Environment – Light, heat, noise and comfort are all essential elements in our search for sleep. Light excites centers in our brain causing them to secrete chemicals that promote alertness and wakefulness. The use of room darkening shades can help, and placing lights on dimmers to mute out brightness before bed or during middle of the night bathroom trips aids to minimize the rousing effect of bright lights. Temperature also plays a big environmental cue to the body's internal clock, so seek an ambient temperature cooler than that of the rest of the house for better sleep. Odors can provide comfort and relaxation effects, so consider the use of a sachet of lavender or other relaxing fragrances for use inside of pillow cases. Noise that is unfamiliar or unusual stimulates us, as our brain seeks to interpret the sounds, automatically scanning for the unusual or potentially threatening. Consider the use of a fan or other low background noise as a means of masking disruptive sounds. Do advise caution with environmental noises such as those marketed on CD’s for relaxation. Unusual bird sounds or even the trickling of water may provide unwanted distractions from sleep. Keep sleeping areas dark, cool, quiet, and especially comfortable. Few things are more disruptive to sleep hygiene than the automatic shifting of our bodies trying to find the best position in an uncomfortable bed. Benefit may be gained from demonstrations of proper sleep positions, such as laying on the side with a pillow between the knees and another snuggled up to the chest in a supportive hug.
Consistent Wakening Times – To create the mind/body habit that allows recognition of when the time to sleep has arrived, as well as when it should end, it is important to have consistent bed and awakening times, even on your days off. Remember to advise caution however for clients who are carrying a large sleep debt, as attempting consistent waking times may create frustration or resentment due to lingering fatigue. It is important to help clients create realistic schedules, and to be generous when working out times for waking. Your client can always shorten scheduled times set aside for sleep later, after some of their sleep debt is repaid.
Exercise – Exercise and when not to exercise can be a confusing proposition. Regular exercise actually helps everyone to sleep better. However, exercise within the six hours prior to bedtime has an excitatory effect on our metabolism and can disrupt sleep throughout the night. No exercise or very limited activity during the day can also contribute to sleep disruption, so do exercise; however, try to schedule exercise times as consistently as possible, and during daylight hours only.
Manage Stress – When we think of things causing stress, we need to stop it. Stress, worry, and anger are all sleep killers. Dozens of programs are available for stress management, so pick a few to have on hand for clients and get them involved with actively managing their stress. Combat stress with a multi-faceted regimen, so have the client choose two, or at most three stress reduction activities that they feel will work for them and focus on these first. More activities can be added in or switched with others as each person finds the correct balance that fits with their style. Some basic stress reduction activities include encouraging routine times of talking with friends, exercising regularly, playing computer games, learning to meditate, using progressive muscle relaxation, the list is endless, yet it must actually be done in order to show benefits.
Designate Worry Time – One way to fight the stress associated with troubled sleep is to harness it. Stress is actually a good thing, in limited amounts, during short periods of time. It helps us focus better, work harder, problem solve more clearly. Worry is our self-check that we have done everything we reasonably could for a particular event or situation. Set aside a designated time each day to do introspection on your life, events, plans, or expectations. Write down what you are concerned about and especially actions you want to take so you will not forget to do them. Use worry to find areas you can effect, use stress to fix them, and then get on with life. I recommend, and everyone has to figure out what works for them, about 30 minutes of worry time in the afternoon each day. During daylight hours only though, as you want to have stimulating thoughts, events or concerns out of your system as your body readies itself for sleep. As an additional aid to the middle of the night worrier, suggest that they place a writing pad and pencil next to the bed. Should they wake up with a concern, have them jot it down so they will be certain that they will not forget to deal with it, after they awaken.
No Napping – Seems counterintuitive, yes? Seriously though, we are creating lifelong life-style habits by implementing good sleep hygiene. That means we want each individual to avoid teaching their body bad patterns. Unless they are confident that a daily nap regimen will be available throughout the rest of their years, persuade them not to start now. If your client is already a nap-aholic, take the time to discover if this is in fact contributing to a lack of sleep discipline. Naps may be part of the sleep problem, not the solution. Should naps appear to not be contributing to sleep difficulty and therefore a non-issue, or should removing naps be non-negotiable, encourage reasonable limits such as no naps longer than one hour, and never later than 3 p.m. in the afternoon.
Alcohol – Alcohol of any amount is a trap when taken near bedtime. The depressant effects tend to induce a feeling of sleepiness at first, yet will continue to affect the central nervous system throughout the night, disrupting the normal cycle of sleep. A nightcap before bed often results in awakenings, nightmares, and even early morning headaches. Alcoholic beverages should be avoided for at least four to six hours before bedtime. One easy method of remembering is the rule no alcohol after dark.
Stimulants - Coffee, tea, colas, cocoa, chocolate, and nicotine all have stimulation effects that negatively affect internal signals that prepare our bodies for sleep. Encourage developing a habit of avoiding these items for at least the three to four hours prior to bedtime. This allows the winding down process our body undergoes in preparation for sleep to proceed uninterrupted by outside chemical stimulants.
Diet - Consuming a full meal shortly before bedtime can interfere with your ability to fall asleep and stay asleep. A light snack prior to bedtime, however, may actually promote sleep. Good bedtime snacks include milk and other dairy products, turkey and items rich in the amino acid tryptophan. If your client is a midnight snacker, have them develop the habit of preparing a light, ready to eat snack before bed for consumption later in order to minimize the time and trouble associated with that late night voyage to the kitchen.
Establish Signals – Our minds are continually taking in environmental clues, whether we want them to or not. Encourage clients to use this to send preparation for sleep signals to their bodies and minds. Such things as turning down the lights, turning off the TV, turning on soft music, especially something relaxing such as a familiar CD, putting on bed clothes, turning down the sheets, brushing teeth, washing the face, all of these can be used as sensory and action cues to our body that yes, it is now time to sleep. Remember to stress that the key to success with such cues is consistency of use.
Make a No-Clock Zone – Many individuals with troubled sleep become fixated on time issues. Needless to say, the added pressure of watching the seconds drift past only adds stress to the problem. If your client must have a clock such as an alarm clock, in the bedroom, encourage them to turn the face of it away from the bed.
Time Awake in Bed – The longer in bed awake, the harder it is to achieve sleep. Both sleep hygiene and cognitive behavioral therapies focus on the relationship between our mind and body anticipating that when in bed it should sleep, rather than doing awake activities (i.e. reading, eating, watching TV, surfing the net, etc). As a general rule encourage bedroom activities be limited to intimacy, and sleep.
Sleep Only when Tired – Closely connected to the frustration of laying in bed awake and unable to sleep is the importance reminder to purposely avoid awake activities in bed, including laying awake unable to sleep. Encourage your client to work on forming a habit in their mind and body that bed is only for sleep. Suggest that on those occasions when they are unable to get to sleep in a reasonable time, say twenty minutes, or awaken during sleep and find that they are wide awake – they get up out of bed and find something mindless to do until sleepy again, i.e. read a boring book, listen to soft music, but no TV. Television, studies show, has an enchanting ability to captivate the attention, and stimulate thoughts, feelings and emotions. This is no surprise really, considering that advertisers desire you to pay attention to their products.
