Nancy Fickert DNP, CRNP, FNP- BC

Janene Luther Szpak, DNP, PMHNP-BC

Sleep Hygiene

We spend about one third of our lives sleeping.  Many people believe this is wasted time.  However, the quality and quantity of sleep impacts the remaining two thirds of how we function while awake. About one fourth of the population is occasionally not getting enough sleep. Our sleep behaviors affect how we sleep.  Sleep hygiene is defined as the promotion of regular sleep and the actions we take to ensure it.  Lack of sleep may lead to mental and physical problems therefore it is important for good health. The average length of sleep for adults is 7.5 and children need 9 or more hours.  People that are deprived of sleep often have difficulties performing at work or school.  There is also a belief that sleep improves our ability to create memories.  There are a number of things we can do to help promote a healthy sleep.  Before we review them is it important to understand the purpose of sleep.

Each night we cycle through four stages of Non-rapid eye movement (non-REM) sleep.  We spend about 75% of the time in these stages.  Rapid eye movement (REM) follows non-REM stages and occurs ninety minutes after falling asleep and recurs every 90 minutes or longer during the night.  A person cycles through five episodes of non-REM/rapid eye movement (REM) activity during sleep.  If sleep is cut short we do not complete each stage and the body is unable to repair the damage from daily stressors.  When we are in a deep sleep hormones are released that affect appetite, alertness, growth and development.  This impacts how we function and can result in chronic health conditions such as diabetes, cardiac disease, obesity, and depression.  Sleep also affects the way we look and feel.  



Sleep Cycle: Stages of Sleep




Non-rapid eye movement (non-REM)  

Divided into 4 stages

  1. Light Sleep

5% sleep time; going from awake to sleep

  1. Light Sleep

50% sleep time; onset of sleep; no eye movement; weak muscle tone

  1. Delta Slow Wave Sleep

20% both 3 & 4: sleep time; deep sleep

  1. Delta Slow Wave Sleep

Body repairs itself; hormones released; energy restored

Rapid eye movement (REM)


20% sleep time; rapid eye movement-muscle twitches; affects learning; dreaming; major muscles paralyzed; supports daytime performance; provided energy to brain/body

Table 1

Lack of sleep may be due to the inability to fall or stay asleep.  This affects about 10-15% of the general population.  Research has shown that people taught skills while sleep deprived could not remember what they learned.  Memories are created with good sleep. This leads to an increase in accidents such motor vehicle or work related putting everyone’s safety at risk.  It is well known that some disasters in our history were related to a lack of sleep.  Symptoms of decreased sleep include:  irritability, fatigue, difficulty concentrating, decreased alertness, poor judgment, changes in mood, visual hallucinations, and paranoid thoughts.  This affects a person’s overall functioning, physical and mental well-being.  

Some common sleep disorders that should be discussed with a medical provider include obstructive sleep apnea, restless leg syndrome, narcolepsy, delayed sleep phase disorder, insomnia, depression, anxiety, and chronic diseases associated with sleep concerns such as dementia and Alzheimer’s disease.  Side effects of some medications are associated with insomnia.  If getting up to use the bathroom frequently during the night is preventing a good night’s sleep consult with a medical provider.  Other causes of sleep cycle disruption include drinking too much caffeine especially before bed, smoking, alcohol and other substance abuse.  Working long hours or shift work, stress at work or home, or even lack of sun exposure can interfere with getting enough sleep.

Establishing good sleep hygiene practices improve sleep.  The first thing to do is establish a regular bed time and wake time even on the weekends. This helps maintain a circadian rhythm or regular sleep-wake cycle. Do not sleep in on weekends or nap during the day; this disrupts the cycle.  If you have stress in your life as many of us do; look into some relaxation techniques such as yoga, deep breathing, or meditation.  Try simple things such as taking a warm soaking bath or listen to soothing music before bed.  Reading self help books have proven to help with sleep.  Keep a journal by the bed and write down things that can be taken care of the next day to prevent thinking about it all night. Exercising reduces stress but do not perform exercise right before bed. 

Create a sleep environment-the bed and bedroom should be a place intended for sleep.  Keep the bedroom dark and quiet with a room temperature that is comfortable (60-67 degrees). Avoid using the bed for activities other than sleep and sex.  Do not read, watch TV, eat, or worry in bed.  If you cannot fall asleep within 20 minutes get up and go into another room until you are sleepy.  This may need to be repeated several times. 

If you enjoy caffeine try reducing it before bed.  That goes for smoking as well.  Do not use alcohol for sleep it impairs the sleep cycle. Do not go to bed hungry but avoid eating a large meal before bed. Stop drinking fluids about 2 hours before bed and take medications such as diuretics in the morning, when possible, to avoid getting up to use the bathroom.

Important tips for adolescents include avoiding caffeine after lunch, avoid bright lights in the evening, and avoid heavy study, text messaging, long conversations before bed.  Bright lights and lights from electronics increase activity in the brain and can interfere with the circadian rhythm. Do not sleep more than 2-3 hours past usual wake time and avoid all nighters as they will disrupt the sleep cycle.

Melatonin and other over the counter medications used to promote sleep should be discussed with a medical provider before taking them.  Also, talk to your medical provider if these sleep hygiene practices are not effective. There are medications that are prescribed for sleep but a medical evaluation is important first step to ensure they are right for you.



Bjorvatin, B., Fiske, E., Pallesen, S. A self help book in better than sleep hygiene advice for insomnia: a randomized controlled comparative study. Scandinavian Journal of Psychology. (2011), 52, 580-585.

Ellis, J. Hampson, S.E, Cropley, M. Sleep hygien or compensatory sleep practices: an examination of behaviours affecting sleep in older adults. Psychology, Health & Medicine. (2002), 7 (2), 157-162.

Higgins, E.S. & George M.S.(2013). The Neuroscience of Clinical Psychiatry the pathophysiology of behavior and mental illness( 2nd ed).Philadelphia:  Wolters Kluwer. 174-187.

McCurrey, S.M., Gibbons, L.E., Logsdon, R.G., Vitiello, M., Teri, L. Training caregivers to change the sleep hygiene practices of patients with dementia: the NITE-AD project. Journal of American Geriatrics Society. (2003), 51, 1455-146.

National Sleep Foundation (2014). Sleep health. Retrieved October 5, 2014

Wells, M.E., Vaughn, B.V. Poor sleep challenging the health of a nation. Neurodiagnostic Journal. (2012), 52, 233-249.