Sleep Hygiene/Dissenting Opinion

[49er]

As one who thinks that sleep hygiene advice is greatly overused by doctors when there are underlying issues that haven't been addressed, I had trouble writing a coherent argument. But fortunately, I found this great blog entry by Gayle Greene, who wrote the Insomniac, as someone who has dealt with insomnia her whole life. As an aside, it is a great read as she went inside the sleep industry to get alot of great information.

Anyway, she agrees with the advice on caffeine, alcohol and limited big meals in the evening. But regarding the rest of the standard advice, she feels it is too much of a one size fits all solution.

I loved this comment regarding the standard advice regarding going to bed and getting up at the same time:

""Experts tell us we should adhere to a regular sleep schedule, get up at the same time every day to an alarm, even if we haven’t slept enough. Sorry, there is no way I will sacrifice sleep to regularity. Sleep is such a shy and fleeting presence in my life, and is so essential to my mood and functioning, that, no, I won’t scare it away with an alarm. So my schedule sometimes drifts way late. But I’m an academic, I get to schedule classes late in the day. If your work allows it, if you’re retired or a student or self-employed, why feel you have to march to the world’s time? True, you don’t want to drift entirely out of synch with the world. But people in the not so distant past, as recently as the nineteenth century, slept in segments, and people in traditional cultures today drift in and out of sleep more fluidly than we do. The consolidated 8-hour block may actually be an artifact of industrialization and artificial lightning.""

More at the link:

http://sleepstarved.org/2010/02/02/how- ... e-experts/

49er

[mollete]

Experts tell us we should adhere to a regular sleep schedule, get up at the same time every day to an alarm, even if we haven’t slept enough. Sorry, there is no way I will sacrifice sleep to regularity. Sleep is such a shy and fleeting presence in my life, and is so essential to my mood and functioning, that, no, I won’t scare it away with an alarm.

I would respectfully submit that if someone is waking up to an alarm every day that they are not practicing good sleep hygiene, as that would certainly suggest they are building a sleep deficit.

I would like to see her reference on the "expert" who told her that. "IMHO", a blaring alarm in the middle of Final REM is a great way to pretty much guarantee that you'll be in a state of high anxiety for at least a couple hours.

Simply, it sounds like this person's bedtime is too late.

[mollete]

That said, if her lifestyle offers her the luxury of being able to freewheel, then fine, but that takes the argument out of context.

[snuginarug]

I have been having insomnia problems for maybe ten years. My sleep doc gave me the standard sleep hygiene lecture. I adhered to his advice and came close to being hospitalized for a hypomanic bipolar episode caused by lack of sleep. From then on, I have followed the advice of my psychiatrist, who says a minimum of 6 hours is necessary for me, whether by nap during the day or by night time sleep. She does say a consistent bedtime is a good idea, but the 6 hour minimum trumps all. The sleep doc knew I was bipolar and gave me this horrible advice because it is a knee jerk canned response on the part of lazy and/or uneducated doctors. One size fits all doesn't work in this case any more than it does in other realms. I get sick of hearing about sleep hygiene. My bipolar interferes with my ability to sleep. Period. All the sleep hygiene in the world will never fix that. Following sensible practices such as limiting stimulants like caffeine and getting enough exercise helps, but I feel like the psychological stuff is nonsense. At least in my case it was nonsense. I can't speak for others.

[zoocrewphoto]

As a severe night owl. (clincial term is delayed sleep phase syndrome), I do not get to bed at an early time (unless you count early in the morning). Going to bed early is NOT an option. When I try, I do not sleep. I am restless, bored, and irritated. If a attempt to sleep early when not sleepy, then I end up falling asleep later than I would have had I just waited until I was tired enough to sleep.

If I do not have to go to work or something else, then I sleep until I am ready to get up. I do try to get at least 7 hours of sleep. But I would rather have 6 good hours than be in bed for 8 hours and only get 4 or 5.

I get up for work at 1:09 pm. That is the last time that allows me to get ready for work on time. I start work at 2:30pm. If I go to bed by 6am, I can get 7 hours of sleep. I try to get to bed by 5am if I can. Some nights, I do get to bed by 3 or 4am, but that is more rare. It is currently 4:43 am, and I probably won't get to bed until 6am. But I don't have to work tomorrow or go anywhere, so I will probably get up between 2 and 3pm. I won't be setting my alarm.

