Why sleep hygiene is not the cure for insomnia…

Sleep hygiene not the cure for insomnia

With one in four of us suffering with poor sleep the first thing we often do is turn to Google for help. If you’ve ever tried this, or even visited your GP, the first advice you will likely come across is usually centred around something called ‘sleep hygiene’.

Sleep hygiene not the cure for insomniaThese recommendations usually include:

  • Avoid caffeine and alcohol in the evening
  • Don’t go to bed hungry
  • Make sure your room is relaxing
  • Keep your room pitch black
  • Don’t smoke before bed
  • Stick to a set sleep routine

All of the above tips are reasonable and not particularly bad advice. But how helpful are they in actually improving sleep?

Despite how widely distributed this advice is, for poor sleepers there is very little evidence to suggest that sleep hygiene alone will help alleviate insomnia symptoms.

Sleep and the menopause

Did you know that 61% of women struggle with poor sleep during the menopause? This is unsurprising when we consider not only the hormonal changes but also the added mental health challenges that menopause can bring.

While most sleep hygiene tips on their own are pretty sensible, what they can sometimes do is make the sleep problem worse. This is because they encourage an attitude of ‘trying’ to sleep. Imagine this.

You haven’t slept well for a while so you buy a sleep spray, practice mindfulness every night, don’t watch TV before bed, go to bed at exactly the same time each night, get a new mattress and drink no caffeine at all, despite the fact you are exhausted. Yet when you get into bed you are left starting at the ceiling. The more things we do and buy to help us sleep simply creates a hyper-vigilance around sleep. In turn this makes it much harder to actually do.

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The message behind all of these devices, gadgets and products is that there is something we need to ‘do’ in order to sleep well. The more we try to sleep the harder it becomes. Believe it or not, sleep is a natural process and one which our body is designed to do without our input.

In order to fix our sleep, the first thing we need to do is look at why it’s no longer working.

Firstly, something triggers an episode of insomnia. This could be a period of emotional stress, such as losing a loved one, or even a symptom of the menopause, such as hot flushes.

As a result of poor sleep, we then make changes which we feel will combat the effects of sleep loss. For example, going to bed earlier, wearing eye masks, insisting on silence and even stopping socialising in case it stimulates our minds and causes us to stay awake.

In turn, we take on all the sleep hygiene advice to the letter, including giving up caffeine, alcohol and often even TV for fear of blue light. We then start to spend more time in bed in order to get more sleep, but simply end up lying awake staring at the ceiling. This is where the problem really begins.

Not only have we started to associate bed with being awake, leading to further poor sleep, we’ve also given up lots of things we enjoy and taken on lots of things we probably don’t!

If we look at good sleepers, we see that they don’t do any of these things to sleep. They simply go to bed when they are tired and don’t worry too much about a bad night. They certainly don’t know the temperature of their room, or when their last cup of tea was. This demonstrates how focusing on sleep hygiene alone is unlikely to fix the issue.

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In order to understand and combat poor sleep the NHS recommends a programme of treatment called Cognitive Behavioural Therapy for Insomnia. The step-by-step programme helps people to understand how their body has ‘un- learnt’ how to sleep well, and how we can re-set our body clock and reduce sleep-related anxiety to improve sleep.

My top tips

1. Don’t spend too long in bed

Reduce the amount of time you spend in bed by going to bed later and getting up earlier. It sounds counterintuitive, but this will encourage the natural sleep drive of your body to kick in, meaning you will crave more sleep, fall asleep faster and find your quality of sleep improving. Even if menopausal symptoms are waking you up, still go to bed later. This will improve your chances of falling back to sleep quicker after a wakening as your ‘drive’ to sleep will be higher.

2. Set a wake time and stick to it

Regardless of how badly you’ve slept. Getting up early will train your body to associate mornings with being awake. Dozing in bed only results in grogginess and low mood, so get up, have a cuppa and get some fresh air or exercise rather than trying to catch up on lost sleep

3. Stop clock-watching

If you’re waking in the night then it’s very tempting to look at the clock every time, monitoring how little sleep you’re getting. However, this increases pressure to fall back to sleep and therefore makes it less likely. Set your alarm for the morning and then avoid looking at the time again

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4. Don’t lie in bed awake

If you can’t get back to sleep, get out of bed. The longer we lie in bed trying to fall back to sleep, the more frustrated we get, and in turn we begin to relate bed to stress and wakefulness rather than sleep. This can lead to a negative pattern, so leave your bed, do something relaxing like reading a book, and then return to bed once you’re tired.

5. Try not to worry

Easier said than done but worrying about lack of sleep is worse than simply not sleeping well. Not sleeping just makes you tired, and you’ve been tired before, but worrying about sleep makes you stressed, anxious and low. Realise that sleep is not the only thing you can do to feel better and look for other ways to increase energy until your sleep is back on track

6. Follow a course of CBT for insomnia

This will teach you how to re-set your body clock and manage your racing mind so that you sleep more soundly.

So following a strict ‘sleep hygiene’ regime might actually make things worse for you. Sometimes the ways to break through insomnia can be a bit surprising but they really do work.

Kathryn Pinkham

About Kathryn Pinkham

I'm an Insomnia Specialist, using Cognitive Behaviour Therapy for Insomnia to help people identify and change the causes of their sleep problems. I have a Masters Degree in Counseling, and worked as a Psychological Practitioner in the NHS, working with people with mild to moderate mental illnesses. I discovered that I loved working with people with sleep problems and it became my passion! Come and see me for an appointment, or we can chat on the phone or through Skype. You can find out more at The Insomnia Clinic.