The document discusses sleep hygiene and provides tips to improve sleep. It recommends adults get 7-8 hours of sleep per night and outlines consequences of insufficient sleep such as impaired mood and concentration. Factors that influence sleep quality are discussed, including age, stress, medications, and medical conditions. Specific sleep hygiene tips are given such as avoiding screens, light, noise and caffeine before bed as well as establishing a relaxing pre-sleep routine. The document stresses establishing good sleep habits and seeking medical advice if poor sleep persists.

1. Sleep Hygiene
Fall 2011

2. Sleep “Hygiene”?
• Sleep hygiene refers to the
habits, environmental factors, and
practices that may influence the
length and quality of one's sleep.
These include bedtime, nighttime
rituals, and disruptions to one's
sleep.

3. How much sleep do I
need?
• A general guideline for adults is 7-
8 hours of sleep a night.
• Older adults need a similar
amount, but the sleep may be
lighter and may include a brief nap
during the day.

4. What happens when I
don’t get enough sleep?
• Impaired mood, memory, and
concentration
• Dampened immune system
• Increased risk of accidents
• Stressed relationships

5. How Much Is Enough?
There are, generally, four categories of sleep behavior:
*Long sleepers vs. Short sleepers: some people need 9 or 10
hours of sleep in order to feel well, while others thrive on just
5 or 6 hrs.
*Rigid sleepers vs. Flexible sleepers: some people wake up at the
same time every morning no matter what time they go to
bed, even if they’ve slept only a few hours. Others can easily
adjust their sleep patterns to accomodate changes in their
normal social or work schedules.
*Larks vs. Owls: No doubt you’ve heard of this category already:
the morning people-those who do their best work at the crack
of dawn- and the night people- those who don’t really come
alive until evening.
*Nappers vs. Non-nappers: some people are able to make up for
lost sleep time by taking a nap, whereas others simply have to
exist through the day until their next normal sleep perion.
Dedictated nappers find that daily nap becomes an essential
part of their sleep/wake pattern, and that they don’t function
as well on days when they miss that afternoon snooze.

6. Aging
• After the age of 40 our sleep patterns change, and we have
many more night-time awakenings than in our younger years.
These awakenings not only directly affect the quality of our
sleep, but they also interact with any other condition that may
cause arousals or awakenings, like the withdrawal syndrome
that occurs after drinking alcohol close to bedtime. The more
awakenings we have at night, the more likely we will awaken
feeling un-refreshed and un-restored.

7. Psychological Stressors
• Psychological stressors like deadlines, exams, marital
conflict, and job crises may prevent us from falling
asleep or wake us from sleep throughout the night. It
takes time to "turn off" all the noise from the day. If
you work right up to the time you turn out the
lights, or are reviewing all the day's events and
planning tomorrow (sound familiar?), you simply
cannot just "flip a switch" and drop off to a blissful
night's sleep.

8. How to deal with stressors
• Develop some kind of pre-sleep ritual to break the connection
between all the stress and bedtime. This is perhaps even
more important for children. These rituals can be as short as
10 minutes or as long as an hour. Some find relief in making a
list of all the stressors of the day, along with a plan to deal
with them, as it serves to end the day.
• Combining this with a period of relaxation, perhaps by
reading something light, meditating, or taking a hot bath can
also help you get better sleep. And don't look at that clock!

9. Social or Recreational Drugs
• The effects of nicotine are similar to those of
caffeine, with a difference being that at low
doses, nicotine tends to act as a sedative, while at
high doses it causes arousals during sleep.
• Alcohol may initially sedate you, making it easier to
fall asleep; however, as it is metabolized and cleared
from your system during sleep, it causes arousals
that can last as long as two to three hours after it has
been eliminated.

10. Sleep Disorders - Facts
• Mood disorders often have sleep disruption as a chief
complaint
• Major depression is characterized by either insomnia or
hypersomnia
• Anxiety disorders often coexist with sleep disorders
– Worry and nervousness lead to sleep disruption
– Primary insomnia occurs in generalized anxiety, panic
disorder & posttraumatic stress disorder
• 50% of elderly experience poor sleep
• 94% of institutionalized are prescribed sedative-hypnotics
• Males: 8 times the risk for obstructive sleep apnea

