A very long list of sleep maintenance suggestions

Leading up to this year’s Lesswrong Australia megameetup, in the interest of improving people’s lives in the most valuable way possible, I was hoping to include a session on sleep, sleep quality and sleep maintenance.  With that in mind I put together A very long list of sleep maintenance suggestions.

Some of the most important take-aways:

  1. Do you think you get {good sleep/enough sleep}?  
    – If no then fix it.  This single thing will improve your life drastically.  (also don’t lie to yourself about this, research shows that people who are sleep deprived are bad at predicting how sleep deprived they are, if you are unsure; probably err on the side of caution.  As a measure – if you turned off your alarms – would you be able to get out of bed at the same time every day?)
  2. “I do this weird thing with my sleep but it works well for me, is that a problem?”
    – not really.  if it works – keep doing it.  if it works most of the time but falls apart every Monday, then maybe its time to consider a different plan.
  3. Uberman, and other polyphasic sleep cycles?
    – depends if it works for you.  Don’t force yourself to do it if it, don’t expect it to work for you.  Feel free to try it; lifestyle is also relevant in considering this sleep implementation, (if you have a 9-5 job you certainly can’t make it work, if you have a flexible life then maybe)

Also living a healthy lifestyle will make a big difference.

Some good highlights from the list:

  • limit caffeine, especially to earlier in the day
  • avoid using alcohol as a nightcap – it disrupts sleep maintenance
  • Avoid heavy meals and heavy exercise within 3 hours of bedtime
  • use bedroom for sleep and sex only
  • have sleep in your schedule (go to bed and get up at the same time every day, even on weekends)
  • decrease brightness of home lighting ~1-2 hours before bed
  • avoid electronics ~1-2 hours before bed
  • reduce light and noise (via earplugs / white noise) in bedroom as much as possible while sleeping
  • If you tend to sleep in a lot if you don’t set an alarm, you are not getting enough sleep on average – go to bed earlier, consistently.
  • If your alarm keeps going off in the middle of REM sleep, move your bedtime about 45 minutes in either direction – REM sleep occurrs in 1.5 hour increments.
  • Use melatonin.
  • avoid smoking.

The list is best formatted here:


But is also included below for convenience.

