Sleep Hygiene Tips: 6 Worksheets for a Healthy Night’s Rest

2:57 a.m. Another five minutes have passed, and I am still awake. Morning looms.

A third of adults in developed countries fail to get the recommended seven to nine hours of sleep each night (Walker, 2018). Its effect is catastrophic.

Not only does a lack of sleep affect mood and concentration in the short term, but over time, it increases the risks of developing Alzheimer’s disease, diabetes, and certain cancers (Walker, 2018).

Sleep may be vital to our wellbeing, but getting enough of it is not always straightforward.

And this is where sleep hygiene comes in. This article looks at the habits involved in our bedtime rituals to help us get to sleep and have a restful night.

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What Is Sleep Hygiene in Psychology? 5 Scientific Facts

In Why We Sleep, neuroscientist Matthew Walker (2018) suggests that if science announced a treatment that improved our memory, boosted our creativity, lowered food cravings, offered protection from cancer and dementia, and reduced the risk of heart disease, we would all be rushing to the doctor.

And yet, many of us are ignorant of the fact that good sleep offers us such benefits, for free.

Indeed, “not only does sleep disruption play a role in the declining mental abilities that typify Alzheimer’s disease, but getting enough sleep is one of the most important factors determining whether you will develop the condition in the future” (Walker, 2017).

It is important to note that, as with other conditions, sleep disruption is only one of several risk factors involved in Alzheimer’s disease; however, prioritizing sleep is one way to lower your risk.

So, what is sleep hygiene?

Poor habits and unsuitable environments can make it tough to fall asleep and stay asleep.

According to the UK’s Sleep Council (2020), “you have no control over what happens when you sleep, but you can control what you do throughout the day to prepare for a better night’s sleep.”

So, can we learn to sleep better? According to research, yes.

Charles Czeisler from the Division of Sleep Medicine at Harvard University says there are three points you need to consider: “how much you sleep, how well, and when,” impacted by the following factors (O’Callaghan, 2016):

• Familiarity
  When we sleep in unfamiliar places, one hemisphere of our brain remains active. This night watch has developed to keep us safe in uncertain environments.
• Noises
  Even if we are sleeping at home, noises can force us out of our deep sleep (a dog barking or a distant house alarm).
• Temperature
  Our body temperature can significantly affect the quality and quantity of our sleep. Surprisingly, special sleep suits that slightly warm the skin (or taking a hot bath before bed) help the body release heat, reduce the number of nighttime awakenings, and increase restorative slow-wave sleep.
• Timing
  Your circadian rhythm (tied to your mammalian biological clock) affects the amount of rapid eye movement (REM) sleep you get. Getting up too early means you miss out on later, longer REM sleep cycles.
• Blue light
  The light emitted from our phones and tablets when we use them late at night shifts our circadian rhythms. REM cycles start later, and we are less likely to reach extended REM sleep cycles.

According to Walker (2018), almost 10 million Americans per month take something to help them sleep. And yet, sleeping pills do not provide natural sleep, and they “can damage health, and increase the risk of life-threatening diseases” (Walker, 2018).

Sleeping pills work by knocking out higher regions of the brain’s cortex, resulting in a lack of the largest and deepest brainwaves. The result is a catalog of possible side effects during the day, including forgetfulness, daytime grogginess, and slowed reactions.

Where possible, therapists and mental health practitioners should promote good practices that result in a more natural night’s sleep (Walker, 2018).

