Diet:

• Opt for a nutrient-rich, wholefood diet, inclusive of high intake of fruits and vegetables, lean protein, quality essential fatty acids, and wholegrains (limiting starchy grains and vegetables), with a low intake of sugar/refined foods.
• Reduce caffeine, alcohol, and/or tobacco late in the day, particularly during the evening.
• Try to eat within a 6 to 11 hour window, ideally after sunrise and before sunset. Time restricted eating windows, such as intermittent fasting, has shown promising benefits in improving metabolic parameters, including sleep.
• Extending caloric intake over the course of 15 hours can cause circadian rhythm disruption.
• Avoid eating heavy meals at night, but consider a light snack before bed such as natural yoghurt and fruit or a handful of nuts. This may prevent night-time waking due to hunger.
• Reduce liquids in the last 4 hours before bedtime to prevent night-time urination.

Lifestyle:

• Support circadian rhythm by addressing excessive light exposure and increasing day time light exposure:
• Avoid screens for at least 1 hour before bed (television, laptops, computers, tablets, smart phones).
• Use eye masks and/or black out curtains while sleeping.
• Glasses that block blue light may prevent the effects of blue light on melatonin production and are indicated for patients who use interactive devices in the evening.
• Alternatively, blue light filter apps or settings can be installed/activated on devices to minimise blue light exposure.
• Increase daytime exposure to natural light in addition to limited night light exposure.
• Spend at least 30 minutes outside with sunlight on the skin (while being SunSmart) in the morning, i.e. sunrise, between 11.00 am and 1.00 pm and twilight.
• Increase daytime activity, but avoid exercise within 3 to 5 hours of bedtime to prevent evening overstimulation.
• Consider white and pink noise as a background sound for the sleep environment.
• White noise creates a constant ambient sound that helps to mask other noises, such as traffic.
• Pink noise is similar to white noise, however is slightly louder and more powerful at the lower frequencies (i.e. white noise with a stronger bass tone).
• Listening to binaural beats may also enhance sleep.
• Using headphones to listen to multiple sound frequencies at the same time (i.e. left ear receives a 300 hertz (hz) tone and right ear receives a 280 hz tone) allows the brain to process and absorb a low-frequency 10 hz soundwave.
• This in turn may slow brain wave activity, reducing arousal and thereby supporting sleep cycles.
• Various devices have been developed to monitor sleep activity via measuring brain electroencephalography. Devices may also use therapeutic soundwaves or thermodynamic head cooling to promote sleep. These may offer some benefit in enhancing sleep cycles.

Sleep Hygiene:

• Try to go to bed with a calm mind, try to resolve arguments or set a time earlier in the day to review problems and perhaps write down plans, solutions, or things to do.
• Cognitive-behavioural therapy for insomnia (CBT-I) offers evidence-based techniques that include behavioural and cognitive strategies to enhance sleep quality.
• In a meta-analysis of randomised controlled trials, evidence shows that CBT-I reduces sleep onset latency and nocturnal arousals while improving sleep efficiency (i.e. the length of time asleep relative to the amount of time spent in bed), with effect sizes comparable in magnitude to hypnotics such as benzodiazepines and non-benzodiazepines.^[
• Unlike hypnotics, improvements in sleep following CBTI are maintained after treatment cessation for up to three years.
• In Australia, CBT-I sessions are covered by a mental healthcare plan.
• Refer to the Australasian Sleep Association (ASA) service directory for treatment centres (www.sleep.org.au).