Sleep Hygiene: Training Your Body for Better Sleep

Prevalence

As a psychiatric nurse practitioner, many of the clients I treat often present with concerns of insomnia. It is often treated as a priority as prolonged insomnia may lead to a variety of chronic illnesses, including pulmonary disease, hypertension, diabetes, cancer, chronic pain, and heart failure to name a few (Benca, 2026). The recommended amount of sleep for most adults is seven hours a day, yet, in the United States, nearly 33% of adults report sleeping less than seven hours a night (Maski, 2026). With the development of modern technology and the ever rising expectations of an average American, these statistics are not surprising. What is surprising, however, is how poorly insomnia is managed in the healthcare setting despite a plethora of more effective treatments.

Underlying Causes

To effectively treat insomnia, it’s important to first rule out various illnesses, medication side effects, and health conditions that could be contributing to poor sleep. As healthcare providers, are we assessing a client’s caffeine, alcohol, or nicotine intake? Each of these substances can produce an activating effect and contribute to poor sleep. If a health history shows an elevated risk for sleep apnea, clients should be referred for a sleep study. Kline (2026) reports an increased prevalence in obstructive sleep apnea, with rates as high as 10-15% in females and 15-30% of males. Signs and symptoms that may trigger the need for a referral include frequent loud snoring, witnessed apnea (bouts without breathing), or gasping and choking during sleep (Kline, 2026).

If a physical health condition has been ruled out, it’s time to get an accurate representation of the insomnia symptoms. This can be done with the use of a sleep diary. A thorough sleep diary can differentiate between the amount of total sleep time and the amount of time they are in bed intending to sleep. If these amounts differ drastically, it’s time to discuss sleep hygiene. Sleep hygiene involves the nightly interventions one takes to address behavioral habits that may negatively be impacting their sleep (Martin, 2026). This may include a consistent bedtime and rise time, exercising 4-6 hours before bed, limiting bedtime snacks, creating a quiet environment free of distractions, and limiting one’s afternoon intake of caffeine. A sleep diary may be helpful in tracking the effectiveness of these interventions.

Changing the Sleep Environment

If these interventions are not effective but behavioral habits are still at play, it’s time to assess the sleep environment. Are clocks present in the room? Is it dark and calming? Are screens muted and put away? Now that we’ve created an environment conducive to restful sleep, relaxation therapies such as progressive muscle relaxation (PMR) and diaphragmatic breathing can be used to reduce arousal (Martin, 2026). 

The “3-P’s”

The gold standard treatment for insomnia is cognitive behavioral therapy-insomnia (CBT-I). CBT-I notes insomnia develops in most individuals as a result of the “3 P’s”: predisposing factors, precipitating events, or perpetuating factors (Martin, 2026). Predisposing factors are those that place individuals at a higher risk for insomnia, such as pain, shift work, past trauma, and some mental health conditions. It’s important to screen for conditions such as bipolar disorder as standard treatment interventions for unipolar conditions may be ineffective.

The next “P”, precipitating events, are those that cause acute sleep disruptions, such as illness, changes in the living environment, or other traumatic events (Martin, 2026). In psychiatry, we would refer to these as environmental stressors. Lastly, perpetuating events are those that reinforce insomnia, such as screen time before bed, daytime napping, and anxiety about a loss of sleep (Martin, 2026). Perpetuating events are arguably the most detrimental as they tie heavily into an individual’s habits and behaviors. Martin (2026) recommends finding a CBT-I provider (most easily accessed via internet search) to further discuss the 3 P’s and implement an individualized treatment plan to address sleep concerns and promote more restful sleep.

Medication Safety

Improvements in therapy are not immediate, so medication may be warranted in some cases. In these cases, it’s important to start the lowest possible effective dose of medication to reduce the risk for side effects or adverse events. It’s important to avoid operating heavy machinery or combining medication with other sedatives, such as opioids, alcohol, or marijuana. Medication should usually be prescribed one to two hours before desired bedtime and as part of one’s bedtime routine. Some medications may cause next-day impairment in alertness, memory, and coordination, so some clients trial their first dose on a weekend to minimize potential disruptions to work responsibilities. Lastly, one should ensure regular follow–up with their prescriber to ensure efficacy and limited side effects (Neubauer, 2026). 

Important Tips

In summary, insomnia is a common but often treatable condition. Nonpharmacological interventions are most effective when behavioral and lifestyle changes are incorporated, with emphasis on developing a relaxing nighttime routine. This can include working with a therapist and tracking your sleep patterns. If pharmacological treatment is necessary, ask questions and stay informed to ensure safe and appropriate care. By being proactive and informed in your care, you can improve your sleep quality and overall well-being.

References

Benca, R. (2026). Risk factors, comorbidities, and consequences of insomnia in adults. UpToDate. Retrieved August 14, 2026, from https://

www.uptodate.com/contents/ risk-factors-comorbidities-and-consequences-of-insomnia-in-adults

Kline, L. R. (2026). Clinical presentation and diagnosis of obstructive sleep apnea in adults. UpToDate. Retrieved July 20, 2026, from https://

www.uptodate.com/contents/ clinical-presentation-and-diagnosis-of-obstructive-sleep-apnea-in-adults

Martin, J. L. (2026). Cognitive behavioral therapy for insomnia in adults. UpToDate. Retrieved July 25, 2026, from https://www.uptodate.com/contents/

cognitive- behavioral-therapy-for-insomnia-in-adults

Maski, K. (2026). Insufficient sleep: Evaluation and management. UpToDate. Retrieved July 20, 2026, from https://www.uptodate.com/contents/

insufficient-sleep-evaluation-and-management

Neubauer, D. N. (2026). Pharmacotherapy for insomnia in adults. UpToDate. Retrieved July 25, 2026, from https://www.uptodate.com/contents/

pharmacotherapy-for-insomnia-in-adults