There seems to be a disconnect between how people are actually sleeping and sleep science.
From 2004 to 2017 a study found that one-third of adults in the United States got less than seven hours of sleep, and more than half report being sleepy during the day. Recent reports also show that 56% of us suffered from sleep problems in 2021, and in a survey of 10 countries worldwide, nearly a third of participants were classified as having insomnia. Poor sleep and its negative associations, including depression, disability, and metabolic disorders, are on the rise.
However, also in 2021 more than 90,000 scientific studies contained “sleep” in the title, and researchers are working vigorously to better understand the impact of sleep in our lives. The bottom line is, too many people aren’t sleeping well and their mental and physical health are deeply suffering.
Despite these trends, we continue to depend on sleep hygiene as a common treatment even though sleep hygiene doesn’t get to the root of sleep issues. The term sleep hygiene dates back to the 1890s but was redefined as we know it today in the 1970s by Dr. Peter Hauri. His original 10 rules contain scientifically credible practices (e.g., cool room temperature, limiting light and alcohol), however, the issue lies in the implementation and feelings sleep hygiene evokes.
Why Doesn’t Sleep Hygiene Work?
Changing our health is complicated, and there is often a gap between knowing what is best and doing it, and sleep hygiene is no exception. Several studies have found that sleep hygiene as a standalone treatment does not work. Overall, sleep hygiene education may help improve awareness of poor sleep habits but ultimately it does not change our behaviors. Sleep hygiene likely fails because it does not explain why strategies may work. People often benefit from understanding why things work to increase motivation.
Additionally, the sequence of sleep strategies matters, and sleep hygiene tools need to be individualized. For example, we know that a fixed wake time, light exposure and not going to bed until you are sleepy are among the most successful strategies to improve sleep, but sleep hygiene is not always delivered that way, nor may people need to do all of them.
Sleepy Hygiene’s Limitations
The term sleep hygiene may have a negative impact. It has moral connotations that are unlikely to facilitate change. If someone is not engaging in sleep hygiene, does it mean they forgot to shower or are they a dirty sleeper?! Using a word like hygiene that has heavy social implications does not help, and it is more likely to make someone feel shame instead of getting on a path to better sleep and well-being.
Julie Flygare, a sleep health advocate and CEO of Project Sleep, put it best when she stated, “...we know that moralizing behavior (bad vs. good habits) is not helpful for actual behavior change. We should stop sleep-shaming people.”
The term sleep hygiene overlooks and discounts certain health disparities and inequities, for instance, the ability to control temperature, noise, and light, which is a privilege. Research is starting to delve into findings that minority populations are more likely to experience poor sleep, more significant daytime sleepiness, and an overall higher prevalence of sleep disorders compared to those in a higher socioeconomic status.
When sleep hygiene tips are provided to people already at risk of having poor sleep, it could unintentionally lead to feelings of blame and added stress, and could contribute to the inability to improve their sleep when the driving forces are not fully controllable. There are modifications and interventions available that need to be continually tailored and go beyond the standard sleep hygiene handout.
To add to the sleep hygiene conundrum, when sleep hygiene recommendations are the standard front-line treatment for all fatigue and sleeplessness, it can overlook other sleep issues. Sleep apnea, restless leg syndrome, and narcolepsy are on the rise. People with poor sleep or excessive daytime fatigue may receive sleep hygiene guidelines, leaving the actual root cause of their issues unattended.
The effects of poor sleep are not confined to the nighttime and clearly have significant impacts on our daytime mood, energy, concentration, functioning, and circadian regulation. To achieve the overall benefits of sleep we need different parameters.
Leaning into Sleep Health
So, what are our solutions?
We need to move past the term and practice of sleep hygiene intervention and lean into the term sleep health. In 2014, sleep health was defined as a public health issue that is centered on wellness that should not be focused on deficits, or as the opposite of sleep problems.
Since sleep can be measured by its duration, efficiency, timing, daytime alertness, self-rated quality, and variability, this data can all point to the optimal sleep health for an individual. Different measures of sleep can be tied to various health outcomes, so it is important to look at our sleep in many ways and to examine it across a range of “normal” values versus a singular set point (e.g., 8 hours of sleep).
We also need broader dissemination of sleep education that covers the population health benefits of proper sleep. In an ideal state, this education would expand across medical training and funnel down to patients, clients, and the population at large. Access to evidence-based and individualized approaches that look at sleep health broadly and its impact on our overall well-being is rare and needed. These interventions need to be data-driven and incorporate the science of biological rhythms into interventions. This is being recognized by the scientific community, as noted by Perez-Pozuelo and colleagues,
“...there has been a significant expansion in the development and use of multi-modal sensors and technologies to monitor physical activity, sleep and circadian rhythms. These developments make accurate sleep monitoring at scale a possibility for the first time. Vast amounts of multi-sensor data are being generated with potential applications ranging from large-scale epidemiological research linking sleep patterns to disease to wellness applications, including the sleep coaching of individuals with chronic conditions,”
We have the ability to measure the biological rhythms of the most important inputs and outputs to our rhythmic physiology, including our body temperature, heart rate, heart rate variability, sleep timing and structure, blood glucose, movement type, and duration. We can also manually track other actions we take that can fine-tune our rhythms: our light exposure, food/drink intake, and our social contacts. Embedding circadian science into these inputs and actions bolsters the definition of sleep health and widens the possibilities of strategies, avenues, and health benefits we can leverage.
Instead of relying on a narrow vision of sleep hygiene, Crescent Health aims to empower people with data-driven information for their sleep and biological rhythms, and ultimately transform that knowledge into meaningful actions that can benefit the spectrum of our well-being, performance, and health.