Developing a Theory-based Sleep Hygiene Education Intervention for Insomnia Patients - A Mixed Method Study

Insomnia is a prevalent sleep disorder associated with substantial negative health consequences, including fatigue, irritability, and impaired daytime functioning. Although effective pharmacological (e.g., hypnotics) and psychological treatments (e.g., cognitive behavioral therapy for insomnia, CBT-I) are available, both local and international surveys indicate that fewer than 50% of individuals with insomnia seek treatment. This treatment gap highlights the need to develop effective non-pharmacological interventions that are both accessible and acceptable to individuals with insomnia.

Sleep hygiene education (SHE) represents a potentially suitable intervention to address this unmet need. SHE is an educational approach that encompasses a range of lifestyle and environmental recommendations aimed at optimizing sleep quality and duration, such as maintaining a regular sleep-wake schedule, avoiding substances (e.g., caffeine, nicotine, and alcohol) and daytime napping, limiting stimulating bedtime activities, creating an optimal bedroom environment, and adopting appropriate diet and exercise habits etc. Given its simplicity, low cost, accessibility, and ease of delivery and mastery, SHE holds promise as a non-pharmacological strategy for insomnia management.

Despite these advantages, SHE is not typically recommended as a stand-alone treatment for sleep-vulnerable populations, as it is often perceived to be less effective than CBT-I or mindfulness-based therapies. Notably, the efficacy of SHE may be underestimated. In many prior studies, SHE has been used primarily as a passive control condition to account for nonspecific treatment effects, resulting in its active therapeutic components being largely overlooked.

Advancing SHE beyond a simple advice-giving modality to a structured, theory-informed intervention may enhance its effectiveness by ensuring that its content is not only informative but also practicable and behaviorally achievable. Integrating SHE with evidence-based behavior change techniques may further equip participants with the skills necessary to initiate and sustain meaningful behavioral change. Accordingly, this pilot study aims to examine the feasibility and preliminary effectiveness of a theory-based SHE program previously developed by our team.