Sleep Hygiene
Introduction
Sleep is one of the biggest "vulnerability factors" in DBT: when you're under-slept, your nervous system is easier to overwhelm, urges hit harder, and emotion regulation gets way more expensive. Sleep hygiene is how you set your body up to sleep by building strong external cues (routine + environment) so you don't have to rely on willpower at 1:47am.
For neurodivergent brains (ADHD/autistic), sleep can be extra tricky because internal "sleep signals" may be less reliable (interoception), sensory needs may be higher, and circadian rhythm can drift. Sleep hygiene helps by externalizing rhythm: consistent cues, consistent timing, consistent "bed = sleep" association.
When to Use This Page
Use this page when:
- you're having trouble falling asleep or staying asleep
- bedtime ramps up rumination, anxiety, or sensory discomfort
- your sleep schedule drifts (late nights → late mornings → worse sleep)
- you wake up and your brain starts doing "middle-of-the-night catastrophizing"
Not the best tool when:
- you're in an immediate crisis where safety is at risk (use crisis skills first)
- you suspect sleep apnea, severe insomnia, night terrors, PTSD flashbacks, or medication side effects (still use skills, and loop in a clinician)
DBT Sleep Hygiene Protocol (Core Steps)
This is adapted from DBT's Sleep Hygiene Protocol.
1) Keep a consistent schedule (even weekends).
Go to bed and get up at the same time. Avoid naps longer than ~10 minutes.
2) Protect the "bed = sleep" association.
Don't use your bed for daytime scrolling, TV, phone calls, or reading.
(Stimulus control is a widely used insomnia approach: bed is for sleep, not awake-time.)
3) Avoid late-day sleep disruptors.
Caffeine, nicotine, alcohol, heavy meals, and vigorous exercise late in the day can make sleep harder.
4) Build a sensory-safe sleep environment.
Cool-ish, quiet, dark. Use tools on purpose: fan/white noise, earplugs, sleep mask, heating blanket, "feet out of blanket," etc.
5) Give yourself 30–60 minutes to fall asleep.
If you're not asleep by then, don't force it. Check whether you're calm vs. anxious/ruminating.
6) Don't catastrophize.
"Being awake is not a catastrophe." Aim for rest/reverie, and don't "start the day" at 3am.
If You Can't Sleep: Choose the Right Branch
DBT splits this into calm but awake vs anxious/ruminating.
A) If you're calm but wide awake
- Get out of bed and do something low-stimulation in another room (no bright lights). Return to bed when sleepy.
- Try a light snack (something simple).
B) If you're anxious or ruminating
Pick one:
- TIPP (cold water + paced breathing) if your body is revved up.
- 9→0 breathing countdown (then restart at 8→0, 6→0, etc.)
- Focus on the bodily sensation under the rumination (often rumination is avoiding a harder body-feeling).
- Label it "middle-of-the-night thinking" (your brain will think differently in the morning).
- If it keeps looping: If solvable, solve it. If not solvable now, go all the way to the "catastrophe" and then cope-ahead with it.
- If nothing else works: quiet, steady audio (low-variation voices) can help some people settle.
Neurodivergent-Friendly Sleep Hygiene Add-Ons
Use these as accommodations, not "fixes."
Sensory calibration (make sleep easier for your nervous system):
- Pick one "safe sensory anchor" (fan noise, weighted blanket, compression sheet, specific scent, etc.).
- If silence is painful, use consistent low-variation sound (fan/white noise/steady voices).
Transition support (ADHD/autistic "task switching"):
- Add a short repeatable wind-down script (same 3–5 steps nightly).
- Use timers to externalize time: "screens off in 10," "bed routine starts now."
If screens are a regulation tool:
Don't fight yourself at bedtime; route it. Choose one lower-stimulation option (dim, night mode, predictable content), then step down to audio or print.
Practice Sheet (Track What Works)
Use DBT's Sleep Hygiene Practice Sheet to track: bedtime/wake time, what you did before bed, rumination level before/after, and usefulness.
Mini-experiment idea: Pick one variable for 7 days (bedtime consistency, caffeine cutoff, fan noise, leaving bed after 60 min) and track the change.