Sleep Hygiene (Good Sleep Habits)

Definisi: berbagai cara penting yang dilakukan (praktik, habit, lingkungan) supaya
memiliki waktu tidur yang normal dan berkualitas serta kesadaran penuh di siang
hari.
There are four general areas important to sleep hygiene:

Our circadian rhythm, or 24-hour cycle

We all have a day-night cycle of about 24 hours called the circadian rhythm. It
greatly influences when we sleep and the quantity and the quality of our sleep.
The more stable and consistent our circadian rhythm is, the better our sleep.
This cycle may be altered by the timing of various factors, including naps,
bedtime, exercise, and especially exposure to light (from traveling across time
zones to staring at that laptop in bed at night).

Aging
Aging also plays a role in sleep and sleep hygiene. After the age of 40 our sleep
patterns change, and we have many more nocturnal awakenings than in our
younger years. These awakenings not only directly affect the quality of our
sleep, but they also interact with any other condition that may cause arousals or
awakenings, like the withdrawal syndrome that occurs after drinking alcohol
close to bedtime. The more awakenings we have at night, the more likely we will
awaken feeling unrefreshed and unrestored.

Psychological stressors -- those factors can cause difficulty falling asleep and
disturb the quality of your sleep
Psychological stressors like deadlines, exams, marital conflict, and job crises may
prevent us from falling asleep or wake us from sleep throughout the night. It
takes time to "turn off" all the noise from the day. No way around it. If you work
right up to the time you turn out the lights, or are reviewing all the day's events
and planning tomorrow (sound familiar?), you simply cannot just "flip a switch"
and drop off to a blissful night's sleep.

Common social or recreational drugs like nicotine, caffeine, and alcohol

Reducing sleep by as little as one and a half hours for just one night reduces
daytime alertness by about one-third. Excessive daytime sleepiness impairs
memory and the ability to think and process information, and carries a substantially
increased risk of sustaining an occupational injury. Long-term sleep deprivation from
sleep disorders like apnea have recently been implicated in high blood pressure,
heart attack, and stroke.

Sleep hygiene bisa sangat individual. Bergantung kebutuhan setiap orang. here are
some sleep hygiene tips to help you relax, fall asleep, stay asleep, and get better
sleep so that you wake up refreshed and alert.
Personal Habit

Hindari stimulan seperti caffeine, nicotine, dan alcohol saat menjelang tidur.
Meski alcohol dikenal dengan kemampuannya untuk mempercepat ondet tidur,
alcohol dapat mengganggu tidur saat tubuh mulai memetabolisme alcohol.
Exercise can promote good sleep, but not right before bed. Vigorous exercise
should be taken in the morning or late afternoon. Strenuous exercise within the 2
hours before bedtime, however, can decrease your ability to fall asleep.
Food can be disruptive right before sleep; stay away from large meals close to
bedtime. Also dietary changes can cause sleep problems, if someone is
struggling with a sleep problem, it's not a good time to start experimenting with
spicy dishes. And, remember, chocolate has caffeine.
Ensure adequate exposure to natural light. Light exposure helps maintain a
healthy sleep-wake cycle.
Fix a bedtime and an awakening time. Do not be one of those people who
allows bedtime and awakening time to drift. The body "gets used" to falling
asleep at a certain time, but only if this is relatively fixed. Even if you are retired
or not working, this is an essential component of good sleeping habits.
Avoid napping during the day. If you nap throughout the day, it is no wonder
that you will not be able to sleep at night. The late afternoon for most people is a
"sleepy time." Many people will take a nap at that time. This is generally not a
bad thing to do, provided you limit the nap to 30-45 minutes and can sleep well
at night.

Sleeping Environment

Use comfortable bedding. Uncomfortable bedding can prevent good sleep.

Evaluate whether or not this is a source of your problem, and make appropriate
changes.
Find a comfortable temperature setting for sleeping and keep the room
well ventilated. If your bedroom is too cold or too hot, it can keep you awake.
A cool (not cold) bedroom is often the most conducive to sleep. Try to keep your
bedroom at a comfortable temperature -- not too hot (above 75 degrees) or too
cold (below 54 degrees).
Block out all distracting noise, and eliminate as much light as possible.
Reserve the bed for sleep and sex. Don't use the bed as an office, workroom
or recreation room. Let your body "know" that the bed is associated with
sleeping.

