Did you know that people with insomnia spend more time in bed than people without sleep problems? So what the heck are they doing in there?

Insomnia is a chronic pattern of sleep disturbance. It can affect anyone regardless of age, gender, and culture. It can stand alone but is often part of another diagnosis like depression or anxiety. Insomnia can be described as having difficulty falling asleep, staying asleep, or waking up too early. Sleep is an integral part of our ability to function daily. Sleep is so vital that most insurance companies will pay for mental health services just to support sleep. That’s huge because insurance companies don’t like to pay for anything!

Just a few days without sleep, and we basically turn into hallucinating zombies. Lack of sleep significantly impacts our ability to learn and control our emotions and behaviors. As a result, kids (and adults) are often more irritable and have a more challenging time getting things done. I constantly review a child’s basic needs when I first start working with my clients, and if sleep is off for any reason, I tend to start there because improved sleep means improved behaviors. 

Since sleep is just as important for adults as children, I’ll be making suggestions that work in both age groups. Also, please note that this is a summary, there is a lot more information that I can’t cover in a blog post, and I encourage you to work with a professional if this type of treatment sounds interesting to you.

The most common treatment for insomnia is called Cognitive Behavioral Therapy for Insomnia (CBTi). It consists of 5 components that you can do simultaneously or one at a time. When working with children, I like to start in the sleep hygiene phase of treatment. Sleep hygiene is preparing ourselves and our environment for sleep. It involves dedicating approximately 30-60 minutes to get ready for bed.

You want to focus on your internal needs, such as hunger, thirst, and caffeine/alcohol/cigarette use, and eliminate these. Then you want to focus on external needs, like whether your room feels safe? Is it quiet? Is it dark? Is your bedding comfortable, or are you too hot or cold?

And the big one is making sure that there are not electronics distracting you. No phone within reach, no TV or iPad or tablet, or computer. This one is essential because your brain needs time to unplug. It reduces stress when we avoid our devices. The light from the devices messes with our ability to feel sleepy. Some people are so sensitive to the blue light from devices messing with the natural sleep rhythms that they need to be away from phones for 5-6 hours before bed!

Making changes in the sleep environment can often lead to better quantity and quality of sleep in kids, but sometimes more support is needed. The next phase of treatment I like to use is called conditioned arousal. The concept of this treatment comes from behaviorist theories that have proven that people can build habits unconsciously when two unrelated events happen together enough times. In the case of sleep, if we use our beds for doing anything other than sleep, we are programming our minds to think we need to take action when we see the bed.

What I mean is if we watch TV, eat, play video games, etc., on our beds, we build the habit that the bed is NOT for sleeping but for doing all of these other things. So when it is time to sleep, we stay alert and wonder why we can’t shut off our minds.

Instead, we need to relearn the connection that bed equals sleepiness by using the bed for sleep only. In severe cases, the bedroom should be completely off-limits until you are sleepy and it is time for bed.

The third phase I like to use, especially if the issue is that you have racing thoughts or anxiety, is to learn to use relaxation techniques. Several apps can help with this, such as headspace and calm. The trick is to use relaxation when you are awake throughout the day and only use it for sleep as needed.

Along those same lines, the fourth phase is cognitive restructuring. In this phase, your therapist helps you to reframe your thoughts so that you reduce stress. Any therapist trained in CBT can help support you with cognitive restructuring, and there are many more CBT training therapists than CBTi trained therapists. If you are looking for one, contact your insurance or your primary care physician for a referral.

The last phase of treatment is called sleep restriction. This phase is about improving the quality of your sleep by reducing the amount of time you are in bed. I leave this last when working with children, but it is one of the first things to try if you’re an adult because the results are much faster and easier to do than the other steps. I leave it for last with kids because when your children are in bed, it gives you a moment to yourself, and parents need that space and time to focus on other things.

With sleep restriction, you take the average amount of time your child is asleep and determine what time you want them to wake up in the morning. Then they will have to do anything and everything they can to stay awake until a predetermined time. For example, say your kids sleep for 5 hours total, but they’re staying up late, and they wake up in the middle of the night and can’t get back to sleep. If they need to be up at 6:00 am, then their new bedtime would be 1:00 am, and they would have to stay awake until 1:00 am before they can go to bed. Each week you would increase the amount of time they are in bed by 15 minutes.

I know this sounds controversial, but think about it. Your child will be getting 5 hours of sleep either way. Blocking sleep time into a 5-hour chunk gives your child the opportunity to have better sleep because their sleep cycles will not be disrupted like when they wake up a bunch of times. They will feel sleepy once it is time for bed, and honestly, the hardest part is staying awake the whole time.

However, it is important to note that sleep restriction can backfire and cause other problems because of sleep deprivation. For example, people with Bipolar Disorder, sleep apnea, and seizures should NOT use sleep restriction. CBTi can be done independently, and there are several books and apps that you can use to guide you in using this method. But I would recommend working with a trained CBTi practitioner.


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