Sleep is an essential part of overall health and is identified as one of the key health metrics for cardiovascular health by the American Heart Association’s Life Essential 8.1 Guidelines from the National Sleep Foundation recommend that adults get 7-8 hours of sleep each night.2,3
Although sleep is important, many adults find it challenging to achieve optimal sleep quality. According to statistics from the Centers for Disease Control and Prevention (CDC), 36.8% of adults reported sleeping less than seven hours per night in 2022.4
The United States Department of Health and Human Services National Institutes of Health (NIH) and National Heart Lung and Blood Institute (NHLBI) 2011 guide to healthy sleep included the following recommendations for a good night’s sleep:5
- Maintain a consistent sleep schedule
- Refrain from exercising within 2-3 hours of going to sleep
- Avoid caffeine in the late afternoon
- Avoid nicotine
- Avoid alcoholic drinks before going to sleep
- Avoid large meals and beverages before going to sleep
- Avoid medicines that delay or disrupt sleep
- Avoid napping after 3:00 pm
- Relax before going to sleep
- Maintain a healthy sleeping environment that avoids loud noises, bright lights, discomfort, overly warm temperatures, and screens (e.g., TVs, cell phone, computer)
- Get at least 30 minutes of exposure to sunlight each day, especially in the morning
Relaxation techniques in particular can be effective in helping improve not only sleep quality but the time needed to fall asleep and are a recommended intervention in guidelines for the treatment of sleep disorders.6,7 Research into effective techniques to combat insomnia have found that non-pharmacological approaches are most effective, namely cognitive behavioral therapy (CBT) approaches such as relaxation and counter-arousal methods. These methods can improve sleep quality, latency, and waking after sleep onset.
A 2004 randomized trial (n=63) compared CBT, pharmacotherapy, a combination therapy, and placebo.8 CBT was superior in improving sleep onset latency (34.2 minute improvement at 12-month follow-up) and sleep efficiency (13.7% improvement at 12-month follow-up) with the longest duration of therapeutic gains. While pharmacotherapy was effective, it was less beneficial than CBT (sleep onset latency 12.6 minutes improvement at one month follow-up, sleep efficiency 3.6% improvement at one month follow-up), and benefits ceased upon drug cessation. Combined treatment offered no advantages over CBT alone.
A 2023 randomized control trial found that CBT was associated with lower insomnia severity and sleep disturbance (two primary outcomes), and lower sleep-related impairment at the pregnancy endpoint (p-values ≤ .001), as well as at 24 months postpartum (p ranges .012–.052). Group differences across the first postpartum year were nonsignificant.
A military CBT training program developed during World War II allowed combat soldiers and pilots to fall asleep in under two minutes.9 The technique involves relaxing the body systematically from head to toe, focusing on slow, deep breathing, and clearing the mind.
Regular exercise has also been shown to improve sleep quality. A 2018 meta-analysis of nine randomized controlled trials (n=557) found that exercise can improve sleep quality in patients with insomnia.10 Studies included exercise interventions of various intensity (ranging from walking to high-intensity aerobic exercise), duration (ranging from four weeks to six months, mean of 12.5 weeks), and frequency (ranging from one to seven days per week, mean of four days per week). Sleep quality as assessed by the Pittsburgh Sleep Quality Index (scored 0-21 with higher scores indicating poorer sleep quality) improved by an average of 2.87 points among those who exercised. Similarly, scores on the Insomnia Severity Index (scored 0-2 with higher scores indicating poorer sleep quality) improved by an average of 3.22 points. However, exercise was not associated with improved sleep efficiency, defined as the percentage of time spent in bed asleep as measured by a sleep device.
References
- Lloyd-Jones DM, Allen NB, Anderson CAM, et al. Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association. Circulation. Aug 2 2022;146(5):e18-e43. doi:10.1161/CIR.0000000000001078
- Ohayon M, Wickwire EM, Hirshkowitz M, et al. National Sleep Foundation's sleep quality recommendations: first report. Sleep Health. Feb 2017;3(1):6-19. doi:10.1016/j.sleh.2016.11.006
- Hirshkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation's updated sleep duration recommendations: final report. Sleep Health. Dec 2015;1(4):233-243. doi:10.1016/j.sleh.2015.10.004
- FastStats: Sleep in Adults. U.S. Centers for Disease Control and Prevention. Updated May 15, 2024. Accessed June 12, 2025. https://www.cdc.gov/sleep/data-research/facts-stats/adults-sleep-facts-and-stats.html?CDC_AAref_Val=https://www.cdc.gov/sleep/data-and-statistics/adults.html#cdc_facts_stats_data_sou-where-the-data-comes-from
- Your Guide to Healthy Sleep. U.S. Department of Health and Human Services National Institutes of Health (NIH) and National Heart, Lung, and Blood Institute (NHLBI); 2005.
- Edinger JD, Arnedt JT, Bertisch SM, 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. Feb 1 2021;17(2):255-262. doi:10.5664/jcsm.8986
- Taylor DJ, Peterson AL, Pruiksma KE, et al. Impact of cognitive behavioral therapy for insomnia disorder on sleep and comorbid symptoms in military personnel: a randomized clinical trial. Sleep. Jun 1 2018;41(6)doi:10.1093/sleep/zsy069
- Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW. Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med. Sep 27 2004;164(17):1888-96. doi:10.1001/archinte.164.17.1888
- Winter L. Relax and Win: Championship Performance in Whatever You Do. Oak Tree Pubns; 1981.
- Banno M, Harada Y, Taniguchi M, et al. Exercise can improve sleep quality: a systematic review and meta-analysis. PeerJ. 2018;6:e5172. doi:10.7717/peerj.5172
