1. Sleep Hygiene Presented by Andrew Stochel, Ph.D. Marquette University Counseling Center

2. Sleep Hygiene: What It Is and Is Not Sleep Hygiene is: ● A series of strategies used to regulate behaviors and environmental factors that affect and/or interfere with sleep. – Focused on lifestyle and habits ● Helps to alleviate some of the difficulties that contribute to insomnia and other sleep disorders – a way to find relief from acute (short-term) insomnia. ● Can be preventative. – may make it easier to fall asleep and stay asleep.

3. Sleep Hygiene: What It Is and Is Not Sleep Hygiene is not: ● a form of treatment for insomnia. ● a replacement for treatment for chronics sleep disorders – Poor sleep hygiene worsen mild insomnia, but improving sleep hygiene alone is unlikely to impact severe insomnia.

4. Basic Facts about Sleep: ● People spend approximately 1/3 of their life asleep. ● Sleep is an active, organized process. ● Affected by both factors that we can control (i.e. behaviors, substances, and environment) and those we cannot control (i.e. neurotransmitters, medical conditions).

5. Basic Facts about Sleep: Sleep occurs in 2 stages: REM and Non-REM ● REM ● 20% of sleep ● Occurs in segments instead of one large block. Cycles of 90 minutes. ● Memories and thoughts from the day are processed. Dreams. – lose use of our limbs – helps prevent acting out of dreams. ● Non-REM ● 80% of sleep ● 4 different stages ● Restorative function, helps body heal.

6. Sleep Disorders: ● 6 out of every 10 adults have sleep problems a few night a week or more. ● Some 40 million Americans suffer chronic disorders of sleep and wakefulness. ● Often remain unidentified and undiagnosed. ● More than 80 different sleep-related disorders. Examples include: Insomnia, Sleep Apnea, Narcolepsy, Restless Leg Syndrome/Periodic Limb Movement Disorder, Sleepwalking/Somnambulism, and Medical and Mental Condition-Related Disorders. – Poor sleep habits can contribute to and exacerbate many of these difficulties

7. Insomnia: ● Inability to achieve sleep or to sleep well at night. ● A very common problem: 9-12 % of American population report chronic insomnia. ● Has many causes including medical, mental, and situationally-related sources. ● Lasting a few days to weeks and months.

8. Sleep Needed: ● A “normal” amount of sleep varies. ● Average amount is 7.5 ● Some do fine with 5 hrs, other do fine with 9 hrs. ● Need to find the amount that is right for you and make adjustments to make sure you get it. ● Use your daily functioning as a guide: feeling rest and awake during the day. ● If you are getting what you consider to be an adequate amount of sleep and are still un-refreshed and sleepy, then you might have a sleep disorder and should consider consulting with a healthcare professional.

9. Just Like Brushing Your Teeth: Sleep Hygiene is like Dental Hygiene! ● Need to do upkeep and maintain routines. ● These are things that you do every night just before going to bed. ● Requires to keep your mind and body healthy, rested, and strong. ● Dental hygiene can even be a part of your sleep hygiene.

10. Sleep Hygiene Strategies:

11. Personal Habits: ● Wake up and go to bed at the same time every day. Do not allow your bedtime and awakening time to drift. The body "gets used" to falling asleep at a certain time, but only if this is relatively fixed. ● Avoid napping during the day. Napping is not a bad thing to do, provided you limit the nap to 30-45 minutes and can sleep well at night. Try to take naps earlier in the day if possible. ● Avoid the following items 4 to 6 before going to bed: Alcohol Caffeine Nicotine Heavy, Spicy, or Sugary foods ● Exercise regularly, but not right before bed. Regular exercise, particularly in the afternoon, can help deepen sleep. Strenuous exercise within the 2 hours before bedtime, however, can decrease your ability to fall asleep ● Get regular exposure to outdoor sunlight during the day. Your circadian rhythms respond to daylight.

12. Sleeping Environment: ● Use comfortable bedding. Uncomfortable bedding can sometimes prevent good sleep. ● Find a comfortable temperature setting for sleeping and keep the room well ventilated. If your bedroom is too cold or too hot, it can keep you awake. A cool (not cold) bedroom is often the most conducive to sleep. ● Block out all distractions, such as noise and light. ● Reserve the bed for sleep and sex. Don't use the bed as an office, workroom or recreation room. Let your body "know" that the bed is associated with sleeping.