A very long list of sleep improving suggestions:-2 to 2    
Area of interest:Evidence RatingExplanation by Adam KComments by othersComments by others
Everyday life
eat healthy1Being overweight reduces sleep quality and risk of sleep disorder
reduce sugar and refine carb intake?These contribute to daytime sleepyness which may result in overnapping - Kat
be a healthy body weight2BMI over 30 puts you at risk of sleep apnea, if anything above Normal BMI w/ sleep apnea, losing weight may help reduce apnea symptomsbeing overweight can contribute to sleep apnea - Kat
limit caffeine (in chocolate or decaf too)2Caffeine response differs significantly in peopleLimiting caffeine to earlier in the day may also be of some use - Kat
quit smoking (stimulant and breathing)2Less deep sleep, less total sleep, and longer sleep latency
exercise daily (not around your sleep time by at least 2-4 hours)2Increased deep sleep, less sleep interruptionsEven a small amount helps - start with 10 minutes of cardio and work your way up if you have to - KatOr, google "stronglifts 5x5"
reduce anxiety and stress2Anxiety increases sleep latency and sleep interruptions
limit irregular work shifts2Circadian rhythmicity important for all parts of health
avoid long commutes1Rising too early can miss REM, and less total sleep, some confounding factors to consider
Be physically healthy2Diseases generally lead to sleep disorder, e.g. diabetes, cancer, etc
Get enough sunlight2Light is most important zeitgeiber for circadian rhythmicity
Analysing your sleep setup
use your bed for sleep and sex only1Bed restriction in *older adults*I don't really know, but older adults who dawdle in bed tend to get better sleep quality if they restrict bed times to reasonable sleep times
sleep in darkness – the more the better; including all LEDs2Light is most important zeitgeiber for circadian rhythmicity
Cool room temperature of sleep 15-25c015 may be too cold for people with poor core body temperature control but good for younger healthier more active people. 25 probably too warm for everyone.In-bed, or rectal measurement are more accurate measures, too complicated for normal people to do
check if you are using comfortable pillows0highly subjective, no guarantees, only moderate, weak or no associations with sleep quality and wakingsI guess room temperature is only important if it is to cool down, because if it's too cold you can always pile more blankets on until you are comfortable. Recommended room temperature would be 17-22C then
body pillow, neck pillow, arm pillow, to permit a better body position while asleep0highly subjective, no guarantees, only moderate, weak or no associations with sleep quality and wakings
check if your bed is comfortable0highly subjective, no guarantees, only moderate, weak or no associations with sleep quality and wakings
evaluate sleep location in bedroom - too close to window, door, other noise / light?0highly subjective, no guarantees, only moderate, weak or no associations with sleep quality and wakings
Evaluate sleep distractions in the room1distractions, by definition, increase sleep latency
mattress life expectancy check (around 10 years)0highly subjective, no guarantees, only moderate, weak or no associations with sleep quality and wakings
pillow life expectancy check (around 2-4 years)0highly subjective, no guarantees, only moderate, weak or no associations with sleep quality and wakings
allergens in the bedroom2definitely affects sleep qualityEasiest thing to do is buy dust-mite-proof pillow and mattress covers. Wash bedding weekly in hot water and a little bleach (kills mold). Vacuum regularly. Keep windows closed during known allergy seasons. If you have bad allergy symptoms, get tested and get immunotherapy shots if you can afford it. - Kat
limit pets in bed1Sharing bed space with anything decreases sleep quality, including sleeping with partners
limit children in bed1Sharing bed space with anything decreases sleep quality, including sleeping with partners
make sure there is enough room for those in the bed1Sharing bed space with anything decreases sleep quality, including sleeping with partnersand enough sheets and blankets for each - consider separate sheet/blanket for each side of the bed if your sleep partner tugs on the sheets and wakes you - Kat
bedside notepad for anything you might want to write down - if something is keeping you up; you can use this to record things and effectively put them out of your mind so that you can go to sleep.??is this a distraction?
Understand approximate sleep hours needed (7-9 in most adults, different summer-winter)2Most people underestimate how much they needphysiological 'need' for sleep doesn't decrease with age, only 'feel' for need for sleep does
certain smells can help, certain smells can hinder.0highly subjective, no guarantees, only moderate, weak or no associations with sleep quality and wakings
Have sleep in your schedule2Regular bed time important for circadian rhythmicity
have a sleep schedule that includes sleep on the weekends (no skipping the weekends)2Sleeping in on the weekend can be very good for people who undersleep during the weekdays, but it's not as good as regular sleep of courseok
Turn your clock so you can't see it while the lights are out / don't check time on your phone2If you have a clock, make sure clocks are either dimmed or red LED
what is your bed and blankets made out of? Are these the best materials for you for this bed?0highly subjective, no guarantees, only moderate, weak or no associations with sleep quality and wakings
don't have a TV in the bedroom2Emits light, is a distraction, etc
Don't have a computer, tablet, or phone in the bedroom2Emits light, is a distraction, etc even worse than TV
