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Do you need sleep every night?

Do you need sleep every night?



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I haven't slept for a day, but feel fine. It is sometimes assumed that one needs 8 hours of sleep each night, but I think this is sometimes not true.

Is it okay to get no sleep one night and then 8-9 hours sleep the next night, as long as it only happens occasionally (e.g., once a month)?


Here's why people need to sleep:

The brain does its "cleaning up" during sleep. As cells in the nervous system are active, waste products are produced. In the rest of the body, waste removal is carried out by the lymphatic system, but this system does not extend to the brain. Instead, cerebrospinal fluid (CSF) must be pumped through the brain tissue in order to flush waste back into the circulatory system where it can be excreted by the liver. Pumping CSF seems to require a great deal of energy, and researchers speculate that this energy expenditure is incompatible with the intense metabolic demands of brain cells during wakefulness. Also, cells in the brain shrink considerably during sleep, resulting in a 60% increase in interstitial space which allows CSF to wash more freely through the brain tissue. The consequence is significantly faster clearance of neurotoxic waste (e.g., β-amyloid).

  1. http://www.sciencemag.org/content/342/6156/373
  2. http://stm.sciencemag.org/content/4/147/147ra111

As mentioned in one of the TED talks by Russell Foster, we need sleep not only for resting or cleaning up, but also for developing memories.

In addition, a good sleep has also requirements (mostly environmental); e.g. no-light, no-noise room etc.

Here is the talk: http://www.ted.com/talks/russell_foster_why_do_we_sleep.html


Science Says: Do These 6 Things to Sleep Soundly

Sleep doesn’t come easily for a lot of people. If you know the struggle, here are some helpful tips backed by science.

A good night’s sleep is deeply restorative.

When you’re asleep, your body gets a chance to refresh and heal itself: Your brain can sort and process the day’s experiences and information. Your liver gets to work cleaning up the place. Your digestive and nervous systems get a chance to chill. And your immune system can fight off any infections or inflammation.

When you don’t get enough sleep, it can lead to a variety of physical and mental health problems, including diabetes, obesity, anxiety, depression, and decreased quality of life.

The good news is there are several things you can do to help improve your sleep quality.

Exercising during your nonworking hours may be one of the best things you can do for better sleep. Even a single bout of exercise can help you fall asleep more quickly, wake up fewer times, and increase slow-wave sleep (deep sleep).

If you’ve ever gone hiking for the day and crashed into bed that night, you’ve experienced this firsthand.

Suppporting science

Several studies suggest that exercise can improve sleep quality and promote longer sleep, particularly among middle-aged and older participants and those with health problems.

Another small study of young, healthy males found that a single bout of 60-minute vigorous exercise increased delta brain waves during sleep, indicating deeper sleep.

For some people, exercising too late in the day can actually interfere with sleep. This is because exercising increases your core body temperature, which may delay sleep and lead to waking up more in the night. The general recommendation is to finish your workout at least 2 hours before bedtime.

Lighting plays a significant role in getting a good night’s sleep. Our bodies have natural circadian rhythms that are part of the body’s internal clock. The most well-known circadian rhythm is the sleep-wake cycle.

When we get too little light during the day or too much light at night, it can throw off the “master clock” in our brains that regulates the sleep-wake cycle.

Suppporting science

One study found that nursing home residents slept better after installing LED lights designed to mimic the 24-hour natural light cycle.

Of the 63 nursing home residents, 35 had been diagnosed with dementia, which is associated with mental health problems such as depression, agitation, anxiety, and delusions. All of these symptoms can lead to sleep disturbances.

The study found that residents with the new LED lighting technology experienced about half the sleep disturbances than those still living with the regular lighting fixtures.

Another study found that people exposed to more light in the morning (8 a.m. to noon) fell asleep more quickly at night and had fewer sleep disturbances than those exposed to less light. More daylight exposure was also tied to less depression.

Limit TV and phone use at night

It’s also believed that the blue light emitted from electronic devices can interfere with your body’s natural sleep-wake cycle.

Suppporting science

A small study analyzed the biological effects of reading an e-book on an iPad compared to reading a printed book in the hours just before bedtime.

The findings show that when participants read from an iPad, they took longer to fall asleep, had reduced melatonin secretion, and spent less time in an important phase of sleep known as rapid eye movement (REM) sleep. They also said that they felt more sleepy the following morning than when they read from a printed book.

Having a regular bedtime schedule may help improve sleep. This includes going to bed and waking around the same time every day.

Sleep experts recommend setting your alarm clock for the same time every day — and if possible, try not to sleep in on the weekends. This will help reinforce the circadian rhythm and help your body get tired around the same time every night.

A healthy bedtime routine should also focus on calming your mind before bed. For example, some people enjoy reading a book before bed as it helps take their minds off their troubles. As mentioned, it’s better to read books in print (not on a screen) as the phone light can affect your brain’s ability to switch into sleep mode.

There are several natural supplements that may help improve sleep for some people.

Supplements aren’t without the risk of side effects or interaction with prescription meds and recreational substances, including alcohol. You’ll want to notify your healthcare team before trying supplements, including a psychiatrist, if you have one, and your doctor. Though supplements may be naturally occurring elements, the Food and Drug Administration (FDA) doesn’t regulate those sold on shelves.

