Does Sleep Hygiene Cure Insomnia? The Truth About Sleep Hygiene As An Insomnia Treatment
Sleep hygiene advice is everywhere on the net, too bad it doesn’t help as an insomnia treatment
Insomnia sucks. And when a health problem strikes, if you’re anything like me, it’ll make perfect sense for you to find some information by turning to the world’s most reliable source of conspiracy theories, misinformation and Nigerian princes wanting to send you money: The Interweb.
For sleep problems and insomnia treatment, Dr. Google’s most popular advice is undeniably “sleep hygiene”. Sleep hygiene is a set of instructions on “do’s” and “don’ts” to get a better night’s sleep.
Sleep hygiene advice ranges from cutting back on caffeine (sensible), to sleeping in a Carbonite fridge and hoping you don’t wake up in Jabba The Hutt’s palace (somewhat silly).
(Okay, I admit, sleeping in a Carbonite fridge isn’t actually a sleep hygiene recommendation and it’s scientific status as an insomnia treatment is…..hmmm).
But like everything on the web, if sleep hygiene is so popular it must be an effective insomnia treatment right? Hmmm..... again.
Well, let's just say the science is “eye opening”.
Is Sleep Hygiene An Insomnia Treatment?
Most sleep scientists will tell you, it’s standard knowledge in sleep science circles that there’s very little, to no evidence that sleep hygiene is effective as an insomnia treatment.
In fact, sleep hygiene is not recommended as an insomnia treatment by the American Academy of Sleep Medicine.
“a Practice Parameter paper from the Standards of Practice Committee of the American Academy of Sleep Medicine concluded that there is ``insufficient evidence'' to recommend sleep hygiene as a single therapy, and further, that there is not enough data to evaluate if sleep hygiene is effective in combination with other treatments.”
In fact, it’s so well known that sleep hygiene is ineffective that sleep scientists often use sleep hygiene as the control condition in sleep studies looking at insomnia cures and treatments (think: sham insomnia treatment):
Via Use Of Sleep Hygiene In The Treatment Of Insomnia
“in some cases, investigators have elected to use a ``sleep hygiene alone'' treatment condition as a control condition to compare with those treatments they believe to be robust…..Sleep hygiene is often used as an ``active placebo'' in these studies. “
That’s kinda surprising. After all, sleep hygiene advice, like cutting back on caffeine and alcohol, seem sensible.
So why is there no scientific backing for sleep hygiene when it comes to sleep problems like insomnia?
Why Sleep Hygiene Doesn’t Cure Insomnia
Well, it seems the main reason why sleep hygiene recommendations don’t have scientific backing is that there isn’t any single standard set of sleep hygiene instructions.
Via The Role of Sleep Hygiene in Promoting Public Health: A Review of Empirical Evidence
“Inconsistent and uncompelling findings may be due, in large part, to the lack of a standardized approach in the application of sleep hygiene principles to clinical practice and research.”
And while many individual sleep hygiene instructions have some scientific backing that they improve sleep, the research hasn’t always come from real world sleep situations:
Via The Role of Sleep Hygiene in Promoting Public Health: A Review of Empirical Evidence
“Most sleep hygiene recommendations draw upon research that was not intended to test the validity of behavioral recommendations to improve sleep. Thus, much of the empirical foundation for sleep hygiene recommendations in the general population has tested artificial, and often extreme, behaviors in laboratory settings.”
Okay, I hear you asking: If sleep hygiene isn’t effective as a treatment for insomnia, why is it still such a wildly popular prescription for improving sleep on the internet (and everywhere else, including from most psychologists)?
Well, it’s probably because sleep hygiene advice generally makes intuitive sense.
And sleep hygiene has some limited backing for people with minor, non-clinical levels of sleep problems (even if the evidence is inconsistent).
Via The Role of Sleep Hygiene in Promoting Public Health: A Review of Empirical Evidence
“Relatively few studies have investigated the efficacy of sleep hygiene interventions in nonclinical samples…. Overall, this work has provided some preliminary support for the use of sleep hygiene education in nonclinical populations, but the findings are inconsistent.”
Okay. So what conclusions can we draw from this muddle?
Well, in my clinical experience, if you are a good sleeper and want a better night’s sleep, going over sleep hygiene instructions could help.
And if you’re a poor sleeper and have poor sleep hygiene, you’d probably benefit from “un-pooring” your sleep hygiene.
After all, if you’re knocking back a litre of coffee, smoking a pack of ciggies, then lying down on a sunbed for the night in the middle of a rave, some basic sleep hygiene could improve your sleep.
But if your sleep hygiene is already as hygienic as a hazmat suit after a chemical washdown, sad to say the internet’s most popular sleep advice isn’t going to help your sleep problem. It’ll just be frustrating.
You’ll need something more specific to your problems.
Think about it. Sleep hygiene instructions are the equivalent of having trouble with your car and your mechanic saying “oh here’s my standard instructions for fixing your car…..make sure you’re using the right key for your ignition, don’t put diesel in a petrol engine, make sure your tyres aren’t flat, replace your battery…”
If you’re lucky, your car has an issue on your mechanic’s list and it’s fixed. If it’s something more seriously mechanical, you’ll probably be thinking about where you’d like your mechanic to stick his spanner, or looking for a new mechanic.
What Is Effective For Treating Insomnia?
So if sleep hygiene isn’t working for you, what does help cure insomnia? Cognitive Behavioral Therapy for Insomnia (aka CBTi):
Via Sleep hygiene education as a treatment of insomnia: a systematic review and meta-analysis
“Compared to CBTi, Sleep hygiene was shown to be significantly less efficacious. The difference in effect size was medium to large, depending on the outcome measures.”
That’s scientific speak for “CBTi works better as an insomnia treatment and the difference in effectiveness is pretty big to very big”.
So if you’ve tried all the advice on the internet and it hasn’t worked for you, you definitely aren’t alone (most of my clients have “tried all that stuff”).
You should consider talking to a sleep specialist and see if a treatment like CBTi is right for you (there are some situations where it won’t be appropriate and may have safety implications, so make sure you are offered a proper sleep assessment first).
Where to start? If you’re having sleep issues, you can evaluate how bad your insomnia problem is here.
If your results worry you, get in touch.