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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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“For example, sleep hygiene, the practice of performing behaviours that may facilitate or hinder sleep, has been studied in a wide variety of populations that may experience sleeping difficulties [27, 28].”
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“Others, however, have suggested that, when only young adults were considered, strength or endurance exercise has only minor beneficial effects on total sleep time and sleep efficiency (Kovacevic et al. 2018; Stepanski and Wyatt 2003; Youngstedt 2005).”
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“단독 치료방법으로 사용하기보다는 주로 다른 치료방법과 함 께 사용하며, 치료효과를 향상시키고 재발을 방지하는 효과가 있 다[20].”
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“Sleep hygiene recommendations were to avoid looking at cellphones in bed before sleeping, reduce the amount of time spent napping, monitor room temperature and lighting to be conducive to sleep, not eat late at night, and reduce or abstain fromcaffeine, tobacco, and alcohol consumption.(15)The control group received e…”
BackgroundThe top 100 most cited papers in insomnia: A bibliometric analysis
Wan, Q., Liu, K., Wang, X., Luo, S., Yuan, X., Wang, C., Jiang, J., & Wu, W. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1040807 · Cited by 12
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“Sleep regularity is thought to maximise the synchrony between physiological sleep drive and circadian rhythms (Stepanski and Wyatt 2003).”
BackgroundOnline detection and removal of eye blink artifacts from electroencephalogram
Egambaram, A., Badruddin, N., Asirvadam, V. S., Begum, T., Fauvet, É., & Stolz, C. (2021) · Biomedical Signal Processing and Control · doi:10.1016/j.bspc.2021.102887 · Cited by 11
Nocturnal Lifestyle Behaviours and Risk of Poor Sleep during Pregnancy
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“Although some have postulated that sleep hygiene could be more a contributing factor than a causal factor [13], a few interventional studies have shown that sleep hygiene education leads to better sleep [14].”
BackgroundHow emotions induced by reading influence sleep quality in young and older adults
Sella, E., Palumbo, R., Domenico, A. D., & Borella, E. (2022) · Aging & Mental Health · doi:10.1080/13607863.2022.2138266 · Cited by 11
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Therapie der Insomnie im höheren Lebensalter
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Smith, C. E., Lee, S., & Allen, T. D. (2023) · Journal of Business and Psychology · doi:10.1007/s10869-023-09882-y · Cited by 11
“Working adults are a substantial population that suffer unique sleep challenges (e.g., short duration, heightened sleep disorder symptoms; Swanson et al., 2011).”
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Ong, J. C., Cvengros, J. A., & Wyatt, J. K. (2008) · Psychiatric Annals · doi:10.3928/00485713-20080901-06 · Cited by 11
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Exploring Interventions for Sleep Disorders in Adolescent Cannabis Users
Furer, T., Nayak, K., & Shatkin, J. P. (2018) · Medical Sciences · doi:10.3390/medsci6010011 · Cited by 10
“Sleep hygiene education delivers basic information about sleep, providing practical advice on managing circadian rhythm, body temperature, napping, exercise, diet, caffeine, alcohol, tobacco, and drugs in an effort to improve sleep quality [61,62].”
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“Based on these findings, experts have recommended not exercising at night as part of good sleep hygiene and suggest that one avoid exercising early as 4–6 h before bedtime (26, 27).”
BackgroundRegulation of Sleepiness: The Role of the Arousal System
Bakotić, M., & Radošević-Vidaček, B. (2012) · Arhiv za Higijenu Rada i Toksikologiju · doi:10.2478/10004-1254-63-2012-2137 · Cited by 11
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Sleep quality and daily lifestyle regularity in workers with different working hours
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“There is an extensive debate in the literature on whether treatment of chronic insomnia exclusively through sleep hygiene is effective, since this disorder is associated not only to circadian factors but also to homeostatic and psychosocial factors (Stepanski and Wyatt 2003 ).”
BackgroundIntegrating Modern Concepts of Insomnia and its Contemporary Treatment into Primary Care
Doghramji, P. P. (2014) · Postgraduate Medicine · doi:10.3810/pgm.2014.09.2802 · Cited by 12
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Individual light history matters to deal with the Antarctic summer
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“Sleep quality is therefore associated with longer sleep duration, proper timing, high efficiency, and less fragmented sleep 46–51 .”
