A sleep hygiene PDF is easy to find and easy to hand over. When we checked Google's first page for that search in October 2026, every handout on it was written for patients or parents. None of them told the therapist handing it out what it can and can't do. This page has both parts. First, a client handout in plain words and a sleep diary your client can fill in each morning. Print the page or save it as a PDF. Then, the part for you: what the American College of Physicians and the American Academy of Sleep Medicine say about sleep hygiene, what stimulus control and sleep restriction are, who shouldn't try sleep restriction, when to refer, and how to document it.
The short version for clinicians: sleep hygiene is a reasonable start, but on its own it is weak treatment for chronic insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment.
Every client in this article is invented. Any resemblance to a real person is a coincidence.
How to print this page or save it as a PDF
- On a computer: press Ctrl+P (Windows) or Cmd+P (Mac).
- On a phone: open your browser's share menu and choose Print.
- To keep a PDF: in the print window, choose "Save as PDF" as the printer. You can then send the file to a client or keep it with your other handouts.
- To print only the client pages: check the print preview for the pages from "Client handout" to "End of the sleep diary", and enter just those pages as the page range. Print the diary page once for each week the client will track.
- If the cookie notice is still open, choose an option first, so it doesn't print across the bottom of every page.
Client handout: sleep habits that help
These are habits that help many people sleep better. You don't need to do all of them. Pick two or three with your therapist, try them for two weeks, and fill in the sleep diary each morning so you can both see what changes. Sleep often gets better slowly, so give each change time.
Keep the same wake-up time
- Get up at the same time every day, weekends too, even after a bad night.
- Get daylight soon after you wake up. Open the curtains or step outside for a few minutes.
- Go to bed when you feel sleepy, not just because the clock says it's bedtime.
Keep your bed for sleep
- Use your bed for sleep and sex only. Watch, scroll, work and worry somewhere else.
- If you've been awake in bed for what feels like about 20 minutes, get up. Go to another room, do something calm in dim light, and go back to bed when you feel sleepy. Do this as many times as you need to.
- Turn the clock so you can't see it. Checking the time makes it harder to fall asleep.
- Safety first: if you're unsteady on your feet at night, or you take medicine that makes you drowsy, ask your doctor or therapist before you start getting up in the night. Keep a dim light on your path.
During the day
- Move your body most days. A walk counts.
- If you can get through the day without a nap, skip it. If you do nap, keep it short and early in the afternoon.
- If you feel sleepy while driving, stop somewhere safe. Don't push on.
Caffeine, alcohol and nicotine
- Have your last caffeine at least 6 hours before bed. Caffeine is in coffee, tea, cola, energy drinks and some other sodas.
- Alcohol close to bedtime makes that night's sleep worse, even a small amount.
- Nicotine keeps you alert. If you're cutting down or quitting, sleep can get worse for a short time before it gets better. Tell your doctor or therapist so they can help.
The hour before bed
- Give yourself 30 to 60 minutes to wind down: dim lights, a warm shower, reading, quiet music or gentle stretching.
- Put your phone and laptop away, or at least out of reach of the bed.
- If your mind races at night, set aside 10 minutes earlier in the evening to write down what's on your mind and one next step for each thing. Then put the paper away.
- Don't go to bed very hungry or very full. A light snack is fine.
Your bedroom
- Keep it dark, quiet and at a temperature that feels comfortable to you.
- Use earplugs, a fan or an eye mask if noise or light gets in.
- If you can, keep work, bills and screens out of the room.
Talk to your doctor or therapist if
- You snore loudly, or someone has seen you stop breathing, choke or gasp in your sleep.
- You're very sleepy during the day, or you've nodded off while driving.
- An urge to move your legs in the evening or at night keeps you awake.
- You act out your dreams, sleepwalk, or have nightmares most weeks.
- You have trouble sleeping 3 or more nights a week, and it has gone on for 3 months or more.
- Your sleep changed when you started or stopped a medicine. Don't stop or change any medicine without asking the person who prescribes it.
- You have bipolar disorder or epilepsy. Losing sleep can affect both, so check with your care team before you change your sleep schedule.
- You suddenly need much less sleep than usual and don't feel tired.