Here are some supplements and their reported benefits that you might want to research further:

GABA (Gamma-aminobutyric acid) is an important calming neurotransmitter in the brain. Many supplements, like valerian and theanine, act on GABA receptors. You can also buy straight GABA supplements.

GABA helps get your body into a state of relaxation which may help you fall asleep.

One study found that participants with insomnia who took GABA an hour before bed fell asleep faster than those who took a placebo. The GABA group also reported improved sleep quality 4 weeks after starting the supplement.

Valerian root

Valerian root has been used in traditional medicine since the first century A.D. Many people take valerian supplements for insomnia or anxiety. It is believed that valerian root acts on GABA, a calming neurotransmitter in the brain.

L-theanine

L-theanine is an amino acid found in high amounts in green tea. It is commonly taken in supplement form by people who want to reduce anxiety, stress or improve sleep.

Research suggests that l-theanine improves sleep through relaxation rather than sedation. In other words, it helps reduce anxiety and stress, allowing you to fall asleep naturally (without that heavy feeling).

Melatonin

Melatonin is a natural hormone released by the pineal gland in response to darkness. It plays an important role in the sleep-wake cycle.

Melatonin is a common supplement often used for insomnia or jet lag. Some literature reviews on this hormone have been mixed or inconclusive . While it’s likely safe for most people in the short term, melatonin is linked to side effects, including headache, drowsiness, nausea, or depression.

It’s important to remember that melatonin is a hormone, so if you have hormone imbalances and are interested, consider talking first with your healthcare team.

CBD (cannabidiol) is derived directly from the hemp plant, and by itself, it doesn’t cause a high. It’s commonly used for insomnia, anxiety, pain, and inflammation.

One study found that, on average, taking CBD led to significant improvements in anxiety and sleep for most participants and that many of these improvements were sustained over time.

You can buy CBD in several forms — from oils and tinctures to gummies to topical creams.

Sleep problems are often rooted in anxiety and stress. Starting a meditation practice is a great way to deal with this. Meditation works by training the brain and body to relax — essentially the opposite of the fight-or-flight response.

One of the most popular and well-studied forms of meditation is mindfulness meditation.

This involves focusing on your breathing and bringing your mind’s attention to the present moment. When your mind wanders, you can gently bring your attention back to your breathing.

One study found that participants enrolled in a mindfulness-based intervention showed significant improvements in insomnia and fatigue.

Caffeine is a stimulant found in many beverages, including coffee, tea, soft drinks, and pre-workout mixes.

Caffeine keeps us awake by blocking adenosine receptors. Adenosine is a neurotransmitter that helps us feel drowsy and ready for bed. Adenosine builds up as we go about our day. The longer we’re awake, the more it accumulates and the sleepier we become.

Consuming caffeine before bed stops the drowsy feeling and promotes a wakeful state of mind. This is certainly helpful if you’re driving on a long road trip and need to stay awake, but not if you’re planning on going to bed within a few hours.

The stimulant can also worsen symptoms in several mental health conditions.

If you’re sensitive to caffeine, skip the iced tea at dinner and opt for an herbal tea instead.

Getting a good night’s sleep is important for your overall health and well-being. Poor sleep is linked to decreased quality of life, low resilience to stress, mood disorders, and memory problems.

If you’re having trouble getting sufficient sleep, these six tips can help. It pays to be very protective of your sleep — your body and brain will thank you.


Stress and sleep

Sleep is a necessary human function — it allows our brains to recharge and our bodies to rest. 1 When we do not sleep long or well enough, our bodies do not get the full benefits of sleep, such as muscle repair and memory consolidation. 2 Sleep is so crucial that even slight sleep deprivation or poor sleep can affect memory, judgment and mood. 3 In addition to feelings of listlessness, chronic sleep deprivation can contribute to health problems, from obesity and high blood pressure to safety risks while driving. 4 Research has shown that most Americans would be happier, healthier and safer if they were to sleep an extra 60 to 90 minutes per night. 5

This year’s Stress in America™ survey shows that stress may be interfering with Americans’ sleep, keeping many adults and teens from getting the sleep they need to be healthy.

Survey findings show that stress may be getting in the way of quality sleep. American adults report sleeping an average of 6.7 hours a night — less than the minimum recommendation of seven to nine hours. 6 In addition, 42 percent of adults report that their sleep quality is fair or poor and 43 percent report that stress has caused them to lie awake at night in the past month.

Many report that their stress increases when the length and quality of their sleep decreases.

When they do not get enough sleep, 21 percent of adults report feeling more stressed. Adults with higher reported stress levels (eight, nine or 10 on a 10-point scale) fare even worse — 45 percent feel even more stressed if they do not get enough sleep. Five percent of adults with lower reported stress levels (one, two or three on the 10-point scale) say the same.

Only 20 percent of adults say the quality of their sleep is very good or excellent.

Thirty-seven percent of adults report fatigue or feeling tired because of stress.

Many adults report negative consequences from not getting enough sleep. More than half (53 percent) report feeling sluggish or lazy, 38 percent report feeling irritable, 29 percent report they have trouble concentrating and 25 percent report feeling no motivation to take care of responsibilities.

Adults who sleep fewer than eight hours a night report higher stress levels than those who sleep at least eight hours a night (5.5 vs. 4.4 on a 10-point scale).

