Hero textpages child desktop X2
Chronic Insomnia / Insomnia Disorder

Basic Sleep & Sleep Hygiene Education

A basic component of all insomnia treatment strategies is sleep education and sleep hygiene information.

Sleep education and sleep hygiene information includes general recommendations and information relating to environmental factors, physiologic factors, behaviour and habits that that aim to improve and maintain good sleep.

Sleep hygiene information alone is not a sufficient treatment for insomnia. It should be paired with evidence-based behavioural treatment such as BBTi, or CBTi, including bedtime restriction therapy and/or stimulus control therapy.

Basic sleep information

It is important to provide the patient with basic information about the structure of sleep during the night, and some of the factors that control our sleep (Process S, Process C).

Sleep consists of a repetition of 4 to 6 sleep cycles on average throughout the night with the first cycles of the night being shorter than the later cycles.

A sleep cycle consist of 4 sleep stages and lasts about 90 minutes:

  • Stage 1: Lightest stage of sleep, still have drifting thoughts, easiest to wake up
  • Stage 2: Moderate stage of sleep, unique brain wave activity, slightly harder to wake up
  • Stage 3: Deepest stage of sleep, hardest to wake up
  • REM Sleep: Associated with rapid eye movements and vivid dreams


Source: Alexander Sweetman

Older age reduces time of the REM stage.


Source: Alexander Sweetman

The deep sleep and REM sleep stages are of particular importance to the recuperation of body and brain. Circadian rhythm (our body clock) regulates the sleep-wake cycle. The sleep-wake cycle is described to be regulated by the interplay of Process S, which promotes sleep, and Process C, which maintains the biological clock and controls the timing of our sleep and wake patterns. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Institute of Medicine (US) Committee on Sleep Medicine and Research; Colten HR, Altevogt BM, editors. Washington (DC): National Academies Press (US) 2006

The need for sleep (Process S) accumulates across the day, peaks just before bedtime at night and dissipates throughout the night. Attempting to sleep when not having acquired sufficient sleep pressure (Process S) will make it more difficult to fall asleep, or may lead to (longer) nocturnal awakenings. 1


Source: Alexander Sweetman

Basic sleep information can help the patient understand the rationale for Bedtime Restriction Therapy, and promote sustained engagement with this treatment. The restricted sleep period on one night will result in greater sleep pressure towards the evening, which will promote to fall asleep easier with shorter wake-time during the subsequent night. 1


Source: Alexander Sweetman

Table. Sleep hygiene actions2, 1, 3, 4, 5

  • Maintain a regular wake up time, even on weekends, regardless of a poor night sleep
  • Resolve concerns or worries before bedtime
  • Avoid going to bed until you are drowsy and ready to sleep
  • Try not to force sleep
  • Avoid daytime naps, especially if they are longer than 20–30 minutes or occur late in the day
  • Reserve the bedroom for sleep and intimacy and adjust the bedroom environment as needed to decrease stimuli (e.g. reduce ambient light, turn off the television or radio)
  • Avoid bright light immediately before bed or while in bed including TV and mobile phone use
  • Avoid visual access to a clock throughout the night
  • Allow sufficient time in bed to gain an adequate amount of sleep
  • Avoid caffeinated beverages after lunch
  • Avoid alcohol late afternoon and evening
  • Avoid large meals immediately before bed
  • Avoid smoking or other nicotine intake, particularly during the evening
  • Avoid pets sleeping in the bedroom
  • Exercise regularly for at least 20 minutes, preferably more than 1-2 hours prior to bedtime
  • Do not stay in bed if you do not fall asleep quickly (stimulus control therapy) and encourage relaxing activities before bedtime

AHI - Apnoea-Hypopnoea Index
BBTi - Brief Behavioural Therapy for Insomnia
BMI - Body Mass Index (kg/m2)
BQ - Berlin Questionnaire
CBTi - Cognitive Behavioural Therapy for Insomnia
CELL - Coblation Endoscopic Lingual Lightening
COPD - Chronic Obstructive Pulmonary Disease
CVA - Cerebrovascular Accident
CPAP - Continuous Positive Airway Pressure
CSA - Central Sleep Apnoea
DASS - Depression Anxiety Stress Scale
DBAS - Dysfunctional Beliefs and Attitudes about Sleep
DBP - Diastolic Blood Pressure
DIMS - Difficulties Initiating and/or Maintaining Sleep
DISE - Drug-Induced Sleep Endoscopy
DISS - Daytime Insomnia Symptom Scale
ENT - Ear Nose and Throat
ESS - Epworth Sleepiness Scale
FOSQ - Functional Outcomes of Sleep Questionnaire
FSH - Follicle-Stimulating Hormone
FTP - Friedman Tong Position
GP - General Practitioner
HANDI - RACGP Handbook of Non-Drug Interventions
HGNS - Hypoglossal Herve Htimulation
ISI - Insomnia Severity Index
K10 - Kessler Psychological Distress Scale
MAD - Mandibular Advancement Device
MAS - Mandibular Advancement Rplint
MBS - Medicare Benefits Schedule
MMA - Maxillomandibular Advancement Surgery
MRA - Mandibular Repositioning Appliance
ODI - Oxygenation Desaturation Index
OSA - Obstructive Sleep Apnoea
PLMD - Periodic Limb Movement Disorder
PT - Positional Therapy
PTSD - Post-Traumatic Stress Disorder
PSG - Polysomnography
QSQ - Quebec Sleep Questionnaire
REM - Rapid Eye Movement
RFTB - Radiofrequency Thermotherapy of the Tongue Base
SBP - Systolic Blood Pressure
SCI - Sleep Condition Indicator
SE - Sleep Efficiency
SF36 - Short-Form (36) Health Survey
SMILE - Submucosal Minimally Invasive Lingual Excision
SNRIs - Serotonin-Norepinephrine Reuptake Inhibitors
SOL - Sleep Onset Latency
SSRI - Selective Serotonin Reuptake Inhibitors
TFTs - Thyroid Function Tests
TIB - Time In Bed
TORS - Transoral Robotic Surgery
TST - Total Sleep Time
UPPP - Uvulopalatopharyngoplasty
WASO - Wake After Sleep Onset

Quick links


  1. Sweetman A, et al. A step-by-step model for a brief behavioural treatment for insomnia in Australian General Practice. Australian Journal of General Practice 2021
  2. RACGP gplearning ‘Managing insomnia in general practice https://www.racgp.org.au/education/professional-development/online-learning/gplearning
  3. Winkelman JW. Overview of the treatment of insomnia in adults. In UpToDate, Benca R (ed). Waltham, MA: UpToDate 2020
  4. Falloon K, et al. The assessment and management of insomnia in primary care. BMJ, 2011;342:2899
  5. Stepanski EJ, et al. Use of sleep hygiene in the treatment of insomnia. Sleep Med Rev. 2003;7(3):215–25