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Use of sleep hygiene in the treatment of insomnia
Abstract
Sleep hygiene (SH) refers to a list of behaviors, environmental conditions, and other sleep-related factors that can be adjusted as a stand-alone treatment or component of multimodal treatment for patients with insomnia. This paper presents a review of SH, how this concept has been applied and often modified over the past 24 years, and how it relates to the modern sleep disorder nosology, particularly Inadequate Sleep Hygiene. Although a recognized and commonly utilized treatment option, there is no absolute consensus about which steps must be included to constitute SH treatment, and there is much overlap between SH and other cognitive-behavioral treatments for insomnia such as Stimulus Control Procedures and Sleep Restriction Therapy. The literature on the effects of manipulations of individual components of SH under experimental conditions (e.g. effects of presleep alcohol or caffeine intake) in normal sleepers show mixed results. Empirical data demonstrating the role of poor SH as a contributor to insomnia, or showing that good SH improves sleep in patients with insomnia, is not available. Instead of evaluating the impact of a comprehensive list of SH recommendations, a focus on guidelines for use of individual rules is needed.
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“A strength in using such methods as comparators is the low efficacy compared to other interventions (50, 51).”
From Total Sleep Deprivation Followed by Bright Light Therapy as Rapid Relief for Depression: A Pragmatic Randomized Controlled Trial (2021) · cites this paper as [51]
In the citing paper
“Although there is insufficient evidence for sleep hygiene to be an option for single therapy, it is usually provided in conjunction with other modalities [18,28].”
From Non-Pharmacological Treatment of Insomnia (2012) · cites this paper as [28]
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“Regular exercise not only reduces risk for developing many common disabling age-related illnesses,(87) it improves sleep and circadian rhythmicity in older adults, and is included in the recommendations of most behavioral sleep programs.(17) King and her colleagues(91) found that moderate-intensity exercise significan…”
BackgroundSleep hygiene education as a treatment of insomnia: a systematic review and meta-analysis
Chung, K.-F., Lee, C.-T., Yeung, W.-F., Chan, M.-S., Chung, E. W.-Y., & Lin, W.-L. (2018) · Family Practice · doi:10.1093/fampra/cmx122 · Cited by 313
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“Media use in bed may act as a direct displacement of sleep, and may also replace activities that promote good sleep (Stepanski & Wyatt, 2003).”
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InfluentialAssociation Between Sleep Hygiene and Sleep Quality in Medical Students
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“Sleep hygiene has been defined as those behaviors that are believed to promote improved quantity and quality of sleep ( Stepanski & Wyatt, 2003 ).”
BackgroundInfluentialCOVID‐19 lockdown: Physical activity, sedentary behaviour and sleep in Italian medicine students
Luciano, F., Cenacchi, V., Vegro, V., & Pavei, G. (2020) · European Journal of Sport Science · doi:10.1080/17461391.2020.1842910 · Cited by 209
“Students should maintain a regular sleep schedule and wake-up time in the morning, reduce the use of light-emitting screens before bedtime and consumption of caffeine, alcohol and nicotine (Spadola et al., 2019; Stepanski & Wyatt, 2003).”
BackgroundEvaluation of a School-Based Intervention for Adolescent Sleep Problems
Moseley, L., & Gradisar, M. (2009) · SLEEP · doi:10.1093/sleep/32.3.334 · Cited by 197
Sleep in the Military: Promoting Healthy Sleep Among U.S. Servicemembers
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“As a primary recommendation, exercising regularly is incorporated into standard ‘‘sleep hygiene’’ advice [1].”
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“In summary, it seems that the use of computers and mobile telephones, particularly, in the bedroom is associated with poor sleep habits, as variation in sleep–wake schedules are likely to have detrimental effects on both sleep quality and wakefulness during the day (Dijk and Czeisler, 1995; Stepnaski and Wyatt, 2003;…”
BackgroundSleep, its regulation and possible mechanisms of sleep disturbances
Porkka‐Heiskanen, T., Zitting, K. ‐., & Wigren, H. ‐. (2013) · Acta Physiologica · doi:10.1111/apha.12134 · Cited by 157
“Silence and pleasant temperature in the bed room further help in calming down the mind (Stepanski & Wyatt 2003).”