11. Types of Insomnia
• Type 1) Sleep Onset Insomnia
When you cannot go to sleep, and usually have to lie in bed from 30 minutes to 3-4
hours (or more) before you finally go to sleep, after much anxiety, stress, tossing and
turning. You usually wake up with a massive headache, feeling drowsy, or with your
whole body aching.
• Type 2) Sleep Maintenance Insomnia
You go to sleep normally, but you wake up during the night, once or several times,
and you can't go back to sleep, or it takes a long time for you to go back to sleep.
• Type 3) Sleep Disturbance Insomnia
You go to sleep normally, you sleep for a normal amount of time (7-8 hours for adults,
5-6 hours for the elderly), but you wake up un-rested, with a headache, aching,
feeling drowsy, dizzy, etc.
Most Insomniacs suffer from a combination of type 1 and 2, if you suffer from type 3,
you are most likely suffering from Sleep Apnea, or PLM (period limb movement), or
other underlying sleep disorders. Also, if you are pregnant it is very common to
experience type 3 Insomnia, especially in the last tri of pregnancy.

12. Medical Conditions
& Sleep Disruption
• Fibromyalgia • Arthritis
• Cystic fibrosis • Chronic fatigue
syndrome
• Head injury
• Hyperthyroidism
• Migraine headaches
• Menopause
• Huntington’s chorea • Allergies
• Tourette’s syndrome • AIDS
• Alzheimer’s disease • Pain secondary to a
• Cancer medical condition

13. Substance-Induced Sleep Disorder
• Antidepressants • Cholinergic agents
• Antihypertensives • Cold preparations
• Antihistamines • Alcohol
• Corticosteroids • Caffeine
• Stimulatants • Opioids
• Sedative-hypnotics • Amphetamines

14. Sleep Hygiene Tip
• Don’t go to bed unless you are
sleepy
– If you are not sleepy at
bedtime, then do something else.
Read a book, listen to soft music or
browse through a magazine. Find
something relaxing, but not
stimulating, to take your mind off of
worries about sleep. This will relax
your body and distract your mind.

15. Sleep Hygiene Tip
• If you are not asleep after 20
minutes, then get out of the bed.
– Find something else to do that will
make you feel relaxed. If you can, do
this in another room. Your bedroom
should be where you go to sleep. It is
not a place to go when you are
bored. Once you feel sleepy again, go
back to bed.

16. Sleep Hygiene Tip
• Adequate comfortable
temperature
• Ensure absence of light
• Reduce or eliminate noise
• Remove TV & avoid listening to
radio in bed
• Avoid other activities
• Do not look at the clock when you
wake up at night

17. Sleep Hygiene Tip
• Avoid working in bed & set
reasonable limit for finishing work
prior to bedtime
• Avoid serious discussions or
arguments prior to bedtime
• Avoid working on potentially
upsetting things

18. Sleep Hygiene Tip
• Do not make late night phone calls
• Exercise in the morning or several
hours before bed
• Make bed and bedroom as
comfortable as possible
• Do not turn lights on when getting
up during the night

19. Sleep Hygiene Tip
• Avoid alcohol
• Avoid caffeine
• Avoid OTC medications that cause
sleep problems
• Establish regular pattern prior to
bed (brush teeth, change clothes)
• Avoid naps

20. Sleep Hygiene Tip
• Protect bedtime and sleep from
disruptions
• Minimize effects from bed partner
(snoring, different
bedtime, movement)
• Take hot bath within 2 hrs
• Drink small amount of warm drink
(non- caffeinated)

21. A Word About Television
• Many people fall asleep with the television on in their
room. Watching television before bedtime is often a
bad idea. Television is a very engaging medium that
tends to keep people up. We generally recommend that
the television not be in the bedroom.
• Late night news or prime time shows frequently have
disturbing, violent material. Even non-violent
programming can have commercials which are jarring
and louder than the actual program.
• Light and noise. The continuous flickering light coming
from the TV (or a computer screen) can interfere with
the body’s clock, which is sensitive to any light.

22. If These Hygiene Tips Don’t Work
• Several physical factors are known to upset sleep. These
include arthritis, acid reflux with
heartburn, menstruation, headaches and hot flashes.
• Psychological and mental health problems like
depression, anxiety and stress are often associated with
sleeping difficulty.
• Many medications can cause sleeplessness as a side effect.
• To help overall improvement in sleep patterns, your doctor
may prescribe sleep medications for short-term relief of a
sleep problem.
• Always follow the advice of your physician and other
healthcare professionals.
• The goal is to rediscover how to sleep naturally.

23. Good night 