Sleep Hygiene Checklist

Core body temp must drop ~1°C to initiate sleep (Walker, Sleep Foundation).

Even dim light suppresses melatonin and reduces deep sleep (AASM).

Small light sources at night raise next-day insulin resistance (Northwestern, 2022).

Stimulus control retrains the brain to associate bed with sleep (CBT-I core principle, AASM).

Intermittent noise causes micro-arousals you don't remember (Cleveland Clinic).

Pain-driven awakenings fragment sleep architecture (Sleep Foundation).

Conditioned arousal in the bed is a top driver of chronic insomnia (Stanford Sleep Medicine).

Rising CO2 above 1000 ppm degrades sleep quality and next-day cognition (Harvard T.H. Chan).

Clock-watching during awakenings drives anxiety and prolongs them (CBT-I).

Nasal congestion fragments sleep (AASM).

A fixed wake time anchors the circadian rhythm more than bedtime does (Walker, AASM).

Morning light advances the circadian clock and locks in nighttime melatonin release (Stanford, Huberman).

Chronic sleep under 7 hours raises all-cause mortality (CDC, AASM consensus).

Regular activity deepens slow-wave sleep, but late vigorous exercise raises core temp.

Dimming light cues melatonin onset on schedule (Walker).

Food timing is a secondary zeitgeber that reinforces the master clock (Salk Institute).

Late large meals raise core temp and trigger reflux that fragments sleep.

Longer or later naps reduce homeostatic sleep pressure for the night (AASM).

Pattern data beats guessing (CBT-I diagnostic standard).

Bright evening light delays melatonin onset by up to 90 minutes (Harvard, Walker).

Short-wavelength blue light is the strongest melatonin suppressor (AASM).

Consistent pre-sleep cues become conditioned sleep triggers (CBT-I).

Post-bath skin-temp drop accelerates sleep onset by ~10 min (meta-analysis, Sleep Medicine Reviews 2019).

Helps the body initiate the core temp drop.

Low-arousal tasks lower cortisol and sympathetic tone.

Offloading rumination reduces sleep-onset latency (Baylor, 2018).

Slowed breathing shifts the autonomic system toward parasympathetic (Stanford).

Modest evidence for sleep quality, low risk.

Half-life is 5-6 hours; a quarter dose still circulates at bedtime (Walker, AASM).

Alcohol is a sedative, not a sleep aid. It fragments REM and deep sleep (Walker).

Blue light plus dopamine-driven scrolling raises arousal and pushes sleep onset later (Stanford).

Nicotine is a stimulant; withdrawal causes mid-night awakenings.

Reflux and nocturia interrupt sleep.

Social jet lag of >1 hour worsens Monday insomnia (Roenneberg, Current Biology).

Elevated core temp and adrenaline delay sleep onset.

Drains the adenosine pressure you need for sleep onset (CBT-I).

Preserves melatonin (Walker).

It is a timing signal, not a sleeping pill. Most OTC doses are 5-30x physiological (Walker, AASM).

Stimulus control breaks the bed-awake association (CBT-I, AASM).

First-line CBT-I technique per AASM.

Defuses the pressure (Cochrane review).

'One bad night will not ruin tomorrow' is usually accurate (CBT-I).

Shifts attention from rumination to somatic awareness.

Maintain your wake time to rebuild sleep pressure (AASM).

Meets clinical threshold for chronic insomnia disorder (DSM-5, ICSD-3).

AASM and ACP guidelines name CBT-I as first-line with longer-lasting effects than hypnotics.

Untreated OSA raises cardiovascular and dementia risk (AASM).

Treatable, often missed (Cleveland Clinic).

Bidirectional. Treating sleep often improves the other condition (Harvard).

Beta-blockers, SSRIs, stimulants, steroids, decongestants commonly disrupt sleep (AASM).

Cheaper and easier than in-lab polysomnography for uncomplicated cases.

Tolerance, dependence, and next-day impairment make them poor chronic options (ACP guideline).