On average, adults with lower reported stress levels report sleeping more hours a night than do adults with higher reported stress levels (7.1 vs. 6.2 hours). They are also more likely to say they have excellent or very good-quality sleep (33 percent vs. 8 percent) and get enough sleep (79 percent vs. 33 percent).

Adults who sleep fewer than eight hours a night are more likely to report symptoms of stress in the past month, such as feeling irritable or angry, than adults who sleep more than eight hours a night (45 percent vs. 32 percent of adults) feeling overwhelmed (40 percent vs. 27 percent) lacking interest, motivation or energy (42 percent vs. 30 percent) losing patience or yelling at their children (52 percent vs. 27 percent) losing patience or yelling at their spouse or partner (50 percent vs. 36 percent) and skipping exercise (41 percent vs. 33 percent). They are also more likely to say their stress has increased in the past year (40 percent vs. 25 percent).

Adults with high stress are more likely to say they are not getting enough sleep because their minds race (49 percent vs. 10 percent of adults with low stress).

Adults with high stress are also more likely than those with low stress to say they feel the effects of getting too little sleep:

  • Sixty-eight percent say they feel sluggish or lazy versus 36 percent of adults with low stress.
  • Fifty-nine percent say they are irritable versus 20 percent of adults with low stress.
  • Forty-five percent say they have trouble concentrating versus 12 percent of adults with low stress.
  • Forty-five percent say they feel more stressed versus five percent of adults with low stress.
  • Twenty-seven percent say they feel sad or depressed versus two percent of adults with low stress.

Teens also report that stress has an impact on their sleep and vice versa. Teens report sleeping far less than the minimum age-based recommendation of 8.5 to 9.25 hours. 7 On average, teens say they sleep 7.4 hours a night on a school night and 8.1 hours a night on a non-school night. Nearly one-quarter of teens (24 percent) also report that their sleep quality is fair or poor.

More than one-third of teens (35 percent) report that stress caused them to lie awake at night in the past month. And for teens who sleep fewer than eight hours per school night, many say their stress level has increased over the past year (42 percent), compared with 23 percent of teens who sleep at least eight hours per school night. In addition, 18 percent of teens say that when they do not get enough sleep, they are more stressed and 36 percent of teens report feeling tired because of stress in the past month. Thirty-nine percent of teens with higher reported stress levels (eight, nine or 10 on a 10-point scale) during the past school year feel even more stressed if they do not get enough sleep, while only 3 percent of teens with lower reported stress levels (one, two or three on a 10-point scale) during the past school year say the same.

When they do not sleep enough, more than half of teens (53 percent) report feeling sluggish or lazy and 42 percent say they feel irritable. Thirty-two percent say they are unable to concentrate and 23 percent report feeling no motivation to take care of responsibilities.

Teens with low stress during the past school year report sleeping more hours per night than do teens with high stress (7.8 vs. 6.9 hours).

Ninety percent of teens with low reported stress levels during the past school year say they get enough sleep, compared to less than half (48 percent) of teens with high reported stress levels during the past school year.

Teens with lower reported stress levels during the past school year are also more likely than highly stressed teens to say they have excellent or very good-quality sleep (59 vs. 22 percent). Teens with high reported stress levels during the past school year are more likely to report having trouble sleeping well — 43 percent say they do not get enough sleep because their mind races, compared to 9 percent of teens with low stress who say the same.

Teens who report experiencing high stress during the past school year are also more likely than those who report having low stress to say they feel the effects of getting too little sleep:

  • Sixty-one percent of highly stressed teens say they feel sluggish or lazy versus 42 percent of teens with low stress.
  • Fifty-four percent of highly stressed teens say they are irritable versus 25 percent of teens with low stress.
  • Forty-four percent of highly stressed teens say they have trouble concentrating versus 20 percent of teens with low stress.
  • Thirty-nine percent of highly stressed teens say they are more stressed versus three percent of teens with low stress.
  • Twenty-six percent of highly stressed teens say they feel sad or depressed versus one percent of teens with low stress.

When it comes to stress, teens who get fewer than eight hours of sleep on a school night appear to fare worse than teens getting eight hours of sleep on school nights:

  • Teens who sleep fewer than eight hours per school night report higher stress levels in the past month than teens who sleep at least eight hours per school night (5.2 vs. 4.1 on a 10-point scale).
  • Teens who sleep fewer than eight hours on a school night are more likely than teens who sleep at lease eight hours on a school night to report experiencing symptoms of stress, such as feeling irritable or angry (50 percent vs. 32 percent), nervous or anxious (46 percent vs. 28 percent), depressed or sad (43 percent vs. 18 percent) and overwhelmed (42 percent vs. 22 percent).

Younger Americans (Millennials and Gen Xers) report getting fewer hours of sleep per night on average, and are more likely than other adults to say they do not get good-quality sleep and have more trouble achieving their sleep goals. 8 Younger adults are more likely to say they feel stressed by a lack of sleep (Millennials: 29 percent Gen Xers: 23 percent) than Boomers (19 percent) and Matures (7 percent). Millennials and Gen Xers are also more likely to report feeling sad or depressed because of stress (Millennials: 47 percent Gen Xers: 42 percent Boomers: 29 percent Matures: 15 percent).