BackgroundInternational study of the prevalence and factors associated with insomnia in the general population
Aernout, E., Benradia, I., Hazo, J., Sy, A., Askevis-Leherpeux, F., Sebbane, D., & Roelandt, J.-L. (2021) · Sleep Medicine · doi:10.1016/j.sleep.2021.03.028 · Cited by 156
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“A strength of the current study is that we examined empirically theoretically important but understudied sleep hygiene domains such as daytime sleep (Malone, 2011; Stepanski and Wyatt, 2003) with sleep duration and quality outcomes.”
BackgroundRandomized trial of a cognitive-behavioral intervention for insomnia in breast cancer survivors
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“…and sleep restriction therapy, a review of sleep hygiene shows that the previously mentioned recommendations, used in the control intervention, all have been included in sleep hygiene treatment in previous intervention studies (Stepanski & Wyatt, 2003), with the exception of the bar graphs.”
Understanding and Treating Insomnia
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“The goal of sleep hygiene is to correct certain behavioral patterns, environmental conditions, or other sleep-related factors that may be inhibiting sleep (Hauri, 1991; Stepanski & Wyatt, 2003).”
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“The term “sleep hygiene” was first used by Hauri (1977) to describe a variety of sleep scheduling, dietary, environmental, and activity recommendations designed to minimize impediments to sleep onset and enhance sleep maintenance and quality (Stepanski & Wyatt, 2003).”
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The medicalization of sleeplessness: a public health concern
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“, light, temperature, noise) can counteract sleep deterrents such as artificial light and 24-hour Internet access.(39) Preventing occupational stress and implementing job sharing, flexible hours, and sleep hygiene school curricula, could reduce the societal burden of sleeplessness.”
Assessment and treatment of insomnia in adult patients with alcohol use disorders
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Sleep Hygiene and Recovery Strategies in Elite Soccer Players
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“As the vulnerability to developing sleep disturbance seems to differ between individuals [15, 22], elaborating customized sleep hygiene strategies from a set of sleep hygiene recommendations may also be recommended.”
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Sleep Beliefs Scale (SBS) and circadian typology
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“These aspects were in some measure related with sleep hygiene and sleep disturbances (Jefferson et al., 2005; Kohn and Espie, 2005; Saint-Hilaire et al., 2005; Stepanski and Wyatt, 2003).”
BackgroundInfluentialGPs’ management strategies for patients with insomnia: A survey and qualitative interview study
Everitt, H., McDermott, L., Leydon, G., Yules, H., Baldwin, D., & Little, P. (2014) · British Journal of General Practice · doi:10.3399/bjgp14x677176 · Cited by 127
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Fragmented Sleep, Fragmented Mind
der Kloet, D. V. H., Merckelbach, H. L. G. J., Giesbrecht, T., & Lynn, S. J. (2012) · Perspectives on Psychological Science · doi:10.1177/1745691612437597 · Cited by 133
Sleep-hygiene education improves sleep indices in elite female athletes
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“Most of the previous studies, however, have involved participants whom suffer from sleep disturbances or complaints, rather than athletic populations (3, 9, 27).”
BackgroundResultSleep Habits and Fatigue of Children Receiving Maintenance Chemotherapy for ALL and Their Parents
Zupanec, S., Jones, H., & Stremler, R. (2010) · Journal of Pediatric Oncology Nursing · doi:10.1177/1043454209358890 · Cited by 127
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“SHSs have been shown to improve sleep quality and onset latency in university students and reduced sleep irregularity in adolescents (Stepanski & Wyatt, 2003).”
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“Good sleep hygiene is a central part of cognitive-behavioral therapy to treat insomnia [9] and is now often the first method sleep clinicians suggest when patients complain of poor sleep quality [28].”
BackgroundEffects of a Nap on Nighttime Sleep and Waking Function in Older Subjects
Campbell, S. S., Murphy, P., & Stauble, T. N. (2004) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2005.53009.x · Cited by 122
“Effects of napping on waking function notwithstanding, some advocates of the use of sleep hygiene to alleviate sleep problems have cautioned against napping, based on the assumption that a daytime nap would diminish the quality of subsequent nighttime sleep.(15,16) Although this view has been tempered somewhat in rece…”
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“Experimental investigations have revealed that many of these SH variables disturb sleep (Riedel, 2000; Stepanski & Wyatt, 2003), and studies have shown a significant association between poor global SH characteristics and poor sleep (Brown & Buboltz, 2002; Gallasch & Gradisar, 2007; Lacks & Rotert,…”
Therapeutic Options for Sleep‐Maintenance and Sleep‐Onset Insomnia
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Shimura, A., Yokoi, K., Ishibashi, Y., Akatsuka, Y., & Inoue, T. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.730969 · Cited by 136
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Opportunities for computing technologies to support healthy sleep behaviors
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“Sleep Hygiene Sleep doctors and the sleep research literature make consistent recommendations to maximize one’s chance of getting a good night’s sleep [26].”