Use of mHealth Technologies to Increase Sleep Quality among Older Adults: A Scoping Review
Grotto, G., Martinello, M., & Buja, A. (2024) · Clocks & Sleep · doi:10.3390/clockssleep6030034 · Cited by 10
The Impact of Restless Legs Syndrome/ Willis–Ekbom Disorder on Quality of Life
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Prediction of good sleep with physical activity and light exposure: a preliminary study
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“Additional research is required to improve the model's performance by adding information about other factors that can affect sleep, such as temperature, noise, humidity, 51,52 and psychological features (eg, worry, anxiety, and stress).”
Teece, A. R., Beaven, C. M., Argus, C. K., Gill, N., & Driller, M. W. (2023) · Sleep Science · doi:10.1055/s-0043-1772788 · Cited by 9
“18,19 Driller et al. 20 reported that individualized sleep education provided to elite cricket athletes through the Athlete Sleep Behavior Questionnaire (ASBQ) can improve subjective and objective sleep measures.”
BackgroundThe Need for an Integrated Cognitive-Behavioral Model for Co-occurring Chronic Pain and Insomnia
Bryson, W. J., Read, J. B., Bush, J. P., & Edwards, C. L. (2015) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-015-0213-z · Cited by 9
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“The sleep promotion activities can be classified into four categories: environmental factors, scheduling, sleep practices and physiologic factors (9, 20, 24).”
BackgroundTansaz, M., Bahman, M., Hajimehdipoor, H., Afrakhteh, M., Bioos, S., & Hashem-Dabaghian, F. (2018) · International Journal of Preventive Medicine · doi:10.4103/ijpvm.ijpvm_352_16 · Cited by 12
“Sleep hygiene recommendations often advise regular bed and wake‐times, which are considered to increase the synchrony between circadian rhythms, physiological sleep drive, and the nocturnal sleep period.[62] An irregular sleep‐wake pattern leads to shortening of sleep period and as a result daytime sleepiness.”
Ghante, A., Raj, J. P., Krishna, B., & Thomas, A. (2020) · Journal of Taibah University Medical Sciences · doi:10.1016/j.jtumed.2020.11.008 · Cited by 9
“Sleep hygiene can be defined as behaviours that are thought to promote better quantity and quality of sleep.(8) The literature suggests that improved sleep hygiene can decrease gestational co-morbidities and improve maternale foetal outcomes.”
BackgroundHeadache and Sleep Disturbances in the Pediatric Population
Ackley, E., Clementi, M. A., & Yonker, M. E. (2021) · Seminars in Pediatric Neurology · doi:10.1016/j.spen.2021.100924 · Cited by 9
Sleep hygiene in paramedics: What do they know, and what do they do?
Shriane, A. E., Russell, A. M. T., Ferguson, S. A., Rigney, G., & Vincent, G. E. (2023) · Sleep Health · doi:10.1016/j.sleh.2022.10.008 · Cited by 11
Countermeasures for Mitigating Fatigue in Motor Vehicle Operators
Wesensten, N. J., Balkin, T. J., & Belenky, G. L. (2015) · Reviews of Human Factors and Ergonomics · doi:10.1177/1557234x15574827 · Cited by 9
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“The location that the child sleeps should also be consistent throughout the night (Stepanski & Wyatt, 2003), and children should fall asleep on their own, which can be difficult for those with nighttime anxiety.”
BackgroundBirdsey, N. (2020) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x20000410 · Cited by 12
“The third phase of therapy therefore returned to CBT-focused anxiety management, psycho-education (Whitworth, 2016) on understanding and managing stress and sleep hygiene (Stepanski & Wyatt, 2003) and self-care (Barlow, Sturt & Hearnshaw, 2002).”