calming bedroom colour ( need source)0Unless referring to red light or candle light use at night, not sure what it's referring toI suspect this is relating to the 'look' of the bedroom in general, and how you fee when you walk into it. I.e., if you hate mustard yellow, re-paint your room if the walls are mustard yellow - Kat
On the way to sleep
Pre-Bed foodextreme diets (VHC or VLC) can ruin sleep quality, and carbohydrates for dinner can reduce sleep latency
go to bed neither hungry nor stuffed (food)1highly subjective, but true
don't eat meals too close to sleep2either digestion slows, or sleep is disrupted, one or the other (subjective)
small evening meals0highly subjective, no guarantees, only moderate, weak or no associations with sleep quality and wakings
limit late night alcohol2alcohol reduces quality of deep sleepit only reduces sleep quality if it is in your system while you sleep, so you could drink in the afternoon and have it leave your system by the time you sleep and you'd be fine.
limit late night liquid0usually trueone thing to note is marijuana, which is commonly consumed, also affects sleep quality, but far less is known about its effects, it seems it is variable
avoid sugar heavy foods-1carbs will reduce sleep latency, though I don't recommend sugar for general good health
avoid spicy or greasy meals before bed (or other food you know does not agree with you)1high fat meals correlated with poor sleep measure
tryptophan snack – if you are hungry try a light snack before bed-2evidence for this actually working is non-existent, a well perpetuated mythCommon suggestions included warm milk, a banana, cheese on crackers, cereal and milk, also turkey - combine carbohydrates and either calcium or a protein that contains the amino acid tryptophan to boost seratonin for calmness.
Things that aren't food
Have set a regular bedtime2Circadian Rhythmicity important
have a bedtime routine or ritual which includes relaxation1highly subjective, but I guess true
decrease brightness of home lighting ~1-2 hours before bed2
eliminate blue-spectrum home and screen lighting ~1-2 hours before bed2blue light increase heart rate, and wake inducing catacholamines and brain activity, reduces sleep qualityAvoid fluorescent tube lights, compact fluorescent or LED bulbs labeled daylight, cool white, or bright white (instead, use sub-3500K color temps, sometimes called warm white or soft white), and screens without a red-shift application running - Kat
avoid electronics before bed2game-like activity increase heart rate, and wake inducing catacholamines and brain activity, reduces sleep quality
keep noise down while heading to bed0highly subjective, but may be valuable despite no 'evidence'
organise for tomorrow so you can stop thinking about it0highly subjective, but may be valuable despite no 'evidence'At its simplist, make a todo list for tomorrow. If there's a lot on your mind, try a full-on 'brain dump' on a very large sheet of paper, several hours before bed: write down everything you think is important for the next month or so. Use that to inform your todo lists.
Bedtime media; book; audiobook; calming music (soft),0highly subjective, but may be valuable despite no 'evidence'I guess it's up to the person
stretch (debatable)0more likely to be because of exercise
wind down an hour before bed1exercise too close to sleep increases heart rate, increases sleep latency
take a warm bath/shower1only if you need to lower your core body temperature (see temperature advice above)
before bed – write down what is on your mind and resolve to leave it for tomorrow0highly subjective, but may be valuable despite no 'evidence'
read before bed by soft light0highly subjective, but may be valuable despite no 'evidence'
don't have a nightcap (alcohol)2alcohol reduces quality of deep sleep
neutral neck position in bed and before bed.0mostly supported by alternative chiropractic studies, which is poor form of evidence
hot pack on the neck1only if you need to lower your core body temperature (see temperature advice above)
do a simple armchair hobby to relax0highly subjective, but may be valuable despite no 'evidence'
Go to sleep when you are tired. Don't wait in bed frustrated if you can't fall asleep.0highly subjective, but may be valuable despite no 'evidence'
consider wearing socks to bed0highly subjective, but may be valuable despite no 'evidence'
sleep diary of if you felt sleepy during the day, things that you think might influence your sleep tonight.0highly subjective, but may be valuable despite no 'evidence'Include food, exercise, sleep details, # of awakenings in the middle of the night and their approx. duration, rate the sleep out of 10, time of last wakeup - naturally or to an alarm? If you were dreaming when your alarm went off, go to bed earlier so that your alarm is not waking you up in the middle of a REM cycle - Kat
Going to bed
Select nightclothes (or none) and bedding to keep yourself heat stable (thermoregulation)0
If you are having difficulty getting to sleep – try imagine what you would like to dream about0only anecdotal evidence, but may be valuable, I personally recommend this techniqueIf you are an artist or a crafter, imagine the design of a project you would like to do someday - Kat
deep breathing (or other relaxation technique - visualisation breathing, yoga)2sufficient evidence to say it works if you have good compliance with the practice
For while you are asleep
Noise / Light
earplugs0-2benefits depends on environment, will help (2) in high noise environment
white noise (device, fan, or app, pink noise)0-2white noise improves noisy environment, but silence is better
humidifiers for air quality1may improve breathing problems, if sleep quality is compromised by breathing problems, cpap etcMust be cleaned on a regular basis to prevent mold - Kat
