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  • Mariam Daneshgar

Sleep Hygiene: The 4 Categories

Sleep Hygiene is one of the terms most synonymous with sleeping difficulties and insomnia, but why is it that so many still can't sleep after following the rules to the T?

If you’ve ever had trouble with your sleep, chances are you’ve come across the term ‘Sleep Hygiene”. If you’ve talked to your friends or your doctor about your insomnia or sleep issues, you may have been given sleep hygiene tips and rules about what you should and should not be doing to fix your sleep. The internet is also full of tips based on sleep hygiene rules (I just typed "sleep hygiene" into google and got 207 million results). So it is safe to say that there is A LOT of information out there on this topic. But there are two issues that I routinely come across:

1) Many are confused around the set of rules. When asked to list what they do as part of their 'sleep hygiene', various 'rules' (some of them very outlandish) are mentioned.

2) They say "I've done everything by the 'rules' but my sleep issues persist. Sadly, most of the time this negative experience leads to the perception that sleep difficulties are not curable and that "there in no hope for me".

Unfortunately the experience of trying what you think (and often told) is the solution and not getting any results can feel defeating. Even though there are tons of information available on this sleep hygiene rules, based on what I have witnessed over the years, there seems to be a lack of knowledge around what they exactly are, when it is the best time to implement them, and what specific issues they are meant for. So I've decided to put together this quick guide on this topic in the hope of filling this information gap.

What is Sleep Hygiene?

The term "sleep hygiene" has been around for over a century and has referred to various groups of behavioural rules, which have evolved and changed shape during this period. However, currently sleep hygiene refers to a set of rules that are commonly used to implement healthy sleeping habits and to produce better sleep quality and quantity. They are generally focused on behaviour, thoughts, and the environment that can have an impact on sleep. Personally, I am not a big fan of the term "hygiene", as it presents a sense of cleanliness (or lack there of) when it comes to sleep. But there seems to be a historical root to it that has been around for decades, so let's go with it.

What Are The Rules?

There are many different sleep hygiene rules and sometime at a glance may seem overwhelming. However, generally they fall under 4 categories, which are explained below and included the general rules associated with them:

1. Sleep Schedule

The rules in this category are related to when you sleep and wake up and aim at keeping consistency in order to not confuse your internal clock (circadian rhythm) and to enhance your sleep ‘hunger’:

​. Wake up at the same time EVERYDAY (even on the weekends) . Avoid all naps during the day (or if you have to, nap briefly early in the day) · Get daylight exposure when you wake up to help set your internal clock

2. Sleep Disrupting Products

There are products that contain stimulating chemicals that impact the ability to sleep. It is generally advised to distance their consumption from the time you are going to sleep in order to allow the chemicals to metabolize. The following is a general guideline:

​. Avoid Coffee 5-6 hours before sleep · Avoid Nicotine 5-6 hours before sleep · Avoid Alcohol 3-4 hours before sleep · Have your large meal at least 2-3 hours before bedtime

3. Mentally and Physically Stimulating Activities Close To Bedtime

Engaging in stimulating activates close to bed can cause your body to produce cortisol, which is a stress hormone meant to keep you alert and awake, therefore suppressing your sleep system. So spacing these activities farther away from your sleep time can help with better sleep.

​. Avoid exercising at least 2-3 hours before bedtime · Stop all mentally stimulating activities about an hour before bedtime, even the fun ones (e.g. planning, work, etc.) · Set about an hour before bedtime as a ‘wind down’ time and engage in calming activities that do not stimulate your mind or body · Create a pre-sleep routine that you find works for you and be consistent with it

4. Sleeping Environment

External factors in your sleeping environment can often have a big impact on how you sleep. If there are things that keep on waking you up or triggering your ‘wake’ system (such as light and noise) then it makes it very difficult for the body and the brain to activate ‘sleep mode’. So attending to many of these factors can help with a calmer and better sleep:

​. Have a comfortable Mattress and Pillow · Keep your room temperature on the cooler side (between 18C to 23C) · Keep room as dark as possible during the night (black out curtains or an eye mask) · Reduce all noise when sleeping (use white noise or wear ear plugs if you can’t control external noise) · Remove electronic devices (e.g. TVs, computers, phones, etc.) · Keep pets out of the room, if they wake you up regularly

Do Sleep Hygiene Rules Work?

The answer to this question depends on what sleep issues you are trying to resolve. The rules can be effective if you are looking to improve general sleep quality and habits. Sleep hygiene can be considered an equivalent to ‘healthy eating habits’. Just like how you want to include a good balance of fruits and vegetables in your regular diet, it is beneficial to follow the sleep hygiene rules regularly for better sleep health. They can also be used if you are having minor or temporary difficulties with your sleep and as preventive measures if implemented at the right time in certain situations, such as short-term or acute insomnia. However, for the rules to work they need to become part of a natural routine and to be followed regularly. This is where it gets tricky: consistency and persistence! In cases where the rules are not applied consistently, the effectiveness of the sleep hygiene can be compromised.

If, on the other hand, you are having more severe issues with your sleep, such as chronic insomnia or circadian rhythm misalignment, sleep hygiene rules alone will not help in effectively resolving your sleep troubles (chances are you probably have already tried all the rules with no luck and found this out for your self). In cases where there is a persistent sleep disorder like chronic insomnia, effective treatments, such as CBT-I, will need to be utilized to address the underlaying maintaining factors and sleep system. The treatment will include components of the sleep hygiene, but it will be more individualized to your specific sleep pattern. It will also go beyond and will address psychological, physiological, and behavioural factors in your sleep disorder. [Read "What Is CBT for Insomnia (CBT-I)]

Knowing how to manage your sleeping difficulties and what the right tools are can be confusing. It can also be challenging to commit through the steps and handle all the unwelcome emotional rollercoasters, as well as the hiccups that life throws your way. If you find yourself in a similar situation reach out for help and don't suffer quietly while keeping awake in the middle of the night.


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