BackgroundMethodEvolution of insomnia: current status and future direction
Roth, T. G., & Drake, C. L. (2004) · Sleep Medicine · doi:10.1016/s1389-9457(04)90004-4 · Cited by 116
“However, there is little data on the efficacy of different nonpharmacological therapies for insomnia, with no particular approach shown to be more effective than others [3,110].”
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“In the morning open the curtains immediately’]) [18].”
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“This may be as part of a systematic regulation of a sleep hygiene routine, which is commonly utilized as a treatment option for individuals with insomnia [62].”
BackgroundInsomnia Symptoms and Risk for Unintentional Fatal Injuries—The HUNT Study
Laugsand, L. E., Strand, L. B., VATTEN, L. J., Janszky, I., & Bjørngaard, J. H. (2014) · SLEEP · doi:10.5665/sleep.4170 · Cited by 116
Lavender and sleep: A systematic review of the evidence
Fismer, K., & Pilkington, K. (2012) · European Journal of Integrative Medicine · doi:10.1016/j.eujim.2012.08.001 · Cited by 108
“001 as yet to demonstrate its efficacy [10].”
BackgroundSabia, S., Dugravot, A., Léger, D., Ben Hassen, C., Kivimaki, M., & Singh-Manoux, A. (2022) · PLOS Medicine · doi:10.1371/journal.pmed.1004109 · Cited by 106
“These findings support the promotion of good sleep hygiene in both primary and secondary prevention by targeting behavioral and environmental conditions that affect sleep duration and quality [44].”
BackgroundOta, A., Masue, T., Yasuda, N., Tsutsumi, A., Mino, Y., Ohara, H., & Ono, Y. (2009) · Sleep Medicine · doi:10.1016/j.sleep.2009.03.005 · Cited by 106
“Fourth, certain potential determinants of sleep disorders, such as obesity [53,54], environment of the room where the subjects slept [28,55], and caffeine consumption [28,55], were not considered in this study.”
BackgroundEvaluation and treatment of insomnia in adult cancer survivorship programs
Zhou, E. S., Partridge, A. H., Syrjala, K. L., Michaud, A. L., & Recklitis, C. J. (2016) · Journal of Cancer Survivorship · doi:10.1007/s11764-016-0564-1 · Cited by 105
“Limitations in provider knowledge and experience may explain why most patients with insomnia in these clinics received treatments that are ineffective as monotherapy (sleep hygiene [29, 30]) or are more appropriate as a short-term solution (pharmacotherapy [31, 32]) rather than empirically supported treatments recomme…”
BackgroundVitale, J. A., Bonato, M., Galasso, L., Torre, A. L., Merati, G., Montaruli, A., Roveda, E., & Carandente, F. (2016) · Chronobiology International · doi:10.1080/07420528.2016.1256301 · Cited by 103
Drake, C. L., Kalmbach, D. A., Arnedt, J. T., Cheng, P., Tonnu, C. V., Cuamatzi-Castelan, A. S., & Fellman-Couture, C. (2018) · SLEEP · doi:10.1093/sleep/zsy217 · Cited by 114
Sleep, Recovery, and Athletic Performance
Bird, S. P. (2013) · Strength and conditioning journal · doi:10.1519/ssc.0b013e3182a62e2f · Cited by 102
“Typically, this involves avoiding behaviors that interfere with sleep patterns and/or engaging in behaviors that promote good sleep (22).”
BackgroundMethodInfluentialPersistent Insomnia: the Role of Objective Short Sleep Duration and Mental Health
Vgontzas, A. N., Fernandez-Mendoza, J., Bixler, E. O., Singareddy, R., Shaffer, M. L., Calhoun, S. L., Liao, D., Basta, M., & Chrousos, G. P. (2012) · Sleep · doi:10.5665/sleep.1586 · Cited by 113
The Impact of Sleep Interventions on Athletic Performance: A Systematic Review
Cunha, L. A., Costa, J. A., Marques, E. A., Brito, J., Lastella, M., & Figueiredo, P. (2023) · Sports Medicine - Open · doi:10.1186/s40798-023-00599-z · Cited by 140
“Sleep hygiene currently refers to a list of behaviors, environmental conditions, and other sleep-related factors believed to promote improvements in sleep duration and quality [61].”