Does your pet sleep with you? This, too, may cause arousals from either allergies
or their movements in the bed. Thus, Fido and Kitty may be better off on the
floor than on your sheets.

Getting Ready For Bed

Try a light snack before bed. Warm milk and foods high in the amino acid
tryptophan, such as bananas, may help you to sleep.
Practice relaxation techniques before bed. Relaxation techniques such
as yoga, deep breathing and others may help relieve anxiety and reduce muscle
tension.
Don't take your worries to bed. Leave your worries about job, school,
daily life, etc., behind when you go to bed. Some people find it useful to assign a
"worry period" during the evening or late afternoon to deal with these issues.Try
to avoid emotionally upsetting conversations and activities before trying to go to
sleep. Don't dwell on, or bring your problems to bed.
Establish a pre-sleep ritual. Pre-sleep rituals, such as a warm bath or a
few minutes of reading, can help you sleep.
Get into your favorite sleeping position. If you don't fall asleep within
15-30 minutes, get up, go into another room, and read until sleepy.
Try not to drink fluids after 8 p.m. This may reduce awakenings due to
urination.

Getting Up in the Middle of the Night

Most people wake up one or two times a night for various reasons. If you find that
you get up in the middle of night and cannot get back to sleep within 15-20
minutes, then do not remain in the bed "trying hard" to sleep. Get out of bed. Leave
the bedroom. Read, have a light snack, do some quiet activity, or take a bath. You
will generally find that you can get back to sleep 20 minutes or so later. Do not
perform challenging or engaging activity such as office work, housework, etc. Do
not watch television.
A Word About Television
Many people fall asleep with the television on in their room. Watching television
before bedtime is often a bad idea. Television is a very engaging medium that tends
to keep people up. We generally recommend that the television not be in the
bedroom. At the appropriate bedtime, the TV should be turned off and the patient
should go to bed. Some people find that the radio helps them go to sleep. Since
radio is a less engaging medium than TV, this is probably a good idea.
Other Factors

Several physical factors are known to upset sleep. These include

arthritis, acid reflux with heartburn, menstruation, headaches and hot flashes.

Psychological and mental health problems like depression, anxiety

and stress are often associated with sleeping difficulty. In many cases,
difficulty staying asleep may be the only presenting sign of depression. A physician
should be consulted about these issues to help determine the problem and the best
treatment.

Many medications can cause sleeplessness as a side effect. Ask your

doctor or pharmacist if medications you are taking can lead to sleeplessness.

To help overall improvement in sleep patterns, your doctor may

prescribe sleep medications for short-term relief of a sleep problem. The
decision to take sleeping aids is a medical one to be made in the context of your
overall health picture.

Always follow the advice of your physician and other healthcare

professionals. The goal is to rediscover how to sleep naturally.

Sleep Disorder
Klasifikasi sleep disorder menurut DSM-IV-TR berdasarkan basis of clinical diagnostic
criteria and presumed etiology.

primary sleep disorders

- Dyssomnia: kelainan kuantitas atau waktu tidur
Insomnia: difficulty initiating or maintaining sleep. Bentuknya
terdiri dari:
Primary insomnia
circadian rhythm sleep disturbances
Hypersomnia: excessive amounts of sleep, excessive daytime
sleepiness (somnolence), or sometimes both.
- Parasomnia: abnormal behaviors during sleep or the transition
between sleep and wakefulness.
sleep disorders related to another mental disorder
other sleep disorders (due to a general medical condition or are substance
induced).

ICSD (International Classification of Sleep Disorders: Diagnostic and Coding Manual)

divides sleep disorders into four categories:
1. Dyssomnias
A. Intrinsic sleep disorders
1. Psychophysiological insomnia

2. Sleep state misperception

3. Idiopathic insomnia
4. Narcolepsy
5. Recurrent hypersomnia
6. Idiopathic hypersomnia
7. Posttraumatic hypersomnia
8. Obstructive sleep apnea syndrome
9. Central sleep apnea syndrome
10.Central alveolar hypoventilation syndrome
11.Periodic limb movement disorder
12.Restless legs syndrome
13.Intrinsic sleep disorder NOS
B. Extrinsic sleep disorder
1. Inadequate sleep hygiene
2. Environmental sleep disorder
3. Altitude insomnia
4. Adjustment sleep disorder
5. Insufficient sleep syndrome
6. Limit-setting sleep disorder
7. Sleep-onset association disorder
8. Food allergy insomnia
9. Nocturnal eating (drinking) syndrome
10.Hypnotic-dependent sleep disorder
11.Stimulant-dependent sleep disorder

