Sleep hygiene

Dr. S.M. Yasir Arafat, Resident-Psychiatry (BSMMU)

Mob: 01713272917, email: [email protected]

Sleep, Insomnia and Sleep Hygiene Measures

Introduction:

Sleep is a universal behavior that has been demonstrated in every animal species studied, from

insects to mammals. It is one of the most significant of human behaviors, occupying roughly one

third of human life. According to the Greek Mythology, Hypnos was the God of sleep and his

son Morpheus, the creature of the night, who brought dreams in human forms.

Sleep Requirements:

Requirement of sleep varies widely. Some persons are normally short sleepers who require fewer

than 6 hours of sleep each night to function adequately. Long sleepers are those who sleep more

than 9 hours each night to function adequately. Short sleepers are generally efficient, ambitious,

socially adept, and content. Long sleepers tend to be mildly depressed, anxious, and socially

withdrawn.

Sleep Disorders:

There are many classifications of sleep disorders. According to Diagnostic and Statistical

Manual of Mental Disorders (DSM-5) of the American Psychiatric Association (APA), there are

types of sleep-wake disorders as mentioned:

1. Insomnia Disorder

2. Hypersomnolence Disorder

3. Narcolepsy

4. Breathing-Related Sleep Disorders

5. Circadian Rhythm Sleep-Wake Disorders

6. Parasomnias

7. Non-Rapid Eye Movement Sleep Arousal Disorders

8. Nightmare Disorder

9. Rapid Eye Movement Sleep Behavior Disorder

10. Restless Legs Syndrome

11. Substance/Medication-Induced Sleep Disorder



Insomnia

Insomnia is difficulty in initiating or maintaining sleep. It is the most common sleep complaint

and may be transient or persistent. A brief period of insomnia is most often associated with

anxiety, either as a sequale to an anxious experience or in anticipation of an anxiety-provoking

experience (e.g., an examination or an impending job interview). In some persons, transient

insomnia of this kind may be related to grief, loss, or almost any life change or stress. Specific

treatment for the condition is usually not required.

Persistent problems (at least 3 days/wk for 1 mth) in falling asleep, maintaining sleep, or poor

quality of sleep can be a complex situation & demands clinical attention. Individuals are

preoccupied and excessively concerned with their sleep problems, distressed by them, and social

or occupational functioning is affected.

Prevalence: Population surveys show a 1-year prevalence rate of 30 to 45 percent in adults, F >

M, greater in the elderly. Clinically significant insomnia, when it causes marked personal distress

or interference with social and occupational functioning.

Management:

Identifying and addressing the underlying problems (drug dependency, medication issues,

primary medical or psychiatric conditions)

Education regarding sleep cycle, physiology and usual changing

Sleep hygiene measures

Relaxation training

Sleep restriction

Use of pharmacotherapy

Other necessary measures

Here only Sleep hygiene measures are detailed as it is only the behavioral changes, that benefits

much.



Sleep Hygiene Measures

Sleep Environment:

Familiar & comfortable

Dark

Quiet

Encouragement for:

Bedtime routines

Consistent time for going bed & waking up

Going to bed only when tired

Exercise regularly & routinely

No work in the bed except sex

Avoidance of:

Late evening exercise

Caffeine, excess alcohol & smoking

Large late meals

Too much time in bed lying awake

Avoid bright light in night & self expose in the morning

References:

1. Synopsis of Psychiatry, 11th edition by Kaplan & Sadock

2. Oxford Handbook of Psychiatry, 3rd edition by Semple & Smyth

3. Shorter Oxford Textbook of Psychiatry, 6th edition by Cowen, Harrison & Burns

4. Stahl’s Essential Psychopharmacology-Neuroscientific Basis Practical Applications, 4th

edition by Cambridge

Health & Medicine

Sleep hygiene