Sleep Guidelines

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The National Sleep Foundation (2015) has recommended the following hours of sleep for each age range:

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• 0-3 months    14-17 hours

• 4-11 months  12-15

• 1-2 years        11-14

• 3-5 years        10-13

• 6-13 years      9-11

• 14-17 years   8-10

• 18-25 years   7-9

• 26-64              7-9

• 65+                 7-8

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YOUR SLEEP HABITS:

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1. Select a standard wake-up time. Stick to it every day regardless of how much sleep you get on any given night. Eventually you will notice that you will become sleepy at about the right time each evening to allow you to get the sleep you need. 
    

2. Use the bed only for sleeping. The reason for this is avoiding things that you do when you are awake. This means no reading, watching television, eating, studying, using the phone, texting, or doing other things that require you to be awake while you are in bed. If you use your bed for activities other than sleep and adult relations, you are training yourself to stay awake in bed.
    

3. Do not try to fall asleep. The mere act of trying is incompatible with what you are trying to achieve. You cannot be relaxed and exerting effort at the same time. You cannot unfocus your thoughts and disengage, when your thoughts are focused and you are indeed engaged in a task –trying-.
    

4. Get up when you can’t sleep. Lying in bed awake and trying harder and harder to go to sleep only increases anxiety and frustration, with tossing and turning, which make the sleeping problem worse.  These reactions, in turn, make it more difficult to fall asleep. Also, if you lie in bed awake for long periods, you are training yourself to be awake in bed. When sleep does not come or return quickly (say about 20 minutes), it is best to get up, go to another room, and return to bed only when you feel sleepy enough to fall asleep quickly.
    

5. Do not worry, plan, etc. in bed. Bedtime is not the time to attempt problem solving or to engage in thinking or worrying. Engaging in these sorts of activities only serves to keep the mind awake, making it extremely difficult to fall asleep. Do not worry, mull over your problems, plan future events, or do other thinking while in bed. These activities are bad mental habits. Also, the brain does not fall asleep all at once, so that functions such as logical thoughts will be compromised; therefore you won’t be solving problems, just worrying. If your mind seems to be racing or you can’t seem to shut off your thoughts, get up and go to another room until you can return to bed without this thinking interrupting your sleep. If this disruptive thinking occurs frequently, you may find it helpful to routinely set aside a time early each evening to do the thinking, problem solving, and planning you need to do. If you start this practice you probably will have fewer intrusive thoughts while you are in bed. Another suggestion is writing a list before you go to bed, of the thing you need to attend to the next day. If you wake up still thinking about these things, get out of bed and make a few notes. When you feel that you have put enough of your thoughts on paper so that you can ‘pick up the thread’ in the morning, go back to bed.
    

6. To nap or not to nap? Until recently, napping was not recommended at all, but research has shown it can be helpful if it is part of the regular sleep schedule. If you must absolutely take a daytime nap, keep to less than an hour and complete it before 3:00 p.m. If you do nap during the day, adjust accordingly that night by delaying your bed time by the amount of time you slept during the day. Sleeping during the day partially satisfies you sleep needs, and thus, will weaken your sleep drive at night. (Exception- naps may be particularly helpful for the elderly or persons with medical problems.)
    

7. Turn the clock around. Turn it so you can’t see it, or put it under the bed. If the alarm is set, there’s no need to know in the middle of the night what time it is. Clock watching leads to worry and frustration, and adds ‘wind to the flame’ of insomnia.  
    

8. Check your mattress. Often people have not bought new bedding for decades.  Sleeping on worn-out pillows and mattresses may contribute to sleep disturbance by promoting levels of discomfort and/or pain that, if not precipitating frank awakenings, shallow sleep and increase one’s vulnerability to awakenings.             
    

9. Go to bed when you are sleepy, but not before the time suggested. In general, you should go to bed when you feel sleepy. However, you should not go to bed so early that you find yourself spending far more time in bed each night than you need for sleep.

 

YOUR LIFESTYLE
 

1. Limit your use of caffeinated foods and beverages such as coffee, tea, soft drinks with added caffeine, or chocolates. Limit your caffeine to the equivalent of no more than three cups of coffee per day and that you do not consume caffeine in the late afternoon or evening hours. (Exception- for some persons it may help fight drowsiness earlier in the day)
    

2. Limit your use of alcohol.  Alcoholic beverages may make you drowsy and fall asleep more easily. However, alcohol use also usually causes sleep to be much more broken and far less refreshing than normal. It results in rebound arousal and rebound insomnia, and may be sufficiently dehydrating that this alone may promote awakenings. Therefore it is recommended you do not use much alcohol in the evening or as a sleep aid.
    

