Summary The ineffectiveness of sleep hygiene as a treatment in clinical sleep medicine has raised some interesting questions. If it is known that, individually, each specific component of sleep hygiene is related to sleep, why wouldn't addressing multiple individual components (i.e., sleep hygiene education) result in improved sleep? Is there still a use for sleep hygiene? Global public health concern over poor sleep has increased the demand for effective sleep promotion strategies that are easily accessible to the general population. However, the extent to which sleep hygiene principles and strategies apply outside of clinical settings is not well known. The present review sought to evaluate the empirical evidence for several common sleep hygiene recommendations, including regular exercise, stress management, noise reduction, sleep timing regularity, and avoidance of caffeine, nicotine, alcohol, and daytime napping, with a particular emphasis on their public health utility. Thus, our review is not intended to be exhaustive regarding the clinical application of these techniques, but rather to focus on broader applications. Overall, though epidemiologic and experimental research generally supported an association between individual sleep hygiene recommendations and nocturnal sleep, the direct effects of individual recommendations on sleep remains largely untested in the general population. Suggestions for further clarification of sleep hygiene recommendations and considerations for the use of sleep hygiene in nonclinical populations are discussed.

S leep quality and daytime sleepiness are salient and clinically relevant dimensions of sleep-wake function. Poor sleep quality and insomnia symptoms have been associated with worse health, increased health care costs and utilization, absenteeism from work, and increased risk for psychiatric disorders, including depression. 1 Daytime sleepiness has been associated with increased risk of motor vehicle accidents, worse physical health, and increased mortality risk. 2 Although sleep and sleepiness can be measured by objective means such as polysomnography (PSG) and the multiple sleep latency test (MSLT), these methods are often impractical as clinical screening or research tools. Self-report questionnaires are most commonly used to assess sleep quality and daytime sleepiness. Many different instruments have been developed to measure sleep quality, insom-nia, and daytime sleepiness (for review, see 3 ), but 2 of the most widely-used are the Pittsburgh Sleep Quality Index (PSQI) 4 and the Epworth Sleepiness Scale (ESS). 5,6 A search of the ISI Web of Knowledge Citation Index in January 2008 identified over 900 publications citing the PSQI, and over 1500 citing the ESS. Despite their widespread use, however, relatively little attention has been paid to how the PSQI and ESS relate to each other, or to other clinical and sleep measures.The PSQI is a 19-item self-rated questionnaire for evaluating subjective sleep quality over the previous month. The 19 questions are combined into 7 clinically-derived component scores, each weighted equally from 0-3. The 7 component scores are added to obtain a global score ranging from 0-21, with higher scores indicating worse sleep quality. The clinical and psychometric properties of the PSQI have been formally evaluated by several research groups. 4,[7][8][9] The PSQI has a sensitivity of 89.6% and specificity of 86.5% for identifying cases with sleep disorder, using a cut-off score of 5. Validity is further supported by similar differences between groups using PSQI or polysomnographic sleep measures. The PSQI has been translated into 48

Older adults with specific EEG sleep characteristics have an excess risk of dying beyond that associated with age, gender, or medical burden. The findings suggest that interventions to optimize and protect older adults' sleep initiation, continuity, and quality may be warranted.

These data suggest that sleep duration is a significant correlate of the metabolic syndrome. Additional studies are needed to evaluate temporal relationships among these measures, the behavioral and physiologic mechanisms that link the two, and their impact on subsequent cardiometabolic disease.

Objective-To examine the independent and interactive effects of race and socioeconomic status (SES) on objective indices and self-reports of sleep.Methods-The sleep of 187 adults (41% Black; mean age = 59.5 ± 7.2 years) was examined. Nine nights of actigraphy and two nights of inhome polysomnography (PSG) were used to assess average sleep duration, continuity, and architecture; self-report was used to assess sleep quality. Psychosocial factors, health behaviors, and environmental factors were also measured.Results-Blacks had shorter sleep duration and lower sleep efficiency, as measured by actigraphy and PSG, and they spent less time proportionately in Stage 3 to 4 sleep, compared with others (p < . 01). Lower SES was associated with longer actigraphy-measured latency, more wake after sleep onset as measured by PSG, and poorer sleep quality on the Pittsburgh Sleep Quality Index (p < .05).Conclusions-Blacks and perhaps individuals in lower SES groups may be at risk for sleep disturbances and associated health consequences.

The majority of adults sleep with a partner, and for a significant proportion of couples, sleep problems and relationship problems co-occur, yet there has been little systematic study of the association between close relationships and sleep. The association between sleep and relationships is likely to be bi-directional and reciprocal-the quality of close relationships influences sleep and sleep disturbances or sleep disorders influence close relationship quality. Therefore, the purpose of the present review is to summarize the extant research on (1) the impact of co-sleeping on bed partner's sleep, (2) the impact of sleep disturbance or sleep disorders on relationship functioning, and (3) the impact of close relationship quality on sleep. In addition, we provide a conceptual model of biopsychosocial pathways to account for the covariation between relationship functioning and sleep. Recognizing the dyadic nature of sleep and incorporating such knowledge into both clinical practice and research in sleep medicine may elucidate key mechanisms in the etiology and maintenance of both sleep disorders and relationship problems and may ultimately inform novel treatments.

All patients and caregivers need initial and ongoing screening for sleep/wake disturbances. When disturbed sleep/wakefulness is evident, further assessment and treatment are warranted. Nursing educational programs should include content regarding healthy and disrupted sleep/wake patterns. Research on sleep/wake disturbances in people with cancer should have high priority.

Self-reported global sleep quality is significantly related to the metabolic syndrome and several of its core components.