5:  SLEEP ENVIRONMENT                                                              [Rev 2-9 -2019]

This section starts our consideration of general issues that can affect a person’s sleep. It appears in Step C. It might be a good starting-point, because people can think about their environment and consider changes while they are in the office. How they have set up their lives can also be informative relative to other psychological issues they may be having.

External factors can interfere with falling asleep, staying asleep, and waking normally. This is especially true for light sleepers. (Some resources consider the sleep environment to be part of “sleep hygiene”, which appears as a list several different issues that a person is urged to fix. Here, the component issues are considered separately for greater clarity, so the blanket term is not used.) A person may have considered some obvious sources of sleep disruption and not others.

Disruptions can occur at any time of night. A person might not think of environmental conditions that change and yet be affected by them – a dog that sleeps in bed and wants to go out in the middle of the night, or a change in the temperature as the stove cools or the furnace thermostat goes into a new time zone.

5a: Some Possibilities

It could be that eliminating disturbers will make it easier for the person to sleep. Here are some possible disruptive sources. See also Chapter 5 of Hauri and Linde, and Chapter 7 of Hirshkowitz and Smith.

LIGHT

Ask what the lighting is like in the bedroom, and what would be ideal. Some possible sleep disruptors include…

  • A room that is too bright for comfort
  • A blinking neon light outside the window
  • Other lights that go on and off during the night.

Actually, even a small amount of light in the room can delay melatonin production at bedtime and make falling asleep a problem. If it happens repeatedly, the person’s circadian cycle can be re-set and subsequent nights affected as well. Because of this, a person should consider keeping the bedroom as consistently dark as possible. See Section 27 on light management

Lights may be kept on to engage in alerting activities – reading exciting novels, watching stimulating television, telephone conversations with friends, and so on. These activities are also antithetical to preparation for sleep.

ROOM TEMPERATURE

At bedtime, falling asleep is easier if a person’s core body temperature drops by 2-3°F (Walker, p.275). A lower body temperature facilitates the release of melatonin to signal the time for sleep. A cool room facilitates this process. A room temperature of 65°F seems ideal for most people (Walker, p.277). Some people sleep under a blanket with their feet sticking out, to keep overall body temperature down.

Temperature throughout the night affects sleep. Ask about it. The best seems to be a warm bed in a cool room (McKenna, 77)

  • A room that is too warm or too cold for comfort can be a problem.
  • Room temperature that changes during the night can affect sleep. It may be important to be able to add or take away bedding in the night.

The remedy will depend on circumstances, but could include

  • Open a window or close a window.
  • Leave the furnace fan on all night, so the air circulates throughout the house and the temperature remains constant.
  • Get up and walk around, to cool off. Then return to bed.

SOUNDS

Many sounds can interfere with sleep. This can happen in many ways. You may not be conscious, but you may be registering and recognizing them, and they may have meaning for you.

Sounds that are continuous and repetitive commonly suggest stability and safety. Sounds that are unpredictable may suggest danger. Sounds that resemble dangerous sounds may alert a person to the need to awaken. Other sounds may engage a person’s curiosity. Perception of danger increases a person’s alertness and makes sleep more difficult.

Ask if there are any problems with the sounds in the bedroom at bedtime or throughout the night. (Hauri and Linde, 67-69) Variable noise is often a problem (McKenna, 75)

  • When one partner needs television to fall asleep and the other needs total quiet, there is a problem.
  • A ticking clock can keep one person awake and help another sleep.
  • Street noise or a passing train can wake a person.
  • Drive-by shootings are hard to get used to.
  • Neighbors with different hours can create disruptive sounds, especially to party, listen to music, clean house, argue or watch television.

 

Some outside sounds can be reduced by closing a door or putting weather seal around the edges of the door.

A white noise generator can mute outside sounds. Other sound machines generate specific sounds – rain falling or birds chirping – that some people like. Sometimes meditation CD’s can be helpful. These sounds suggest normalcy and safety.

COMFORT LEVEL

Qualities of the bed and bedding may interfere with sleep (see Hauri and Linde, 65-67). Ask about the mattress, the pillows and sheets and blankets. Anything that reduces a person’s comfort can lead to attempts, conscious or unconscious, to make a change.

CLUTTER

Clutter in the bed can be disruptive of sleep – food, a book or laptop. A person can roll over on an object that suggests – unconsciously – a need to fix the problem. If the problem lasts or is sufficiently uncomfortable, the person may awaken.

A cluttered room can make nighttime trips to the bathroom hazardous and likely to awaken you more than necessary.

PARTNER

Sleeping with another person can be comforting and romantic. It can also interfere with sleep (Hauri and Linde, 70). Many aspects of the situation can be problematic.

  • A partner who needs quiet when you need sound, or the reverse.
  • A partner who is a restless sleeper or who snores.
  • Incompatibilities about room conditions or bedding.
  • A partner with other sleep-disruptive habits, like reading in bed, or watching television
  • A small bed can accentuate difficulties.

Once identified, these issues can be addressed directly by the person and his/her partner.

CHILDREN OR PETS

Ask whether there are any in bed with the patient. If so, they may be interfering with the patient’s sleep.

  • It can be difficult to sleep soundly if you could roll over and crush an infant or small child.
  • A dog could love to lie on your feet, or lick you awake early in the morning.
  • A cat jumping on the bed from the floor could land on your belly.
  • An infant that wakes in the night to be nursed disrupts someone’s sleep. Many parents are sleep deprived for the first few months of an infant’s life.

Whenever other creatures are in the bed, sleep can be compromised, and the person can become resentful and irritable. Some examination of the reasons for accepting others into the bed may be in order, along with a consideration of alternatives.

AIR QUALITY

Ask “What’s the air like in your bedroom?” Many things could interfere with sleeping:

  • The smell of cooking from a nearby restaurant or fish from a fish market
  • Smoke or old cigarettes
  • Stale or musty air
  • A draft
  • High humidity
  • Air conditioning vs an open window (Hauri and Linde , 66)

DANGERS AND DISTRACTIONS

These may not be qualities of the environment, exactly, but they can affect sleep. Here, the objective nature of the danger may be less important than the person’s perception of danger. If you think that there are monsters under the bed, that in itself is enough to keep you awake for a while. Other perceived dangers can include…

  • Concerns about the sleep of an infant, small children, or a sick person.
  • A dangerous partner
  • Waiting for a phone call – about work, an aging parent, a risk-taking family member
  • Waiting for someone to come home
  • Dangers re living alone or in a risky neighborhood (Hauri and Linde, 70)
  • For some other possibilities, see Section 20 (Use of the Bed and Bedroom).

5b: How to Ask

There are so many possibilities, that it is probably better to begin with an open-ended approach, and go to a checklist once the person has completed his/her own survey.

For a checklist, consider the main headings above, in whatever order seems reasonable. You might want to print out this list or make another one, but it is a good idea to be comprehensive – often things that disrupt sleep are seen by the person as just normal.

The assumption of normality often prevents problem-solving. “I have to let the dog sleep in bed with us, or she would be crying outside the door all night.” Really? Every night? For how long? I suppose it would disrupt your sleep, right?