Sleep Hygiene

By Robert Oexman, DC

Sleep hygiene is a term that refers to creating a proper sleeping atmosphere in the bedroom and preparing the body for sleep. Address the following sleep hygiene factors with your patients.

Light
The ambient light in our bedroom, as well as the light we are exposed to prior to sleep, is a strong circadian cue that reduces melatonin. Start limiting the amount of light you are exposed to 30 minutes to one hour prior to bedtime. Do not watch TV or work on a computer. Do not read with a bright light. If you wake up during the night, do not expose yourself to bright light. An eye mask during sleep is an inexpensive treatment for light problems.

Temperature
A reduction in core body temperature is associated with sleep onset. To optimize this occurrence, you should sleep in a cool room (68 to 70 degrees). A warm bath at bedtime increases peripheral blood flow, which decreases core body temperature and will enhance sleep.

Noise
Limit noise from inside or outside your bedroom. Intermittent noise is disrupting, while constant noise from fans or sound machines can improve sleep. If you listen to music to fall asleep, it should be soothing to you, and it should be on a timer to shut off during sleep. If you have a partner who snores, make sure he or she does not have sleep apnea. Earplugs are a good solution for environmental noise. If they are uncomfortable, you can cut them in half.

Alcohol
Although alcohol decreases sleep latency or the time to fall asleep, it is very disruptive to sleep later in the night.

Caffeine
Caffeine should not be consumed six hours prior to bedtime.Some people are more sensitive to the effects and should eliminate caffeine all day.

Exercise
A very effective method of consolidating sleep is exercise. Any exercise that increases core body temperature is good for sleep. A person who is unable to perform at a level that increases core body temperature will still see some increase in sleep quality. This should be done at least four hours prior to bed-time.

Medications
A large number of medications, including painkillers, can disrupt sleep. Pain can disrupt sleep, and poor sleep can increase the sensitivity to pain. You should consider non-pharmacological approaches to pain relief. It has also been shown that patients with pain and sleep problems can reduce the amount of pain they have by improving the quality of their sleep.

Mattresses
If you wake up with low-back pain or shoulder pain, consider getting a new mattress. A recent study completed by Research Triangle International showed that sleep quality changes based on the characteristics of different sleep surfaces. Make sure that the sleep surface is the right one for each person.

Pillow
The height of the pillow needed for proper sleeping depends on the shoulder width of the person, the firmness of the mattress and the sleeping position.

The last step in boosting sleep hygiene is to assure your patients that they can get better. Help them dispel some of their negative thoughts about sleep, as well as the myths that they have heard or created. The future for treating insomnia appears to be heading in the direction of a natural approach. Make sure that you are doing everything you can to help your patients get well by including a discussion about their sleep.

Robert Oexman, DC, is director of the Sleep to Live Institute in Joplin, Mo. He currently oversees the institute’s research studies, particularly the impact of the sleep environment on quality of sleep. Dr. Oexman is also the vice president of strategic development and research for Kingsdown Inc., a North Carolina-based company that manufactures and distributes sleep-related products in domestic and international markets. Dr. Oexman has worked on research projects at major universities across the United States. He also lectures nationally and internationally to physicians, manufacturers, retailers and the general public on the topic of sleep and how the environment affects sleep. Dr. Oexman has taught strategic business development for graduate students at Missouri State University.