Sleep Hygiene for Insomnia: The Complete Guide

Sleep hygiene isn’t a new concept, most research papers on it are from decades ago.

And yet most people still have terrible sleep hygiene.

But the fact that you’re here is a great start to improvement.

One study found that simply learning about sleep hygiene resulted in better sleep quality (1).

In this post you’ll learn about the 10 main parts of sleep hygiene, and how to implement them.

By itself, sleep hygiene is just one part of an insomnia solution (2). However, improving your sleep hygiene is a quick win that can get you sleeping better almost immediately.

The Sleep Hygiene Index

For overall sleep quality, most use the Pittsburgh Sleep Quality Index.

For sleep hygiene, most researchers and physicians use the Sleep Hygiene Index (SHI), which consists of 13 questions where you answer from 0 (never) to 4 (always) (3).

The total score is out of 52, where a higher score represents poorer sleep hygiene.

Here are the questions:

1. I take daytime naps lasting two or more hours.
2. I go to bed at different times from day to day.
3. I get out of bed at different times from day to day.
4. I exercise to the point of sweating within 1 h of going to bed.
5. I stay in bed longer than I should two or three times a week.
6. I use alcohol, tobacco, or caffeine within 4 h of going to bed or after going to bed.
7. I do something that may wake me up before bedtime (for example: play video games, use the internet, or clean).
8. I go to bed feeling stressed, angry, upset, or nervous.
9. I use my bed for things other than sleeping or sex (for example: watch television, read, eat, or study).
10. I sleep on an uncomfortable bed (for example: poor mattress or pillow, too much or not enough blankets).
11. I sleep in an uncomfortable bedroom (for example: too bright, too stuffy, too hot, too cold, or too noisy).
12. I do important work before bedtime (for example: pay bills, schedule, or study).
13. I think, plan, or worry when I am in bed.

Not all of these are equally important, and a few likely outdated.

Based on current research (the SHI was made using criteria from 1990), exercising before bed isn’t an issue for most people (4):

Evening exercise was not associated with worse sleep. These findings add to the growing body of evidence that sleep hygiene recommendations should not discourage evening exercise.

Let’s go into each item on the list in more detail. I’ll point out any that might be outdated.

Why Daytime Napping May Be Bad

We’re starting out with one of the more controversial ones.

Some research suggests that napping makes it harder to fall asleep.

However, the reason that some people nap is that it's a side effect of their insomnia.

Which one is the cause, and which one is the effect?

Furthermore, some research doesn’t show a relationship between the two at all (5):

However, a correlation between sleep disturbance and daytime napping has not been consistently observed.

Finally, it also depends on the length of the nap.

A 4 hour nap will almost certainly make it harder to establish a nightly sleep routine, but a short one shouldn’t have much of an effect (6):

Very short naps (under 20 min) have been shown to have no significant effect on sleep

So the takeaway here isn’t that daytime naps are terrible no matter what.

Instead, naps are likely only counterproductive if they are causing you to not be able to get to sleep at night, and consequently not get enough sleep at night.

SummaryDaytime napping when needed is fine, but try to keep it short, and don’t do it if you feel it has an impact on getting to sleep at your ideal time at night.

Why a Consistent Sleep Schedule Is Important

Everyone has a circadian rhythm, an internal clock that governs a host of physiological changes.

Note that not everyone has the exact same timings, which is why some people benefit from going to sleep a bit earlier or later than others. It’s usually not that huge of a difference though (i.e. it’s unlikely you should be going to sleep past midnight).

Whenever this rhythm is disrupted, like from going to sleep late or getting up late, there are consequences (7):

This transient rhythm desynchronization is typically characterized by delayed sleep onset, sleep fragmentation, changes in sleep quality and length, early morning awakening, excessive daytime sleepiness, and fatigue

Sometimes this is out of your control if you have to travel or do shift work.

Otherwise, your sleep schedule is in your control and you should take it seriously.

If you’re trying to reset your sleep schedule, start by going to bed when you’re tired and wake up early so that you don’t just lie in bed when you’re not sleepy. Then slowly push your bed time a bit earlier over time until you find a good sleep duration.

