I worked on my sleep hygiene, but why do I still have sleep issues?

Ah, yes, sleep hygiene. The buzzword that can be the bane of my existence as a sleep provider.

You’ve probably been lectured before about sleep hygiene from healthcare providers or a well-meaning friend when you mention sleep difficulties.

No caffeine after noon!

No blue light!

No PHONES IN BED!

While these approaches all have their place, they risk misplacing the cause and cure for insomnia on sleep hygiene.

Insomnia has been around much longer than cell phones and televisions, so removing technology from the bedroom alone is not the solution. In other words -  unless you are chugging a pot of coffee before bed or starting a horror film marathon at bedtime, sleep hygiene alone rarely fixes insomnia. Rather, poor sleep hygiene is often the result of poor sleep.

Watching TV in bed for hours because you can’t sleep?

Drinking a lot of caffeine to stay awake during the day?

Scrolling on your phone in the middle of the night because you can’t fall back to sleep?

Yep, sounds like insomnia to me –  but still a little room for improvement in the sleep hygiene department! Yet removing the TV, caffeine, and phone by itself will not necessarily “cure” insomnia. Insomnia is multifactorial – meaning that there are many factors – genetic, behavioral, environmental – that contribute to the development and maintenance of insomnia.

And this is where evidence-based practices like Cognitive-Behavioral Therapy for Insomnia (CBT-I) come into play. CBT-I is much, much more than a sleep hygiene intervention. In fact, I am a study therapist now on a clinical trial where sleep hygiene is not mentioned until the 4th session!  CBT-I taps into the psychology and physiology of sleep in a way to address unhelpful thoughts and behaviors behind insomnia. Sleep hygiene improvement alone will not necessarily increase one’s sleep drive, entrain your circadian clock, or reduce hyperarousal before bed – each of which are the main culprits in the maintenance of insomnia.

So if you’ve worked on sleep hygiene – congratulations! Behavior change is hard. If you continue to experience sleep issues, CBT-I might be right for you.