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Bathing shortly before bedtime significantly improves sleep quality
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People who bathe or shower in warm water 1 to 2 hours before bedtime fall asleep faster and experience significantly better quality of sleep, according to findings of a systematic review published in Sleep Medicine Reviews.
Haghayegh explained how the findings can prompt a discussion between primary care physicians and their patients.
“We hope this research can be used as a tool by primary care physicians to talk to their patients about sleep problems and the importance of , biological cycles and how the body temperature circadian is linked to our sleep,” he told Healio Primary Care.
“While many investigations demonstrate improvement of various sleep parameters by evening or before bedtime water-based passive body heating, some do not,” Shahab Haghayegh, PhD candidate in the department of biomedical engineering of the Cockrell School of Engineering at the University of Texas at Austin, and colleagues wrote.
Researchers reviewed 17 studies with 352 patients whose ages ranged from late teens to late 70s and with a multitude of health conditions — acute coronary syndrome, cancer, insomnia, sleep apnea, sleep disturbed, traumatic brain injury — among them.
They found that water-based passive body heating with water temperatures of 40 to 42.5 C obtained through a bath or shower were associated with improved self-rated sleep quality and sleep efficiency. When these baths or showers occurred 1 to 2 hours before bedtime for as little as 10 minutes, sleep onset latency also improved. However, specific improvement levels were unobtainable given the wide range of ways the reviewed studies’ authors gauged progress.
“PCPs should use these findings to discuss the importance of timing their baths. The body temperature naturally starts to decline according to its circadian cycle about 1 to 2 hours before the usual time of going to sleep,” Haghayegh said in the interview.
“Taking a warm bath or shower during this time span augments the natural biological process of sleep induction, but taking the warm bath or shower too earlier may induce the feeling of sleepiness but be ineffective in actually inducing sleep and taking the warm bath or shower too close to bedtime may too late to be effective and may even disrupt the natural circadian processes controlling sleep induction and maintenance,” he added. – by Janel Miller
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Timothy I. Morganthaler, MD
Sleep has been tremendously undervalued and underappreciated for decades, and the costs of this neglect to individuals and society are mounting. About 30% to 35% of the population has brief symptoms of insomnia, 10% have chronic insomnia disorder and about 4% of U.S. adults aged older than 20 years use prescription sleep aids in any given month. The annual losses in work performance associated with insomnia, even when controlling for comorbidity, are estimated to reach $63.2 billion, and personal and public health care spending for insomnia adds up to an estimated $5.1 billion per year. What can we do to help patients?Pharmacologic management of insomnia has a role, but is not fully satisfactory, and there are valid safety and long-term side effect concerns. Thankfully, there are nonpharmacologic ways to improve insomnia. But what works? When trusted health care providers do not provide convincing and effective advice, patients seek help from alternative sources, sometimes leading them to address their insomnia with unproven, wasteful, or even dangerous methods. Thankfully, some of the “try this” kind of advice can be tested scientifically. That is exactly what researchers examined: they evaluated whether taking a warm bath or shower prior to bedtime, something commonly recommended, was actually effective in improving sleep quality.
Using standard meta-analytic approaches, the authors combined the results of 17 studies that examined the effect of water-based passive body heating, (ie, showering or bathing), on sleep latency (time to fall asleep), sleep efficiency (proportion of time in bed actually sleeping), and sleep quality (assessed in various ways). They also reviewed pertinent literature that contributed to understanding mechanisms of effects but did not lend themselves to meta-analytic combination of data. Their findings can really guide our advice to patients: 1) taking a warm shower, foot bath, or shower prior to bedtime significantly improves the time it takes to fall asleep and the sleep efficiency; 2) warm water exposure tends to improve subjective sleep quality as well; and 3) timing the warm water-exposure 1 to 2 hours prior to bedtime, rather than within the 1 hour prior to bedtime may be the most effective.
Addressing patients’ sleep needs often begins with teaching some facts and expelling myths about sleep. Sufficient sleep is now clearly recognized as one of the three pillars of health, alongside good nutrition and healthy activity levels. Many need to be alerted that the healthy sleep duration goal for adults is at least 7 hours and that keeping a regular sleep schedule will provide the best sleeping experiences. Improving the duration and timing of sleep is more effective for most than trying to alter depth or stages of sleep. Therefore, the most important steps to take are to set and keep a reasonable sleep schedule. It appears that for those struggling to fall or stay asleep, one low-risk and evidence-based actionable recommendation would be for them to schedule a warm bath, shower or foot bath 1 to 2 hours prior to bedtime.
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