air filter1may improve breathing problems, asthma and allergies specificallyTape a 20x20" electrostatic furnace filter to a 20" box fan for a cheap air filter - Kat
fans for air movement+cooling, and/or white noise0-2white noise improves noisy environment, but silence is better
eye mask for light0-2benefits depends on environment, will help (2) in high light environment
Sleep in the dark - at night if you have a choice; use heavy curtains if streetlights or sunlight present2
Sleeping positions - get comfortable!
try a leg pillow (pillow between the knees) or holding a pillow0highly subjective, but may be valuable despite no 'evidence'
make sure you are sleeping in a neutral neck position0mostly supported by alternative chiropractic studies, which is poor form of evidence
try other positions if that one is uncomfortable0highly subjective, but may be valuable despite no 'evidence'
try each side, back, front.-1I'd say sleeping on back is not good for sleep parameters, higher risk of sleep disorders developing and worse sleep quality
Staying asleep
Body temperature, Room temperature1only if you need to lower your core body temperature (see temperature advice above)
gel mattress topper (to cool your mattress down)
noises0-2see white noise vs silence, see ear plugsAsk housemates to avoid low-frequency sounds, like slamming doors, music, etc as these cannot be masked by white noise or earplugs - Kat
smells (i.e. smoke, food)????Ask housemates to avoid cooking aromatic foods while you are asleep (ex, frying sausage, onions, canned tuna, etc) - Kat
If your sleep is interrupted
small bathroom nightlight (not blue and not bright like normal bathroom lights)2try to go to the loo without any lights being turned on, otherwise use red lightbulb
avoid cold floors (rugs/socks)1subjective, but warm feed important for getting back to sleep and decreasing sleep latency
get back to sleep: stay in bed0subjective
get back to sleep: just try to relax, don't try for sleep0subjectiveDrowsing in bed is still more restful than being awake and doing something - Kat
get back to sleep: avoid electronics with blue light2avoid blue, green, white light
dont use portable electronics in bed2avoid blue, green, white light
If wide awake, go do low-key activity for 15m, then back to bed again1can stay up for up to an hour and a half
When you wake up
wake up at the same time every day0light exposure at same time every day more important, sun lamp or lamp timer
keep a sleep diary of all these possible related factors0highly subjective, but may be valuable despite no 'evidence'
increase light levels (just after waking up)2lamp and timer or lifx
get up when the alarm goes off – don't snooze button2snooze bad, either sleep in or don't, having a string of alarms just compromizes sleep quality even if you think it makes you feel its easier to get up
One option: nap every single day (siesta style)2naps = lots of health benefits
The other: Don't nap0no benefits to no napsNo naps was recommended to me by neurologist; helpful if sleep schedule is completely messed up. Otherwise, I would say, don't nap if you're not tired. If you are tired, then nap, and look to how you can add sleep time at night in the future, rather than relying on naps - Kat
If you do; nap for less than 30 minuteseither nap <25 or nap for 70-90min
You can use naps to make up for lost sleep2yes, to a degree
avoid naps in the evening2leave at least 8h before your bed time else you risk compromising night sleep quality or sleep latency
Medical solutions
see a doctor after symptoms (depression, acid reflux, asthma, medications, headaches)2
sleeping pills have side effects2yes, many are actually bad for sleep quality, and just make you forget you didn't get any sleep (rather than put you to sleep), also dependency and addiction
sleep medications exist2yes; more useful for really messed up sleep patterns; see aboveAddiction can be avoided by tapering the dose off over the course of several days or weeks when you no longer need it - Kat
check your existing medications for insomnia side effects2
antihistamine with drowsiness side effects1reduces sleep latency but compromizes sleep quality
.5-2mg melatonin before bed. But see a doctor before doing anything high dose2melatonin + whitenoise/earplugs + sleep mask good combo for bad environmentsMelatonin has a fairly short half-life. Best effectiveness may be in taking it right before lights out. Start with small dose (300 micrograms) and slowly increase until most effective dose is found. - Kat
melatonin also good for everything else, lots of health benefits
melatonin is a chronobiotic and not a sleeping pill, gotta take it regularly at same time every night even if you don't plan on staying up (if you want to keep your schedule, that is)
CPAP machine1https://en.wikipedia.org/wiki/Continuous_positive_airway_pressureif this is your problem - E
Nasal surgery??if your problem is a obstructed airways -E
test by spending 2 weeks in a row; going to bed at the same time and recording when you wake up without an alarm feeling rested.??less valuable than just fixing lighting and taking melatonin for 2 weeksuseful for therapists trying to track someone with a shifting circadian rhythm
consider allowing less sleep time (by trial) (don't expect to sleep for 9 hours or be frustrated if you don't sleep exactly that long)1can cut down 1 sleep cycle, and after 2 weeks body adapts (BUT THIS IS FROM HEALTHY 8.5h BASELINE and NOT from "already sleep deprived")By 'sleep cycle' do you mean REM cycle? - Kat
tracking QSdevices that measure eeg and eye movement most accurate
sleepy study??~$1000 from your local sleep research centre (sometimes located as part of hospitals)
