Sleep hygiene is the set of habits around caffeine, alcohol, light, napping, exercise and timing that almost everybody is told to fix first. It helps, and reviewers of the evidence have concluded it is not adequate on its own once insomnia is clinically significant.
Knowing that in advance is worth a great deal, because the alternative is following a checklist for months and concluding that you are the problem.
What the evidence actually says
Sleep hygiene is not recommended as a single-component treatment for insomnia. A review of the empirical evidence behind the individual recommendations, covering exercise, stress management, noise, sleep timing, caffeine, nicotine, alcohol and napping, found it inadequate as a sole therapy where insomnia is clinically significant. [irish-2015-sleep-hygiene]
Two things follow, and people usually take only the first.
It is still worth doing. It remains part of the treatment that works, and for ordinary short-term poor sleep after a stressful fortnight it may be entirely sufficient.
It is not the treatment. If you have insomnia rather than a bad week, the checklist is the opening move rather than the answer, and it was never designed to carry the whole job.
A schematic of the relationship described in this article and in the review cited. Not measured data.
The three lower bars are the components of cognitive behavioural therapy for insomnia that sleep hygiene does not contain. That is the whole reason the checklist stops working.
The part almost nobody is told
The first-line treatment for long-term insomnia is cognitive behavioural therapy for insomnia, and it contains sleep hygiene as one component among several. The others are where most of the effect comes from:
- Sleep restriction. Deliberately shortening time in bed to rebuild the pressure to sleep, then extending it again. It is uncomfortable for a week or two and it is the single most powerful element.
- Stimulus control. Getting out of bed when you are awake, so the bed stops being the place where you lie there failing to sleep.
- Cognitive work. Addressing the thoughts about being awake, which is what turns one bad night into a pattern.
Those are the parts that are missing when somebody hands you a list about caffeine and blue light. Our guide to relaxation techniques for sleep covers what genuinely helps at the point of lying awake, and why you cannot sleep covers the causes worth ruling out first.
Has the checklist run out?
Tick anything true. This is a reflection prompt rather than a test, and it produces no diagnosis.
0 of 8 ticked
The sixth and seventh items are the most useful ones here. Lying in bed awake is the specific habit stimulus control exists to break, and a sleep routine that has become another performance to get right is doing the opposite of what it was meant to. Three months or more is the usual threshold for treating this as long-term insomnia rather than a bad patch.
Poor sleep during a demanding period is ordinary and usually settles once the period does. Keep going with the basics, and treat the one-month mark as the point to escalate rather than an invitation to try harder.
Nothing here matched. If waking in the small hours specifically is the pattern, our guide to waking at 3am covers what is behind it.
The free insomnia screener uses the ISI, seven questions on how severe and disruptive the problem has been over the past fortnight. Two minutes, nothing sent anywhere, and the score is a useful thing to take to a doctor.
Why it sometimes makes sleep worse
Because it can turn sleeping into something you are trying to do well. Sleep is not responsive to effort, and a routine followed precisely, with the room temperature checked and the phone banished and the lights dimmed on schedule, adds effort to the one activity that requires its absence.
The tell is a specific feeling: getting into bed and noticing that you are now waiting to see whether it worked. At that point the checklist has become part of the problem, and the useful move is to loosen it rather than tighten it.
Our guide to why you wake up at 3am covers the middle-of-the-night version of the same loop, and revenge bedtime procrastination covers the case where the difficulty is going to bed rather than sleeping once there.
What to do
Do the basics, once, and then stop optimising. Consistent wake time, caffeine before early afternoon, alcohol understood as something that fragments sleep rather than aids it, daylight in the morning.
Fix the wake time before the bedtime. It anchors everything else and is the only one you can actually control.
Get out of bed when you are awake. Twenty minutes is the usual guide. This feels wrong and it is the component with the best evidence behind it.
Ask for CBT-I by name. Digital versions exist and are offered in many areas, so this is a realistic request rather than a long wait everywhere.
Stop grading your nights. Sleep trackers make this considerably worse for people who are already anxious about sleeping.
When to seek help
See a doctor if difficulty sleeping has lasted three months or more, if it is affecting your mood, work or driving, or if you have followed sleep advice consistently and it has not shifted.
Ask specifically about cognitive behavioural therapy for insomnia. It is the recommended first-line treatment for long-term insomnia, and sleeping tablets are intended for short-term use rather than as the answer to a chronic problem.
Mention it too if you snore heavily, stop breathing in the night, or feel unrefreshed despite long nights, since that points at a different problem requiring a different assessment.
Go urgently if you have thoughts of harming yourself.
How MyFreud can help
The link between a bad fortnight of sleep and everything else is easy to assert and hard to see without a record. MyFreud gives you daily mood tracking that takes seconds, so what you bring to a doctor is a pattern across weeks rather than a memory of last night.
Download MyFreud and start today: App Store or Google Play.