Inadequate sleep hygiene

Souzana Obretenova MD (

Dr. Obretenova of Washington University School of Medicine has no relevant financial relationships to disclose.

)
Raman Malhotra MD (Dr. Malhotra of Washington University School of Medicine in St. Louis has no relevant financial relationships to disclose.)
Antonio Culebras MD, editor. (

Dr. Culebras of SUNY Upstate Medical University at Syracuse received an honorarium from Jazz Pharmaceuticals for a speaking engagement.

)
Originally released March 5, 2001; last updated March 7, 2019; expires March 7, 2022

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 regarding 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 improve academic performance and productivity or to 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. Electronic device use before or during bedtime, especially in young adults, is becoming more common and has been associated with higher risk of poor sleep. 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

The concept of sleep hygiene has been referenced as far back as 1864 by Italian neurologist Paolo Mantegazza (Gigli and Valente 2013). Inadequate sleep hygiene was formerly recognized as a subtype of chronic insomnia; however, this classification was abandoned in the 2014 revision of the International Classification of Sleep Disorders (ICSD-3) due to the ubiquity of poor sleep practices across various forms of insomnia and other sleep disorders. Inadequate sleep hygiene can be construed as behaviors that result from or are sustained by daily living activities that are inconsistent with the maintenance of good-quality sleep and normal daytime alertness. Patients 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, and illicit substances) 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.

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