Sleep Hygiene Index (SHI)


The Sleep Hygiene Index is a 13 item self administered index used to assess the presence of behaviours that are thought to compromise sleep quality such as “I take daytime naps lasting two or more hours” “I think, plan or worry when I am in bed” and ”I get out of bed at different times from day to day”. The Sleep Hygiene Index can be used in those 17 years and above. Sleep Hygiene may be described as practicing behaviours that facilitate sleep and avoiding behaviours that interfere with sleep (Mastin, Bryson, & Corwyn, 2006; Riedel 2000). Poor sleep hygiene is associated with poor sleep quality (Brick et al., 2010; Suen, Tam and Hon, 2010; Gellis, & Lichstein, 2009). Paying attention to sleep hygiene is one of the most straightforward ways you can help your clients get a better sleep. The Sleep Hygiene Index is a useful clinical assessment tool for evaluating sleep hygiene to guide case formulation, treatment planning, or the progress of interventions. Poor sleep health is common, with a prevalence of 20-29% in adults (Australian Institute of Health and Welfare, 2021). Poor sleep can seriously affect a person’s quality of life, and is associated with daytime impairments such as fatigue, irritability and poor mood, and increased risk for major depression. Insomnia co-occurs with most psychological disorders (Khurshid, 2018) and therefore is important for clinicians to be aware of behaviours that may be contributing to poor sleep quality. In high school, poor sleep hygiene was associated with lower grades (Harsh, 2011). Declines in sleep hygiene for students across the college years was also associated with a decline in grades. Therefore being aware of sleep hygiene habits will be important for clinicians in supporting young people. In addition, sleep hygiene is one of the first things to check when patients with chronic pain complain about poor sleep quality (Cho, Kim, & Lee, 2013).

Validity and Reliability
The Sleep Hygiene Index has illustrated satisfactory reliability and validity (Mastin, Bryson, & Corwyn, 2006). The items for the Sleep Hygiene Index were constructed from the diagnostic criteria for inadequate sleep hygiene in the International Classification of Sleep Disorders (American Sleep Disorders Association. 1990). There were 603 complete data sets for the Sleep Hygiene Index, participants were non-clinical volunteering psychology university students from a mid-sized university in the United States (M = 34.66) and (SD = 6.6) with a range from 17–55. Cronbach’s α for the Sleep Hygiene Index (α = 0.66) was found to be superior to previously published sleep hygiene instruments, the Sleep Hygiene Index was found to have good test–retest reliability (r(139) = 0.71, p < 0.01). The Sleep Hygiene was found to have adequate validity, it was positively correlated with all features of inadequate sleep hygiene (American Sleep Disorders Association. 1990). The Sleep Hygiene Index was also correlated positively with the Epworth Sleepiness Scale (r(599) = 0.244, p < 0.01), and the Pittsburgh Sleep Quality Index total score (r(269) = 0.481, p < 0.01), which suggests that poor sleep hygiene is related to poor sleep quality and more daytime sleepiness.

Total scores range from 0 to 52 – with a higher score representing more behaviours that are compromising sleep hygiene. Scores are also presented as a percentile rank, comparing the respondents scores against those of a normative sample (Mastin, Bryson, & Corwyn, 2006). Percentiles above 50 represent more problematic sleep behaviours than average, to the extent that they are likely contributing to poor sleep quality. Scores below 26 are considered as good, 27-34 as normal, and 35 and above (indicated by a dotted line on the graph) are considered as poor sleep hygiene (Mastin et al. 2012). When interpreting the Sleep Hygiene Index, it is important to consider that sleep hygiene does not exist in isolation. It is important for clinicians to use clinical judgement to understand the psychosocial context of the patient, as precipitating and maintaining factors of poor sleep hygiene behaviours may not be addressed by sleep education alone (Mastin, Bryson, & Corwyn, 2006).

Mastin, D. F., Bryson, J., & Corwyn, R. (2006). Assessment of sleep hygiene using the Sleep Hygiene Index. Journal of behavioral medicine, 29(3), 223-227.

Number Of Questions

American Sleep Disorders Association, & Diagnostic Classification Steering Committee. (1990). The international classification of sleep disorders: diagnostic and coding manual. American Sleep Disorders Association. Australian Institute of Health and Welfare. (2021). Sleep problems as a risk factor for chronic conditions. Brick, C. A., Seely, D. L., & Palermo, T. M. (2010). Association between sleep hygiene and sleep quality in medical students. Behavioral sleep medicine, 8(2), 113-121. Cho, S., Kim, G. S., & Lee, J. H. (2013). Psychometric evaluation of the sleep hygiene index: a sample of patients with chronic pain. Health and quality of life outcomes, 11(1), 1-7. Deloitte Access Economics. (2021). Re-awakening Australia: The economic cost of sleep disorders in Australia. Gellis, L. A., & Lichstein, K. L. (2009). Sleep hygiene practices of good and poor sleepers in the United States: an internet-based study. Behavior Therapy, 40(1), 1-9. Harsh, J. R. (2011). Sleep Hygiene, Chronotype and Academic Performance During the Transition from High School Through Four Years of College. Sleep, 34, A81. Khurshid, K. A. (2018). Comorbid insomnia and psychiatric disorders: an update. Innovations in clinical neuroscience, 15(3-4), 28. Mastin, D. F., Bryson, J., & Corwyn, R. (2006). Assessment of sleep hygiene using the Sleep Hygiene Index. Journal of behavioral medicine, 29(3), 223-227. Mastin, D. F., Siddalingaiah, H. S., Singh, A., & Lal, V. (2012). Excessive daytime sleepiness, sleep hygiene, and work hours among medical residents in India. Journal of Tropical Psychology, 2. Suen, L. K., Tam, W. W., & Hon, K. L. (2010). Association of sleep hygiene-related factors and sleep quality among university students in Hong Kong. Hong Kong Med J, 16(3), 180-5. Zagaria, A., Ballesio, A., Musetti, A., Lenzo, V., Quattropani, M. C., Borghi, L., … & Franceschini, C. (2021). Psychometric properties of the Sleep Hygiene Index in a large Italian community sample. Sleep Medicine, 84, 362-367.

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