Gen Xers are most likely to say that they sleep fewer than eight hours a night (77 percent vs. 74 percent of Boomers, 66 percent of Matures and 64 percent of Millennials). They are also least likely to say they are getting enough sleep (45 percent vs. 74 percent of Matures, 56 percent of Boomers and 54 percent of Millennials).

Half of Gen Xers (49 percent) say their sleep quality is fair or poor, compared to 43 percent of Millennials, 42 percent of boomers and 28 percent of matures.

Only 24 percent of Gen Xers say they are doing a very good or excellent job at getting enough sleep, despite the majority of this generation (61 percent) who say that getting enough sleep is extremely or very important to them. A wide gap between perceived importance and achievement of sleep goals also exists for Millennials (59 percent vs. 28 percent), Boomers (64 percent vs. 30 percent) and Matures (70 percent vs. 50 percent).

Gen Xers and millennials are most likely to say lack of sleep makes them irritable (49 percent and 47 percent, respectively, vs. 30 percent of Boomers and 15 percent of Matures).

While Gen Xers report sleeping the fewest hours, Millennials report poorer sleep habits than other adults. In particular, Millennials are more likely to say they do not get at least eight hours of sleep because they stay up too late (52 percent compared with 36 percent of Gen Xers, 29 percent of Boomers and 22 percent of Matures).

Nearly one-third of Millennials also attribute lack of sleep to thinking of all the things they need to do or did not get done (31 percent compared with 27 percent of Gen Xers, 24 percent of Boomers and 14 percent of Matures).

More than one-third of Millennials say they do not sleep at least eight hours a night because they have too many things to do and do not have enough time (35 percent compared with 19 percent of Gen Xers, 13 percent of Boomers and 6 percent of Matures).

Younger Americans are also more likely to report consequences of unhealthy sleeping habits. When they do not get enough sleep, 60 percent of Millennials say they feel sluggish or lazy, compared to 58 percent of Gen Xers, 50 percent of Boomers and 37 percent of Matures 38 percent of Millennials say they have trouble concentrating on things they need to do, compared to 32 percent of Gen Xers, 27 percent of Boomers and 11 percent of Matures and 34 percent of Millennials say they are not motivated to take care of responsibilities, compared to 23 percent of Gen Xers, 22 percent of Boomers and 14 percent of Matures.

1 Division of Sleep Medicine at Harvard Medical School and WGBH Educational Foundation. (n.d.). Why do we sleep, anyway? Healthy Sleep . Retrieved from http://healthysleep.med.harvard.edu/healthy/matters/benefits-of-sleep/why-do-we-sleep.

3 Division of Sleep Medicine at Harvard Medical School and WGBH Educational Foundation. (n.d.). Consequences of insufficient sleep. Healthy Sleep. Retrieved from http://healthysleep.med.harvard.edu/healthy/matters/consequences.

4 Spira, A. P., Gamaldo, A. A., An, Y., Wu, M. N., Simonsick, E. M., Bilgel, M., … & Resnick, S. M. (2013, October). Self-reported sleep and β-amyloid deposition in community-dwelling older adults. The Journal of the American Medical Association Neurology. doi:10.1001/jamaneurol.2013.4258.

5 American Psychological Association. (2004, May). More sleep would make most Americans happier, healthier and safer. Retrieved from http://www.apa.org/research/action/sleep-deprivation.aspx.

8 The four generations are defined as the following: Millennials (18- to 34-year-olds), Gen Xers (35- to 48-year-olds), Boomers (49- to 67-year-olds) and Matures (68 years and older).


Other Things to Consider

Snoring. If you snore, you can buy special strips to go over your nose (or sometimes inside your nose) that may help you breathe more easily. It might also help to raise the head of your bed, either with a wedge pillow or with risers. You can also do this with special motorized, adjustable bed frames.

Supplements. Over-the-counter supplements that claim to help with sleep don’t go through the same careful testing that FDA-approved medicines get. In general, there’s not enough research to know if they work and whether they’re safe.

When to call your doctor. If you still can't sleep well or you’re really tired during the day, even after following this checklist, it may be time to talk to your doctor. You may have a treatable sleep problem like sleep apnea, a serious cause of interrupted breathing during sleep, or some other treatable illness.

Sources

American Academy of Sleep Medicine: "Two Week Sleep Diary."

Medscape Education: "Consequences of Nighttime Heartburn: QoL and Sleep Disturbances: Nighttime Heartburn and Sleep Disturbances -- Issues in Prevalence and Quality of Life."

National Heart, Lung, and Blood Institute: "Your Guide to Healthy Sleep."

National Institute of Neurological Disorders and Stroke: "Brain Basics: Understanding Sleep."

National Sleep Foundation: "Diet, Exercise and Sleep," "Healthy Sleep Tips," "How Much Sleep Do We Really Need?" "Let Sleep Work for You."

Psychology Today: "Get Fido His Own Bed."

Roehrs, T. Sleep Medicine Review, 2007.

Drake, C. Journal of Clinical Sleep Medicine, Nov. 15, 2013.

ScienceDaily: "Dog Tired? It Could Be Your Pooch."

The Harvard Medical School Family Health Guide: "Insomnia: Restoring Restful Sleep."

Sleep Foundation: “Are Natural Sleep Aids Safe?”

Harvard Medical School Division of Sleep Medicine: “An Overview of Sleep Disorders.”