polyphasic sleep cycles?I have never known anyone to be able to keep those up for very long without exhibiting signs of sleep deprivation. I consider it a 'do it if you have to, but avoid if possible'.
make sleep a priority on weekends (to recover from sleep debt)
check up on your sleep quality over time and re-evaluate these details
waking up groggy? Coffee, look at what point in your sleep cycle you are waking up, try the science suggestion, get more light to your eyes when you wake up.1sleep cycle calculations may help, but bright lighting more helpfulIf alarm going off during REM, try going to bed 45 minutes earlier. REM cycles every 1.5 hours - Kat
Sleep-walking, sleep-talking?0no evidence of treatments for sleep walking 🙁See a doctor? - Kat
daytime tiredness? (get more sleep)2obviously 🙂 either night sleep or napsOr lay off the sugar and simple carbs - consuming these and nothing else can cause a blood sugar crash - Kat
afternoon sleepiness? (normal, take a break; get fresh air, eat something, get more light)1best to keep moving and on your feet if you want to 'walk off' the midday sleepiness period, keep core body temperature high (cold exposure, body movement)
waking in the night? (can be normal, can be something wrong with your environment, try sleep tracking apps, there is one that records ambient sounds in the room while you are sleeping. Something might be making noise that you were unaware of, rats, possums, cars, devices) How do you feel during the day? If you feel fine then its normal wakeful cycles and don't worry about it1evidence says waking in middle of night is, like taking a siesta, just part of natural sleeping pattern for some people, probably depends on genetics, but also depends on circadian rhythmicity, age and environment (like night length, melatonin dose). Obviously could also just be drinking too much water.
grinding teeth or clenching jaw? (reasonably common, reduce stress, use a mouthguard)1mouthguard is the main one, also reduce stress, be less hungry (improve diet)
nightmares, strange dreams? (common, reduce stress, check for a dislocated rib or major sleep disturbance, become more busy or occupied during the day – having too much free time can leave your mind to not know what to churn about)1usually comes down to brain chemistry (can be related to diet, or medications/drugs, or genetics, or strange lifestyle)
sleeping too much? (normal, reduce exercise if over exerting yourself, improve other health areas, check for depression, check medication, consult medical professionals)2more than 10h sleep regularly is either unhealthy in it's own right, or is a sign that you have or are developing a disease that causes sleep abnormality
can't get to sleep? (normal, Check intake of stimulants, alcohol, disagreeable foods etc. check environment, check total sleep time, check if it actually matters, try visualisation or relaxation exercises)I guess see all of the aboveyes, one night of insomnia is not clinical insomnia and nothing to worry about
can't get up at the right time? (get more sleep, get more light at that time, get out of bed really quick, then figure the rest out)
most important question: is this strange seeming sleeping habit actually a problem? Does it bother you or anyone (who matters)? If no; don't change it.agreed
Changing sleep by changing sleep hygiene takes time - allow ~2 weeks for any change to have an effectTrying something for one night and then declaring, "this doesn't work!" is counterproductive. Stick with it. Change one thing at a time if an entire list of things seems overwhelming - Kat
If you try most things on this list for >2 weeks and still have daytime tiredness / poor sleep, see primary care doctor or neurologistDoc will refer you to neurologist for simple testing to determine primary or secondary insomnia. Or you can just say, "I think it's stress (primary insomnia), can I try ambien / lunesta / whatever?" In the US, most docs start PTs on generic ambien - Kat
Get f.lux or redshift for all electronics that emit white light, also "night mode" and "twilight" for android2reduces blue and green light emissions
Anyone does nightshift? different rules can apply2Reducing light in home before bed, and blocking as much light as possible in bedroom is absolutely necessary - Kat
Sleep posture, babies are different to adults2babies sleep on their backs to avoid SIDS, adults sleep on side or front to avoid sleep disorders and get best quality
no midnight snacks2metabolizes food differently about 2 hours after dark or after melatonin administration
jetlag2fast, and eat a big carb meal first thing in the 'morning' of your destination, can do this several days in preparation
take large dose of melatonin at the 'night' time of your destination, can do this several days in preparation
slow release caffeine on the morning of arrival, can prepare the day beforehand
light therapy on morning of arrival, can prepare days beforehand
best thing is to do pre-flight adaptation, but this takes planning and commitment
other drugs?
Cool sleeping cap (one study recently)?
Personal recommendations
Take 5g creatine before bed, wake up with energy
Take magnesium citrate, sleep 1hr less a night

Meta: the original collection of this list took at least 10 hours; plus several other people’s time to point out the quality of the suggestions.  From deciding to post this to post-ready took 2 hours.

This post was finalised with the assistance of participants on the Slack chat.

Thanks to Kat and AdamK for their help with this post.

As per usual; any suggestions are welcome, and improvements would be appreciated, and I hope this helps you.

This post was originally published here: http://lesswrong.com/r/discussion/lw/mvf/

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