SummaryGo to bed at the same time each night (give or take 30 minutes), and wake up around the same time each day as well.

Why Alcohol, Tobacco, and Caffeine Are Bad to Have Before Bed

In general, drugs (even medication) can have a significant effect on your sleep.

Let’s take a quick look at the most common ones that contribute to insomnia.

Caffeine

Some caffeine is perfectly fine, but too much caffeine can cause insomnia.

Research has shown that 2 or fewer cups per day (about 200 mg of caffeine), consumed early enough in the day, causes no increased risk of insomnia (8):

Individuals who consumed on average >3 cups of coffee had the highest incidence of chronic insomnia.

But it needs time to pass through your system, so consume any caffeine (from coffee, tea, energy drinks) as early in the day as possible. This can be tricky on certain diets like intermittent fasting and can lead to insomnia.

Alcohol

Research shows almost the same thing for alcohol as it does for caffeine (8):

Having 3 or more alcoholic drinks per day resulted in the highest risk of insomnia.

However the timing may be different for you.

Some people find that alcohol makes it harder for them to get to sleep, while others find it makes it easier (in the short term). You’ll have to take that into consideration.

Note that insomnia can persists after quitting drinking for a while.

Tobacco

Multiple studies have found that tobacco use is a significant risk factor for insomnia (9).

Note that even second hand smoke can cause sleep issues (10):

...current smokers and current smokeless tobacco users had twice the odds of insufficient sleep. Second-hand smoke exposure was associated with insufficient rest/sleep among non-smokers.

Unlike alcohol and caffeine, it doesn’t appear that “some” tobacco or smoke is fine. Someone struggling with sleep issues may not be able to fix them until they ditch the tobacco.

Similar to alcohol, quitting smoking can make insomnia worse in the short term before sleep eventually improves.

SummaryOverall, people who limit their intake of caffeine, alcohol, tobacco, and other drugs have fewer sleep issues. Consuming those substances well before sleep is generally best.

Why Stimulating Activities Before Bed Are Bad For Sleep

Sleep relies on your conscious mind shutting down and your body relaxing while your unconscious mind takes over.

If you’re doing things that stimulate your brain or body, it’s going to take longer for those things to happen. And if it takes too long, you can start worrying about getting to sleep, which makes it even harder.

Having your mind and body as relaxed as possible before going to sleep is a huge part of sleep hygiene.

There are 2 common types of these activities to consider.

Screen Based Activities: Television, Phones, Tablets

Most people (myself included) spend a lot of their day looking at screens.

Screens have blue light (light of a particular wavelength) that affects our hormones in a way that keeps us awake. This is good during the day, but explains why blue light at night can cause insomnia. The older you are, the more blue light impairs sleep (11).

And if you’re playing a fast-paced video game before bed, or watching an action movie that stimulates your mind, that makes sleep even harder.

What can you do if you like watching screens before going to sleep?

First of all, don’t watch or play anything too stimulating. A light hearted sitcom? Sure. A horror movie? Not such a good idea.

Additionally, you need a way of filtering out blue light.

For computers, most operating systems have a built-in way of doing this. Windows has Night Light, Mac has Night Shift, or you can use Flux on either.

Phones and TVs are harder (although some TVs have a mode for this).

The best option is to get a pair of blue light glasses. They’re cheap and look just like regular reading glasses, but will filter out blue light.

Research has shown that properly made blue light glasses are effective (12).

Work and Other Stressful Activities

There are some obvious stimulating activities that you should avoid before bed: studying and work (13).

On top of that, many other things cause stress, or make you want to get them over with as soon as possible (which is stimulating). Things like paying bills and cleaning (for some people).

SummaryThe general recommendation from sleep researchers is to stop any stimulating activities like work and video games 90 minutes before going to sleep. This gives your brain and body time to slowly start to shut down.

How Stress Causes Sleep Issues

Stress is one of the biggest risk factors for insomnia.

Research has also shown that a higher tendency to experience anxiety is a strong risk factor for new onset insomnia syndrome (8).

