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Regular sleep/wake schedule

Bedtime and particularly wake-up time should be the same each day, including weekends. Patients should not spend excessive time in bed.

Appropriate use of the bed

Limiting time in bed improves sleep continuity. If unable to fall sleep within 20 minutes, patients should get out of bed and return when sleepy. The bed should not be used for activities other than sleep or sex (eg, not for reading, eating, watching television, reviewing email, working on a computer, or paying bills).

Avoidance of daytime naps, except by shift workers and patients with narcolepsy

Daytime naps may aggravate sleeplessness in patients with insomnia. However, naps decrease the need for stimulants in patients with narcolepsy and improve performance in shift workers. Naps should be taken at the same time each day and limited to 30 minutes.

Regular routine before bedtime

A pattern of activities—brushing teeth, washing, setting the alarm clock—can set the mood for sleep. Bright lights and blue light (eg, with phones, televisions, computer screens) should be avoided before bedtime and during nocturnal awakenings.

Sleep-conducive environment

The bedroom should be dark, quiet, and reasonably cool; it should be used only for sleep and sexual activity. Heavy curtains or a sleep mask can eliminate light, and earplugs, fans, or white-noise devices can help eliminate disturbing noise.

Pillows

Pillows between the knees or under the waist can increase comfort. For patients with back problems, helpful positions include lying supine with a large pillow under the knees and sleeping on one side with a pillow between the knees.

Regular exercise

Exercise promotes sleep and reduces stress, but if performed in the late evening, it can stimulate the nervous system and interfere with falling asleep.

Relaxation

Stress and worry interfere with sleep. Reading or taking a warm bath before bedtime can aid relaxation. Techniques such as visual imagery, progressive muscle relaxation, and breathing exercises can be used. Patients should not watch the clock.

Avoidance of stimulants and diuretics

Drinking alcoholic or caffeinated beverages, smoking, eating caffeinated foods (eg, chocolate), and taking appetite suppressants or diuretics—especially near bedtime—should be avoided.

Bright light exposure while awake

Light exposure during the day can help rectify circadian rhythms, but if light exposure is too close to bedtime, it can interfere with sleep. Not using devices that have blue light a few hours before bedtime is recommended.