Sleep-Wake Disorders

Experiencing stress or having too much caffeine in your system can keep you up for hours on end. But if you’re spending multiple nights awake, it might be something more serious.

Share on Pinterest Nike Jun Talaroc/EyeEm/Getty Images

About 50 million folks in the United States experience sleep deprivation because of a sleep disorder. And it turns out that about 30% of adults sleep for fewer than 6 hours each night.

The good news is that sleep disorders can be managed with medication and therapy. By knowing the signs of a sleep disorder, you can get the proper help when it’s time to hit the hay.

Sleep disorders, or sleep-wake disorders, are chronic conditions involving an abnormal sleep cycle stopping you from getting the right amount of sleep. While adults need an average of 7 or more hours of sleep every night, about one-third of us report insomnia symptoms.

Sleep-wake disorders also affect your quality of sleep. There are two main phases of sleep, called rapid eye movement (REM) and non-REM sleep.

Both work together to keep you sharp and alert for the next day by improving learning, attention, and the processing of new memories. Sleep is also vital in clearing out any waste that built up the brain while you were awake.

But people with sleep-wake disorders are chronically sleep deprived, or oversaturated, and miss out on these benefits of sleep. Seeking help and finding the best treatment plan could help you continue living a healthy life.

According to the DSM-5, people with a sleep disorder have the following symptoms in common:

  • excessive daytime sleepiness
  • trouble with attention and memory
  • potential symptoms of depression
  • insomnia or difficulty staying asleep

Sleep-wake disorders fall under an umbrella of sleep conditions, but all are manageable with proper treatment.

Common sleep disorders

Circadian rhythm sleep disorders occur when the body’s internal clock, which is involved in regulating when it’s time to be awake and when it’s time to go to bed, is disrupted.

Common types of circadian rhythm sleep disorder include:

Jet lag disorder. This occurs when your sleep is disrupted when traveling across time zones. Because your body hasn’t had time to adjust to another time zone’s day-night schedule, your body may signal when it’s time to sleep at inappropriate hours.

Shift work disorder. This is a condition that causes you to have difficulty sleeping because of a nontraditional work schedule, such as taking on night shifts for your job.

Delayed sleep phase disorder. This is when your sleep patterns are “delayed” by 2 hours or more in a regular sleep schedule. People who consider themselves “night owls” tend to have this condition, including 7% to 16% of teenagers and young adults.

Advanced sleep-wake phase disorder. This happens when you go to bed and wake up too early or too late compared with traditional sleep schedules. People with this condition can sleep as early as 6 p.m. and have their internal clock geared to start the day at 2 a.m.

Other common sleep disorders that disrupt rest include:

Insomnia. This is a sleep disorder that causes you to have trouble sleeping or getting good quality sleep. People with long-term diagnosed insomnia experience it on at least three or more nights per week or for at least 3 months.

Nightmare disorder. About 50% to 85% of adults report having at least one nightmare in their life, and the likelihood of this happening decreases as you get older. But 2% to 8% of people will continue to experience severe and chronic nightmares, preventing them from getting a good night’s rest.

Substance/medication-induced sleep disorder. This happens when you take drugs such as alcohol or stimulants like cocaine that temporarily disturb REM sleep and keep you alert .

Severe sleep disorders

The following sleep disorders are classified as severe for their effect on people’s well-being:

Obstructive sleep apnea. This is a sleep-related breathing disorder where you can temporarily stop breathing. This can happen at least five times an hour, and each time can last from a few seconds to minutes. People with this condition may have trouble staying awake in the daytime.

Narcolepsy. This is a neurological condition where there are disruptions in brain signals that tell you when to sleep and when to stay alert. About 135,000 to 200,000 people will experience narcolepsy and are at risk of muscle paralysis and suddenly falling asleep while in the middle of an activity like driving a car.

Restless legs syndrome. This affects 7% to 8% of people in the United States. It’s a condition where you have an overwhelming urge to move your legs and other body parts, especially at night.

Because sleep-wake disorders cover a broad range of sleep disorders, you might feel overwhelmed by the labels that clinicians use to describe what you’re feeling.


How to cope

There's no need to live with the burden of disrupted sleep. Change your lifestyle if you feel it's interfering with your sleep, or talk to your doctor about ways to better treat or possibly investigate underlying conditions.

And practice good sleep hygiene:

Wake up at the same time each day.

Avoid electronic devices (which emit light and stimulate the brain) at least two hours before bed.

Sleep in a quiet, dark, cool space.

Get regular exercise (but not within an hour of bedtime).

If you are already practicing healthy sleep behaviors but still have trouble sleeping, consider cognitive behavioral therapy for insomnia (CBT-i). CBT-i is a proven way to treat insomnia through relaxation techniques, talk therapy, and adjustment of the amount of time you spend in bed. It works with your body's natural controllers of sleep to reset the brain to achieve healthier sleep.

The good news: you can boost sleep quality and regain that sunny morning feeling. "When you sleep better," says Dr. Bertisch, "you're more likely to see improvements in your day-to-day function, concentration, energy levels, and quality of life."

Image: © Wavebreakmedia/Getty Images


How Much Sleep Do You Really Need?

The amount of sleep each person needs depends on many factors, including age.

Infants generally require about 16 hours a day, while teenagers need about 9 hours on average. For most adults, 7 to 8 hours a night appears to be the best amount of sleep, although some people may need as few as 5 hours or as many as 10 hours of sleep each day.

