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Understanding and Overcoming Chronic Insomnia – Part II

October 17, 2010


This is part two of a four part series on understanding and overcoming chronic insomnia.


1. True or False: Raising body temperature by exercising ½ hour before bedtime can help us fall asleep.

2. True or False: Raising body temperature by taking a warm bath ½ hour before bedtime can help us fall asleep.

Answers and explanations provided at the end of this article.

What is Sleep Hygiene?

Sleep hygiene is the practice of preserving your sleep health.  When working with insomnia patients, I review two general categories of sleep hygiene: bedroom factors and lifestyle factors.

Bedroom Factors

  • Alarm clock
  • Air quality
  • Temperature
  • Noise
  • Light
  • Bed comfort

Lifestyle Factors

  • Caffeine
  • Nicotine
  • Alcohol
  • Diet
  • Exercise
  • Work
  • Travel

After reviewing these factors together, we discuss possible changes to their routines that may improve sleep.  Making these changes often requires sustained effort over time to develop healthy habits.  Try to be consistent and patient.  Remember that improvements in your sleep won’t necessarily occur overnight.  Some sleep hygiene changes take weeks or months to translate into better sleep.

Sleep Hygiene as a Frontline and Long-Term Treatment

Improving sleep hygiene makes sense as a “frontline” approach, or the first approach to try, because of its favorable risk/benefit ratio.  There are very few risks associated with making improvements to your bedroom routine and lifestyle, but the potential benefits in terms of how you sleep, feel, and function can be great.

The most important concept to keep in mind with sleep hygiene is long-term commitment to the changes.  The benefits of sleep hygiene tend to be subtle in the short-term, but more pronounced in the long-term.  In contrast, sedative medications can have a pronounced impact in the short-term, but become less and less effective in the long-term.  Even if you utilize other additional strategies to manage insomnia in the beginning, sleep hygiene will be an important part of the equation for success in the long run.  I urge my patients to not underestimate the importance of sleep hygiene.

Specific Examples of Sleep Hygiene in Practice

Alarm Clock: Bianca used to wake up many times throughout the night and compulsively look at her alarm clock to see what time it was.  When she saw the time on the clock, she would become frustrated, and sometimes stare at the alarm clock for hours.  When it finally went off, she would dread getting out bed, feeling exhausted.  A simple change Bianca was able to make was to turn her clock so she could no longer see the time display from her bed.  When she woke up, she practiced distraction and relaxation strategies instead of looking at her clock.  With practice, she was able to fall back asleep within a few minutes when she woke up.  (Note: Waking up and falling back to sleep a few times per night is considered normal for healthy sleepers.)

TV in Bedroom: When I first began working with Jeff, he had a flat screen TV mounted on his bedroom wall that he watched every night (and sometimes in the mornings and daytimes on the weekends).  Jeff vehemently defended his TV in the bedroom as a necessary tool to help him decompress after a stressful day and fall asleep.  He was unwilling to compromise and make a change in this arena.  After some success with other strategies to improve his sleep, Jeff experimented with not watching TV in his bedroom.  Begrudgingly, he acknowledged that his sleep was more restorative after committing to watching TV only in the living room, and going right into bed when he began to feel sleepy on the couch.  It was still a sacrifice for him because he missed the TV in the bedroom, but his improved energy and mood were worth it to him.  Eventually, he moved his flat screen TV to a place where he could watch it while exercising on his elliptical trainer.

A Healthy Bedtime Routine

The last tidbit of sleep hygiene advice that I will share is from a great book on the topic of sleep hygiene by Michael Breus called Good Night: The Sleep Doctor’s 4-Week Program to Better Sleep and Better Health. One of the strategies described in the book is the 20/20/20 bedtime routine used during the last hour before getting into bed.

  • 20 Minutes: Prepare for tomorrow (lunch, clothes, reminders, etc.)
  • 20 Minutes: Bedtime routine (pajamas, wash face, brush teeth, etc.)
  • 20 Minutes: Relaxation (prayer, meditation, deep breathing, imagery, etc.)

Answers to Quiz

1.  False.  Actively raising your body temperature by exercising raises your core body temperature which may take a few hours to cool down.  An increase in your core body temperature will tend to keep you awake.  Therefore, rigorous exercise before sleep is generally considered poor sleep hygiene.

2. True. Passively raising your body temperature by taking a warm bath usually raises the temperature of your skin tissue, which cools down more quickly.  A slight drop in body temperature can induce sleepiness.  Thus, a warm bath before sleep is considered good sleep hygiene.

I hope the insights I’ve shared thus are helpful for you.  As always, be kind and compassionate with yourself. Managing your sleep health is a life-long process.

Jim Carter, Ph.D.

Clinical Psychologist

Specialty Behavioral Health

San Diego, CA

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