If you're in crisis in the US, call or text 988.
End of the handout
Sleep diary to copy
For your client: fill in the morning lines within an hour of getting up, and the "yesterday" lines at bedtime or first thing in the morning. Your best guess is fine. Don't look at the clock during the night to get exact times. Use one copy for each night, and keep going for two weeks. Bring the diary to your next session.
End of the sleep diary
The fields follow the core items of the Consensus Sleep Diary, a standard diary agreed by insomnia researchers (Carney et al. 2012), written here in our own words. The AASM's insomnia guideline asks for at least a two-week sleep log at assessment, and for diary data before and during treatment (Schutte-Rodin et al. 2008).
For you, a weekly summary. Average each field over the week and keep the numbers in your note:
How to work out total sleep and sleep efficiency. Time in bed runs from getting into bed to getting out of bed. Total sleep is the time from trying to sleep to the final waking, minus the time it took to fall asleep and the time awake in the night. Sleep efficiency is total sleep divided by time in bed, times 100.
An invented example: in bed at 10:15 PM, tried to sleep at 10:30 PM, 45 minutes to fall asleep, 60 minutes awake in the night, final waking at 6:00 AM, out of bed at 6:45 AM. Time in bed is 8 hours 30 minutes. Total sleep is 7 hours 30 minutes minus 1 hour 45 minutes, which leaves 5 hours 45 minutes. Sleep efficiency is about 68%. The AASM's brief behavioral treatment fact sheet describes sleep efficiency below 85% as poor (AASM, BBTI provider fact sheet).
What the evidence says about sleep hygiene
Sleep hygiene is a set of general advice about daily habits (caffeine, alcohol, exercise, naps) and the bedroom (light, noise, temperature), sometimes with some teaching about normal sleep. It is sensible advice. It is not, on its own, a treatment for chronic insomnia, and the two main US guidelines are clear about that.
American College of Physicians, 2016. Its first recommendation reads: "ACP recommends that all adult patients receive cognitive behavioral therapy for insomnia (CBT-I) as the initial treatment for chronic insomnia disorder." That is a strong recommendation based on moderate-quality evidence. Medication comes second: ACP suggests shared decision-making about adding a medicine for adults in whom CBT-I alone was unsuccessful, a weak recommendation based on low-quality evidence (Qaseem et al. 2016).
American Academy of Sleep Medicine, 2021. The AASM's guideline on behavioral and psychological treatments makes one strong recommendation, for multicomponent CBT-I. It makes conditional recommendations for brief behavioral therapies, and for stimulus control, sleep restriction therapy and relaxation therapy used alone. It makes one conditional recommendation against: "We suggest that clinicians not use sleep hygiene as a single-component therapy for the treatment of chronic insomnia disorder in adults." The reasons given are indirect evidence that sleep hygiene was less effective than other treatments when used alone, and a concern that relying on it "may divert resources and delay" the use of treatments that work better. The guideline adds that sleep hygiene may still be part of a multicomponent treatment (Edinger et al. 2021).
What the research reviews found. A 2018 meta-analysis of 15 studies found that sleep hygiene education was followed by small to medium improvements in sleep, but was significantly less effective than CBT-I. On sleep diaries, sleep efficiency improved by about 5 percentage points after sleep hygiene education, and CBT-I beat it by about 8 points. Only self-reported measures improved (Chung et al. 2018). A 2015 review of each individual piece of advice found that habits like late caffeine, alcohol close to bedtime and nicotine are linked to worse sleep, but that the advice itself is "somewhat vague and inconsistent" across sources, and that the direct effect of following each recommendation is largely untested. The authors saw sleep hygiene's best use in public health rather than as a clinical treatment (Irish et al. 2015).
That review also changed a few lines in our handout. It found little support for the common rule that evening exercise ruins sleep, so the handout says to move most days without a cutoff time. It found limited research on naps, so the handout keeps nap advice soft. And it noted that clinical treatments fix the wake time but let bedtime vary, and advised against a fixed bedtime as a general rule, so the handout fixes the wake-up time instead.
What this means for you:
- For a client with a short-term sleep problem, or as general wellness advice, the handout is a reasonable step.