BackgroundInsomnia in the context of traumatic brain injury
Zeitzer, J. M., Friedman, L., & O'Hara, R. M. (2009) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2008.08.0099 · Cited by 102
“[50–51].”
Sleep Disturbances in Persons Living With HIV
Buchanan, D. T. (2013) · Journal of the Association of Nurses in AIDS Care · doi:10.1016/j.jana.2012.10.006 · Cited by 96
“There is limited research showing that sleep hygiene education improves sleep in PLWH (Dreher, 2003; Hudson et al., 2008), but other studies in general samples of people with insomnia have not shown sleep hygiene to be effective (Stepanski & Wyatt, 2003).”
BackgroundRavichandran, R., Sien, S.-W., Patel, S., Kientz, J. A., & Pina, L. R. (2017) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3025453.3025557 · Cited by 95
“Examples of sleep hygiene include avoiding caffeine later in the day, exercising regularly, and establishing a relaxing bedtime routine [18, 31].”
BackgroundChildren’s emotional security and sleep: longitudinal relations and directions of effects
Keller, P. S., & El‐Sheikh, M. (2010) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2010.02263.x · Cited by 100
Chen, P.-H., Kuo, H.-Y., & Chueh, K. (2010) · Journal of Nursing Research · doi:10.1097/jnr.0b013e3181fbe3fd · Cited by 89
Ballesio, A., Bacaro, V., Vacca, M., Chirico, A., Lucidi, F., Riemann, D., Baglioni, C., & Lombardo, C. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2020.101378 · Cited by 87
Non-Pharmacological Treatment of Insomnia
Siebern, A. T., Suh, S., & Nowakowski, S. (2012) · Neurotherapeutics · doi:10.1007/s13311-012-0142-9 · Cited by 88
“It is likely that patients with insomnia presenting to a sleep clinic will have some knowledge of sleep hygiene, so that providing sleep hygiene instructions may contribute to optimizing clinical outcomes and relapse prevention [28].”
BackgroundInfluentialvan der Heijden, K. B., Smits, M. G., & Gunning, W. B. (2006) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2006.00491.x · Cited by 93
“However, we do not expect significant intercultural differences in sleep hygiene within western countries since definitions of sleep hygiene across studies are very similar in their core factors (Stepanski and Wyatt, 2003).”
BackgroundMeasures to counteract the negative effects of night work
Pallesen, S., Bjorvatn, B., Magerøy, N., Saksvik, I. B., Waage, S., & Moen, B. E. (2010) · Scandinavian Journal of Work, Environment & Health · doi:10.5271/sjweh.2886 · Cited by 122
“As a result, shift workers should receive sleep hygiene advice (161).”
BackgroundRecent Developments in the Classification, Evaluation, and Treatment of Insomnia
Summers, M. O., Crisostomo, M. I., & Stepanski, E. J. (2006) · CHEST Journal · doi:10.1378/chest.130.1.276 · Cited by 87
Self-citationPeach, H. D., Gaultney, J. F., & Gray, D. D. (2016) · Cogent Psychology · doi:10.1080/23311908.2016.1168768 · Cited by 90
“Such behaviors typically span four domains which include arousal-related behaviors, sleep scheduling and timing, eating/drinking behaviors, and sleep environment (Gellis & Lichstein, 2009; Kor & Mullan, 2011; LeBourgeois, Giannotti, Cortesi, Wolfson, & Harsh, 2005; Stepanski & Wyatt, 2003).”
BackgroundZhang, C., Fang, R., Zhang, R., Hagger, M. S., & Hamilton, K. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17041209 · Cited by 83
“Although the influence of sleep hygiene on healthy sleep remains mixed [27], participating in good sleep hygiene could be argued to still be the most effective strategy for promoting sleep health, particularly on a population level [28].”
Frimpong, E., Mograss, M., Zvionow, T., & Dang‐Vu, T. T. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2021.101535 · Cited by 104
JuSt – a multimodal program for treatment of insomnia in adolescents: a pilot study
Schlarb, A. A., Liddle, & Hautzinger (2010) · Nature and Science of Sleep · doi:10.2147/nss.s14493 · Cited by 85
Wyatt, J. K., Stepanski, E. J., & Kirkby, J. (2006) · SLEEP · doi:10.1093/sleep/29.8.1075 · Cited by 85
Self-citationLandry, G. J., & Liu-Ambrose, T. (2014) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2014.00325 · Cited by 84
“…in feeling more rested and alert upon awakening, as well as a greater ability to function throughout the day—while experiencing less of the cognitive drag associated with excessive daytime sleepiness (Stepanski and Wyatt, 2003; Lockley and Foster, 2012; American Academy of Sleep Medicine, 2014).”