How to Maintain Good Sleeping Habits: 10 Strategies

There are several relatively straightforward habits and techniques, known as sleep hygiene practices, that promote a better night’s sleep (Walker, 2018; National Institute on Aging, 2020):

• Maintain a regular sleep schedule.
  Aim for consistency when you go to bed and get up, even during the weekend.
• Avoid napping in the late afternoon.
  While it may be necessary for those with prolonged sleep deficits, for others, it can disrupt sleep.
• Create a bedtime routine.
  A soak in the bath, relaxing music, or a book before bedtime can set the scene for sleep.
• Avoid phones, tablets, and TV immediately before bed.
  The light from digital sources can damage your sleep and overstimulate your brain.
• Find the right temperature.
  Your bedroom should be neither too hot nor too cold, and where possible, quiet.
• Lower the light.
  Reduce the lighting as you prepare for bed.
• Avoid late-night exercise.
  Do not exercise in the three hours before going to sleep.
• Avoid big meals late in the evening.
  Eat earlier in the evening.
• Time your caffeine.
  Caffeine (found in coffee, tea, chocolate, and soda) can make it more difficult to get to sleep and stay asleep.
• Reduce alcohol consumption.
  Contrary to what many of us think, alcohol negatively affects our sleep quality.

According to Walker (2018), if you only adopt one of the above good habits, make it “going to bed and waking up at the same time of day” no matter what.

3 Helpful Handouts, Checklists, and Worksheets (PDFs)

The following handouts help you to look at the environment, habits, and practices surrounding your sleep routine.

Sleep Hygiene Checklist and Actions

Use the Sleep Hygiene Checklist and Actions worksheet to assess your bedroom environment and identify what can be improved to encourage a good night’s sleep.

Consider your bedroom and what it needs to be more sleep friendly. Accept that you have a duty to care for yourself. Self-care is not selfish.

Two-Week Sleep Diary

Keeping track of sleeping habits can be a useful way to identify factors that may interfere with your sleep.

Complete the Two-Week Sleep Diary over the next 14 days. Look for patterns based on how you are sleeping, the time you went to bed, alcohol and caffeine intake, etc.

Try to identify what may interrupt your sleep. Make one positive change at a time, continue for a week, and observe the results.

Bed Checklist

With up to a third of our lives spent in bed, it should be as comfortable as possible.

Sleeping on a supportive, good-quality bed can be the difference between a refreshing night’s sleep and waking up tired and aching.

Ask yourself the questions in the Bed Checklist to identify if your bed contributes to your poor night’s sleep and may need replacing.

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8 Activities That Help Improve Sleep Hygiene

There are several activities throughout the day that can positively impact your sleep:

Mental tricks

Some people find that playing mental tricks can make them sleepy.

Try gently counting back from 100.

Or, if you prefer, reflect on the following three points based on the day’s events:

• Three things you enjoyed the most
• Three actions you performed well
• Three things you learned in the last 24 hours

This reflection activity will remind you that the day was valuable and contained positive events and memories.

Adequate sunlight exposure

Many of us work indoors in artificial light (especially in the winter) with limited sunlight exposure. And yet, “daylight is key to regulating daily sleep patterns” (Walker, 2018).

Try to get outside for at least 30 minutes each day to increase your time in natural light.

Smells and sounds

Try calming sounds and smells to see if they help you sleep and leave you feeling more rested in the morning.

When researchers played natural sounds such as a waterfall or gentle waves (known as pink noise) to sleeping participants, their sleep quality and learning improved (Ngo, Martinetz, Born, & Mölle, 2013).

Smells can also stimulate the brain overnight. Participants exposed to lavender while they slept experienced increased slow-wave sleep and reported feeling more invigorated on waking (Goel, Kim, & Lao, 2005).

Treating sleep apnea

Sleep apnea occurs when people have momentary pauses in their breathing during sleep. This can occur throughout the night, and if left untreated, can be linked to high blood pressure, memory loss, and even strokes (National Institute on Aging, 2020).

If you are experiencing tiredness during the day and snoring loudly at night, it is worth seeking help from a specialist.

Seeking help for sleep disorders

It’s useful to be aware of some more unusual behaviors humans exhibit during sleep, as they can affect sleep quality.

If you are experiencing any of the following (or other phenomena not mentioned) and it is damaging your sleep, it may be useful to seek expert advice (Lange, 2016):

• Sleep paralysis
  During REM sleep, our body naturally becomes temporarily paralyzed to avoid excessive movement.

