upset your stomach? Does bread bloat you? Avoiding these kinds of foods at dinner or in the evening will ensure they’re not impacting your sleep as your body works to process them.
Avoid sugar in the evening. Sugar will make your blood sugar spike and then crash, something that will not help you sleep, so it’s best to avoid it in the later parts of your day.
Don’t eat anything too heavy within 2 hours of your bedtime. If your body is busy trying to process a big meal, then this can make sleep difficult. It may also increase the chances of having indigestion / heartburn in bed as you lay flat.
Don’t go to bed hungry! If you’re hungry as you get into bed, this will also disrupt your sleep, so if you need a light snack before getting into bed, choose a healthy choice that is beneficial for your sleep.
Eat your meals at the same time every day. Your body loves regularity in eating, not just sleeping, so having your meals at the same time every day will improve the functioning of your Circadian Rhythm.
Consider a multivitamin supplement. If you think your diet is poor and you’re not getting the right nutrients your body needs, then consider taking a multivitamin. This may be worth discussing with your doctor to determine if you may be deficient.

Actual Hygiene and our Bed

Sleeping in a clean and comfortable environment is important, don’t believe me? Think of those times you’ve slept on a bad mattress or had to use a thin, lumpy pillow. Not only did you sleep badly, but you probably woke up with a sore neck and an aching body. It is important that our bed is comfy and supportive to get a good night’s sleep.

Also, we share our bed with thousands of others: bacteria and dust mites. Having excessive amounts of bacteria and dust mites in our bed can cause our body to have a small inflammatory response, which will impact our sleep quality. They’re unavoidable but we can take steps to help reduce their numbers.

Here are some practical steps to ensure a good sleeping environment:

Have serviceable bedding. Ideally, change your pillow every 1-2 years and your mattress every 6–8 years. This will ensure they are giving you the right amount of support. The type of mattress and pillow isn’t important, as long as they provide your body with adequate support and you find them comfortable. Everyone has different preferences.
Wash your sheets regularly. At least once a week you should be changing your sheets for new clean ones. If you sweat a lot at night, consider changing them more often.
Get into bed clean. Getting into bed dirty or sweaty will add to your discomfort. Having a shower prior to getting into bed (see above) will reduce this. If you’re a morning-shower person, then that is fine, as long as you’re not actively dirty in the evening as you climb into bed.
Pay attention to any allergies. If you wake up in the morning and you feel congested, have itchy/red eyes or itchy skin, then you may have a dust mite allergy. If you suspect this might be the case then speak to your doctor about getting an allergy test to confirm it. Removing carpets and curtains, damp dusting regularly and getting hypo-allergenic pillows and bedding can help reduce the impacts of a dust mite allergy.

A Bedtime Routine

The hours leading up to bed can be important to prepare you for a good night’s rest. Some activities you’re doing in those final hours may be leading to poor sleep. You should be getting into bed with a relaxed body and mind, so taking steps as part of your nighttime routine can help you get better sleep. Here are some practical suggestions for a bedtime routine:

Do something relaxing. Think about what relaxes your mind, and do those things in the last hour before bed. This could involve reading a book, practicing meditation/ mindfulness, or doing some deep breathing exercises. There are also podcasts out there that you could listen to, to help calm your mind before you go to bed. Whatever helps you calm your mind, do it in the time leading up to bed.
Avoid stressful activities. Don’t check your work emails just before bed, or if social media gives you stress and anxiety, avoid that too. Avoid things that make your mind ‘busy’ with worry and overthinking.
Avoid a hot shower just before bed. Getting into bed after a hot shower will help trap that warmth in the blankets and may make it harder to cool down enough for good sleep. Having a hot shower/bath 2 hours before bedtime is better.
Avoid exercising 2 hours before bed. Exercise can increase our core body temperature and make it difficult to fall asleep, so make sure you get it done within 2 hours of your bedtime. A light stretch before bed is fine, as long as you’re not increasing your breathing rate or starting to sweat.

When you can’t sleep…

If you’re lying awake in bed and are starting to get frustrated by being unable to fall asleep, then it’s a good thing to get out of bed again. Do something that’s relaxing to calm your mind before getting back into bed again. Avoid doing things that will actively wake you up, such as playing on your phone or scrolling through social media. If you find that this is becoming a reoccurring issue, then read on…

OK, I’ve done all this, But I STILL CAN’T SLEEP….

When someone has been suffering from insomnia for an extended period of time, they are likely to go into research mode and start to give everything a try—anything to get that good night’s sleep. Chances are, they have read all the above advice before and already have a locked-in day and night routine that aims to optimise their sleep. But they find it’s not enough, and the sleeplessness continues.

When insomnia becomes chronic, treatment becomes much more specific. It is best to contact a trained sleep professional who can assess your condition and recommend appropriate medical treatment. The most clinically proven way to treat chronic insomnia is called Cognitive Behavioural Therapy for Insomnia (CBT-). CBT-I is a medication-free approach to addressing the cause of your insomnia and reverting it to healthy, normal sleep.

At TM Insomnia Treatment, we provide one-on-one CBT-I to patients anywhere in the world via online telehealth appointments. You do not need a referral and can book an appointment without any hassle.