We Turned Sleep Into Homework. Now We’re Losing Sleep Over It

Applied uniformly, sleep hygiene ignores an obvious fact. Sleep is not the same for everyone. A rule that calms one person’s nervous system agitates another’s. Some anxious patients sleep better with the TV on. Others, especially shift workers and jet-lagged travelers, need a hard digital cutoff.

The rules were written for the average person who does not exist. They are obsessed over every night by people who very much do.

Even for chronic insomnia, sleep hygiene alone does not solve the problem. British researchers ran a large primary care trial and found that simply providing a sleep hygiene booklet barely moved the needle. A short course of behavioral treatment worked more than twice as well. The American Academy of Sleep Medicine had already reached the same conclusion, advising against using sleep hygiene as a stand-alone treatment for chronic insomnia.

I advise my patients to treat sleep-related lifestyle interventions as a menu instead. Individualize it. Some will work, and some won’t. The only way to find out is to test them one at a time, with nothing riding on the result. Maybe consistent wake times matter more than consistent bedtimes. Maybe a Sunday afternoon nap is harmless. Maybe the phone in bed is fine as long as it’s not the news. What doesn’t work, you cross off. What’s left is your menu, and you don’t order the same thing every night. It changes as your life does.