Inadequate sleep hygiene

Raman Malhotra MD (Dr. Malhotra, Co-Director of the SLUCare Sleep Disorders Center at Saint Louis University School of Medicine, has no relevant financial relationships to disclose.)
Antonio Culebras MD, editor. (Dr. Culebras of SUNY Upstate Medical University has no relevant financial relationships to disclose.)
Originally released March 5, 2001; last updated September 20, 2016; expires September 20, 2019

Overview

Inadequate sleep hygiene entails the behaviors, practices, rituals, and habits that result in sleep onset or maintenance difficulties and unrefreshing sleep. It is prevalent across all age groups from young children to the elderly. Consensus statements have been published by the American Academy of Sleep Medicine and Centers for Disease Control in regards to recommended duration of sleep for both the pediatric and adult populations (Consensus Conference Panel et al 2015; Paruthi et al 2016). In our present society, we embrace a culture of taking liberties with our sleep in order to get better grades in school, be more productive, or fulfill social or official obligations. This leads to behaviors and habits that then make it difficult to fall asleep or stay asleep through the night. This can result in chronic sleep complaints, as well as daytime fatigue and sleepiness. In addition, poor sleep hygiene has been shown to worsen other comorbid psychiatric and neurologic disorders. Recognition, counseling, and therapeutic strategies can result in increased sleep quantity, improved sleep quality, and improved daytime functioning. In this article, the authors discuss the presentation, impact, and treatment of inadequate sleep hygiene.

Key points

 

• Staying in bed for longer than 20 minutes or trying to force sleep may increase latency to sleep.

 

• Exposure to light (such as from screens associated with televisions, computers, mobile phones, handheld video games, or tablet devices) prolongs latency to sleep.

 

• Frequent daytime napping or napping late in the evening often results in sleep-onset difficulties.

 

• As the components of sleep hygiene, including bedtime routine, bed time, and wake up times, are individual-specific, it is important to keep in mind that the treatment for inadequate sleep hygiene must also be individually tailored.

Historical note and terminology

Sleep hygiene has been mentioned as far back as 1864 by Italian neurologist, Paolo Mantegazza, in one of his books (Gigli and Valente 2013). In the 2014 revised edition of the International Classification of Sleep Disorders (ICSD-3), inadequate sleep hygiene is classified as a subtype of chronic insomnia (American Academy of Sleep Medicine 2014). The ICSD-3 was designed to establish a set of diagnostic criteria for establishing a clinical diagnosis. Inadequate sleep hygiene, as stated in the ICSD-3, is presumed to result from or be sustained by daily living activities that are inconsistent with the maintenance of good-quality sleep and normal daytime alertness. Patients with this form of insomnia have ongoing sleep/wake difficulties as a function of practices such as daytime napping, maintaining a highly variable sleep/wake schedule, routinely using sleep-disruptive products (caffeine, tobacco, alcohol) too close to bedtime, engaging in mentally or physically activating or emotionally upsetting activities too close to bedtime, routinely using the bed and bedroom for activities other than sleep, or failing to maintain a comfortable environment for sleep. The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), also includes discussion of inadequate sleep hygiene within the insomnia disorders section.

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