If you’re an insomniac, you’ve probably heard of sleep hygiene rules. If you haven’t, be warned: ‘Sleep hygiene’ doesn’t mean keeping your bed sheets clean!
This simple non-medicine solution is really just a set of going-to-bed rules – a common-sense set of both environment and behavioral guidelines which pave the way for good quality sleep. When one has poor sleep hygiene, this alone is likely to lead to insomnia, while keeping good sleep hygiene will help you to overcome it.
Although simple, these sleep rules are tremendously powerful. If you have ever tried anything like this before, you may well be astonished by the speed at which following these guidelines can make a difference.
However, for some people, particularly those with more persistent or chronic insomnia, sleep hygiene may seem to have no beneficial effect. In these cases, following the rules becomes little more an an annoyance. One of the most complaints I hear in my sleep therapy practice is that ‘sleep hygiene doesn’t work on me’.
It may surprise you to hear that, in my experience, sleep hygiene is essential for all. It is just as important for long-term, chronic insomniacs as it is for those with a recent, minor problem, even if it hasn’t worked for you so far. Read on, and I’ll explain why.
So, what are these sleep hygiene rules? The specifics can vary from therapist to therapist, but I recommend the following seven guidelines.
1. Spend a little less time in bed.
A natural early response to a bout of insomnia is either to go to bed early, or to try to ‘catch up’ by lying in bed for as long as possible. This only serves to create a mental association of being in bed with being awake. Also, when you go to bed the night after a long lie-in, you may not be particularly tired, with the result that it takes hours to fall asleep. Spending a little less time in bed (usually cutting down by no more than one house) is one of the most effective treatments for all types of insomnia.
2. No naps.
For all insomniacs, any napping weakens the connection between bed, nighttime and sleep. Even if you are very tired, a nap in the day lessens your chances of sleeping at night.
3. Get out of bed if you can’t sleep and do something else.
This is often a very unpopular rule! But there is a good reason for it – every hour you lie awake in bed weakens the association of bed and sleep, while every hour you lie awake and frustrated reinforces the association of bed with lying awake and being frustrated! By getting up, you start to break that negative association. Unlike some therapists, I don’t recommend getting out of bed after 15 or 20 minutes. If you still feel drowsy, like you might still sleep, than stay in bed. I suggest you get up only if you are becoming stressed, anxious, and tossing and turning.
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4. Get up at the same time every day (even on weekends).
This will seem harsh if the weekends are the only time you currently get any decent sleep, but when you begin to notice the effect this has on your sleeping patterns, it will no longer be a hardship. Lack of routine is the enemy of good sleep. Good sleep loves routine. Keep to yours each and every day and you’ll find good sleep will become a habit.
5. Do nothing in bed except sleep or have sex (this includes no reading or watching TV, at least in the early days).
When you do anything in bed, you are creating an association between your bed and that thing. That means that whenever you do anything in bed other than sleep, you are, in effect, weakening your ‘falling asleep response’. If your bed has become about talking, arguing, reading, eating, TV and everything but sleep, it is hardly surprising that you do not feel ready to drop off when you lie down at night.
6. Stop clockwatching.
Clock-watching creates an unhealthy obsession with time. So don’t look at the clock until morning. We have all had perfectly happy and productive days in the past after only a few hours’ sleep. Obsessing about the number of hours we ought to be sleeping makes the possibility of these carefree days more unlikely.
7. Cut out or reduce coffee, tea and energy drinks.
Without wanting to insult anyone’s intelligence… please do be sensible with caffeine. I am continually surprised to discover that a lot of insomniacs are still drinking far too much caffeine. Remember, it’s not just coffee that can cause a problem. Cola can be extremely stimulating, as can a strong cup of tea. So, if you drink coffee, tea, cola or energy drinks after about 4pm, try cutting them out before you do anything else.
So Why Doesn’t Sleep Hygiene Work For You?
For some people, the above guidelines do not turn out to be effective in improving sleep. If you have a long-term problem, your reaction at this point is probably ‘been there, done that, it doesn’t work‘. Are you becoming fed up with hearing about the importance of sleep hygiene on every website and from every sleep book? Is it becoming tiresome hearing the same old thing?
The following are the four most common complaints I hear from insomniacs about sleep hygiene:
- I find it boring and inconvenient.
- My insomnia is too severe, too chronic or has been going on for too long to be helped by something so basic and simple.
- Much of it seems counter-intuitive.
- I tried it before without success.
In my experience, there are two distinct reasons why sleep hygiene may not have worked for you:
1. You haven’t done it properly.
Have you simply read about sleep hygiene, or have you actually, properly (and I mean properly, not just for a couple of nights) tried it? Have you made it part of your life for a sustained period of time? Or have you read about it, picked out the bits you liked, tried it for a night or two and then rejected it as too basic and simple to help with your particular problem? I say this because most long-term insomniacs have, as some point, tried sleep hygiene rules, but a few sleepless nights here or there often result in their abandoning the whole idea. Be honest: do you believe your insomnia is just too severe to be helped by something so simple?
It may seem boring or counter-intuitive, but there is a reason that all insomnia books contain sleep hygiene – it is because sleep hygiene is essential to recover from insomnia. When it came to curing myself, actually sticking to these guidelines had a huge effect on my sleeping habits, even after 15 years of chronic insomnia. So don’t make things difficult for yourself: follow the sleep hygiene guidelines even if you have tired them before and give yourself a fighting chance to succeed. One thing is certain: you will have a very difficult job overcoming any type of insomnia if your sleep hygiene remains poor.
2. For those with a longer-term or more serious problem, sleep hygiene is only half the story!
It’s easy to presuppose that insomnia is just about what goes on in the bedroom, but long-term insomnia is almost always more of a thoughts-and-beliefs problem than anything else. If you are a chronic insomniac, the essence of your recovery will be in learning to believe that you can sleep. So, for the long-term insomniac, negative beliefs, fears and obsessive thoughts mean that sleep hygiene alone is unlikely to cure insomnia.
Most long-term insomniacs will have tried sleep hygiene before, but without attention to their expectation, attitude, thoughts and beliefs, they will have had little chance of making any real progress. This is why sleep hygiene is often rejected by chronic insomniacs as something else that ‘didn’t work’.
I have come to realize that success in overcoming insomnia lies not just in sleep hygiene, but in changing negative thoughts and beliefs you may have about sleep.
So, when it comes to overcoming insomnia, both sleep hygiene and attention to thoughts are essential. Asking which is more important is like asking which is more important to losing weight, diet or exercise. Of course, the answer is both. You can lose weight by dieting alone, but if you are lying in front of a television 24 hours a day, you will have a tough time making progress. Similarly, you can do a lot of exercise, but if you eat junk food the moment you get out of the gym, progress will be tough. It’s exactly the same with sleep hygiene and positive thinking. If you want to give yourself the best chance of success, do them both.