Gordon Ashby could recite the sleep hygiene leaflet from memory. He had followed it, faithfully, for approximately a decade.

Shift patterns cannot be treated around. Where the pattern is the cause, the conversation has to be about the pattern, and it is usually the least welcome conversation in the clinic.

Restriction, then expansion

The diary runs for two weeks before anything is changed. Retrospective estimates of sleep are unreliable in both directions, and the diary is the correction.

Hygiene advice is necessary and nowhere near sufficient. Handing it out alone is how we lose people for ten years.

Tomas Ferreira, sleep psychology

The window widens

Sleep hygiene alone has a poor evidence base as a standalone treatment, which is awkward, because it is the most widely distributed sleep advice in existence.

“It wasn’t wrong,” he says. “It was just about four per cent of the answer.”

Contributing writer

Tomas Ferreira

A demonstration byline created for this prototype. Not a real writer, and not a clinician.

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