Why Sleep Hygiene Doesn’t Always Work

Better sleep habits often help you get a good night’s rest. But when you have an ongoing sleep disorder like insomnia, treatment involves taking a closer look at the reasons behind your sleepless nights.

What Is Sleep Hygiene?

Sleep hygiene means habits that help you get a good night’s sleep. It includes things like:

• Keeping your room cool, dark, and quiet
• Turning off electronics like cellphones, laptops, and tablets 30-60 minutes before bed
• Getting some sun to balance your body’s internal wake-sleep clock (called circadian rhythm)
• Exercising regularly
• Not smoking
• Cutting down on alcohol and caffeine
• Avoiding heavy meals close to bedtime

Why Sleep Hygiene Doesn’t Always Work for Insomnia

Good sleep hygiene is one of the easiest things you can do for better slumber. But on its own, it’s not likely to help those who live with insomnia. This disorder often causes trouble with falling or staying asleep and poor sleep quality once you do nod off.

Sleep hygiene doesn’t address root causes of insomnia like ongoing pain, depression, or anxiety. “Sleep hygiene gives you a framework to change some habits, but it may not focus on these core things,” says Annie Miller, a behavioral sleep medicine therapist at DC Metro Sleep and Psychotherapy.

Research reveals that sleep is closely tied to mental health. It can be harder to sleep with depression and anxiety, while insomnia can make these mental health problems even worse. Treating one can improve symptoms of the other.

Which Treatments Work for Insomnia?

Cognitive behavioral therapy

Miller and other experts use cognitive behavioral therapy (CBT-I) as a standard treatment for chronic insomnia. CBT-I is a program that includes sleep hygiene and also helps you spot and replace harmful behaviors that get in the way of quality sleep. CBT-I methods include:

• Sleep restriction. Instead of lying in bed tossing and turning, you’ll get out of bed when you can’t drift off. This technique helps break the cycle of staying in bed during a bout of wakefulness, which can lead to even worse sleep. The idea behind it is you’ll become somewhat sleep-deprived and more worn out the next time you go to bed. You’ll also go to bed and wake up at the same time every day and avoid naps.
• Sleep diary. For 1 to 4 weeks, you’ll keep a diary to track your habits in and out of bed, like how much caffeine and alcohol you consume, bedtime routine, naps, and how much sleep you’re getting at night. “I can see how much time they’re spending in bed because that’s what we want to reduce,” Miller says. “We’re trying to set it up for them to be in bed, be asleep, and that’s it.”
• Stimulus control therapy. With insomnia, your brain fights sleep. Stimulus control therapy retrains your mind to think of going to bed as a cue for sleep rather than wakefulness. To do this, you’ll set up and stick to a regular schedule for waking to set your circadian rhythm. You’ll go to bed only when you’re truly sleepy, and if you can’t fall asleep, you’ll get out of bed for a while and only go back when you’re sleepy again. You’ll also avoid taking long naps late in the day so you’re sleepy when it’s time to turn in.
• Relaxation training. Techniques like meditation, imagery, and muscle relaxation help soothe your body and mind.
• Passive wakefulness. You’ll learn to release worry about going to sleep and to stop “trying” to do it, which will help you relax and fall asleep more easily. Experts also call this method paradoxical intention.
• Biofeedback. Biofeedback involves tracking your heart rate, muscle tension, and other functions that impact sleep so that you can learn to control them so that you can relax and sleep. You can do this on your own or with a home biofeedback device.