I will NOT sacrifice sleep for a sleep hygiene schedule. As I said going to bed early does not equal more sleep. And cutting it off early the next day doesn't do me any favors. So, I have to have a good reason to get up early. I have also been told to get up and exercise before work. Um, get up early and give up sleep so that I can exercise? Hell no. I can exercise in the evening (or late night for you normal people). I gave up trying to live on other people's schedule years ago, and I feel much better this way.

I also do other things that are against the sleep hygiene rules. I sleep with the tv on. If I don't I lay awake for a long time, unable to sleep, thinking about stuff. If I have the tv on, I doze off quickly. Every now and then, I try to sleep without the tv, and I toss and turn all night.

No reading, watching tv, etc in bed. Or doing non sleep things in the bedroom. Doesn't work for me. I share a house. My bedroom is also my office. Computer work and projects are mostly done in my bedroom. And I do watch tv in my bed. Otherwise I have to sit at the computer. I also use the computer right before bed. I used to drink caffiene right before bed too. I quit caffiene about 7 months ago. I didn't notice any obvious changes, but I was hoping it would help my blood pressure go down a little.

I do have a clock visible from the bed. I have to. Not being able to see a clock means I will constantly be worried that I am late for work. With a clock, I can look and go back to sleep, content that I am fine.

I probably break a few other rules too, but I can't think of them.

[Sheriff Buford]

Thanks for the post, 49er. It has great points to ponder. If I'm working a case, sleep is on bottom of the priority list, especially if my inner-self tells me to keep going (the old hound dog in me.... "I'm coming for you"). I'll track a guy down for days and maybe catch a few zzz's in a car. Once I nab him, my boss will let me re-charge. I keep my back up machine (Resmed Escape) at the station for when I need it there. I'm an old fart and I'm fixin' to retire. Hopefully I'll be able to get regular sleep. My body won't know what happened to it.

Sheriff

[Madalot]

I have a similar problem in that if I try to go to sleep, say at a set time each night, but I am not feeling sleepy, I toss and turn, get irritated AND frequently have issues on the Trilogy. I find that waiting until I am dozing off (but I have to already be in bed either watching tv, reading or something) is the best way for me and I fall asleep within 5-10 minutes.

Sometimes I'm dozing off at 11:00. Sometimes it's 12:30. Once in a while, I am so tired I don't care that I'm not dozing off and lay down at 10:00 and fall asleep within 15-20 minutes (instead of 5-10 if I'm dozing off).

I get up at 6:15 on school mornings (my son is a Junior in high school and I feel a "motherly" responsibility to get up with him). It makes no difference what time I went to sleep the night before -- school mornings it's 6:15.

Weekends, it just depends. If the situation allows and I'm tired enough, I occasionally sleep in until 10:00 (and you never know what time I went to bed -- could have been anywhere from 10:00 - 1:00). But sometimes I wake up on the weekends and feel rested enough -- and get up at 7:30 -8:00.

I'm all over the map -- doing what I have to do for family obligations and trying to listen to what my body needs and wants.

[chunkyfrog]

I'm hoping for a bit of schedule leniency after I retire.
Will it be a good thing, or not? I suppose it's up to me.

[quietmorning]

I honestly think you should sleep the way you were raised to sleep.

I was raised with a very strict sleep schedule - my father was a Marine. My children were raised with a very strict sleep schedule, I was a single parent.

My husband was raised with a very very lax sleep schedule.

He does NOT do well on my strict schedule. He gets up when he's ready and goes to sleep when he's ready.

Me? I'm DONE by ten, and I'm up at the crack of dawn. I don't need an alarm as I've been conditioned so well to get up at a specific time, I just wake up at that time.

My husband? If he tries to follow a specific sleep schedule, he's really sleep deprived by the fourth day.

I think doctors and sleep scientists discount that our brains were also molded by our environments - and once an adult, that mold is ceramic in a lot of different ways.

[cosmo]

Sleep hygiene orders were probably an assessment Seeing how well discipline and how much effort should they put in your care

If the doctors want you to try to go to bed everyday at the same time, why not try it out for weeks or months? What is the cure for insomnia again? Not really much of one.

I see no problems with them trying to keep you off of meds.