13. Getting Ready For Bed: ● Try a light snack before bed. Warm milk and foods high in the amino acid tryptophan, such as bananas, may help you to sleep. ● Don’t panic if you cannot fall asleep or stay asleep. Worrying about losing sleep will only keep you awake. Remember that for a short while, the loss of sleep is not dangerous. ● Don't take your worries to bed. Leave your worries about job, school, daily life, etc., behind when you go to bed. Some people find it useful to assign a "worry period" during the evening or late afternoon to deal with these issues.

14. Getting Ready For Bed: ● Establish a pre-sleep ritual. Pre-sleep rituals, such as a warm bath or a few minutes of reading, can help you sleep. ● Practice relaxation techniques before bed. Relaxation techniques such as yoga, deep breathing and others may help relieve anxiety and reduce muscle tension. ● Get into your favorite sleeping position. If you don't fall asleep within 15-30 minutes, get up, go into another room, and read until sleepy.

15. Getting Up in the Middle of the Night ● Most people wake up one or two times a night for various reasons. ● You will generally find that you can get back to sleep 20 minutes or so later. ● If you find that you get up in the middle of night and cannot get back to sleep within 15-20 minutes, do not remain in the bed "trying hard" to sleep.

16. A Word about Television: ● Watching television before bedtime is often a bad idea. ● It is a very engaging medium that tends to keep people up. ● Turn off the Tube: It is generally recommended that the television not be in the bedroom. ● Consider radio before bedtime since it is a less engaging medium.

17. Relaxation Techniques: ● Deep Breathing ● Progressive Relaxation ● Guided Imagery ● Thought Stopping (See Handout)

18. Professional Help and Treatment: Over-the-Counter (OTC) Products: ● Some over-the-counter (OTC) products (i.e. melatonin, L-tryptophan supplements, and valerian teas or extracts) are not regulated by the Food and Drug Administration. Therefore, their effects and proper dosages are not well understood. ● Antihistamines may make people feel sleepy, but they may pose risks to some people. ● Consider talking to your doctor before taking OTC products. Therapy: ● Cognitive Behavioral Therapy has been shown to be effective in treating insomnia. ● It addresses dysfunctional beliefs and attitudes about sleep that lead to emotional distress and further sleep problems.

19. Professional Help and Treatment: Medications: ● Many prescription medicines are used to treat insomnia. Some are meant for short-term use, while others are meant for longer use. ● Be aware that while short-lasting insomnia periods are well treated with medication, chronic or long-lasting insomnia may not respond well to medications. ● Talk to your doctor about the benefits and side effects of insomnia medicines. ● May help you fall asleep, but may also feel groggy in the morning. ● Some insomnia medicines may be habit forming – Talk to your doctor about the benefits and risks of insomnia medicines. ● It is best to consult with a physician or sleep specialist when sleep difficulties begin occurring routinely and/or when symptoms affect your ability to function.

20. Services at MU: Counseling Center 204 Holthusen Hall (414) 288-7172 Individual Counseling Group Counseling Psychiatry/Medication Student Heath Services Schroeder Complex, lower level (414) 288-7184 Medical Services

21. References: American Academy of Sleep Medicine (2009). Sleep Hygiene - The Healthy Habits of Good Sleep. Retrieved on February 7, 2010 from the American Academy of Sleep Medicine website: http://www.sleepeducation.com/Hygiene.aspx The American Academy of Sleep Medicine (2008). Insomnia [Portable Document File]. Retrieved from The American Academy of Sleep Medicine website: http://www.aasmnet.org/Resources/FactSheets/Insomnia.pdf Disorders Center: The University of Maryland Sleep Disorders Center. (2009, January 20). Retrieved on February 7, 2010 from The University of Maryland Sleep Disorders Center website: http://www.umm.edu/sleep/index.htm

22. References: Facts Sheets. (2008). Retrieved on February 7, 2010 from The American Academy of Sleep Medicine’s Fact Sheet website: http://www.aasmnet.org/FactSheets.aspx National Heart Lung and Blood Institute (2009). Insomnia: How Is Insomnia Treated? Retrieved on February 7, 2010 from the National Heart Lung and Blood Institute website: http://www.nhlbi.nih.gov/health/dci/Diseases/inso/inso_treatments.html National Sleep Foundation (2009). Healthy Sleep Tips. Retrieved on February 7, 2010 from the National Sleep Foundation website: http://www.sleepfoundation.org/article/sleep-topics/healthy-sleep-tips