Sleep Hygiene Practices: Where to Now?

Round 1

Reviewer 1 Report

Review for hygiene-1877496

Sleep hygiene practices: Where to now?

 

This article is interesting and well written. Below are some recommendations on how to improve this manuscript.

 

There is no argument in the need for customization of therapeutic approaches to insomnia as the underlying factor could be quite different between individuals. It would be helpful if the author could provide some examples on how the sleep hygiene recommendations can be case-dependent and how these differences can be addressed. E.g., the author indicates that intense training and competition could lead to sleep disturbances. So is there a recommendation on how to minimize these sleep-related adverse effects when intense training cannot be avoided, possibly by selecting a time-of-day for training or addition of destressing techniques later in the day to alleviate, at least partially, some of this adverse effect. Please provide some examples and offer related explanation on how the precision medicine approach to sleep hygiene could be proven beneficial.

 

Individuals experience different levels of sensitivity to different aspects of sleep hygiene, e.g., some individuals are more sensitive to caffeine than others, some can fall sleep with lights on while others need a pitch-black room to be able to sleep. This variation in sensitivity of individuals seems to be a valid point in arguing the need for precision medicine approach to sleep hygiene. I did not see this discussed in the text and I recommend for the author to do so.

 

In Figure 1, should it be “daytime napping” and not "avoiding daytime napping"

 

Line 64-67 on page 2, what is the reason for different outcomes following sleep hygiene education between studies presented in Ref# 11&12 and 17&18. The first two do not report sleep improvement in adolescents whereas the other two report a positive effect. Please discuss

 

Line #67, the author indicate that the behavioral changes were not sustained in a follow-up study, is this related to only reference 14 or all the other studies as well? Please clarify.

 

There exist a few different interpretations on what encompasses as sleep hygiene since Hauri first introduced the term. It seems appropriate for the author to provide their interpretation of what should be included.  

 

The author discusses the positive effect of blue light in the morning and the benefit of morning outdoor exercise on sleep. They should also discuss the negative effect of night-time/bedtime blue light exposure as the result of screen usage at night or while in bed.

 

Author Response

Dear Reviewer,

Thanks very much for your thoughtful comments. In responding to these comments, I believe that the revised manuscript is significantly improved.

This article is interesting and well written. Below are some recommendations on how to improve this manuscript.

There is no argument in the need for customization of therapeutic approaches to insomnia as the underlying factor could be quite different between individuals. It would be helpful if the author could provide some examples on how the sleep hygiene recommendations can be case-dependent and how these differences can be addressed. E.g., the author indicates that intense training and competition could lead to sleep disturbances. So is there a recommendation on how to minimize these sleep-related adverse effects when intense training cannot be avoided, possibly by selecting a time-of-day for training or addition of destressing techniques later in the day to alleviate, at least partially, some of this adverse effect. Please provide some examples and offer related explanation on how the precision medicine approach to sleep hygiene could be proven beneficial.

Individuals experience different levels of sensitivity to different aspects of sleep hygiene, e.g., some individuals are more sensitive to caffeine than others, some can fall sleep with lights on while others need a pitch-black room to be able to sleep. This variation in sensitivity of individuals seems to be a valid point in arguing the need for precision medicine approach to sleep hygiene. I did not see this discussed in the text and I recommend for the author to do so.

Response: Section 5 (lines 164-192 and 213-233) has been re-constructed and incorporated your comments.

In Figure 1, should it be “daytime napping” and not "avoiding daytime napping"

Response: Corrected (line 70-71).

Line 64-67 on page 2, what is the reason for different outcomes following sleep hygiene education between studies presented in Ref# 11&12 and 17&18. The first two do not report sleep improvement in adolescents whereas the other two report a positive effect. Please discuss

Line #67, the author indicate that the behavioral changes were not sustained in a follow-up study, is this related to only reference 14 or all the other studies as well? Please clarify.

Response: These comments have been attended to (lines 77-121).

There exist a few different interpretations on what encompasses as sleep hygiene since Hauri first introduced the term. It seems appropriate for the author to provide their interpretation of what should be included.  

Response: Lines 236-267 address this comment.

The author discusses the positive effect of blue light in the morning and the benefit of morning outdoor exercise on sleep. They should also discuss the negative effect of night-time/bedtime blue light exposure as the result of screen usage at night or while in bed.

Response: This point has been addressed in lines 213-216.

Author Response File: Author Response.docx

Reviewer 2 Report

The manuscript is well-elaborated, I have no major no minor remarks. 

Author Response

Dear Reviewer,

Thank you. 

No responses required.

Reviewer 3 Report

See the PDF file attached for the comments! 

Comments for author File: Comments.pdf

Author Response

Dear Reviewer,

Thanks very much for your thoughtful comments. In responding to these comments, I believe that the revised manuscript is significantly improved.

Provide reference for this statement!

Response: Two references provided (line 25)

Please be more precise and clear.

Response: For clarity, a new sentence has been added (line 40).

Similar figure needs to be drawn for the factors contributing the good sleep, which might help readers to visualize them easily.

The authors also can add genetic factors listing out the genes, hormones etc as additional group of factor.

Response: A good suggestion, however, the emphasis here is on factors that are targeted by sleep hygiene practices. Thus, genetic, or hormonal factors or adding factors that contribute to good sleep may distract from focus.

The social structure/networking needs to be included and discussed in relation to the sleep. There are increasing support to the fact that sleep is affected by social status and connections.

Response: Social status and connections may influence the mind state (anxiety, stress, happiness etc) and can be considered, however, anxiety and stress have been covered in the figure and to list ‘social status and connections’ may not directly target sleep hygiene.

Also, lifestyle practices should be categorized based on some weightage of high to less affective etc, if possible? as current clustering is not that informative. 

Response: The factors that lead to poor sleep are now better organised into categories (please see new figure 1, lines 70-71).

I believe the implementing the sleep hygiene at family level creating the awareness can make more stable changes to individuals and family itself. Can author include this point with proper reference?

Response: This suggestion has been adopted: lines 65-67 and lines 217-222.

 

Author Response File: Author Response.docx