• Dr. Pennington, NP

Sleep Hygiene: Worth The Hype?

Good intentions from the most well-meaning providers would leave you to believe that good sleep hygiene is the ONLY piece to the "sleeping well puzzle."




We couldn't have said it better than Diana C. Dolan, Ph.D., CBSM " Here’s the unfortunate truth: sleep hygiene does not work for chronic insomnia, or difficulties sleeping lasting three months or more.  Yes, it can be helpful to improve sleep further in mostly normal sleepers.  Yes, it can be helpful for those who would otherwise be able to sleep but have a poor sleep environment.  Yes, it can be helpful for those experiencing a few bad nights, such as adjusting to stress and changes like a return from deployment or move.  In some cases, implementing sleep hygiene early on can prevent long-term sleep difficulties.  It just doesn’t work once chronic sleep difficulties set in."


The American Academy of Sleep Medicine (AASM) says in their Clinical Practice Guideline for Chronic Insomnia that “Although all patients with chronic insomnia should adhere to rules of good sleep hygiene, there is insufficient evidence to indicate that sleep hygiene alone is effective in the treatment of chronic insomnia. It should be used in combination with other therapies” (Schutte-Rodin et al, 2008).


Dr. Dolan goes on to say " So, what’s the problem with sleep hygiene?  Well, here are my thoughts:

  • Given time pressures in busy medical and mental health clinics, often the only attention paid to sleep problems is to hand over a sleep hygiene pamphlet or perhaps have a brief discussion.  One provider I spoke with said “But it’s so much easier to give patients a handout [than provide CBTI].”  Sleep hygiene displaces interventions that are known to be effective

  • A worse cost may come when patients actually try these recommendations and inevitably fail.  We may know because of the above research that of course these recommendations are unlikely to be successful, but the patient made a good faith effort and may now give up or even develop a sense of hopelessness about sleep.  Sleep hygiene may prevent these patients from seeking further behavioral treatment or following up on a referral to a behavioral sleep medicine provider. 

  • If patients do present for behavioral treatment such as CBTI, hopelessness from sleep hygiene efforts may hinder adherence.  If this happens, low adherence can translate into poor CBTI outcomes thus resulting in a self-fulfilling prophecy."

Cognitive Behavioral Therapy for Insomnia (CBT-I).  CBTI is recommended as the first line treatment for chronic insomnia not only by the American Association of Sleep Medicine but also by the American College of Physicians (Qaseem et al, 2016).  Some CBTI protocols do not even bother to include sleep hygiene at all.  So it makes sense to bypass sleep hygiene altogether and go straight to CBTI for those with true chronic insomnia.





WHWellness Minute:

Sleep hygiene is not all it's hyped to be and believing it is the stand alone key to quality sleep can leave patients feeling hopeless and frustrated. There is nothing wrong with sleep hygiene practices. If they work for you, that is great, but if you're trying all the "recommended sleep hygiene" techniques and still not getting restful and restorative sleep it is time to see a sleep health professional. It's time to get professionally assessed for an underlying sleep disorder like Chronic Insomnia and to rule out medical illnesses like Obstructive Sleep Apena or Restless Leg Syndrome, or Periodic Limb Movement Disorder .





References:

Qaseem, A., Kansagara, D., Forciea, M.A., Cooke, M., & Denberg, T.D. (2016).  Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians.  Annals of Internal Medicine 165(2): 125-133.


Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C. & Sateia, M.  (2008).  Clinical guideline for the evaluation and management of chronic insomnia in adults.  Journal of Clinical Sleep Medicine 4(5): 487-504.







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