Why Sleep Hygiene Alone Falls Short
The familiar sleep-hygiene advice helps a little, and much less than the structured programme it is often mistaken for.
Evidence suggests sleep-hygiene education produces a real but small improvement in insomnia severity and is consistently outperformed by structured behavioural therapy. In a head-to-head trial, therapy and sleep restriction reduced insomnia severity by 7.7 and 6.6 points against 1.1 for sleep-hygiene education. Across forty-two randomized trials, hygiene education was inferior to therapy, exercise and other active approaches. Part of the difficulty is definitional: fewer than half of studies even define what they mean by sleep hygiene. We grade this B rather than A because the comparison is consistent while the content being compared varies between studies.
- Misconception: 'Good sleep hygiene fixes insomnia.' It improves severity by about a third as much as structured therapy.
- Does not diagnose or treat insomnia
- Sleep difficulty at least three nights a week for three months or more → clinician, and see the CBT-I block
Every source below carries its own grade and links to the original study. This is the audit trail.