However, some individuals find that this paralysis can, terrifyingly, continue for a few moments when they wake, sometimes accompanied by pressure to the chest.

• Hypnagogic jerks
  While not fully understood by science, it is not uncommon to twitch or experience a sense of falling as you drift into sleep. This often results in a sudden awakening. If it is only occasional, this is unlikely to need further attention.
• REM sleep disorder
  Talking, shouting, or even hitting your partner during sleep can be upsetting and potentially harmful for you both. It can happen during bad dreams when the body has not been fully paralyzed.
• Exploding head syndrome (not as bad as it sounds)
  This affects 1 in 10 of us from the age of 50. As we drop off, we hear a loud bang (like a gunshot) waking us up. It may be because of physical changes to the middle ear associated with aging.

Handling nightmares

Recurring nightmares or bad dreams can be very upsetting and are not uncommon. Indeed, 6% of adults describe having monthly nightmares (Centre for Clinical Interventions, 2020).

When woken by a disturbing dream, it’s difficult to return to sleep. If happening over a prolonged period, it can be harmful to your rest.

Pushing away the images is natural but unhelpful.

Imagery rescripting – closing our eyes and working through the images and narrative in our minds – can help us regain a sense of control by rewriting what happens. It could be (possibly with the help of a sleep therapist) that you rescript the end of a car chase into something less spectacular or with a different ending.

Overcoming insomnia

Insomnia is the medical term for persistent problems with sleep that can last for more than a month involving one or more of the following (Centre for Clinical Interventions, 2020):

• Difficulty getting asleep (onset insomnia)
• Waking during the night (middle insomnia)
• Poor sleep quality

While insomnia may begin in response to stress, pain, or other factors, negative thoughts about sleep can perpetuate the problem.

• Assuming the worst
  Losing confidence in the ability to sleep
• Blaming everything on sleep
  Blaming everything that goes wrong during the day on a lack of sleep
• Unrealistic expectations
  Believing everyone has the same sleep pattern
• Unhelpful thinking styles
  Catastrophizing, overgeneralizing, and black-and-white thinking can suggest sleep is always either ‘great’ or ‘awful.’

A Thought Diary can be a valuable tool for challenging negative thinking and inaccurate beliefs.

Sleep restriction

Cognitive-behavioral therapy for insomnia was developed to provide patients with a “bespoke set of techniques intended to break bad sleep habits and address anxieties” (Walker, 2018).

One of the surprisingly successful techniques for improving sleep quality is to restrict time spent in bed. By doing so, it encourages the patient to form a stronger connection between their time in it and sleep.

The aim is to limit the number of hours spent in bed to the typical number of hours asleep, known as the sleep window.

When we are sleeping poorly, we often spend too much time in bed, despite not being asleep. Restricting time can resynchronize natural sleep cycles.

Use the Sleep Restriction worksheet to calculate the sleep time needed.

Under increasing sleep pressure, the patient will, over time, gain more psychological confidence in “being able to self-generate and sustain healthy, rapid, and sound sleep, night after night” (Walker, 2018).

As that confidence increases, it will be possible to increase time in bed gradually.

Assessing Sleep Patterns: 2 Quizzes & Questionnaires

The following two quizzes can help you identify if you are taking your lack of sleep seriously and to what degree you are sleep deprived.

Sleep Quiz

It’s useful to understand if you are giving sleep the priority it deserves.

Take the following Sleep Quiz.

If you are answering Yes to multiple questions, you are possibly not putting your sleep first.

Consider what actions you need to take to ensure that getting sufficient, good-quality sleep receives appropriate focus daily.

Are You Sleep Deprived?

Use the Are You Sleep Deprived? Quiz to identify if you have a sleep problem.

If you have answered true several times, then review the handouts and activities to see how you can improve your sleep hygiene.