- For chronic insomnia, the handout is the first page of CBT-I, not the treatment. Use the diary, screen for other sleep disorders, and either deliver CBT-I yourself if you're trained or refer.
- Don't let "try the sleep hygiene sheet" run for months. That delay is exactly what the AASM warns about.
Is it chronic insomnia?
Insomnia means trouble falling asleep, staying asleep or waking too early despite enough chance to sleep, with some effect on the day: tiredness, low mood, poor concentration, or trouble at work, school or home. It counts as chronic when it happens three or more nights a week for more than three months (AASM, BBTI provider fact sheet).
If a client meets that description, sleep hygiene alone isn't the plan. If they don't (a few bad weeks after a move, a new baby, exam season), the handout and two weeks of the diary are a sensible start, with a review date.
What CBT-I includes
In the AASM guideline, CBT-I combines cognitive therapy strategies and teaching about how sleep is regulated with two behavioral parts, stimulus control and sleep restriction. It often adds sleep hygiene and relaxation training. Treatment is guided by the sleep diary and usually runs about 4 to 8 sessions. Brief therapies for insomnia focus on the behavioral parts, a tailored plan built on stimulus control and sleep restriction, over about 1 to 4 sessions (Edinger et al. 2021).
The two behavioral parts are the ones clients have usually never heard of, so here they are in plain words.
Stimulus control in plain words
After months of lying awake, the bed itself starts to signal "awake and frustrated." Stimulus control retrains that link so the bed signals sleep again. The instructions are simple and hard to follow:
- Go to bed only when sleepy.
- Use the bed only for sleep and sex.
- If you can't fall asleep within about 20 minutes (as it feels, not by the clock), get up, do something relaxing elsewhere, and come back when sleepy. Repeat as often as needed, including after waking in the night.
- Get up at the same time every morning, whatever happened in the night.
- Avoid daytime naps.
These steps come from the AASM's guidance (Schutte-Rodin et al. 2008; AASM, BBTI provider fact sheet), and the handout above includes the client version. The AASM notes that stimulus control may need adapting for safety in clients at high risk of falls, with mobility problems or using sedative-hypnotics (Edinger et al. 2021). That is why the handout tells those clients to check before getting up at night.
Sleep restriction in plain words
The name worries clients, so explain it this way: the goal isn't less sleep, it's less time lying awake in bed. People with insomnia often spend far longer in bed than they sleep, trying to catch up. Sleep restriction shrinks time in bed to roughly the amount of sleep the person is actually getting, which builds sleep drive and makes sleep more predictable. Then the window grows back.
How it usually works, per the AASM:
- Keep the diary for two weeks and work out average total sleep.
- Set a "sleep window": time in bed equal to average total sleep plus about 30 minutes. The 2008 guideline says time in bed should not go below 5 hours.
- Fix the wake-up time. The bedtime moves, not the morning.
- Review weekly. If the client falls asleep in under 30 minutes and is awake less than 30 minutes in the night, add 15 minutes to the window. If either is more than 30 minutes, take 15 minutes away.
Sources: Schutte-Rodin et al. 2008 and the AASM BBTI provider fact sheet.
Warn clients they will probably feel more tired at first. In a lab study of 16 patients, sleep restriction cut measured sleep by roughly 70 to 90 minutes a night in the first weeks, raised daytime sleepiness and slowed reaction times. Sleepiness and reaction times were back to baseline by three months, and insomnia had improved. The paper repeats the standard advice that patients not drive or operate heavy machinery if they feel very sleepy (Kyle et al. 2014).
Who shouldn't try sleep restriction
Sleep restriction belongs inside CBT-I or brief behavioral treatment with a trained clinician, and it isn't for everyone. The AASM sources list these cautions:
- Bipolar disorder or a tendency to mania or hypomania.Lost sleep can trigger a high. The AASM fact sheet says sleep restriction is not recommended for patients with bipolar disorder, and the 2021 guideline flags people predisposed to mania or hypomania. For bipolar-specific insomnia work, see our guide to CBT for bipolar disorder.
- Psychotic disorders.Also on the fact sheet's not-recommended list, because restricting sleep can make them worse.
