Author: Dr Ruth Hull. Ruth is a homoeopathic doctor and integrative health consultant with a special interest in working with people struggling with chronic fatigue, burnout or insomnia. She is author of Anatomy, Physiology & Pathology for Therapists and Healthcare Professionals as well as three other health-related textbooks

The third in author Ruth Hull’s in-depth series on chronic fatigue.

There are many causes of fatigue but the most common is often just a lack of good quality sleep.  According to the American Sleep Association, approximately 30% of adult Americans suffer from insomnia[i] and human studies have shown that chronic sleep deprivation is associated with higher risks of developing cancer, diabetes mellitus type II, cardiovascular disease, Alzheimer’s, depression, anxiety and suicide[ii]. 


Photo by SHAHBAZ AKRAM from Pexels

If you have a client who comes to you because they are utterly exhausted and you find out they’re not sleeping, what can you do about it? Firstly, read my blog, One Good Reason To Sleep,  and then educate them on the importance of sleep.  If your client doesn’t value sleep then they’re not going to prioritise it.

Once they understand the importance of sleep, encourage them to develop good “sleep hygiene”. Sleep hygiene involves establishing a calming, peaceful environment in which to sleep as well as a set routine that signals to the body that it is time to slow down and sleep.  I find the following steps most helpful in establishing good sleep hygiene:

  1. Ask your client to go home and ‘declutter’ their bedroom.  They can start with their bedside tables and work around their rooms, removing all bills, paperwork and things they are “meant to do when they eventually get time to”.  In addition, they need to remove all technology.  Bedrooms should be for sleep, relaxation and sex only.  There should be no TVs, cellphones, iPad, laptops, flashing digital clocks etcetera in the room.  

A bedroom needs to be a quiet, peaceful place to which your client can ‘retreat’ at the end of the day.

  • Once they have decluttered their room, they need to turn it into a sanctuary so that when they walk into it in the evenings, they immediately feel calm and at peace. Suggest they look at the lighting, it should be warm and soft.  Images, photos or paintings should be calming and restful.  

In addition, when they turn out the lights their room needs to be as dark as possible.   The hormone melatonin makes us sleepy and helps us sleep.  Its release is stimulated by darkness and inhibited when the eyes are exposed to light.  So darkness and the absence of technology is vital to good sleep.

  • The next step towards sleep hygiene also involves the hormone melatonin. Produced by the pineal gland, melatonin helps set the timing of our body’s biological clock. This timing is known as the circadian cycle or rhythm and is a 24-hour cycle of physiological processes associated with periods of light and darkness.  

It is important that melatonin is regularly released at the same time every 24 hours so ask your client to decide on what time he/she wants to go to sleep at night (i.e. encourage the release of melatonin) and what time he/she wants to wake up in the morning (i.e. stop the release of melatonin). Once they have decided on these times, they need to stick to them no matter what.  After a few weeks of strictly adhering to these times they will be able to re-establish their circadian rhythm.

  • Lastly, in addition to establishing their circadian rhythm, they should also create a bedtime routine with ‘rituals’ that signal to the body and brain that it is time to slow down, wind down and relax.  Suggest your client tries to start their routine about an hour before they want to go to sleep and stick to the same time and the same routine every single night.  They should include the following in their bedtime routine:
    • Not eating a heavy meal for 3 hours before bed.
    • Getting into bed and relaxing for at least 30 minutes – reading a book often helps people switch off their minds.

Although good sleep hygiene is not the answer to every single client’s fatigue or insomnia, it is a good place to start when working with someone struggling with sleep problems.  Clients with chronic insomnia usually have stresses and anxieties that need to be addressed before their sleep problems begin to improve but simple sleep hygiene and a good bedtime routine will help set them up for success.

She is based in Perth, Australia, runs the online educational organisation, The Health Lounge , and also consults with patients online: http://www.ruthhull.com/ 

[1] American Sleep Association https://www.sleepassociation.org/about-sleep/sleep-statistics/

2 Matthew Walker, Why We Sleep: The New Science of Sleep and Dreams (2017), Scribner: New York