Sleep Hygiene

Lack of sleep will result in lowered pain tolerance, higher stress levels, weight gain, obesity, poor concentration, fatigue, and increased risk of accidents at work. Unfortunately, there is NO good sleeping pill on the market that is affective and has acceptable side effects. Many sleep aids cause dependence, some VERY quickly. Once someone is dependent on a sleeping pill, it is VERY difficult to get off of them. Prescription sleep aids not only can be addictive, but also can cause other side effects such as dizziness, fatigue, headaches, weight gain, disorientation, memory loss, falls, and are even known to increase the risk of head trauma due to falls.

However, what most patients don’t realize is that their insomnia may be due to their habits, and that changing habits will improve their sleep. Using a pill, without changing sleep habits, will result in failure. Sleep is controlled by your sleep center in your brain stem, a very primitive part of your brain. You must train your brain stem – like training a puppy dog -- to know when to turn itself off. Following guidelines known as Sleep Hygiene will do exactly that.

Establish a Sleep Time

I remember suddenly waking up from a sound sleep one morning and looking at the clock. The clock read 1:01 a.m. There was complete silence. I knew something was wrong, but I didn’t know what. Then I realized the sprinkler system was not running. The sprinkler system normally came on at 1:00 a.m. Not hearing the sprinklers outside my bedroom caused me to suddenly wake up. Have you ever had a dog that knew the precise time you were going to serve him dinner? Your brain stem, just like a puppy dog, can learn exactly when meal time is and exactly when bedtime is.

Your brain’s biologic clock is very precise and adapts quickly to scheduled rituals. Take advantage of your biologic clock. Decide on a sleep time, and stick to it even if you are not sleepy. The time must be early enough to allow enough sleep. This will be difficult at first as you may not feel like going to bed, but your brain stem will soon learn when sleep time is. Establishing a sleep time is the first step in creating a bed time ritual that will train your brain stem to shut off. If you cannot get out of bed when the alarm clock goes off, you chose a sleep time that is too late. Go to bed earlier.

Stop All Sleep Disrupting Activity

All sleep disrupting activity should stop AT LEAST one hour before the chosen sleep time. This is a critical sleep hygiene rule. The most common sleep disrupting activity is watching television. Turn off the television, computer, video games, etc. at least one hour before your sleep time. Create a quiet environment. Don’t talk on the cell phone, or take care of business if possible. You will NOT be successful if you do not follow this critical step. Eating is also a sleep disrupting activity, but is addressed below.

Establish a Pre-Sleep Ritual

We have already begun a pre-sleep ritual by shutting off the “boob tube”, video games, getting off the internet, etc. Now start your pre-sleep ritual. Do NOT allow any TV while performing your pre-sleep ritual. Typically, this would involve activities like washing your face, flossing, brushing teeth, and changing into PJ’s. You may read a chapter in a book before bed. This is fine, but DON’T get in bed yet! Read the next rule…

The Bed as a Brain Stem Trigger for Sleep

This rule gets some jokes from time to time. Do NOT do ANYTHING in bed, except SLEEP! Do not watch TV in bed. Do not read in bed. Do not play video games or cruise the internet on your iPAD in bed. Do not talk on the phone in bed.

There is one more activity that is not allowed in bed. NO thinking in bed! If you find yourself ruminating in bed, your brain stem is probably still in training. This is a normal part of the process. So how to you keep yourself from THINKING in bed? Get out of bed! If your brain won’t shut off in bed, get your brain OUT of the bed. So, what do I do now?...

Establish Sleep Promoting Activity as a Backup Plan

If you are in bed for more than 30 minutes and find your mind racing, GET OUT OF BED! But don’t even think about engaging in sleep disrupting activity like watching TV or playing video games. TV and video games are a very common cause of insomnia. They wake up the brain and keep you from falling asleep. Sleep promoting activities are any short activities (say one hour long) that give you a sense of accomplishment. Watching TV does NOT give any sense of accomplishment. Here are some examples: clean the kitchen, clean a closet, sweep the shop floor, engage in a hobby, read a chapter in a book, but do NOT turn on the TV!

After accomplishing a task, and feeling like you have reached a stopping point, go back to bed. There is something about a sense of accomplishment that turns off the brain, and lets the sleep center take over. Avoid stressful activity such as stewing over finances, reading about politics or a book addressing our bad economy. Don’t try to solve the world’s problems. Choose a sleep promoting activity that is relaxing, and easy to complete. Then go back to bed.

Late Night Eating

Late night eating is not only associated with insomnia, but obesity, development of diabetes and gastroesophageal reflux disease. Late night eating syndrome is frequently combined with watching the “boob tube”. A double sleep disruption! Avoid eating for several hours before going to bed. If a snack is necessary, keep it light and healthy.

Alcohol and Other Drugs for Sleep

There is the common misconception that alcohol promotes sleep. Well, it does for a few hours and then suddenly you may find yourself wide awake and unable to go back to sleep. Alcohol is a very common cause of insomnia. Many sleep aids also have a rebound effect that will cause you to wake up with your mind racing. Your brain stem does not need chemicals for sleep. Your brain stem needs sleep training.


Exercise improves the quality of sleep and increases energy levels during the day. Avoid exercising a couple hours before sleep as it can become a sleep disrupting activity if you work out just before bed.


Indirect full spectrum light during the day promotes sleep by keeping your internal clock on schedule. Try to move your desk close to a window and open blinds and curtains if possible during the day. Take a walk outside during the day. Don’t forget that direct sunlight on unprotected skin causes skin cancer.

How Many Hours of Sleep do I Need?

As we get older, our sleep patterns will change. This is a fact that cannot be avoided. Most people sleep less at night as they get older. This is normal and expected. This does NOT mean you need a sleeping pill. Try to AVOID counting hours of sleep. This will only result in frustration and insomnia. The quality of sleep may be as important as the amount of sleep. If you follow these sleep hygiene rules, and get to bed on time, your brain stem will decide how many hours of sleep you need.

Final Thoughts

Sleep deprivation can cause medical problems, most notably weight gain and the complications of weight gain. Many patients with chronic muscle pains, fibromyalgia, fatigue, and other pain syndromes are sleep deprived and improve with better quality sleep. If you are suffering from muscle tension, stress, carbohydrate craving, fatigue, then good sleep hygiene may help you. Even if you are a life-long insomniac, you can improve the quality of your sleep with these steps. Other people may need to make additional changes such as switching jobs or making other changes to control stress in their life. And finally, one more time, don’t forget to shut off the “boob tube”!