- Seizure disorders.The fact sheet lists seizures. The 2021 guideline names poorly controlled seizure disorders.
- Untreated sleep apnea or marked daytime sleepiness.Refer for a sleep medicine evaluation first. The fact sheet sends patients with sleep apnea, restless legs or parasomnias to sleep medicine, and the 2021 guideline lists excessive daytime sleepiness as a caution. Sleep restriction makes sleepiness worse for a while.
- High-risk jobs.Drivers, machine operators and others whose work is dangerous when sleepy, according to the 2021 guideline.
The fact sheet adds that clients in the first three groups may still be considered for cognitive behavioral therapy with a behavioral sleep medicine provider, who can adapt the approach (AASM, BBTI provider fact sheet; Edinger et al. 2021).
Screen before you hand it out
A few questions at intake or when sleep comes up will tell you whether the handout is the right next step or whether the client needs a physician first. The AASM's evaluation guideline asks about breathing problems in sleep (snoring, gasping, coughing), risk factors for sleep apnea, and daytime sleepiness, which should prompt a search for other sleep disorders (Schutte-Rodin et al. 2008).
- What's the problem: falling asleep, staying asleep, waking too early, or all three? How many nights a week, and for how long?
- How does it affect the day?
- Do you snore loudly? Has anyone seen you stop breathing, choke or gasp in your sleep?
- Do you doze off without meaning to, for example while reading, watching TV or driving?
- Do you get an urge to move your legs in the evening or at night?
- Do you act out dreams, sleepwalk or have frequent nightmares?
- Do you sleep well when you can keep your own hours, such as on vacation? (If yes, think about a body clock problem.)
- What medicines, caffeine, alcohol, nicotine or other substances do you use, and when?
- Has your need for sleep ever dropped sharply while your energy went up? Any history of bipolar disorder, psychosis or seizures?
- Do you work shifts or nights?
When to refer, and to whom
To the client's physician or a sleep medicine clinic (the AASM keeps a sleep center directory):
- Signs of sleep apnea: loud snoring, gasping, pauses in breathing someone has seen, or marked daytime sleepiness.
- Restless legs, acting out dreams or other unusual behavior in sleep.
- A body clock pattern: the client sleeps well on their own schedule but not on the one work or school requires. The AASM fact sheet recommends a sleep medicine or behavioral sleep medicine referral to evaluate this.
- Insomnia that started with a new medicine, pain or a medical problem.
- Any question about starting, stopping or changing a sleep medicine. That decision belongs to the prescriber.
To a CBT-I provider (the Society of Behavioral Sleep Medicine directory and the CBT-I International Directory both list trained clinicians, including some who work by telehealth):
- Chronic insomnia, if you aren't trained to deliver CBT-I yourself.
- Sleep that hasn't improved after four weeks of brief behavioral treatment. The AASM fact sheet suggests a full course of CBT-I at that point.
- Clients with bipolar disorder, psychosis or seizures who need an adapted approach.
Get the client's written consent before you share anything with another provider. Our release of information form guide covers what the form needs.
How to use the handout in session
Give it out the way you would any homework: explain why, keep it small, and check it next week.
- Explain the why. "Before we change anything big, let's see what your sleep actually looks like. The diary shows us the pattern, and a few habits are worth trying while we find out."
- Pick two or three items, not all of them. Let the client choose. Lists of 15 rules get followed for two days.
- Fill in the first diary entry together for last night, so the client knows what each line means.
- Review the diary next session. Work out the weekly averages together. Clients often find they sleep more than they thought, or spend much longer in bed than they sleep.
- On video, share your screen to go through the handout, then send the link so the client can print it or copy the diary into a phone note.
- Set a review date. If the problem is chronic, use that review to talk about CBT-I.
Adapting it for different clients
- Adults:the AASM and Sleep Research Society recommend 7 or more hours a night for adults on a regular basis (Watson et al. 2015). Use it as context, not a target to chase.
- Teens:the AASM recommends 8 to 10 hours per 24 hours for ages 13 to 18 (Paruthi et al. 2016). Agree the phone plan with the teen, not just the parent, and keep the wake time realistic for school.
