Understanding Sleep Hygiene and Mental Health

After a busy week of exhaustion and overextension, many adults look forward to regaining lost hours of sleep over the weekend. However, sleeping the day away won’t make up for more than an hour or so of lost sleep—and, it will probably make it harder to resume a normal schedule again on Monday morning.

In fact, it takes four nights to make up for one hour of lost sleep, according to a 2016 study on optimizing sleep.

Understanding sleep hygiene is a crucial part of maintaining physical health, immunity, and mental health, but making changes for a better sleep routine requires willful effort and conscious attention to one’s own needs.

It takes 4 nights to make up for 1 hour of lost sleep.

“Our society is so based in technology right now that we often ignore cues [our] bodies give us to start to wind down,” said Dr. Michele Kerulis, associate professor at Counseling@Northwestern, the Online Master of Arts in Counseling Program from The Family Institute at Northwestern University. “Most people need to develop a sleep time routine to help them engage and listen to their body a little bit more.”

Experts at the National Sleep Foundation say that sleep hygiene encompasses “a variety of different practices and habits that are necessary to have good nighttime sleep quality and full daytime alertness.” 

Sleep hygiene builds on the understanding of several clinical terms related to sleep and biological health.

Sleep deprivation (PDF, 42KB): consistent or complete lack of sleep that leads to excessive daytime sleepiness, fatigue, lack of coordination, and attention deficits.

Circadian rhythm: internal biological clock that regulates sleep cycles, productivity, and other activities for humans, animals, and other living beings.

Sleep debt: deficit built up when an individual consistently loses sleep over several days. 

Sleep disorder: clinical diagnosis of a condition that results in sleep disturbances.

The recommended amount of uninterrupted sleep for adults is between seven and nine hours per night, but an individual’s best practices are based on much more than just the amount of time they spend resting.

“Understanding how to set up your environment is conducive to good sleep,” Dr. Kerulis said. That environment includes several factors that affect the quality and duration of one’s sleep, she explained.

Factors Affecting Quality Sleep

NUTRITION

Specific types of food can affect a person’s circadian rhythm, according to a 2016 report on the effects of diet on sleep quality.

Inflammation: Foods that contain dairy, added sugar, and gluten can be disruptive to the digestive system and cause a person to wake up repeatedly at night.

Stimulants: Stimulating food and beverages like caffeine and added sugar consumed late in the day or right before bedtime can confuse the body’s digestive system and make it difficult to fall asleep.

ENVIRONMENT

In a 2012 report about sleep environments, researchers found multiple external factors that can change a person’s sleep cycle.

Temperature and humidity: Extreme temperatures or humidity can disrupt a person’s internal regulation of body temperature and create problems falling or staying asleep.

Sleeping arrangements: Sleeping in a shared or loud space can cause repeated disruptions, especially if others in the space are on different sleep schedules.

Light: The human body’s circadian rhythm is centered around the 24-hour cycle of the day. It can be thrown off if a person isn’t exposed to any natural light or is exposed to too much artificial or fluorescent light, such as from electronics.

BEHAVIOR

A person’s behavioral habits can be regulated to positively affect their sleep cycle, according to a 2017 report about sleep, exercise and other behaviors.

Exercise: Regular movement allows the body to use energy absorbed from food and can help make a person feel tired.

Napping: Excessive or sporadic sleeping throughout the day can confuse a person’s circadian rhythm and make it difficult to fall asleep at a regular bedtime.

Bedtimes: Having a routine bedtime can help a person identify and listen to bodily cues of feeling tired and better regulate the amount of sleep they get each night.

Stress: When the brain is constantly activated by stressful circumstances or thoughts, the result can be difficulty falling asleep or an increase in anxious dreams.

Adults may struggle to identify signs of poor sleep hygiene because many symptoms like irritability and trouble concentrating aren’t obvious or easy to tie to one’s sleep habits.