[Sir NoddinOff]

Sorry, there is no way I will sacrifice sleep to regularity. Sleep is such a shy and fleeting presence in my life, and is so essential to my mood and functioning, that, no, I won’t scare it away with an alarm. So my schedule sometimes drifts way late. But I’m an academic, I get to schedule classes late in the day. If your work allows it, if you’re retired or a student or self-employed, why feel you have to march to the world’s time? 49er

I agree in part with this post, however with one caveat, that is that general sleep hygiene guidelines may work nicely for many people - unfortunately I'm not one of them. My bugaboo is when somebody tells me not to read in bed because it's bad for sleep. The reason they give is that your bed is only for sleeping and sex. BTW, why does sex get an exemption? Probably cuz it's not cool to get it on in the living room, kitchen etc Anyway, I tend to fall asleep better if I read myself to sleep. Sometimes it takes fifteen minutes, sometimes an hour or two. Full disclosure: I am retired so I do have some choice as to when to get up and when to go to sleep. IMO, a person needs to find what works for them. A light snack; a glass of warm milk; mild exercise; reading in bed... you name it. It's your life after all.

[zoocrewphoto]

I honestly think you should sleep the way you were raised to sleep.


I think doctors and sleep scientists discount that our brains were also molded by our environments - and once an adult, that mold is ceramic in a lot of different ways.

It makes sense, but for some odd reason, my sleep pattern changed drastically around age 18. I was a morning person as a kid. My mom said I would get up around 5am and go around the house singing.

In high school, I signed up for zero hour class that started an hour early. In college, I signed up for a 7am class. During that first year in college, I started staying up later and later. I just couldn't get to sleep. I don't know when the morning function quit, but within a few years, mornings were not good anymore.

I did learning that fighting with myself was useless and harmful.

[Janknitz]

I would respectfully submit that if someone is waking up to an alarm every day that they are not practicing good sleep hygiene, as that would certainly suggest they are building a sleep deficit.

I think that's a generality, too. I've been a night owl since the day I was born. I too grew up in a military household with a strict bedtime, and I just spent hours playing VERY quietly with my stuffed animals or reading under the covers with a flash light, often until long past when my parents went to bed. They thought I was asleep that whole time. Even now as an adult it's hard to settle down to sleep no matter what I do (although the CPAP treatment has GREATLY reduced my sleep latency once I settle down to bed and reduced my middle of the night wakenings where I couldn't get back to sleep for hours pre-CPAP). If left to my own devices, I'd go to sleep around 2 a.m. and wake around 10, but that's not possible with kids to get to school and a job to go to.

My point is, that I'm not so good in the sleep hygiene department. I aim to go to bed around 11 and usually it's more like 12:30 or 1 a.m. I don't get enough sleep and I know it. But now on CPAP I routinely wake BEFORE my alarm, calmly, comfortably, and enjoy the last 20 minutes or so of lying in bed with cool, comforting air from the machine, slowly waking up to the day. So waking calmly, peacefully, before the alarm (which I use to remind myself I MUST get out of bed at that point) is not necessarily an indicator of good sleep hygiene, but--in my case, at least, it is a good indicator of effective CPAP treatment.

[Madalot]

The whole argument about NOT watching TV, reading, etc., in bed just isn't realistic for someone like me. I get so physically exhausted by 7:00 or 8:00, but am not ready to sleep. My BODY has had enough and simply cannot move anymore. I try to stay in my recliner, in the family room with my husband, until at least 9:00. Then I head toward the bedroom, dropping my wheelchair off in a second family room to charge overnight and grab my rollator, get undressed, brush my teeth, wash my face -- and make my way into bed and struggle to get in and get settled.

By the time I've done that, I'm WIDE AWAKE. My body cannot function anymore to move around, so I sit in bed and watch TV, read or play Words with Friends on the Kindle. And I continue entertaining myself until I get sleepy enough that I can fall asleep without tossing and turning and getting irritated.

That takes anywhere from say 9:15 to 11:00 - 1:00. And those hours I AM laying in bed, but NOT sleeping.

[Drowsy Dancer]

I became interested in this topic last May, and the results of my experiments are reported here:

viewtopic.php?f=1&t=78127&st=0&sk=t&sd=a

I concluded that the advice to get up at the same time every day can be helpful to a person like me who has difficulty forcing myself to go to bed. Getting up late tends to prompt staying up late, etc. NONE of my comments are directed to anyone with delayed sleep phases, those with mood disorders, etc., just commenting on my own garden variety "schedule drift." (I sometimes wonder if my body's clock isn't set to a 25-hour day.)

In a way, the needs of my body seem opposed to those of my brain. My body seems to thrive on regularity and predictability, but my brain craves variety and surprise. When I want to look up that last article on the Internet, or play one more round of Assassin's Creed III multiplayer, it seems less important that, in the abstract, going to bed earlier and getting up at the same time are better for me.

I no longer keep to a rigidly strict wake-up time, but I felt pretty good when I did. Can't say for sure that the wake-up was the sole variable driving this.