Roughly a third of Americans report sleep difficulty, most commonly insomnia. The World Health Organization defines insomnia as a problem of falling or staying asleep, or of not feeling refreshed after sleep at least 3 times a week. In addition this is accompanied by daytime sleepiness, difficulty concentrating or increased irritability. If you’re experiencing problems sleeping it’s important to let your doctor know. There are a number of physical causes that increase insomnia. These include sleep apnea, restless legs syndrome, acid reflux with heartburn, arthritis, back pain, menopause, and certain medications that interfere with sleep.

Other complicating factors include jet lag, shift work, physical discomfort from an injury or surgery. In some of these situations, your doctor may want to focus on treating the underlying condition and possibly order a sleep study to further diagnose your difficulty. Consult with you doctor before using any over the counter sleep aids.

However, it’s important to note that there a number of “natural” things you can do independently that have the potential of providing you a great deal of relief. These actions are oftentimes referred to as “sleep hygiene”. Just as dental hygiene helps keep teeth and gums healthy, sleep hygiene promotes healthy sleep patterns.

Control your sleep environment.

• If your mattress is uncomfortable, it may be time to replace it. Consumer Reports recommends a new mattress every 5-10 years. In the same way, pillows also need to be replaced regularly.

• The room should be dark, cool (between 60-68 degrees is ideal) and quiet. Yes, people believe that the TV helps them to fall asleep, however, if left on throughout the night it interferes with deep sleep, contributing to not feeling refreshed in the morning. In fact, research is showing that the use of electronic screens up to an hour before bed stimulates the brain and makes falling asleep more difficult. Backlit devices and LED screens have the greatest negative effect.

• Consider who’s in bed with you. A partner who snores or moves excessively during the night may be contributing to your sleep difficulty. In the same way, having babies or children in bed can also be disruptive. Finally, sharing your bed with pets can cause you to awaken multiple times during the night, by their moving about, making noise, or increasing the temperature in bed.

Prepare your body for sleep.

• Exercise regularly, but avoid strenuous exercise in the 3 hours before bedtime.

• Eat regular meals. Don’t go to bed hungry. A light snack (nothing heavy, greasy or highly spiced) can help.

• Notice how caffeine affects you. Some people need to reduce their intake, or at least avoid caffeine in the afternoon and evening.

• Avoid alcohol in the late evening. Yes it seems to induce relaxation, but it also disrupts the normal sleep cycle, interfering with restorative sleep.

• Avoid smoking, especially at night. Nicotine is a stimulant.

• Develop a bedtime routine. Make a to-do list for the next day, to help avoid trying to remember things when you should be relaxing in bed. Take a warm bath or shower. Perhaps set out your clothes for the next day. Listen to relaxing music. Enjoy some light pleasure reading for 15-30 minutes. Learn one of the many forms of relaxation that can help you “let go” of the day and clear your mind.

Final rules.

• Go to bed and wake up at the same time every day, 7 days a week. Once you’re no longer experiencing sleep difficulty you can indulge in “sleeping in” for 1 hour on the weekends.

•  Use your bed only for sleep and sexual activity. Do not do your bills, catch up on work, have phone conversations, email, text, or eat in bed. You want to condition your body and mind so that being in bed = sleep.

•  No clock watching. Turn your clock around or put it on the floor. Watching the minutes tick by tends to increase anxiety and frustration.

•  If you continue to experience difficulties, despite efforts to change your behavior, psychotherapy is often very helpful. Anxiety or depression can contribute to insomnia. A therapist can help you find ways to “turn off” the thoughts that keep you awake.

What about naps? See the Harvard Health Letter.