“There are no blood tests that can tell that you’re sleep deprived, but blood tests can give clues to other problems that might be impacting sleep,” Dr. Kerulis said. Signs of bad sleep hygiene include ignoring cues that your body is ready to wind down, including yawning, trouble with concentration, and irritability.

Additionally, getting too much sleep can yield the same results as sleep deprivation, including feeling fatigued, having difficulty concentrating, and an exacerbation of mental health issues.

The effects of poor sleep extend beyond tiredness and poor performance. Sleep disruptions have been found to alter brain chemistry, which can lead to the development of mental health disorders.

The relationship between sleep and mental health disorders is complex. Poor sleep hygiene can exacerbate symptoms of depression, anxiety, and other diagnoses, as well as the other way around. 

For people experiencing depression, overlapping symptoms between depression, insomnia, hypersomnia, and sleep apnea can make having multiple disorders difficult to diagnose. Depression and insomnia may also co-occur. 

Dr. Kerulis said the manifestation of social isolation in people with clinical depression can also further inhibit a person’s ability to identify their own poor sleep habits and ask for help with establishing new ones.

“Having someone you trust to help you get out of bed is crucial,” she said. “There are biological aspects of depression that can make someone unable to move on with their day without help.” 

Symptoms of anxiety may also be exacerbated by poor sleep hygiene. A racing mind poses a challenge for falling and staying asleep and can manifest through inconsistent sleep patterns, frequent nightmares, and excessive sleepiness during the day.

Anyone experiencing symptoms of a mental health condition should seek support from a licensed mental health counselor.

How Counselors Can Support Sleep Hygiene

• Initiate motivational interviewing about current habits and environments.
• Work with a psychiatrist to discuss medication for specific diagnoses or needs.
• Identify specific symptoms and sources of sleep deprivation.
• Implement cognitive behavioral therapy approaches to address stress and tension.
• Talk through dreams and nightmares about underlying stress and concerns.
• Provide education about healthy habits for sleep hygiene.
• Offer support with working toward goals.

“Our bodies are so unique, even though we operate on the same systems,” Dr. Kerulis said. “It’s not only understanding the science of sleep, but also understanding the individual factors that have to do with genetics, lifestyle, and personal experiences.” 

A counselor can help clients connect those factors to better understand a path forward, she said. 

Working with a counselor to identify opportunities for better sleep hygiene can help individuals move toward new habits with accountability, consistency, and safety. 

“Anyone can practice good sleep hygiene,” Dr. Kerulis said. “But the approach is going to be different for someone who works a night shift than someone who works from 9 a.m. to 5 p.m.” 

The best practices for each individual will vary, but Dr. Kerulis said several general strategies are likely to be helpful for people looking to improve their sleep routines.

“Think of your bedtime as a pre-performance routine just like in exercise,” she recommended. “It’s like a warm-up for sleeping.”

The National Institutes of Health provides specific strategies for people to get enough sleep by building healthy habits:

10 Strategies for Getting Better Sleep

1

Maintain a regular bedtime each night to reinforce circadian rhythms.

2

Avoid eating inflammatory foods that are high in added sugar or gluten right before bed.

3

Exercise earlier in the day to avoid elevated heart rate before bedtime.

4

Refrain from using digital screens one to two hours before bedtime.

5

Use do-not-disturb settings to limit tech disruptions during sleep hours.

6

Implement screen time limits on digital devices to reduce use throughout the day.

7

Seek out natural sunlight during the day—try sitting near a window or walking outside.

8

Consider reducing caffeine intake to one 8- to 12-ounce serving per day.

9

Refrain from consuming caffeinated beverages in the evening or at bedtime.

10

Document sleep routines, disruptions, and nightmares to share with a counselor.

Making individual changes to lifestyle, environmental, and physical health habits should always include consultation with a licensed mental health counselor and primary care provider.

“It is really about knowing your own body and seeing what works for you. And, of course, having your physician’s permission for exercise, nutrition and other health-related changes,” Dr. Kerulis said.

Citation for this content: Counseling@Northwestern, the Online Master of Arts in Counseling Program from The Family Institute at Northwestern University.