5 Techniques for Sleep Therapy & Education

There are several excellent sleep resources available online for free. They describe our current understanding of sleep, disorders, and techniques that can help.

• National Sleep Foundation’s Website
• Centre for Clinical Interventions
• The Sleep Charity
• American Sleep Apnea Association
• National Sleep Federation

For prolonged sleeping disorders, it may be advisable to seek expert help. Lack of sleep has health risks and affects judgment and skills in driving and operating machinery, etc.

Top 3 Apps to Sleep Better at Night

There are many apps that can help you reach a state of calm and encourage a good night’s sleep.

Three of our favorites include the following:

Calm

A hugely popular app for reducing stress and anxiety and improving sleep quality.

Find the app in the Google Play Store.
Find the app in the Apple App Store.

Sleep Sounds – Sleep melodies & Calming sounds

An excellent app that can help you relax and fall asleep to sounds from nature and other meditation sounds.

Find the app in the Google Play Store.

Endel

Creates personalized soundscapes to help you relax, focus, or sleep. Purports to align with your circadian rhythms based on health data available on your phone.

Find the app in the Google Play Store.
Find the app in the Apple App Store.

3 Best Books on the Topic

The following books are three of our favorites on the subject of sleep.

1. Why We Sleep: Unlocking the Power of Sleep and Dreams – Matthew Walker, PhD

This insightful and engaging book by neuroscientist Matthew Walker (2018) uncovers the reasons behind why we sleep and dream, and what happens when things go wrong.

Besides incorporating decades of learning, it brings the reader up to date with the latest research in this fascinating subject.

Find the book on Amazon.

2. The Sleep Solution: Why Your Sleep is Broken and How to Fix It – W. Chris Winter, MD

Use the latest lessons from sleep science along with more traditional techniques to achieve a healthy night’s sleep with no medication.

Importantly, neurologist W. Chris Winter (2018) encourages the reader to develop a personalized approach to sleep that fits their lifestyle.

Find the book on Amazon.

3. Say Good Night to Insomnia: The Six-Week Drug-Free Program Developed by Harvard Medical School – Gregg D. Jacobs and Herbert Benson

The author’s program, developed at Harvard Medical School and based on CBT, promises to improve sleep in 80% of patients.

Try out some of the science-backed techniques to overcome insomnia without the use of sleeping pills.

Find the book on Amazon.

PositivePsychology.com’s Helpful Resources

We have many worksheets and tools to relax your body and mind before attempting a good night’s sleep:

• Noodle Caboodle
  This excellent script is a fun way to help children relax their muscles, relieving nerves and anxiety.
• Progressive Muscle Relaxation (PMR)
  This particular PMR is highly effective for promoting relaxation in younger children and targeting tension in their body.
• ACT Defusion Metaphors
  Negative thoughts can leave us stressed and have the potential to keep us awake at night. This worksheet uses helpful questions to handle unhelpful thoughts.
• Square Breathing
  Square breathing is a powerful way to find relaxation in times of emotional distress and a valuable tool for becoming calmer.

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A Take-Home Message

A regular good night’s sleep will not only make you feel and perform better, but it could also help you live longer. Science is clear. Low-quality sleep long term is hugely damaging to our mental and physical wellbeing (Walker, 2018).

We do not need to accept a poor night’s sleep. We can take practical steps to put in place appropriate sleep hygiene – habits that ready our mind and body for falling asleep.

We can begin by looking at our environment. How does our bedroom look, sound, feel, smell? And what are our worries? If sleep itself is causing concern, we can manage it by only getting in bed when the weight of tiredness means staying awake is no longer an option.

Gaining confidence in our ability to drift off and our capacity to stay asleep can remove some blocks to getting a good night’s rest.

Try out our handouts, including the checklists. Gain a better understanding of what may be getting in the way of your sleep and try out the techniques to restore regular, practical sleep hygiene.

We hope you enjoyed reading this article. Don’t forget to download our Positive Psychology Exercises for free.