Sleep hygiene: which sleep tips actually work?

What is sleep hygiene?

A set of habits and bedroom conditions meant to make good sleep more likely. The NHS version includes a regular schedule, an hour of winding down, a dark and quiet bedroom, regular daytime exercise, no caffeine, alcohol or smoking for 6 hours before bed, no big late meals and no screens right before bed.

Do the individual tips work?

Mostly, a little. A 2015 review looked at the research behind each common tip. It found that studies generally support links between sleep and caffeine, alcohol, nicotine, exercise, noise and regular timing. Our own pages go through the main ones:

• Caffeine: strong evidence that it delays and shortens sleep.
• Alcohol: strong evidence that it disrupts the second half of the night.
• Exercise: modest benefits.
• Bedroom temperature: heat increases waking.
• Screens: effects are real in the lab but smaller in everyday life than often claimed.
• Naps: short naps help alertness; long late ones can hurt night sleep.

So why do we grade sleep hygiene “none”?

Because we are grading the claim people usually make: that following sleep hygiene rules treats insomnia. In trials of people with chronic insomnia, sleep hygiene education on its own produces little improvement, and the American Academy of Sleep Medicine’s 2021 guideline suggests clinicians don’t use it as a single treatment. The same review that found support for individual tips found the evidence for whole sleep hygiene programmes much weaker.

The reason is that long-term insomnia usually isn’t caused by an evening coffee. It is kept going by things that build up after a run of bad nights: spending longer in bed to catch up, lying awake worrying about sleep, napping, and the bed becoming linked with being awake. Sleep hygiene doesn’t tackle those. CBT for insomnia does, and in a review of 20 trials it helped people fall asleep about 19 minutes faster and spend about 26 minutes less awake in the night.

Which tips matter most if you sleep badly?

These come from CBT for insomnia and have the best evidence:

1. Fixed wake time, every day, regardless of how you slept.
2. Bed only when sleepy, not just tired or because it is bedtime.
3. Get up if you can’t sleep for what feels like 20 minutes, and return when sleepy.
4. Use the bed for sleep and sex only.
5. No catching up: avoid lie-ins and long naps after a bad night.

These can feel hard at first, because they may mean less time in bed for a while, but they build sleep pressure and retrain the link between bed and sleep. If you try them for a few weeks without improvement, ask your GP about CBT for insomnia, which is available free on the NHS in many areas as the Sleepio app.