Merck Manual

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Changes in Behavior to Improve Sleep

Changes in Behavior to Improve Sleep

What to Do

How to Do It

Follow a regular sleep-wake schedule

People should go to bed at the same time each night and, more importantly, get up at the same time each morning, even on weekends and vacations. People should not spend too much time in bed.

Follow a regular routine before bedtime

A regular pattern of activities—such as listening to soft music, brushing the teeth, washing the face, and setting the alarm clock—can set the mood for sleep. This routine should be followed every night, at home or away. As part of this routine, people should avoid bright lights before bedtime.

Make the environment conducive to sleep

The bedroom should be kept dark, quiet, and not too warm or too cold. Loud noises can disturb sleep even when people are not awakened by them. Wearing ear plugs, using a white-noise machine or a fan, or installing heavy curtains in the bedroom (to block out outside noises and light) can help. Wearing a mask over the eyes can help people who must sleep during daylight in a room that cannot be completely darkened. If people wake up during the night, they should avoid bright lights.

Use pillows

Pillows between the knees or under the waist can make some people more comfortable. For people with back problems, lying on the side with a large pillow between the knees or lying on the back with a large pillow under the knees may help.

Use the bed primarily for sleeping

The bed should be used for sleep and sex. It should not be used for eating, reading, watching television, paying bills, or other activities associated with being awake.

Get up

When people are unable to fall asleep within 20 minutes, getting up and doing something else in another room and coming back to bed when sleepy may be more effective than lying in bed and trying harder and harder to fall asleep.

Exercise regularly

Exercise can help people fall asleep naturally. However, exercise within 5 hours of bedtime can stimulate the heart and brain and keep people awake.

Relax

Stress and worry interfere with sleep. People who are not sleepy at bedtime can relax by reading or taking a warm bath. Relaxation techniques, such as visual imagery, progressive muscle relaxation, and breathing exercises, can be used. People can aim to leave their problems at the bedroom door. Scheduling a worry time during the day to think about concerns can diminish the need to worry at bedtime.

Avoid stimulating activity before bedtime

Watching exciting television shows, playing thrilling computer games, or dealing with complicated work-related matters during the hour or so before bedtime can make sleeping difficult.

Avoid substances that interfere with sleep

Food and beverages that contain alcohol or caffeine (such as coffee, tea, cola drinks, and chocolate) can interfere with sleep, as can appetite suppressants, diuretics, and nicotine (in cigarettes and nicotine patches). Caffeinated substances should not be consumed within 12 hours of bedtime. Drinking a large amount of alcohol in the evening causes early morning awakenings. Quitting smoking may help.

Eat a light snack if hungry

Hunger can interfere with going to sleep. Occasionally eating a light snack, especially if warm, can help, unless a person has gastroesophageal reflux. However, people should aim to stop eating at least a few hours before bedtime and not eat any meals, especially heavy meals, near bedtime. Heavy meals may cause heartburn, which can interfere with sleep.

Eliminate behaviors that provoke anxiety

People can turn the clock away so that time is not a focus. They should not watch the clock while they are in bed.

Spend time in bright light during the day

Exposure to light during the day can help people readjust their sleep-wake schedule to be in sync with the earth’s cycle of light and dark.

Avoid daytime naps, except for shift workers and people with narcolepsy

Daytime naps may interfere with sleeping at night in people with insomnia. However, naps reduce the need for drugs in people with narcolepsy and improve performance in shift workers. If needed, naps should be taken at the same time each day and limited to 30 minutes.