Sleep Hygiene

This week, I want to share some information about improving your sleep hygiene. The information provided is grounded in research from the American Academy of Sleep Medicine, National Sleep Foundation, and CBT-I (Cognitive Behavioral Therapy for Insomnia) literature.

Stabilize the Circadian Rhythm (Consistency is Foundational)

The body's internal clock (circadian rhythm) relies on predictability, not just total sleep time.

• Go to bed and wake up at the same time daily, including weekends

• Irregular sleep schedules are linked to longer sleep latency, lower sleep efficiency, and increased depressive symptoms

Most people focus on bedtime, but wake time is the primary anchor. Even if sleep was poor, maintaining a consistent wake time strengthens circadian regulation over time.

Use Light as a Biological Tool

Light is the strongest external cue ("zeitgeber") for circadian alignment.

Morning Light Exposure:

• Aim for 15-30 minutes within 1 hour of waking

• Benefits:

  • Suppresses residual melatonin

  • Advances circadian phase (helps earlier sleep onset)

  • Improves mood and alertness

Evening Light Reduction:

• Dim lights 1-2 hours before bed

• Reduce exposure to screens (phones, tablets, TVs)

It's not just blue light - mental stimulation + emotional activation from content (social media, news, etc.) also delays sleep.

Strengthen the Bed-Sleep Association (Stimulus Control)

Over time, insomnia conditions the brain to associate the bed with wakefulness, frustration, or anxiety.

Guidelines:

• Use the bed only for sleep and sex

• Avoid scrolling, watching TV, working, or problem-solving

If unable to sleep:

• After about 15-20 minutes, get out of bed

• Do a low-stimulation activity (dim the lights, no screens)

• Return to bed only when you are sleepy

This restrains the brain: bed = sleep, not struggle.

Align Bedtime With Sleep Drive

Sleep is governed by circadian rhythm (timing) and homeostatic sleep drive (pressure that builds over the day). Going to bed too early reduces sleep pressure and results in more time awake in bed.

Recommendation: Go to bed only when sleepy (heavy eyelids, nodding), not just tired. Fatigue is not the same as sleepiness.

Understand Substances That Disrupt Sleep

Caffeine

• Blocks adenosine (sleep pressure chemical)

• Half-life is about 5-7 hours (longer in some individuals)

• Avoid caffeine 6-8+ hours before bed

Alcohol

• May reduce sleep onset latency

• Causes fragmented sleep, reduced REM sleep, and early awakenings

Nicotine

• It is a stimulant and therefore increases arousal and sleep disruption

Use Naps Strategically

Naps reduce homeostatic sleep drive.

• Limit to 20-30 minutes

• Avoid after 2 or 3 PM

• If you're struggling with insomnia, it may be recommended to eliminate naps entirely

• If you are living with chronic illness you may benefit from brief, structured naps

Exercise Supports Sleep - With Timing Considerations

Regular Physical Activity

• Improves sleep quality

• Reduces sleep latency

• Increases slow-wave sleep

Timing:

• Ideal: morning or afternoon

• Avoid vigorous exercise within 3-4 hours of bedtime

Optimize the Sleep Environment

The brain sleeps best in an environment that signals safety and low stimulation

• Temperature should be between 60-70 degrees if possible

• Light should be minimal (use blackout curtains, eye masks, etc.)

• Noise should be quiet or consistent (white noise can help)

• Sensory sensitivity, which is common in trauma, autism, and anxiety, may require individualized adjustments (textures, sounds, lighting)

Build a Predictable Wind-Down Routine

The nervous system benefits from gradual downshifting, not abrupt transitions. Using relaxation activities reduces sympathetic activation and increases parasympathetic tone.

• Reading (low stimulation)

• Gentle stretching

• Warm shower or bath

• Relaxation exercises such as progressive muscle relaxation, diaphragmatic breathing, or guided imagery (we can talk about how to use these exercises!)

Address Cognitive Arousal

Racing thoughts are one of the most common barriers to sleep. Below are some CBT-I techniques:

• Scheduled worry time earlier in the evening

• Writing a next-day plan or a to-do list

• Journaling intrusive thoughts

• Cognitive restructuring (challenging catastrophic sleep thoughts)

• Decentering ("I'm having the thought that I won't sleep")

Reduce Performance Anxiety Around Sleep

Trying to force sleep increases arousal.

• Sleep is an automatic process, not effort-driven

• Monitoring sleep ("How many hours will I get?") increases anxiety

• Gently allow wakefulness instead of fighting it

• Rest is still beneficial, even if sleep doesn't come right away.

Consider Eating Patterns

• Avoid heavy meals within 2-3 hours of bedtime

• Light snack may help if hungry (example: carb + protein)

• Large meals late at night can increase reflux and disrupt sleep continuity

Use Temperature and Body Signals

• A warm shower/bath 1-2 hours before bed can improve sleep onset

• Mechanism: post-bath cooling mimics natural circadian drop in body temperature

It is important to communicate with your medical provider if you are struggling with sleep.