Women in the first 3 months of pregnancy often need several more hours of sleep than usual.

The amount of sleep a person needs also increases if he or she has been deprived of sleep in previous days. Getting too little sleep creates a &ldquosleep debt,&rdquo which is much like being overdrawn at a bank. Eventually, your body will demand that the debt be repaid.

We don&rsquot seem to adapt to getting less sleep than we need while we may get used to a sleep-depriving schedule, our judgment, reaction time, and other functions are still impaired.

People tend to sleep more lightly and for shorter time spans as they get older, although they generally need about the same amount of sleep as they needed in early adulthood. About half of all people over 65 have frequent sleeping problems, such as insomnia, and deep sleep stages in many elderly people often become very short or stop completely. This change may be a normal part of aging, or it may result from medical problems that are common in elderly people and from the medications and other treatments for those problems.

Experts say that if you feel drowsy during the day, even during boring activities, you haven&rsquot had enough sleep. If you routinely fall asleep within 5 minutes of lying down, you probably have severe sleep deprivation, possibly even a sleep disorder.

Microsleeps, or very brief episodes of sleep in an otherwise awake person, are another mark of sleep deprivation. In many cases, people are not aware that they are experiencing microsleeps. The widespread practice of &ldquoburning the candle at both ends&rdquo in western industrialized societies has created so much sleep deprivation that what is really abnormal sleepiness is now almost the norm.

Many studies make it clear that sleep deprivation is dangerous. Sleep-deprived people who are tested by using a driving simulator or by performing a hand-eye coordination task perform as badly as or worse than those who are intoxicated. Sleep deprivation also magnifies alcohol&rsquos effects on the body, so a fatigued person who drinks will become much more impaired than someone who is well-rested.

Driver fatigue is responsible for an estimated 100,000 motor vehicle accidents and 1500 deaths each year, according to the National Highway Traffic Safety Administration. Since drowsiness is the brain&rsquos last step before falling asleep, driving while drowsy can &mdash and often does &mdash lead to disaster. Caffeine and other stimulants cannot overcome the effects of severe sleep deprivation. The National Sleep Foundation says that if you have trouble keeping your eyes focused, if you can&rsquot stop yawning, or if you can&rsquot remember driving the last few miles, you are probably too drowsy to drive safely.


Why sleep is essential for health

Getting enough sleep is essential for helping a person maintain optimal health and well-being. When it comes to their health, sleep is as vital as regular exercise and eating a balanced diet.

Modern-day living in the United States and many other countries does not always embrace the necessity for adequate sleep. Yet, it is important that people make an effort to get enough sleep regularly.

The following are some of the many benefits health professionals associate with getting a good night’s rest.


Research has linked getting enough sleep to better concentration, productivity, and cognition.

There were several studies that scientists did in the early 2000s that looked at the effects of sleep deprivation.

What the researchers concluded is that sleep has links to several brain functions, including:

A more recent 2015 study in the Journal of Child Psychology and Psychiatry showed that children’s sleep patterns can have a direct impact on their behavior and academic performance.

The link between weight gain and obesity and short sleep patterns is not completely clear.

There have been several studies throughout the years that have linked obesity and poor sleep patterns.

However, a more recent study in the journal Sleep Medicine concludes that there is no link between being overweight and sleep deprivation.

This research argues that many previous studies fail to account adequately for other factors, such as:

  • drinking alcohol
  • living with type 2 diabetes
  • level of physical activity
  • education levels
  • long working hours
  • long sedentary time

A lack of sleep may affect a person’s desire or ability to maintain a healthful lifestyle, but it may or may not be a direct contributor to weight gain.

Similarly to gaining weight, there is evidence to suggest that getting a good night’s sleep can help a person consume fewer calories during the day.

For example, one study in the Proceedings of the National Academy of Sciences of the United States of America says that sleep patterns affect the hormones responsible for appetite.

When a person does not sleep long enough, it can interfere with their body’s ability to regulate food intake correctly.


Getting a sufficient amount of sleep can boost a person’s athletic performance.

According to the National Sleep Foundation, adequate sleep for adults is between 7 and 9 hours a night, and athletes may benefit from as many as 10 hours. Accordingly, sleep is as important to athletes as consuming enough calories and nutrients.

One of the reasons for this requirement is that the body heals during sleep. Other benefits include:

  • better performance intensity
  • more energy
  • better coordination
  • faster speed
  • better mental functioning

One risk factor for heart disease is high blood pressure. According to the Centers for Disease Control and Prevention (CDC) , getting adequate rest each night allows the body’s blood pressure to regulate itself.

Doing so can reduce the chances of sleep-related conditions such as apnea and promote better overall heart health.

Sleep has links to people’s emotional and social intelligence. Someone who does not get adequate sleep is more likely to have issues with recognizing other people’s emotions and expressions.

For example, one study in the Journal of Sleep Research looked at people’s responses to emotional stimuli. The researchers concluded, similarly to many earlier studies, that a person’s emotional empathy is less when they do not get adequate sleep.

The association between sleep and mental health has been the subject of research for a long time. One conclusion is that there is a link between lack of sleep and depression.

A study appearing in JAMA Psychiatry examines patterns of death by suicide over 10 years. It concludes that lack of sleep is a contributing factor to many of these deaths.