12.Alcohol-dependent sleep disorder

13.Toxin-induced sleep disorder
14.Extrinsic sleep disorder NOS
C. Circadian rhythm sleep disorders
1. Time zone change (jet lag) syndrome
2. Shift work sleep disorder
3. Irregular sleepwake pattern
4. Delayed sleep phase syndrome
5. Advanced sleep phase syndrome
6. Non-24-hour sleepwake disorder
7. Circadian rhythm sleep disorder NOS
2. Parasomnias
A. Arousal disorders
1. Confusional arousals
2. Sleepwalking
3. Sleep terrors
B. Sleepwake transition disorders
1. Rhythmic movement disorder
2. Sleep starts
3. Sleep talking
4. Nocturnal leg cramps
C. Parasomnias usually associated with REM sleep
1. Nightmares
2. Sleep paralysis

3. Impaired-sleep-related penile erections

4. Sleep-related painful erections
5. REM-sleep-related sinus arrest
6. REM sleep behavior disorder
D. Other parasomnias
1. Sleep bruxism
2. Sleep enuresis
3. Sleep-related abnormal swallowing syndrome
4. Nocturnal paroxysmal dystonia
5. Sudden unexplained nocturnal death syndrome
6. Primary snoring
7. Infant sleep apnea
8. Congenital central hypoventilation syndrome
9. Sudden infant death syndrome
10.Benign neonatal sleep myoclonus
11.Other parasomnia NOS
3. Sleep disorders associated with medical-psychiatric disorders
A. Associated with mental disorders
1. Psychoses
2. Mood disorders
3. Anxiety disorders
4. Panic disorders
5. Alcoholism
B. Associated with neurological disorders

1. Cerebral degenerative disorders

2. Dementia
3. Parkinsonism
4. Fatal familial insomnia
5. Sleep-related epilepsy
6. Electrical status epilepticus of sleep
7. Sleep-related headaches
C. Associated with other medical disorders
1. Sleeping sickness
2. Nocturnal cardiac ischemia
3. Chronic obstructive pulmonary disease
4. Sleep-related asthma
5. Sleep-related gastroesophageal reflux
6. Peptic ulcer disease
7. Fibrositis syndrome
4. Proposed sleep disorders
A. Short sleeper
B. Long sleeper
C. Subwakefulness syndrome
D. Fragmentary myoclonus
E. Sleep hyperhidrosis
F. Menstrual-associated sleep disorder
G. Pregnancy-associated sleep disorder
H. Terrifying hypnagogic hallucinations

I.

Sleep-related neurogenic tachypnea

J.

Sleep-related laryngospasm

K. Sleep choking syndrome

In the 10th revision of International Statistical Classification of Diseases and Related
Health Problems (ICD-10), the subject of sleep disorders covers only those of
nonorganic type. These disorders are classified as
-

dyssomnias: insomnia, hypersomnia, and disorder of the sleep-wake

schedule
psychogenic conditions: predominant disturbances are in the amount,
quality, or timing of sleep because of emotional causes
parasomnias: abnormal episodic events occurring during sleep
(sleepwalking, sleep terrors, and nightmares)

Sleep disorders of organic origin, nonpsychogenic disorders such as narcolepsy and

cataplexy, and sleep apnea and episodic movement disorders are discussed under
other categories.
Narcolepsy is a condition characterized by excessive sleepiness, as well as auxiliary
symptoms that represent the intrusion of aspects of REM sleep into the waking
state.
Breathing-related sleep disorder is characterized by sleep disruption leading to
excessive sleepiness or insomnia caused by a sleep-related breathing disturbance
Obstructive sleep apnea (OSA) is characterized by periods of functional obstruction
of the upper airway during sleep, resulting in decreases in arterial oxygen saturation
and a transient arousal, after which respiration (at least briefly) resumes normally.
Central alveolar hypoventilation refers to several conditions marked by impaired
ventilation in which the respiratory abnormality appears or greatly worsens only
during sleep and in which no significant apneic episodes are present.
Circadian rhythm sleep disorder includes a wide range of conditions involving a
misalignment between desired and actual sleep periods. DSM-IV-TR lists four types
of circadian rhythm sleep disorders:
-

delayed sleep phase type: the circadian system is operating in a

delayed, but stable, relationship to the day-night cues of the external
world.
jet lag type
shift work type
unspecified