- Depression:long hours in bed and little daytime activity often go together. Pair the handout with a behavioral activation worksheet so the day gets fuller as time in bed gets shorter.
- Worry at night:move the thinking earlier. The handout's 10-minute writing exercise is a start; a CBT thought record works on the content.
- Bipolar disorder:keep the steady wake time and routine, skip sleep restriction, and tell the prescriber about any sharp drop in sleep.
- Older adults or anyone at risk of falls:go through the night-time safety line in the handout, and talk about a safe path and lighting before using the "get up after 20 minutes" step.
- Shift workers:the handout assumes a daytime schedule. Body clock problems need a sleep medicine assessment.
How to document sleep hygiene and insomnia work
Sleep work belongs in the progress note like any other intervention. Record:
- The sleep problem in the client's words: type, nights a week, how long, effect on the day.
- What you screened for and what the client said: breathing in sleep, daytime sleepiness and driving, restless legs, parasomnias, body clock, substances and medicines, mood history.
- What you gave: the handout, the diary, and the two or three habits the client chose.
- Diary averages at each review, including sleep efficiency, next to the previous week's numbers.
- Any referral, to whom and why, and the signed release.
- The treatment plan goal, written so you can measure it, for example "fall asleep within 30 minutes on 5 of 7 nights."
Here is an invented example in DAP format:
Data: Client (invented) reports trouble falling asleep 5 nights a week for about 5 months, lying awake "going over work," and feeling foggy at work. Denies loud snoring, gasping or pauses in breathing; partner has not noticed any. Denies dozing while driving. No history of mania, psychosis or seizures reported. Caffeine: 3 coffees a day, the last at about 4 PM. Two-week diary reviewed: average time in bed 8 h 40 min, average total sleep 6 h 10 min, sleep efficiency about 71%.
Assessment: Symptoms consistent with chronic insomnia, kept going by long time in bed, late caffeine and bedtime worry. No signs of sleep apnea on screening. Sleep hygiene alone is unlikely to be enough.
Plan: Reviewed sleep handout. Client chose a fixed 6:30 AM wake time, last coffee by noon, and leaving bed after about 20 minutes awake. Discussed CBT-I as the first-line treatment; client agreed to a referral to a CBT-I provider and signed a release. Continue diary. Next session in one week.
For more wording, our progress notes cheat sheet lists clinical terms by section, and the treatment plan template shows how to write measurable goals.
How this works in TranqBay
TranqBay is practice software for therapists in private practice: a practice website, online booking, video sessions and session notes in one place. Here is where sleep work fits.
- The handout and diary live on this page. Send your client the link, or print them.
- Forms: TranqBay's form library has ready-made templates you can send a client for a session, including intake, consent to treat, telehealth consent, release of information, the PHQ-9 and GAD-7. The client fills them in online and the answers wait with the session. TranqBay doesn't score them, so add up totals yourself or use our PHQ-9 calculator. The release of information form is the one you'll need before you coordinate with a physician or a CBT-I provider.
- Session notes come in BIRP, DAP, SOAP or GIRP format, or as a blank note in your own words. The structured formats are part of the advanced note templates, which some plans include.
- Video sessions are end-to-end encrypted and HIPAA-ready. TranqBay provides a Business Associate Agreement that applies when you accept the Terms, with no separate document to sign.
- Your practice website lists your services, each with its own length and fee, and can offer packages. If you're trained in CBT-I, a set course of sessions fits as a package, and returning clients book their next session themselves, which suits weekly diary reviews.
Clients with insomnia often search for help themselves, and your website is where they read how you work. A plain line such as "I offer CBT for insomnia, the treatment sleep guidelines recommend first" tells them what to expect. practice.tranqbay.health shows the website designs made for therapy practices and the booking page a client would use, so you can see where that line and a sleep package would sit.
Frequently asked questions about sleep hygiene handouts
Is there a sleep hygiene PDF I can print for clients?
This page works as one. Print it, or choose "Save as PDF" in your browser's print window. Set the page range from "Client handout" to "End of the sleep diary" if you only want the client pages.
What are the main sleep hygiene rules?
