CBT-I (Cognitive Behavioural Therapy for Insomnia)

Intervention: Completing a self-guided CBT-I course

Score: 5.78^/10 (2^nd)

CBT-I is a version of cognitive behavioural therapy specifically tailored for insomnia. Principally, it involves strict sleep hygiene coupled with sleep restriction, concepts that are nicely explained here. Previous research has found that CBT-I provided via individual or group therapy sessions can be more effective than prescription medication at treating insomnia, while also having far fewer notable side effects.

Though CBT-I is targeted at insomnia, the key principles of sleep restriction and strict sleep hygiene seem an improvement on common sleep behaviours. This makes CBT-I valuable to most people as a set of tools for improving sleep.

Our recommendation is based on the use of a CBT-I app, enabling access to the benefits of CBT-I without the cost or difficulty of finding a specialist practitioner. We found good evidence to suggest that six to seven weeks spent following an app-based CBT-I course produces significant improvements to sleep quality and quantity.

The best CBT-I apps currently available appear to be either Dozy, an EA-aligned CBT-I app available via beta testing, or CBT-I Coach, a partnership between the US Department of Veteran Affairs and the Stanford School of Medicine. As an alternative to using an app, Overcoming Insomnia is a CBT-I workbook produced by leading sleep medicine researcher, Colin Espie.

Light therapy

Intervention: Completing a self-guided CBT-I course

Score: 5.63^/10 (3^rd)

There is a significant range of research suggesting the benefits of increasing daytime and minimising night-time exposure to bright light. Most people working indoor jobs are exposed to only a small amount of bright light throughout the day. Bright light treatment generally aims for exposure to 10,000 lux, the equivalent of the light exposure outside on a day with light cloud, for two hours or more.

One study found that the average time spent in light over 1,000 lux (10 times less than the recommended level of ‘bright’ light) was 23% in ‘modern’ conditions vs. 71% in ‘natural’ outdoor living conditions. It seems reasonable to conclude that most people are now experiencing far less bright light than was normal for most of human history.

Exposure to bright morning light can reset the circadian rhythm. This in turn can reduce the time taken to fall asleep and minimise sleep disturbances through the night. The effects on total sleep time and sleep efficiency were generally moderate but consistently positive in the studies reviewed, with some studies showing improvements of more than 15% for patients with significant sleep issues.

Achieving exposure to 10,000 lux requires a moderate investment of time and money, but once a solution is found it can provide permanent benefit.

The simplest method is to purchase a SAD lamp that emits 10,000 lux and place this on your desk, maximising exposure while working. However, the light levels received from a SAD lamp can decrease significantly if placed too far from the face, while the lamp’s light offers minimal benefit when doing non-desk based activities.

The alternative is to install sufficient lighting in a room that the whole space is lit to 10,000 lux or more. This tends to involve buying 10-25 very bright lightbulbs which in combination produce the required brightness. Ben Kuhn and Eliezer Yudkowsky have each written good, practical guides for doing this.

Improved night-time air circulation

Intervention: Leaving a window or internal door open while sleeping

Score: 5.31^/10 (4^th)

Opening a window overnight can reduce CO₂ levels in a bedroom by 60%. There is reasonable evidence to suggest that abnormally high levels of carbon dioxide cause significant decreases in sleep quality and cognitive performance the next day. Direct studies on the impact of improved air circulation by opening a window or internal door overnight are limited but suggestive of improvements in sleep quality.

Given the simplicity of leaving a window or door open, this intervention seems highly worthwhile. While an open window could make for a cold room, this too could be beneficial for sleep quality. An overly cold room also seems simple enough to fix with warmer bedding.

On top of this, improved overnight air circulation could plausibly reduce the accumulation of household air pollution, providing additional benefits to health and wellbeing.

Mindfulness (MBSR)

Intervention: Completing a self-guided MBSR programme

Score: 5.10^/10 (5^th)

Mindfulness-based stress reduction combines practising mindfulness meditation, non-judgmental awareness, and exploration of the feelings and sensations associated with stressful events. A six-week MBSR course produced a 37% improvement in Pittsburgh Sleep Quality Index scores, an aggregated measure of sleep quality and quantity. While app-based therapy appears less effective than this, it is still likely of significant benefit. Specific research into the effects of app-based MBSR on sleep is limited, but this randomised control trial found a significant decrease in sleep disturbance for users of the meditation app Calm.

Given that this and other research has found significant benefits from mindfulness training for numerous aspects of wellbeing, MBSR appears a valuable intervention. In some cases, mindfulness training can make individuals more aware of negative behaviours and thought processes without providing relief, though this appears to be an uncommon outcome.

Apps tailored to improving sleep do not appear common. Two suggestions based on a limited review of available solutions are Calm and The Mindfulness App.

Secondary Recommendations

The following is a summary of the other interventions explored in-depth that did not score as high in our assessment.

Mattresses

Intervention: Changing to a medium-firm mattress

Score: 5.05^/10 (6^th)

Replacing current bedding with a new, medium-firm mattress appears to produce a 5-6% improvement in sleep quality and efficiency. While individual preferences may differ, the majority of studies that we analysed concluded that a medium-firm mattress was the optimal type for maximising sleep quality.