When I used to have sleep issues, it was my main problem. I’d go to bed and then think about:

• The problems in my life
• What I needed to do tomorrow
• What if things didn’t go well
• Endless scenarios of how tomorrow might go

Some planning is okay before bed, like making a todo list or laying out your clothes for tomorrow, but if you find yourself doing while actually in bed, that’s a problem.

There are 2 parts to the solution:

1. Schedule time 90 minutes before you plan to sleep to think about these things. Ideally you can answer them and your mind can relax.
2. In the long term, using cognitive behavioral therapy (CBT) techniques to examine thoughts can help reduce how much these thoughts arise, and how much you “cling” to them and overthink them.

It’s far from an easy problem to solve, but fundamental to good sleep.

Why Beds Should Only Be Used For Sleeping and Sex

This is one piece of advice on sleep hygiene that I’ve read a million times. However, there isn’t a ton of research backing it up.

The common sense explanation is that you want to train your body that once you’re in bed, it’s time to sleep. In a sense, this is a form of state-dependent memory.

However, in some cases (like you live in a small space), you have no choice but to study or watch TV in bed.

SummaryIf you have the living space available, try to only use your bed for sleeping or sex. Your bedroom has one purpose - to sleep in.

Why An Uncomfortable Bedroom Leads to Bad Sleep

If you’re not comfortable in bed, you’re going to be tossing and turning all night.

It’s important to be comfortable not only for getting to sleep, but also for sleep quality. There are 4 main things that you have control over that affect your comfort:

• Temperature
• Light
• Noise
• Bed comfort

Temperature

A comfortable sleeping temperature depends on the individual, plus factors like warmness of blankets and breathability of the mattress.

In general, most people sleep best when it's colder.

However, research has shown that finding the right temperature is one of the most crucial factors in sleeping well. It needs to be not too hot, and also not too cold (14).

The most general recommendation that I’ve come across is to aim for a temperature around 65°F (18.3°C), plus or minus a few degrees Celsius.

I prefer to keep it on the cold side, as it’s easy to grab an extra blanket to warm up.

If you don’t have air conditioning during the summer, a fan blowing directly at you will significantly help.

Light

Even with your eyes closed, you can still tell if the room is bright.

Light exposure affects your circadian rhythm, and sleeping in a light room is a problem (15).

Sleeping with the light on not only causes shallow sleep and frequent arousals but also has a persistent effect on brain oscillations, especially those implicated in sleep depth and stability.

In plain terms, sleeping with lights on wrecks havoc on your sleep quality and duration. It's part of why many people sleep better when it rains.

If some lights must be on, or light shines through from the outside, you have 2 good options:

1. Blackout curtains - Good curtains can block out nearly 100% of incoming light.
2. Sleep facemask - It might feel silly at first, but sleep facemasks are very effective at blocking out light and improving sleep quality. Here’s a high quality one on Amazon.

SummaryBottom line, light in your room will reduce sleep quality, find a way to block it out.

Noise

Just like you can tell if the room is light if your eyes are closed, there’s always a part of your brain monitoring noise in your surroundings.

It’s not surprising that more noise is bad. Research has shown that environmental noise in the hospital is responsible for 17% of patient awakening (16).

A study looked at why noise affects us while we sleep and found (17):

The effect of noise on sleep is associated with physical changes, such as changes in heart rate, blood low volume, breathing and the immune and neurocirculatory systems

In short, noise impacts your sleep quality.

Of course there’s a difference in listening to some relaxing quiet music versus random loud noises, but the ideal environment is still a quiet one.

SummaryIf you live in a noisy environment, use earplugs. You’ll get used to them after a few nights.

Bed Comfort

This shouldn’t need much of an explanation.

If your bed is uncomfortable, you’re going to have a hard time falling asleep, and are likely to wake up more often.

This should inform your choice of bedding. For example, some people get benefits from sleeping on the floor, but others are too uncomfortable from the disadvantages of sleeping on the floor and it makes their sleep worse.

SummaryYou spend about a third of your life in bed. Make sure you have a decent quality mattress and sheets.