Another study in the Australian and New Zealand Journal of Psychiatry suggests that people with sleep disorders such as insomnia are likely to show signs of depression.

There is a link between getting adequate sleep and reducing inflammation in the body.

For example, a study in the World Journal of Gastroenterology suggests a link between sleep deprivation and inflammatory bowel diseases that affect people’s gastrointestinal tract.

The study showed that sleep deprivation can contribute to these diseases — and that these diseases, in turn, can contribute to sleep deprivation.

Sleep helps the body repair, regenerate, and recover. The immune system is no exception to this relationship. Some research shows how better sleep quality can help the body fight off infection.

However, scientists still need to do further research into the exact mechanisms of sleep in regards to its impact on the body’s immune system.


Spending more time outside can improve sleep quality.

Sleep needs vary from person to person, depending on their age. As a person ages, they typically require less sleep to function properly.

According to the CDC , the breakdown is as follows:

  • Newborns (0–3 months): 14–17 hours
  • Infants (4–12 months): 12–16 hours
  • Toddler (1–2 years): 11–14 hours
  • Preschool (3–5 years): 10–13 hours
  • School age (6–12 years): 9–12 hours
  • Teen (13–18 years): 8–10 hours
  • Adult (18–60 years): 7-plus hours
  • Adult (61–64 years): 7–9 hours
  • Adult (65+ years): 7–8 hours

As well as the number of hours, the quality of sleep is also important. Signs of poor sleep quality include:

  • Waking in the middle of the night.
  • Still not feeling rested after an adequate number of hours sleep.

Some things a person can do to improve sleep quality are:

  • Avoiding sleeping in when you have had enough sleep.
  • Going to bed around the same time each night.
  • Spending more time outside and being more active during the day.
  • Reducing stress through exercise, therapy, or other means.

Sleep is a vital, often neglected, component of every person’s overall health and well-being. Sleep is important because it enables the body to repair and be fit and ready for another day.

Getting adequate rest may also help prevent excess weight gain, heart disease, and increased illness duration.


The Importance of Sleep and Understanding Sleep Stages

How much sleep do we need and why is sleep important? Most doctors would tell us that the amount of sleep one needs varies from person to person. We should feel refreshed and alert upon awakening and not need a day time nap to get us through the day. Sleep needs change from birth to old age. The general thought is that newborns through the first year need up to 18 hours daily, 1-3 year olds need 12-15, ages 3-5 need 11-13 hours, 2-12 year olds need 9-11, and teens need 9-10 hours. Adult sleep needs (beginning around 17 years old through the elderly) are generally 7- 8 hours.

Sleep is something most of us take for granted, yet, it is as important to life and health as the air we breathe. When we don’t get enough sleep, we suffer in a multitude of ways. Sleep deprivation causes cognitive loss such as memory, concentration, moodiness, as well as hyperactivity in children. It also can result in health problems including obesity heart disease, hypertension and diabetes. It may also increase the risk of injury, such as motor vehicle crashes.

Sleep Stages are as follows:

During the course of an eight hour sleep period, a healthy sleeper should cycle through the various sleep stages every 90 minutes or so.

Stage N1 (NREM1) sleep is a transition period from being awake to falling asleep. During this time you may have a sudden dream onset. You are drifting off to sleep and may still feel aware of your surroundings and easily be aroused back to wakefulness.

From Stage N1, you will enter Stage N2 where your breathing and heart rate will begin to slow. During the continuous sleep cycles throughout the night, we should spend about half of our sleep time in Stage N2.

Next comes Stage N3, sometimes referred to as Delta Sleep or slow wave sleep, because of the slow delta brain waves, which have been recorded during this sleep stage. N3 sleep is a regenerative period where your body heals and repairs itself. The first episode of Stage N3 lasts from 45-90 minutes. Subsequent episodes of N3 sleep have shorter and shorter time periods as the night progresses.

N3 sleep decreases with age such that elderly people may have no measured N3 sleep at night. This occurs in healthy sleepers and does not indicate a disorder or disease state in itself.

Stage R is referred to as REM sleep or “rapid eye movement” sleep. The first REM sleep episode generally occurs after 90-110 minutes of sleep, cycling about every 90 minutes thereafter. REM sleep periods tend to be longer later in the night. Our heart and breathing rates increase and become irregular. It is during REM sleep that we dream. Many of us will remember dreams from the REM stage. The body creates chemicals that render us temporarily paralyzed so that we do not act out our dreams. . In this stage, the brain is extremely active, and our eyes, although closed, dart back and forth as if we were awake.

During the diagnostic overnight sleep study or Polysomnogram, our sleep architecture is tracked and recorded. With over 80 different sleep disorders, often our diagnoses are partially determined by how we cycle through these sleep stages. As an example, people with narcolepsy fall directly in to REM sleep. People with apnea may have reduced stages N3 and REM when their interrupted breathing causes sleep to be fragmented, possibly alternating between stages N1 and N2 over and over all night.

Understanding the sleep stages, how one should cycle through them and the necessity of achieving healthy sleep hours, is important information for us patients to understand as we strive to become more knowledgeable about our own sleep health.

The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. Contact your physician or health care provider when you have health related questions. Never disregard or delay medical advice because of information you have obtained on this site.


