Sleep hygiene

Sleep hygiene is a group of "behaviors, environmental conditions, and other sleep-related factors" that used to try to reduce insomnia, improve sleep quality, or reduce hypersomnia (excessive sleeping). Sleep hygiene can be used alone, or to support other treatments, for example sleep medication. Sleep hygiene is commonly used in a variety of chronic illnesses, or in otherwise healthy people with insomnia. Sleep hygiene is a self-help approach, and is unlikely to be adequate as a standalone treatment for severe insomnia or sleep disorders such as sleep apnea.

Strategies for improving sleep
There is no overall consensus about what should be included in sleep hygiene, and there is often some overlap with cognitive behavioral therapy for insomnia. Crawley and Chambers (2005) recommend: Other possible changes include:
 * Make sure you only sleep in your bedroom
 * Have a sleep routine
 * Try not to stimulate yourself just before bed
 * Avoid day/night reversal
 * Do not sleep too much and correct day/night reversal
 * Limit daytime naps
 * including regular exercise (usually not part of sleep hygiene for ME/CFS patients)
 * stress management, e.g. doing relaxing activities just before bedtime
 * noise reduction
 * sleep timing regularity, and avoiding caffeine, nicotine, and alcohol

Theory
Each specific component in sleep hygiene is known to be related to improved sleep, so by grouping many components together, and educating the patient, the expectation is that overall sleep will improve.

Evidence in ME/CFS
Sleep hygiene is recommended by the International Consensus primer for ME and the Canadian Consensus Criteria for ME/CFS. These recommendations are based on the experience of expert clinicians, rather than clinical trials of patients with ME/CFS.

A review by Irish et al. (2015) found significant gaps in the evidence for different sleep hygiene recommendations, with many studies focusing on the effects of different sleep hygiene components on healthy people rather than those with sleep problems, or limited to only small studies or specific age groups. Irish et al. also commented that poor sleep may lead to some of the behaviors that sleep hygiene typically advises against, for example using alcohol to induce sleep, or using caffeine. They comment that changing behaviors that began as a result of sleep problems is unlikely to resolve the sleep problems.

Costs and availability
Sleep hygiene is a free self-help approach and does not require any medical equipment.

Notable studies

 * 2015, The Role of Sleep Hygiene in Promoting Public Health: A Review of Empirical Evidence - (Full text)

Learn more

 * Sleep Hygiene handout - Center for Clinical Interventions, Western Australia