A steady wake-up time, daylight in the morning, the bed kept for sleep, no caffeine in the 6 hours before bed, no alcohol close to bedtime, a wind-down hour, and a dark, quiet, comfortable bedroom. The handout above has the full list in plain words.
Does sleep hygiene work for insomnia?
It helps a little, but not enough on its own for chronic insomnia. A 2018 meta-analysis found it clearly less effective than CBT-I, and the AASM's 2021 guideline suggests clinicians not use it as a single-component treatment. Use it as part of CBT-I or as a first step with a review date.
What is the difference between sleep hygiene and CBT-I?
Sleep hygiene is general advice about habits and the bedroom. CBT-I is a structured treatment, usually about 4 to 8 sessions, built on a sleep diary, with stimulus control, sleep restriction and cognitive work. Sleep hygiene is often one small part of it.
How long should a client keep a sleep diary?
At least two weeks before you change much, which is what the AASM's evaluation guideline asks for. Keep it going during treatment so you can compare the numbers week by week.
What is the 20-minute rule for sleep?
It is part of stimulus control: if you can't fall asleep within what feels like about 20 minutes, get out of bed, do something calm elsewhere, and come back when sleepy. Clients at risk of falls or taking sedating medicine should check with their doctor first.
Who shouldn't try sleep restriction therapy?
The AASM lists people with bipolar disorder or a tendency to mania, psychotic disorders, seizure disorders and excessive daytime sleepiness, and those in high-risk jobs. Untreated sleep apnea should be assessed by a physician first.
Do I need special training to deliver CBT-I?
CBT-I is delivered by clinicians trained in it, and the AASM says brief behavioral treatment can be delivered by a range of clinicians. Work within your scope of practice, get training and supervision before you use sleep restriction, and refer when you aren't trained.
Before your next session
Print the handout and one copy of the diary. Ask your next client who mentions sleep the screening questions, let them pick two habits, and fill in the first diary entry together. In two weeks, work out the averages and decide: keep going, start CBT-I, or refer.
If you want booking, video sessions and session notes in one place, see how TranqBay works for private practice: you can look at the practice website designs and the booking page your clients would use. If you're deciding whether to join, this page explains how joining TranqBay works.
Sources
Research 9aasm.org 1sleepeducation.org 1behavioralsleep.org 1cbti.directory 1988 Lifeline 1
Research9
- 1Qaseem A et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med (2016)pubmed.ncbi.nlm.nih.govhttps://pubmed.ncbi.nlm.nih.gov/27136449/
- 2Edinger JD et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med (2021)pubmed.ncbi.nlm.nih.govhttps://pubmed.ncbi.nlm.nih.gov/33164742/
- 3Chung KF et al. Sleep hygiene education as a treatment of insomnia: a systematic review and meta-analysis. Fam Pract (2018)pubmed.ncbi.nlm.nih.govhttps://pubmed.ncbi.nlm.nih.gov/29194467/
- 4Irish LA et al. The role of sleep hygiene in promoting public health: a review of empirical evidence. Sleep Med Rev (2015)pubmed.ncbi.nlm.nih.govhttps://pubmed.ncbi.nlm.nih.gov/25454674/
- 5Schutte-Rodin S et al. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med (2008)pubmed.ncbi.nlm.nih.govhttps://pubmed.ncbi.nlm.nih.gov/18853708/
- 6Carney CE et al. The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep (2012)pubmed.ncbi.nlm.nih.govhttps://pubmed.ncbi.nlm.nih.gov/22294820/
- 7Kyle SD et al. Sleep restriction therapy for insomnia is associated with reduced objective total sleep time, increased daytime somnolence, and objectively impaired vigilance. Sleep (2014)pubmed.ncbi.nlm.nih.govhttps://pubmed.ncbi.nlm.nih.gov/24497651/
- 8Watson NF et al. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med (2015)pubmed.ncbi.nlm.nih.govhttps://pubmed.ncbi.nlm.nih.gov/25979105/
- 9Paruthi S et al. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. J Clin Sleep Med (2016)pubmed.ncbi.nlm.nih.govhttps://pubmed.ncbi.nlm.nih.gov/27250809/