Sleep Issues

Sleep-related concerns, such as difficulties falling asleep or frequent night waking, are common among children. Establishing a consistent bedtime routine, creating a calming sleep environment, and promoting healthy sleep hygiene (i.e., healthy sleep habits and environments) can contribute to better sleep patterns.

How does a behavior analytic perspective help caregivers address sleep concerns? Behavior analysts focus on environmental influences to behavior. What we refer to as “going to sleep” consists of a few different multistep behaviors, generally: preparing for bedtime, falling asleep, and staying asleep throughout the night. When helping people with sleep concerns, behavior analysts consider the events that occur just before sleep (called antecedents) and the events which follow sleep (called consequences; often, reinforcers). Behavior analysts can help identify the specific behaviors related to good sleep, and then help design environments to support healthy sleep habits.

It is important to note that individual sleep goals and routines may vary. However, we can consider an example to illustrate this approach. Given the example behavior of “falling asleep”, we can break this behavior down into multiple components and support or teach each component individually. First, the environment should be designed to signal sleep. The sleep environment should look and feel different from an environment that signals it is time to wake up. Lights should be low or turned off completely. The noise level should be low. Minimize or eliminate talking. Given that screens are often used during awake times, it can be useful to turn screens off and put them away.  It is a good idea to develop a routine around getting ready for bed. Each step in that routine will eventually come to signal that it is almost time to go to sleep. For small children, a reasonable routine may consist of putting on pajamas, brushing teeth, and reading a story in or near the bed before shutting off the lights. Once the sleep environment is established, the behavior of falling asleep can occur.

Although falling asleep will sometimes naturally occur at the conclusion of a consistent bedtime routine that sets the occasion for sleep, some children will have trouble falling asleep without adult help. It is important for adults to help children develop the skills to fall asleep on their own. If a child is used to falling asleep while the adult lies next to them in bed, that adult may become part of the sleep environment, and the child will have difficulty falling asleep without them. That adult becomes a “sleep dependency”. Designating special pillows, stuffed animals, or blankets as sleep dependencies can help children fall asleep without the aid of an adult. If a child is used to an adult lying down with them, the adult might consider moving to a chair next to the bed so they can provide comfort but give the child space to begin to learn how to relax and fall asleep on their own. The adult can gradually, over time, move the chair further and further away from the child and eventually out of the room as the child learns to fall asleep on their own. It is important to take a gradual approach here. If the adult moves too far away from a child who is still dependent on them to fall asleep, it will be difficult for the child to fall asleep on their own. It is also important to move continuously (i.e., don’t sit with the chair in the same spot for multiple weeks) so the child gets used to small changes and experiences positive outcomes even in the face of those small changes. Those experiences, in addition to giving them space to learn how to fall asleep, should help them become more resilient to disruptions in routines over time.