Why What You Do After Waking Up Matters

One aspect of sleep hygiene that isn’t on the Sleep Hygiene Index is what you do after you wake up.

But leading experts on sleep often talk about this very thing.

If you get up and get straight to work, thinking about what you need to do, and rushing around, you’re training your mind to be active in the morning. You’re going to be more prone to wake up early and not be able to get back to sleep.

I know, because this was also a problem I suffered from.

If you instead plan your day so that you can slowly wake up over the course of 30 to 60 minutes without thinking about stressful things, your sleep in the morning becomes higher quality with fewer disruptions.

SummarySchedule your wake up time so that you don’t need to rush around and can slowly wake your brain and body up.

What You Should Do Before Sleeping and After Waking Up

When I got serious about my sleep hygiene, I was a bit lost.

I was used to either studying or watching TV up until going to sleep (and then taking hours to fall asleep of course).

Here’s a list of things you can do before going to sleep that shouldn’t be too stimulating if you’re looking to ditch the work and screens:

• Read
• Meditate (meditation for insomnia can help)
• Make a todo list for tomorrow
• Spend time with pets or friends
• Stretch
• Listen to relaxing music
• Journal (write down things you appreciate, which will make you happier (18))
• Set up for tomorrow (e.g. lay out clothes, make lunch)
• Relaxing activities like knitting

If you’re going to watch TV or use a screen, use a blue light filter like we went over earlier, and stick to watching “boring” feel good shows that won’t stimulate your mind.

Summary: Sleep Hygiene Checklist

Now you’re an expert on sleep hygiene!

Remember that you don’t need to be perfect. Any improvement in sleep hygiene will have at least some effect on your sleep quality.

Here’s a summary of the most important aspects of sleep hygiene for preventing insomnia:

• Avoid daytime naps, or keep them short
• Follow a regular sleep schedule (go to bed and wake up around the same times)
• Don’t use tobacco problems
• Limit alcohol and coffee to 2 drinks per day at most
• Avoid screen based activities in the 90 minutes leading up to sleep, or at least use a blue light filter
• Avoid working or studying in the 90 minutes leading up to sleep
• Work on letting go of stressful habits and thoughts (CBT techniques can help)
• Use your bed only for sleeping or sex
• Create a comfortable sleeping environment:
• Sleep at a comfortable temperature (around 65°F or 18.3°C)
• Get blackout curtains or a sleeping mask
• Use ear plugs if you live in a loud environment
• Invest in a high quality mattress and bedding
• Take time to slowly wake up in the morning before getting to work. Avoid rushing around.

There are also other habits that may impact sleep depending on the specific situation. For example, eating before bed can cause insomnia if you eat too close to bedtime or eat too much of certain foods.

References

1. Relationship of Sleep Hygiene Awareness, Sleep Hygiene Practices, and Sleep Quality in University Students
2. Use of sleep hygiene in the treatment of insomnia
3. Assessment of Sleep Hygiene Using the Sleep Hygiene Index
4. Does nighttime exercise really disturb sleep? Results from the 2013 National Sleep Foundation Sleep in America Poll
5. Insomnia and Daytime Napping in Older Adults
6. The Prevalence of Daytime Napping and Its Relationship to Nighttime Sleep
7. Sleep and circadian schedule disorders
8. Risk Factors for Incident Chronic Insomnia: A General Population Prospective Study
9. Prevalence of insomnia symptoms: results from an urban district in Ankara, Turkey
10. The association between active smoking, smokeless tobacco, second-hand smoke exposure and insufficient sleep
11. Sleep Disturbances Are Related to Decreased Transmission of Blue Light to the Retina Caused by Lens Yellowing
12. Amber Lenses to Block Blue Light and Improve Sleep
13. Association between long working hours and sleep problems in white‐collar workers
14. Effects of thermal environment on sleep and circadian rhythm
15. Let there be no light: the effect of bedside light on sleep quality and background electroencephalographic rhythms
16. Abnormal Sleep/Wake Cycles and the Effect of Environmental Noise on Sleep Disruption in the Intensive Care Unit
17. Noise and Health—Sleep Disturbance in Adults
18. Gratitude and Happiness