Behavioral Sleep Medicine Program

Symptoms or problems treated by the Behavioral Sleep Medicine Program include:

• Problems falling asleep or staying asleep (insomnia)
• Bedtime refusal
• Nighttime fears or anxiety
• Nightmares
• Difficulty with transitions such as from the crib to the bed or from the caregiver’s bed to the child’s bed.
• Poor sleep habits
• Sleep time disorders (circadian rhythm disorders)
• Sleep terrors or other parasomnias
• Difficulty in consistent use of positive airway pressure (PAP) therapy for sleep apnea

We work with you and your child to identify factors contributing to sleep disturbance and develop an individualized treatment plan. Your child will receive care from a licensed psychologist certified in behavioral sleep medicine by the American Board of Sleep Medicine. This psychologist works in coordination with other members of your child’s healthcare team, including the primary care doctor, developmental or mental health therapist, sleep doctor and other specialists.

Your child will receive a thorough evaluation that includes a questionnaire and an interview if he or she is old enough to participate. While the evaluation focuses on behavioral and psychological factors that disrupt sleep, it also includes screening for other sleep disorders such as obstructive sleep apnea and restless leg syndrome. To diagnose sleep problems and monitor progress over time, you or your child may be asked to keep a daily sleep diary. Your child may also wear an actigraphy wristband for a week or two to measure sleep patterns. Worn like a watch, an actigraph provides a 24/7 record of when your child is asleep or awake. Though a sleep study may be performed, they are often not required for behavioral sleep difficulties such as insomnia, because a child's sleep pattern is often different at home than in a sleep lab.

Behavioral sleep treatment tends to be brief, usually from two to six sessions, and is highly focused on sleep. If other mental or behavioral health problems are identified as part of the evaluation, we may recommend that your child also meet with another mental health professional. As part of our program, we offer behavioral sleep treatment approaches that include:

• Cognitive behavioral therapy for insomnia (CBT-I)
• Behavior plans to encourage children to cooperate with changes or recommendations
• Child-focused skills training to manage fears and/or anxiety
• Infant behavioral sleep approaches to encourage independent sleep
• Strategies to make changes in sleep habits, schedules, environment or pre-sleep activities
• Light therapy and scheduling changes for circadian problems
• Chronotherapy to help reset your child’s sleep clock
• Imagery rehearsal therapy for frequent nightmares
• Biofeedback therapy

Biofeedback uses computer-based software and sensors on the skin to show changes in the number of heartbeats per minute depending on activity or relaxation. Your child can learn to relax at bedtime by using this system in our office and doing the exercises we provide for practice at home.

If your child has been diagnosed with obstructive sleep apnea, the sleep doctor may recommend a continuous positive airway pressure (CPAP) mask. Our specialists will provide assistance to help your child adapt to wearing this mask each night.