Integrative Lifestyle Medicine: Practical Sleep Hygiene Strategies for Patient Care
Chronic sleep problems can increase the risk of metabolic disorders, cardiovascular disease, mood disorders, inflammatory disorders, and cancer.1 Sleep may be disturbed by pain, uncontrolled stress, worry, medications, surgery, and poor sleeping habits. By incorporating some simple self-care techniques, patients will be better positioned to obtain restful and restorative sleep, which can aid in their rehabilitative process.
Why Is Sleep Necessary?
Sleep is essential for facilitating learning, clinically relevant functional motor tasks, immune function, tissue healing, cognitive function, and pain modulation. Optimizing sleep may also help athletes recover faster.2,3,4
The American Academy of Sleep Medicine (AASM) recommends adults should sleep seven or more hours per night regularly for optimal health.5 The AASM has separate sleep guidelines for healthy children.6
Practical Sleep Hygiene Guidelines
Sleep hygiene is a set of recommendations to help promote optimal sleep by following certain habits and guidelines.7 These simple sleep hygiene guidelines may help patients improve sleep:3,4,8
- Create a regular bedtime ritual such as washing one’s face, brushing one’s teeth, meditating, or light reading.
- Make sure the bedroom is quiet, dark, and cool.
- Make sure the bed and pillow are comfortable.
- Turn the alarm clock away from the bed, as it can be distracting and some may be tempted to keep looking at the clock.
- Use the bed for sleep and avoid using the bed for activities such as watching television, working on one’s computer, or using the phone.
- Avoid smoking as smoking is a stimulant that disturbs sleep and negatively affects many other functions.
- Avoid caffeinated foods and beverages at least three to five hours before bedtime.
- Avoid alcohol near bedtime since alcohol may fragment sleep.
- Avoid heavy meals near bedtime.
- Avoid spicy food at least two to three hours before bedtime.
- Avoid intense exercise near bedtime since it may act as a stimulant.
- Minimize stimulating mental activities before bedtime, such as emotional discussions, intense movies or books, or watching the news.
A Sample Self-Care Strategy for Sleep
The body scan is an approach to meditation “where attention is paid to different parts of the body (for example, toes, back, or head) as well as sensations (such as pain or muscle tension) in the present moment without any judgment or criticism of the moment-to-moment experience.”9,10 A simple mindfulness-based stress reduction program using a body scan meditation technique may help promote sleep.11
There are several variations of the body scan approach. This brief and adapted body scan meditation is one routine that may be used for patient care:
- Start by lying down or sitting comfortably.
- Gently close your eyes.
- Initiate slow diaphragmatic breaths or belly breathing.
- Slowly shift your attention from the outside world to your body.
- Take one deep chest breath and breath out.
- Relax with two diaphragmatic breaths.
- Bring awareness to your feet. Observe the sensations. If you notice pain or tension, acknowledge it. Then let it dissolve with two diaphragmatic breaths.
- Bring awareness to your calves. Observe the sensations. If you notice pain or tension, acknowledge it. Then let it dissolve with two diaphragmatic breaths.
- Perform the same strategy for your knees, thighs, hips, lower back, abdomen, upper back, shoulders, neck, upper arms, hands, face, and top of your head.
- Relax with two diaphragmatic breaths.
- Slowly shift your attention from inside your body to the outside world.
- Go to sleep (or open your eyes and enjoy the day).
The following resources offer additional information about incorporating sleep hygiene in your practice:
American Academy of Sleep Medicine
American Psychological Association
National Center for Complementary and Integrative Health
National Sleep Foundation
To gain a deeper understanding of how sleep influences health and how to screen for disordered sleep, as well as actionable management strategies, MedBridge instructor Dan Rhon offers the course Sleep as a Compenent of Holistic Health through MedBridge.
- Rippe, J.M. (2019). Lifestyle Medicine, 3rd edition. Boca Raton, FL: CRC Press.
- Al-Sharman, A., & Siengsukon, C. F. (2013). Sleep enhances learning of a functional motor task in young adults. Physical Therapy, 93(12), 1625–1635.
- Siengsukon, C. F., Al-Dughmi, M., & Stevens, S. (2017). Sleep health promotion: practical information for physical therapists. Physical Therapy, 97(8), 826–836.
- Vitale, K. C., Owens, R., Hopkins, S. R., & Malhotra, A. (2019). Sleep hygiene for optimizing recovery in athletes: review and recommendations. International Journal of Sports Medicine, 40(8), 535–543.
- Watson, N. F., Badr, M. S., Belenky, G., Bliwise, D. L., Buxton, O. M., Buysse, D., Dinges, D. F., Gangwisch, J., Grandner, M. A., Kushida, C., Malhotra, R. K., Martin, J. L., Patel, S. R., Quan, S. F., & Tasali, E. (2015). Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep, 38(6), 843–844.
- Paruthi, S., Brooks, L. J., D'Ambrosio, C., Hall, W. A., Kotagal, S., Lloyd, R. M., Malow, B. A., Maski, K., Nichols, C., Quan, S. F., Rosen, C. L., Troester, M. M., & Wise, M. S. (2016). Consensus statement of the American Academy of Sleep Medicine on the recommended amount of sleep for healthy children: methodology and discussion. Journal of Clinical Sleep Medicine, 12(11), 1549–1561.
- Irish, L. A., Kline, C. E., Gunn, H. E., Buysse, D. J., & Hall, M. H. (2015). The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep Medicine Reviews, 22, 23–36.
- Altug, Z. (2018). Integrative Healing: Developing Wellness in the Mind and Body. Springville, UT: Plain Sight Publishing.
- Kabat-Zinn, J. (2013). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness. New York, NY: Bantam Books.
- Fischer, D., Messner, M., & Pollatos, O. (2017). Improvement of interoceptive processes after an 8-week body scan intervention. Frontiers in Human Neuroscience, 11, 452.
- Hubbling, A., Reilly-Spong, M., Kreitzer, M. J., & Gross, C. R. (2014). How mindfulness changed my sleep: focus groups with chronic insomnia patients. BMC Complementary and Alternative Medicine, 14, 50.
