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Dr. Aw on Practicing Good Sleep Hygiene

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Update from Dr. Aw

April 17, 2020

I remember speaking with Medical Director, Johns Hopkins Sleep Disorders Center, Neurologist Dr. Charlene Gamaldo who told me once that “rest is a weapon” for optimal performance and health.  Sleep can be just as important as exercise, nutrition and stress management for physical and mental health.  Poor sleep has been associated with impairment in motivation, emotion, cognitive functions and increased risk for certain medical conditions like diabetes, cardiovascular diseases and cancer.  Most studies suggest that at least 7 hours of sleep a night is optimal – but of course there is some variability and we all know some individuals that seem to function on less sleep or require more sleep. It boils down to whether you feel rested in the morning. 

As we know - sleep routines are easily disrupted during stressful life stages at work and home, raising young children, worrying about aging parents, business travel, academic pursuits and the list goes on.  We also live in a 24/7 society and it is becoming a norm of modern life. Somehow – we manage on less sleep. Life must go on.  As Darwin said – it is not the strongest, most intelligent, but the ones that adapt that survive!

All patients with insomnia should first make sure that there is no existing medical condition that is causing sleep problems. Common causes are sleep apnea, chronic pain, psychological stress or mental health conditions (depression, anxiety, etc.).  Always consult your physician to rule out treatable causes. 

However – several patients suffer from poor sleep and don’t have an existing medical condition. ​​​​​​​

The first step is to practice good “sleep hygiene”:

  1. Sleep only as much as you need to feel rested.

  2. Keep a regular sleep schedule.

  3. Avoid forcing sleep.

  4. Exercise regularly – preferably 4-5 hours before bedtime.,

  5. Avoid caffeine after lunch.

  6. Avoid alcohol near bedtime.

  7. Avoid smoking – particularly at night.

  8. Don’t go to bed hungry.

  9. Avoid prolonged use of light emitting screens before bedtime.

  10. Deal with your worries before bedtime.​​​​​​​

It is best to avoid naps that are greater than 30 minutes during the day.  However – short naps (less than 30 minutes) may be beneficial for cognitive performance, alertness and mood.

Unfortunately – sleep hygiene may not be enough for some individuals. Other interventions may require engaging your personal physician or other clinicians.  Behavioural techniques include relaxation, biofeedback, stimulus control and sleep restriction. 

Relaxation therapy includes techniques such as progressively relaxing your muscles from the head down – where biofeedback may use sensors that provide you feedback to slow down breathing to release tension.  Stimulus control therapy strives to de-program patients that associate the bedroom with staying awake rather than sleeping.  Strategies may include tips such as not spending more than 20 minutes lying in bed trying to sleep and getting up to another room to read or find another relaxing activity until you feel sleepy (while avoiding activities that “reward” staying awake like eating, doing chores, watching TV, etc.).  Sleep restriction therapy involves avoiding naps and induce sleepiness by gradually decreasing the time allowed in bed per night as long as it isn’t less than five hours.

​​​​​​​Some patients benefit from cognitive therapy and/or cognitive behavioural therapy (8-10-week sessions) with a psychologist.  Phototherapy (light therapy) and chronotherapy are other techniques which try to alter the body’s “sleep clock” (circadian rhythm) by either sitting in front of a light box (30-40 minutes) or delaying sleep by 2-3 hours on successive days to make you sleep at the desired time. 

If none of these techniques work – then it may time to review the use of medications with your personal physician. However – medications is the last resort because of concerns of side effects and dependency, other treatments for insomnia have mixed evidence of benefit –
but include melatonin, acupressure, tai chi and yoga.

Sleep is complex, and one size does not fit all.  Hopefully – one of these techniques may be helpful for you.  Sweet dreams!


Johns Hopkins Medicine

Medline Plus

Canadian Sleep Society

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