The role of sleep hygiene in promoting public health: A review of empirical evidence

Abstract

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.

Veterans Affairs Primary Care Provider Perceptions of Insomnia Treatment

“…27,30 In addition to small effect sizes and limited empirical support, sleep hygiene guidelines have been inconsistent. 31 Although sleep hygiene education may be largely ineffective for insomnia, it may nevertheless have a legitimate role in the primary care setting. In prior research, sleep hygiene was strongly associated with sleep quality among normal sleepers but not in those with insomnia.…”

“…In general, however, sleep hygiene should be offered by PCPs primarily as a strategy for maintaining healthy sleep in normal sleepers. 31 The Sleep Research Society workgroup outlined a research agenda designed to "accelerate late-stage translation of sleep and circadian rhythms research findings to benefit public health." 36 With its strong evidence base but limited reach, CBT-I is exactly the kind of intervention in need of efforts to accelerate the pace of translation into clinical practice.…”

A cognitive-behavioral and mindfulness-based group sleep intervention improves behavior problems in at-risk adolescents by improving perceived sleep quality

“…Recent reviews have suggested that while school-based sleep education programs are effective for improving students' knowledge about sleep and insomnia, they are less effective for improving sleep behavior or mental health (Blunden & Rigney, 2015;Blunden, Chapman, & Rigney, 2012;Gruber, 2017). This is consistent with research showing that targeted interventions are more effective than universal interventions in preventing child and adolescent mental health problems (Rohde, 2015), and that simple sleep hygiene instruction does not guarantee positive outcomes in adults (Irish, Kline, Gunn, Buysse, & Hall, 2015).…”

Participant Experiences of Attending a Community CBT Workshop for Insomnia: A Qualitative Six-Year Follow-Up

“…Research has shown that sleep education may function as a first-line intervention in a stepped-care model for individuals who want to improve their sleep, but are unlikely to reach threshold for, or seek, more substantial clinical treatment (Irish, Kline, Gunn, Buysse, & Hall, 2015;Morin, LeBlanc, et al, 2006;Stinson et al, 2006). In the last few years, CBT has become an important treatment option within mental health care services, including the Improving Access to Psychological Therapies (IAPT) initiative in the UK.…”