Mattresses, however, are a significant investment that may not be practical or worthwhile for many given the only moderate improvement in sleep quality. Additionally, studies tended to test subjects who were previously sleeping on mattresses several years old. Given this, we can reasonably expect a diminished effect for people with more recently purchased bedding.

We make no attempt to recommend specific mattresses given the large differences in price and larger amounts of marketing involved in their sale.

Caffeine

Intervention: Eliminating caffeine consumption from the late afternoon onwards

Score: 4.95^/10 (7^th)

Caffeine is a commonly known and consumed stimulant. That caffeine can make it more difficult to fall asleep is fairly obvious. However, regularly high consumption of caffeine can also have a significant impact on sleep quality.

The impact of caffeine on sleep can be avoided by limiting consumption to the first half of the day. Individuals’ speed of processing caffeine varies significantly but it is common for it to still have notable effects up to 10 hours after consumption.

At a minimum, avoiding caffeine consumption within the six hours prior to sleeping seems an easy and valuable intervention. Adjusting the results of this study to the caffeine content of a standard double-shot coffee, we estimate a 3% reduction in sleep time and sleep quality from drinking a coffee six hours in advance of sleep.

Though caffeine consumption has a significant effect and strong evidence base, we expect that avoiding caffeine later in the day is largely common knowledge. Given this, people who currently drink coffee in the evening are likely doing so for benefits that they weigh higher than a small increase in sleep quality (such as increased alertness for evening work), making this a less valuable recommendation.

Magnesium

Intervention: Taking a 300mg magnesium supplement daily

Score: 4.76^/10 (8^th)

Around half of Americans likely consume less than the recommended levels of magnesium, while some studies have suggested that recommended levels are significantly lower than the optimum daily magnesium intake.

While the quality of evidence is low, with no known method of causation, magnesium supplementation is associated with improved sleep efficiency and total sleep time.

Most multivitamins only contain a modest amount of magnesium so we recommend taking a specific, 300-375mg magnesium supplement to test for any noticeable benefit to your sleep. However, magnesium supplementation can have significant side effects, particularly for people taking other medication, so it is important to note possible issues and stop taking supplementary magnesium should these occur.

Cold lighting

Intervention: Installing blue-enriched lighting to your workspace

Score: 4.53^/10 (9^th)

While lighting can come in a wide range of brightness, it also ranges widely in colour temperature. Blue-enriched (cold) lighting can improve daytime alertness and bring a modest benefit to sleep quality but is difficult to find commercially.

In our brief search, we found these household lights at 6,000K as the coolest option available. However, the blue-enriched lights used in the study referenced above were 17,000K, meaning that the benefits of commercially available cold lighting are likely to be significantly lower than those produced in research.

Given the greater evidence base and strength of effect for increasing the brightness of household lighting, we feel that this is a more worthwhile intervention than installing colder lighting.

Morning exercise

Intervention: Shifting exercise from evening to morning

Score: 4.43^/10 (10^th)

The positive effect of regular exercise on sleep quality is well-known. However, the timing of exercise during the day could play a significant mediating role in increasing or decreasing the beneficial effects of exercise on sleep.

For people accustomed to exercising in the evening, shifting their practice to the morning could increase sleep quality while reducing sleep disturbance and the time taken to fall asleep. However, these effects were relatively modest in the research we found and evidence on the topic is thin.

With the constraints of coordinating work, family, and social schedules, we expect that shifting exercise time will be relatively difficult for many people. Feasibly, it could even result in reduced sleep hours if you start waking up earlier to fit in exercise in the morning.

Houseplants

Intervention: Buying multiple succulent houseplants for your bedroom

Score: 3.94^/10 (11^th)

As an alternative to opening a window, there is some evidence that some houseplants can produce a notable reduction in CO₂ levels in a room. In particular, certain plants that store CO₂ at night to then use for photosynthesis during the day (a process known as crassulacean acid metabolism [CAM]) appear particularly effective at reducing night-time CO₂ levels.

While there has been little research into this area, one study found several common houseplants reduced CO₂ concentration in a room by 15-20%. It seems reasonable to assume that placing several houseplants in a room would significantly increase this effect, though likely with diminishing returns.

A study conducted by NASA into the effectiveness of houseplants at removing a range of air pollutants (to then use them on the ISS) found that Variegated Snake Plants and English Ivy were particularly promising.

We leave the decision of whether to create a small indoor forest in your bedroom in your hands but note that this is unlikely to be more effective at reducing CO₂ concentration than simply opening a window.

Summary

This research forms an attempt to find the most effective ways an individual can improve their sleep, with a focus on suggestions that readers are less likely to have previous knowledge of. The methods used are rough and a work in progress, forming the basis of a larger project researching the most effective ways people can improve their wellbeing.

Our principal recommendations for improving sleep quality are (in order):

1. Melatonin supplements: 0.3mg (300mcg) daily taken two hours before bed.
2. CBT-I: a six-to-seven-week, self-guided course in cognitive behavioural therapy for insomnia, accessed through an app.
3. Light therapy: greatly increasing exposure to bright light during the day, either through building a lumenator or purchasing a SAD lamp.
4. Improved night-time air circulation: opening a window to reduce overnight CO₂ accumulation.
5. Mindfulness-based stress reduction: mindfulness training through an app with a focus on sleep.

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