BackgroundShi, H., Nakamura, K., Shimbo, M., & Takano, T. (2005) · British Journal Of Nutrition · doi:10.1079/bjn20051494 · Cited by 9
“As it has been well established that regular exercise and sufficient sleep facilitate more effective coping with stress (Lehmer & Bentley, 1997; Stepanski & Wyatt, 2003), continued self-medication to cope with stress or to compensate for unhealthy behaviours by simply ingesting a range of…”
BackgroundFragmented sleep - fragmented mind : the role of sleep in dissociative symptoms
der Kloet, D. V. H. (2013) · Research Publications (Maastricht University) · doi:10.26481/dis.20131115dk · Cited by 9
Bu, L.-W., Ye, H.-X., Wang, D., Liu, W., Chen, D., & Fan, F. (2025) · Addictive Behaviours · doi:10.1016/j.addbeh.2025.108306 · Cited by 8
O CONHECIMENTO DA HIGIENE DO SONO NA MENOPAUSA
Vigeta, S. M. G., Ribeiro, F. M. N., Hachul, H., Tufik, S., & Haidar, M. A. (2013) · Revista de APS · doi:10.34019/1809-8363.2013.v16.15002 · Cited by 8
Han, T., Wang, W., Kuroda, Y., & Mizuno, M. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.791805 · Cited by 7
“However, inconsistent sleep may disorganize the synchrony between physiological sleep drive, circadian rhythms, and the nocturnal sleep episode (Stepanski and Wyatt, 2003), reduce wakefulness and lead to lower performance in competition.”
BackgroundEtholén, A., Pietiläinen, O. K., Kouvonen, A. M., Hänninen, M., Rahkonen, O., & Lallukka, T. M. (2022) · Journal of Aging and Health · doi:10.1177/08982643221078740 · Cited by 11
“Sleep hygiene consists of sleep-related behaviors, environmental conditions, and other factors that are important to maintain good sleep (Stepanski & Wyatt, 2003).”
BackgroundEffect of Sleep Hygiene Education on Sleep Quality in Patients With Liver Transplantation
Demir, B. (2022) · Holistic Nursing Practice · doi:10.1097/hnp.0000000000000542 · Cited by 8
Current Pharmacological and Nonpharmacological Options for the Management of Insomnia
Pigeon, W. R., Bishop, T. M., & Marcus, J. A. (2013) · Clinical Medicine Insights Therapeutics · doi:10.4137/cmt.s10239 · Cited by 8
Sleep/wake cycle of women submitted to elective gynecological surgery with a one-day hospital stay
Zaros, M. C., & Ceolim, M. F. (2008) · Revista Latino-Americana de Enfermagem · doi:10.1590/s0104-11692008000500007 · Cited by 8
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“• Adolescents who report poor sleep can be given information in schools about Sleep Hygiene as a measure to prevent the onset of chronic insomnia.”
BackgroundInfluentialHolzinger, B., Mayer, L., Levec, K., Munzinger, M.-M., & Klösch, G. (2019) · Archives of Industrial Hygiene and Toxicology · doi:10.2478/aiht-2019-70-3244 · Cited by 9
“Historically, this was done with pharmacotherapy (18) but has gradually given way to behavioural sleep medicine, which is based on behaviourism and cognitive psychology and has been successful in treating sleep disorders (19, 20).”
BackgroundMethodSuwardianto, H., & Sari, D. A. K. W. (2020) · STRADA JURNAL ILMIAH KESEHATAN · doi:10.30994/sjik.v9i1.266 · Cited by 8
“Critically ill patients understand that sleep disturbances are caused by heart rhythm disorders that they suffer, stress, and nursing actions performed (Faraklas, 2013; Stepanski & Wyatt, 2003).”
BackgroundValidity and reliability of an Arabic version of the Sleep Hygiene Index
Costa, J., Helou, S., Sleilaty, G., Costa, T., & Helou, J. E. (2021) · Sleep Medicine · doi:10.1016/j.sleep.2021.01.040 · Cited by 8
Kryger, M., & Chehata, V. J. (2021) · Topics in Spinal Cord Injury Rehabilitation · doi:10.46292/sci20-00044 · Cited by 9
Good Sleep as an Important Pillar for a Healthy Life
Moosavi-Movahedi, F., & Yousefi, R. (2021) · University of Tehran science and humanities series · doi:10.1007/978-3-030-74326-0_10 · Cited by 8
Development of an online sleep diary for physician and patient use
Blake, J., & Kerr, D. V. (2010) · Knowledge Management & E-Learning An International Journal · doi:10.34105/j.kmel.2010.02.014 · Cited by 8
“The guidelines for good sleep quality include having consistent sleep and wake times, avoiding caffeine, nicotine and alcohol before bedtime, avoiding heavy meals close to bedtime, exercise and sleeping in a darkened quiet room (Stepanski & Wyatt, 2003; The Boston Consulting Group, 2003).”
