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 missing in a child’s routine that are preventing good sleep, and then help design environments to support those behaviors so that children can develop 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. Consider 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 that it is time for 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 and consistent. That means that caregivers should minimize or eliminate talking. In a noisy household, it may be useful to identify a source of consistent “white noise” (e.g., a box fan or a white noise machine that produces a consistent sound similar to a fan). A caregiver may be tempted to give a child access to a smartphone or tablet to help settle them down. However, screens are often used during awake times. Therefore, they do not signal that it is time for sleep (additionally, the blue light coming from smartphones mimics daylight, and that can suppress serotonin so the body does not experience naturally-occurring sleep signals). For these and other reasons, it is often a good idea to put screens away at bedtime.

It is also 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 such as that described above, some children will still 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 (i.e., they may become a sleep signal over time), and the child will thus have difficulty falling asleep without them. Sometimes we call these signals “sleep dependencies”.

It is helpful to know that we can design practical sleep dependencies. For example, designating special pillows, stuffed animals, or blankets as sleep dependencies can help children fall asleep without the aid of an adult. We can also change sleep dependencies that are not practical. If a child is used to an adult lying down with them to help them fall asleep, 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. Next, the adult should 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 slow 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. The child may learn to hug their pillow or a stuffed animal during this time. These experiences should help children learn to fall asleep on their own and eventually become more resilient to disruptions in routines over time.