3. Avoid smoking, especially during the night. Nicotine is a stimulant: therefore, using stimulants when you are trying to sleep is going to have a predictable effect, making it hard to fall asleep. On the other hand, withdrawing from nicotine, especially for heavy smokers, may produce more physiologic arousal than satiating the need.  Note that middle of the night awakenings may be precipitated by nicotine withdrawal. Smoking either above or below your usual level of consumption will have deleterious effects on your sleep; smoking when you usually don’t (like in the middle of the night to kill time) will also have deleterious effects on your sleep.
    

4. Exercise regularly. This can be moderate, such as walking, swimming or bike riding. Generally, such exercise performed in the late afternoon or early evening leads to deeper sleep at night.  Also, improving your fitness level, no matter when you choose to exercise, will likely improve the quality of your sleep. However, avoid exercise right before bedtime because it may make it harder to get to sleep quickly. Vigorous exercise should be early in the day, at least six hours before bedtime, and mild exercise should be at least four hours prior.
    

5. Try a light bedtime snack that includes carbohydrates, as hunger may disturb sleep. Avoid heavy or greasy foods. (Exception- may not be recommended for persons with GERD or restrictive diets.)
    

6. Avoid excessive fluids in the evening. This can minimize nighttime awakenings for going to the bathroom. As a suggestion, stay within one cup of liquid within four hours of bedtime. (Exception- if medically necessary, take only the recommended amounts)
    

7. Make your bedroom quiet and dark. Noise or even dim light may interrupt or shorten your sleep. You can block out unwanted noise by wearing earplugs, running a fan, or using a ‘white-noise’ machine that is specifically designed to screen sleep-disrupting noise. Also, if possible, eliminate the use of night lights and consider using dark shades in your bedroom so that unwanted light does not does not awaken you too early in the morning.  (Exceptions- this may not be possible for parents of young children. For the elderly, they could become disoriented or fall.)
    

8. Make sure the temperature in your bedroom is comfortable. Generally speaking, temperatures much above 75 degrees Fahrenheit cause unwanted wake-ups from sleep. Thus, during hot weather you may wish to use an air conditioner to control the temperature in your bedroom. This said, it is important that you are not too cold. As a rule of thumb, the room can be kept between 60 and 68 degrees Fahrenheit.
    

9. Try a hot shower or sitting in a hot tub, before going to bed. This increases your body temperature.  A reasonably hot bath 1.5 to 2 hours before bed has many of the same sleep effects as aerobic exercise.
    

10. Develop a prebed ritual (like the hot shower, reading for ten minutes, a small snack), both for training yourself and for giving yourself time to decompress and “put the day to sleep”.
     

11. Avoid co-sleeping with your pet. Pets will frequently move around and/or jump on and off the bed, causing movement and noise which can be disruptive to sleep. The pet could sleep alongside the bed or in another room.
     

12. Keep a regular schedule. Regular times for meals, medications, chores and other activities help keep the brain’s inner clock running smoothly, allowing you to sleep more easily and soundly.
     

13. Sleeping pills should be used only conservatively, and only under your physician’s strict vigilance. Often, physicians will avoid prescribing sleeping pills for periods longer than two or three weeks.

 

MYTHS: WRONG, WRONG, WRONG!!!

-You need less sleep as you get older

-Alcohol helps you sleep better

-Snoring is annoying but harmless

-There’s something wrong if you don’t remember your dreams

-I can get by fine on five or six hours of sleep

-You can learn to get by on less sleep

-Insomniacs barely sleep at all

-Falling asleep during the day is a sign of laziness

-Listening to self-help recording while you sleep can help you learn

-It’s possible to get too much sleep

-How I sleep doesn’t affect the rest of my health

 

Adapted from:   

-Wellness Booklet. American Academy of Sleep Medicine.2004

-Overcoming Insomnia. A Cognitive-Behavioral Therapy Approach.

Jack Edinger and Colleen Carney. Oxford University Press. 2008    

-Cognitive Behavioral Treatment of Insomnia. A Session-by-Session Guide.

Michael L. Perlis, Carla Jungquist, Michael T. Smith, Donn Posner. Springer Press. 2005

-The Harvard Medical School Guide to A Good Night’s Sleep.

Lawrence J. Epstein, M.D.  McGraw Hill. 2007

-Behavioral Treatments for Sleep Disorders. A Comprehensive Primer of Behavioral Sleep Medicine Interventions. Michael Perlis, Mark Aloia and Brett Kuhn. Elsevier, 2011.