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Use of sleep hygiene in the treatment of insomnia

Stepanski, Edward J, Wyatt, James K·2003·Sleep Medicine Reviews

DOI 10.1053/smrv.2001.0246

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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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“The current most prevalent non-pharmacological therapies for insomnia are sleep hygiene education [6] and cognitive and behavioral psychotherapy, but such treatments require long-term implementation [7].”
Background
Sleep Hygiene Pattern and Behaviors and Related Factors among General Population in West Of Iran
Khazaie, H., Chehri, A., Sadeghi, K., Heydarpour, F., Soleimani, A., & Rezaei, Z. (2015) · Global Journal of Health Science · doi:10.5539/gjhs.v8n8p114 · Cited by 18
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Sleep hygiene awareness: Its relation to sleep quality among medical students in King Saud University, Riyadh, Saudi Arabia
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“Table 4 contrasts sample instances of healthy and unhealthy sleep hygiene (Stepanski and Wyatt, 2003; Mastin et al., 2006; Irish et al., 2015).”
Background
Information without Implementation: A Practical Example for Developing a Best Practice Education Control Group
Balderson, B. H., McCurry, S. M., Vitiello, M. V., Shortreed, S. M., Rybarczyk, B. D., Keefe, F. J., & Korff, M. V. (2016) · Behavioral Sleep Medicine · doi:10.1080/15402002.2015.1036271 · Cited by 16
“In the case of sleep trials, many previous insomnia intervention studies have employed sleep hygiene information as both a treatment and as a CBT-I comparison control condition (see Stepanski & Wyatt, 2003, for a review).”
Background
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Cornu, Q. L., Chen, M., van Hees, V. T., Léger, D., Fayossé, A., Yerramalla, M. S., & Sabia, S. (2022) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-022-01391-0 · Cited by 18
“At older ages it is recommended to sleep 7 to 8 hours per night, to maintain regular sleep timing, and reduce light exposure at bedtime [10, 11].”
Background
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“SCT is also frequently assessed in conjunction with SH (Friedman et al., 2000; Guilleminault et al., 1995; Hagatun et al., 2019; Moss et al., 2013; Muthaiya, 2015; Stepanski & Wyatt, 2003) or used as a control group (Hagatun et al., 2019; Muthaiya, 2015).”
Method
Sleep quality, use of hypnotics and sleeping habits in different age‐groups among older people
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Meditation as an approach to lessen menopausal symptoms and insomnia in working women undergoing the menopausal transition period: A randomized controlled trial
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“Various studies have made recommendations for enhancing sleep quality, for instance, adequate sleep duration [14], maintaining regular bedtime and waketime [15], avoiding excessive caffeine intake [16], and limiting screentime exposure before bed [17, 18].”
Background
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“In summary, these findings suggest that the validity of sleep hygiene recommendations should be examined more thoroughly in future research [50, 53].”
Background
Perceived stress and sleep quality among master’s students in social work
Lee, H., Rauktis, M. E., & Fusco, R. A. (2021) · Social Work Education · doi:10.1080/02615479.2021.1910231 · Cited by 17
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Psychological and Behavioral Treatments for Insomnia II
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“At bedtime, bedrooms are quiet and the light level is generally lower, with people avoiding too much physical activity (except for sex, [53]).”
Nonpharmacologic treatment of insomnia
Means, M. K., Lineberger, M. D., & Edinger, J. D. (2008) · Current Treatment Options in Neurology · doi:10.1007/s11940-008-0037-6 · Cited by 15
The Association of Daytime Maternal Napping and Exercise With Nighttime Sleep in First-Time Mothers Between 3 and 6 Months Postpartum
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“…behaviors commonly enacted to compensate for disrupted sleep, like exercise, napping, caffeine, and alcohol intake, have been shown in some cases to worsen nighttime sleep and lead to greater next-day dysfunction, depending on the dose and timing of those behaviors (Stepanski & Wyatt, 2003).”
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Non-pharmacologic interventions to improve sleep of medicine inpatients: a controlled study
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The impact of sleep loss on sustained and transient attention: an EEG study
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Authors: Stepanski, E. J., & Wyatt, J. K.
Affiliations: Rush University Medical Center (US)
ORCID: Stepanski, Edward J
Wyatt, James K
Venue: Sleep Medicine Reviews
Publisher: Elsevier BV
Published: 2003-06
Volume: 7
Issue: 3
Pages: 215-225
ISSN: 1087-0792 (ISSN-L)
DOI: 10.1053/smrv.2001.0246
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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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Use of sleep hygiene in the treatment of insomnia

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