BackgroundInfluentialPrimary Insomnia: An Overview of Practical Management Using Cognitive Behavioral Techniques
Espie, C. A., & Kyle, S. D. (2009) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2009.07.009 · Cited by 8
Cvengros, J. A., & Wyatt, J. K. (2009) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2009.07.001 · Cited by 8
Self-citationLukowski, A. F., Eales, L., & Tsukerman, D. (2018) · Behavioral Medicine · doi:10.1080/08964289.2018.1509052 · Cited by 9
“by spending more time in bed reading or watching television until they become tired).(36) Because SHB is not believed to be a primary contributor to poor GSQ, research is needed to identify other possible antecedents.”
BackgroundPasquier, F., Chauvineau, M., Castellini, G., Gianola, S., Bargeri, S., Vitale, J. A., & Nédélec, M. (2024) · Journal of Thermal Biology · doi:10.1016/j.jtherbio.2024.104030 · Cited by 7
Emert, S. E., Taylor, D. J., Gartenberg, D., Schade, M. M., Roberts, D. M., Nagy, S. M., Russell, M. A., Huskey, A., Mueller, M., Gamaldo, A. A., et al. (2023) · Contemporary Clinical Trials · doi:10.1016/j.cct.2023.107275 · Cited by 11
Himelfarb, M., & Shatkin, J. P. (2024) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2023.06.008 · Cited by 7
Bennett, S., Johnston, M., Treneman‐Evans, G., Denison‐Day, J., Duffy, A., Brigden, A., Kuberka, P., Christoforou, N., Ritterband, L. M., Koh, J., et al. (2024) · JMIR Human Factors · doi:10.2196/63341 · Cited by 9
“Across the wealth of sleep hygiene literature, 3 sleep hygiene behaviors are reported as having a key impact on sleep: avoiding behavioral and cognitive arousal before bedtime, spending less time in bed, and setting a regular wake time [16].”
BackgroundPrinciples of Mental Health Intervention for Survivors of Major Disasters
Holder, N. D., Surís, A., Holliday, R. P., & North, C. S. (2017) · Psychiatric Annals · doi:10.3928/00485713-20170202-01 · Cited by 7
Sleep hygiene and the prevention of chronic insomnia
Ellis, J. G., & Allen, S. F. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-815373-4.00011-3 · Cited by 9
Does smoking impair sleep hygiene?
Görgün, D., AYDIN, Ş., & YILDIZ, B. P. (2021) · Arquivos de Neuro-Psiquiatria · doi:10.1590/0004-282x-anp-2020-0578 · Cited by 7
Fuentes-Senise, C., & García‐Corpas, J. P. (2022) · Ars Pharmaceutica (Internet) · doi:10.30827/ars.v64i1.26223 · Cited by 7
“Another of the most widely-made recommendations for achieving good SQ was to reduce stress levels before going to sleep, which is why individuals are encouraged not to do any activities that make them nervous or worried, but rather some kind of relaxing activity before going to bed(10).”
BackgroundInfluentialIntroduction to Modern Sleep Technology
Chiang, R. P., & Kang, S.-C. (2012) · International series on intelligent systems, control and automation: science and engineering · doi:10.1007/978-94-007-5470-6 · Cited by 8
Ghoul, Z. E., Pernice, F. M., Branson, J. S., & Lumley, M. A. (2025) · Journal of American College Health · doi:10.1080/07448481.2025.2464762 · Cited by 9
“Interestingly, prior studies of sleep interventions have used some form of education about sleep hygiene as their control condition; 14 however, we believe that targeting behavior change, not just information provision, is needed.”
Li, M., Yu, B., Yang, H., He, H., & Gao, R. (2025) · Journal of Clinical Nursing · doi:10.1111/jocn.17753 · Cited by 7
Irfan, B., Attarian, H. P., Irfan, M., Sankari, A., Kirschner, D. E., & Khan, M. S. (2025) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2025.102138 · Cited by 6
Mahajan, A., Mahajan, S., & Tilekar, S. D. (2021) · Journal of Aging and Physical Activity · doi:10.1123/japa.2020-0207 · Cited by 6
Begum, M., & Puchakayala, D. S. C. (2022) · Asian Journal of Medical Sciences · doi:10.3126/ajms.v13i9.46175 · Cited by 6
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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