Why Sleep Hygiene Doesn’t Work For Insomnia

Introduction

When you bring your sleep problems to friends, family members, and even doctors, the most common answer is usually sleep hygiene. For many people (especially those who don’t struggle with sleep), sleep hygiene is seen as the ultimate panacea for sleep difficulties. In fact, one study found that sleep hygiene was among the top three practices that health providers prescribe to treat chronic insomnia (Moss et al., 2013). I’m sure many people with insomnia have heard something along the likes of: “Oh, you’re having problems falling asleep? You should try good sleep hygiene and buy some more comfy pillows and keep your room quiet and dark. That’ll solve all your sleep problems!”. Let me take a shot in the dark here…it didn’t.

I’d probably be right too since the most upvoted post on r/insomnia on Reddit over the past 12 months is about how sleep hygiene is complete bull.

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What is sleep hygiene and what does the research say?

For the uninitiated, sleep hygiene refers to lifestyle (e.g., no caffeine or alcohol in the evening; regular exercise; balanced diet) and environmental factors (e.g., temperature, light, noise) that are considered optimal for sleep. There is an assumption that people who have insomnia simply need better sleep hygiene. The data seems to suggest otherwise.

One compelling study conducted by Harvey (2000) looked at sleep hygiene practices between people with insomnia and good sleepers. Perhaps unsurprisingly, the researcher found that there were no differences in sleep hygiene between the groups. The general consensus in behavioural sleep medicine is that sleep hygiene is no better than placebos in treating insomnia. In fact, sleep hygiene is sometimes even used as a control group to look at evidence-based interventions for insomnia, such as cognitive-behavioural therapy! Besides the fact that the evidence suggests that sleep hygiene is ineffective, my guess is that people with insomnia who recommended sleep hygiene may actually feel invalidated by such advice. As if someone struggling with years of sleep difficulties would not have thought to close their lights and keep a quiet room when they are about to sleep!

How do we beat insomnia then if not sleep hygiene?

But sleep hygiene kinda makes theoretical sense in terms of falling and staying asleep…why doesn’t sleep hygiene work? The reason is pretty simple. It’s because sleep hygiene doesn’t target the causes of insomnia. People with insomnia are often excessive worried about their sleep and the consequences of not getting enough sleep. Because of this, they begin to engage in behaviours that actually counterproductively impede their ability to produce the deep, restorative sleep they want. Unfortunately, good sleep hygiene is not enough to break out of this vicious cycle. If you’re interested in what these factors that maintain insomnia, check this article out on the three causes of insomnia. Cognitive behavioural therapy for insomnia (CBT-I) is a type of therapy that works by effectively targeting these maintaining factors of insomnia. Components of CBT-I, such as sleep restriction therapy and stimulus control, increase drive to sleep and break the association between the bed and wakefulness. That’s the reason why it is the front-line recommended treatment for insomnia and is one of the treatments that have received the most evidence in support of its efficacy. Medication can also be an effective treatment of insomnia symptoms for some people. Take a visit to this article for some information on deciding between medication vs CBT for insomnia.

Does sleep hygiene not matter then?

I think of sleep hygiene as necessary, but not sufficient. For people who are interested in optimizing their sleep environment, I think sleep hygiene definitely still has a place. It may not be the solution to insomnia, but a comfortable bedroom environment and limiting caffeine and substances in the evening are great ways to support sleep health. Moreover, if a specific strategy or solution is working for you (and it’s adding to your sleep life, rather than something you completely rely on), then I encourage you to keep going! As always, do what works for you. As I love to say to my patients – I am not the sleep police!

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Best wishes,

P

-Featured Photo by Diana Polekhina on Unsplash