Behavioral Treatments for Sleep Disorders in Children

The amount of sleep a child needs changes as he or she grows, as does the type of behavior that can cause sleep disorders. Sleep problems can occur at various stages of development during childhood. They are also very common in children with psychiatric disorders, such as attention deficit hyperactivity disorder, autism spectrum disorder, childhood anxiety, and childhood mood disorders.

At Hassenfeld Children’s Hospital at NYU Langone, our sleep experts recommend a variety of strategies for children of all ages to overcome problems falling and staying asleep. Our doctors develop a personalized plan to help you and your child modify specific behaviors, such as refusal to sleep or difficulty falling asleep. They also consult with pediatricians, psychiatrists, and other physicians if your child is being treated for a psychiatric disorder, ensuring that the child’s treatment and medication do not interfere with sleep.

Many parents and children find that changing sleep behaviors is very difficult. Our doctors offer emotional support to you and your family as you implement behavioral strategies that can help your child to have a better night’s rest.

Self-Soothing Techniques for Infants

At about six months of age, most infants become more aware of light and dark cues and can sleep for about six hours without waking at night. Although it is normal for infants to wake during the night, some have difficulty going back to sleep without help.

Our behavioral sleep experts can teach you techniques to encourage your infant to self-soothe. For example, you can try putting your baby to bed while he or she is drowsy but not yet asleep. Our doctors also recommend ignoring the baby’s cries for a period of time, so that he or she can learn how to fall back to sleep without your involvement.

If you find this method to be distressing, you can try a more gradual approach. You may want to try lying in a separate bed nearby and pretending to be asleep. Sometimes this can help your child to learn to fall asleep on his or her own.

Cognitive Behavioral Therapy and Relaxation

The amount of sleep needed gradually decreases throughout childhood, although most children still need about 10 hours of sleep until age 10. New sleep problems can begin as children reach important developmental milestones. For instance, some toddlers and preschoolers may refuse to go to sleep at their usual bedtime as they begin to assert emotional independence.

In addition, a young child’s growing imagination can lead to the development of nighttime fears. In older children, the need to sleep often competes with the increased stimulation of school, afterschool activities, social activities, and electronic devices.

Our sleep specialists focus initially on teaching parents how to implement good sleep hygiene habits, taking into account the age of your child and his or her sleep requirements. For example, parents of younger children may focus on establishing a bedtime routine, whereas parents of school-age children may need to set limits on how late a child can engage in stimulating activities, such as watching television or using a computer. These rules and routines are coordinated with your child’s bedtime and wake time.

In addition, our therapists may use cognitive behavioral therapy techniques to help your child cope with irrational thoughts that can interfere with sleep, such as fears about monsters under the bed or feeling unsafe in the house at night. Our therapists can also help children combat anxiety about falling asleep or not getting enough sleep.

They teach your child how to change negative thoughts about sleep with the aid of relaxation strategies, such as progressive muscle relaxation, or by talking about fears during the daytime with a physician, which can make them seem less scary. You can participate by setting goals for your child and reinforcing his or her progress in meeting these.

Cognitive behavioral therapy is always used in combination with good sleep hygiene strategies, age-appropriate bedtime routines, and a consistent sleep schedule. Depending on your child’s age and the severity of his or her anxiety, a psychologist may meet with your child weekly for a handful of sessions to teach, practice, and reinforce these techniques. Children who have an anxiety disorder may need to address this condition before focusing on nighttime fears.

Our therapists can also offer tips about how to make sleeping safe for children with disruptive behaviors that occur during sleep, such as sleepwalking or other parasomnias. Putting a child in the lower part of a bunk bed, for instance, or installing door alarms are simple but effective strategies. Maintaining good sleep hygiene and sticking to a regular sleep schedule can also help to reduce the frequency of parasomnias.

Strategies for Sleepy Teens

Changes in circadian rhythm, which affect a person’s biological clock, and increasing academic and social demands can significantly delay bedtime for your teen, causing delayed sleep phase syndrome and excessive daytime sleepiness, especially in the morning. This condition can make it difficult to wake up in time for school, leading to repeated absences and poor performance in class.

Our sleep specialists recommend that teens adopt many of the same behavioral strategies recommended for younger children, such as going to bed at the same time each night, avoiding the use of electronic devices in the bedroom, and limiting caffeine consumption. Cognitive therapy and relaxation techniques are also effective in reducing any anxiety your teen may have about not getting enough sleep.

In addition, our therapists may recommend the use of a therapeutic light to help reset your teen’s circadian rhythm. Artificial lights designed for this purpose produce a white or blue light that filters out the harmful ultraviolet rays found in natural sunlight. When placed next to the bed, these devices can deliver bright light to the teen early in the morning, helping to alter his or her sleep pattern. Bright light therapy can have side effects, such as dry or irritated eyes and headaches, so this treatment should be monitored by a healthcare professional.

Our doctors can work with your child’s school to request a temporary delay in the start of his or her school schedule until the sleep schedule improves.