BackgroundInfluentialFactors Influencing Clinical Correlates of Chronic Traumatic Encephalopathy (CTE): a Review
Asken, B. M., Sullan, M. J., Snyder, A., Houck, Z. M., Bryant, V. E., Hizel, L. P., McLaren, M. E., Dede, D. E., Jaffee, M. S., DeKosky, S. T., et al. (2016) · Neuropsychology Review · doi:10.1007/s11065-016-9327-z · Cited by 90
“…mood and behavioral disturbances (Hofmann et al. 2012), sleep hygiene or cognitive behavioral therapy for insomnia improving sleep quality (Stepanski and Wyatt 2003; Taylor and Pruiksma 2014), and cognitive training interventions (Ball et al. 2002) offer potentially effective ways of…”
BackgroundImpacts of technology use on children
Gottschalk, F. (2019) · OECD education working papers · doi:10.1787/8296464e-en · Cited by 136
“These steps could be incorporated into good sleep hygiene practices, which include behaviours such as avoiding excess (or any) caffeine, engaging in regular exercise, maintaining a regular sleep schedule and eliminating noise from the sleeping environment (Stepanski and Wyatt, 2003[132]).”
BackgroundThe influence of sleep hygiene education on sleep in professional rugby league athletes
Caia, J., Scott, T. J., Halson, S. L., & Kelly, V. G. (2018) · Sleep Health · doi:10.1016/j.sleh.2018.05.002 · Cited by 81
Hudson, J. L., Moss‐Morris, R., Game, D., Carroll, A., & Chilcot, J. (2016) · Journal of Renal Care · doi:10.1111/jorc.12168 · Cited by 80
Self-Experimentation for Behavior Change
Lee, J., Walker, E., Burleson, W., Kay, M., Buman, M. P., & Hekler, E. B. (2017) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3025453.3026038 · Cited by 86
“Previous research suggests knowledge of sleep hygiene alone does not translate to improved sleep [56], thus making sleep hygiene a good control as it provides likely new information that will inspire the sort of unstructured self-experimentation common by QS’ers.”
BackgroundHarris, J. K., Lack, L. C., Kemp, K., Wright, H., & Bootzin, R. R. (2011) · SLEEP · doi:10.5665/sleep.1584 · Cited by 79
Bamer, A. M. (2010) · Clinical Epidemiology · doi:10.2147/clep.s10425 · Cited by 76
“In addition to pharmacological approaches, there is also emerging evidence of the efficacy of self management 40 and cognitive behavioral therapy 41,42 to enhance sleep, and research into the application of these techniques to people with MS seems desirable due to the potential lack of efficacy and…”
Sleep disorders as a cause of motor vehicle collisions.
de Mello, M. T., Narciso, F. V., Tufik, S., Paiva, T., Spence, D. W., BaHammam, A. S., Verster, J. C., & Pandi-Perumal, S. R. (2013) · Europe PMC (PubMed Central) · Cited by 75
Özdemir, P. G., Boysan, M., Selvı, Y., Yıldırım, A., & Yılmaz, E. (2015) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2015.02.001 · Cited by 74
“Therefore, SH practices regulate quantity and quality of sleep [9].”
Background
Metadata
- Authors
- Stepanski, E. J., & Wyatt, J. K.
- Affiliations
- Rush University Medical Center (US)
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2003-06
- Volume
- 7
- Issue
- 3
- Pages
- 215-225
- ISSN
- 1087-0792 (ISSN-L)
- OpenAlex
- W2129344959
- Cited by
- 733
- References
- 50
- Citations by year
- 2026: 18 · 2025: 34 · 2024: 26 · 2023: 56 · 2022: 46 · 2021: 46 · 2020: 58 · 2019: 46 · 2018: 36 · 2017: 42 · 2016: 38 · 2015: 40 · 2014: 47 · 2013: 28 · 2012: 24
- FWCI
- 2.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sleep Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- sleep hygiene, insomnia treatment, cognitive behavioral therapy for insomnia, stimulus control, sleep restriction therapy, caffeine consumption
- MeSH terms
- Ethanol, Central Nervous System Stimulants, Body Temperature, Caffeine, Environment, Humans, Sleep Initiation and Maintenance Disorders, Noise, Television, Wakefulness, Exercise, Cognitive Behavioral Therapy
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