Sleep hygiene: what works and what does not

When someone tells us they cannot sleep, the first question is not “how many hours do you sleep” but “what happens in the thirty minutes before bed”. The answer usually explains half the problem.

What works, with solid evidence

A fixed wake-up time, not bedtime

Counter-intuitively, it is the wake-up time that regulates the rhythm. Get up at the same time even at the weekend, even if you slept badly. Sleep will settle by itself within a few days.

The bed only for sleep

If you work, eat and watch series in bed, the brain learns that bed is a place for being awake. If you do not fall asleep within twenty minutes, get up and do something else in another room, in dim light. Come back when you are sleepy.

Morning light

Fifteen minutes of natural light in the first hour after waking does more for evening sleep than any bedtime ritual. It is the most powerful regulator of the circadian rhythm.

Caffeine, eight hours before

Coffee has a half-life of about five to six hours. A coffee at 4 pm means half the caffeine is still active at 10 pm.

What does not work

• Going to bed earlier to “catch up”. You spend more time awake in bed, and that strengthens the bed–insomnia association.
• Alcohol as a sleeping pill. You fall asleep faster, but it fragments the second half of the night and suppresses REM sleep.
• Long afternoon naps. Over thirty minutes, or after 3 pm, they steal from the evening’s sleep pressure.
• Checking the clock at night. Every check adds an anxious calculation about how much sleep you have left.

When sleep hygiene is not enough

The rules above solve mild, recent insomnia. They are not sufficient when:

• The insomnia has lasted more than three months
• You wake at 3 or 4 in the morning and cannot get back to sleep, which can indicate depression
• Your partner notices that you snore loudly or have pauses in your breathing
• You are sleepy during the day even though you apparently sleep enough

Chronic insomnia has its own treatment: cognitive behavioural therapy for insomnia has better long-term results than sleeping pills.

If you recognise yourself in the list above, a consultation quickly clarifies whether it is primary insomnia or a symptom of another condition.