Help Your Child Sleep Alone

I want to hear from you! Please let me know if this is helpful. Tell me your story: [email protected]

If you want to help me and other families, consider completing this short survey before you start the Goodnight Worry program. Describe your child’s sleep problem and how it affects your family. I will not share your name, your child’s name, or your email address. TAKE THE SURVEY.

Children should be able to fall asleep on their own. By developing their capacity to soothe themselves, our children master their fears. This mastery and independence will spread to other parts of their lives, adding to their sense of confidence and strength as they face their world. The Goodnight Worry program is designed to help school-age children (5-12 years old) learn to sleep alone.

The problem.

Some children are afraid to sleep alone. Every night, a parent has to be with the child until he or she falls asleep. At a minimum, this is time-consuming. Often, the child sleeps in the parents’ bed. Or a parent has to sleep in the child’s bed. Understandably, parents eventually get frustrated with this routine—too many knees and elbows, too little privacy. Sharing a bed with a child every night can be maddening. Maybe this was okay when the child was a toddler. But by the time the child is 7 or 8 years old, parents want to reclaim their bed. Moreover, parents feel that too much dependence on them is unhealthy. They want their child to be confident, not fearful. They want their child to sleep alone, and do so comfortably.

But when parents try to get the child to sleep alone, they run into trouble. First, they try reassurance – tell her she is safe, show her that all doors are locked, buy a new special pillow, and maybe promise a reward. But the reaction they get is intense resistance. No amount of reassurance works. It may only cause the child to feel more anxious and pressured. Mom and Dad try to be firm and set limits, but the child actively refuses to stay in bed. Parents resort to threats and anger. Things escalate. The child cries, pleads, yells, and bangs on her parents’ bedroom door. The child is awake for hours. Parents are awake for hours. The child is not just being stubborn—she is panicked. Eventually, parents throw up their hands. The child stays in the parents’ bed. Everyone feels discouraged and exhausted.

I developed the Goodnight Worry program in 2001 because I kept encountering this problem in my practice as a clinical psychologist. Over the years, I have refined this straightforward behavioral approach to solving the problem. By applying well-validated behavioral techniques, listening carefully to parents and kids, and lots of trial and error, I have discovered the specific strategies that children need to establish a habit of independent sleep.

Here is a common scenario. A child won’t sleep in her own bed. She’s afraid. Every night in order to fall asleep she needs a parent to be with her. Her parents tell her not to worry, but she stays worried. She asks, “What if burglars come?” Her parents suggest she think about something else. She says, “I tried that and I’m still scared.”

The parents grow weary. They lie down with her on her bed until she sleeps. Later, in the middle of the night, she awakens and cries and again needs her parents to help her fall asleep. Despite their misgivings, the parents allow the child to sleep in their bed every night.

This problem is actually very common. A surprising number of children—7 years old, 9 years old, even 12 years old—cannot sleep alone in their own beds the whole night.

If this is happening in your home, perhaps you worry it is because your child has an emotional problem, some deep insecurity. Perhaps you think you shouldn’t make her do what she’s not ready to do. Maybe this reflects a deep fear that she needs to work out. Can you be cruel to the poor child? Won’t pushing her away only traumatize her? Isn’t it natural for children to sleep with their parents?

But perhaps you have come to feel that this sleep problem is disrupting family life–it takes up a lot of time, robs parents of precious time to themselves, perhaps interferes with the relationship between husband and wife, and causes conflict between parents and child. Wouldn’t the child be more confident and self-reliant if she could face her fears and overcome them? Wouldn’t everyone in the family feel better if these fears could be mastered?

The Goal.

We want our children to feel confident and secure, able to relax knowing they are safe, able to seek help when they feel bad, yet able to soothe themselves when bothered by minor worries. We want our children to know their own feelings, identify anything wrong, and talk about problems. We want a balance of independence and closeness. When it comes to sleep, we want them to feel okay about coming to parents occasionally on an anxious night, yet comfortable sleeping alone on a regular basis.

So why is this happening?

Sometimes the problem starts abruptly, like after seeing a scary movie. More often, however, the child has always been an anxious sleeper and has always needed a parent present to fall asleep ever since she was a toddler. Such children have never developed the habit of independent sleeping. They have developed a strong association between sleep onset and the presence of a parent—the two always go together. It has become a habit. When a parent is absent, the child is anxious. When anxious, the child does anything and everything to get a parent to give in and provide the comfort needed to alleviate the anxiety. That means crying, demanding, badgering, and yelling. And when those don’t work, they try wailing, begging, banging on doors, and screaming bloody murder.

As children grow their imaginations grow, including their capacity to visualize potential threats. Kids think about things that can GET them. “What if” thinking develops. (What if a burglar gets into the house? What if kidnappers try to get me?) Their expanding imagination can result in increased awareness of their vulnerability. And sleep is when they surrender watchfulness. Sleep is when they feel most vulnerable. If they feel anxious, they can’t sleep.

  • Bad guys, intruders, kidnappers, burglars.
  • Zombies, ghosts, witches.
  • Storms, lightning, fire.
  • Being the last one awake.

Why doesn’t rational discussion work? A child’s solution to this problem of vulnerability is to seek the protection of parents. When scared, all kids seek the comfort of their parents. Rational discussion doesn’t work because your modern adult brain is speaking to a sophisticated but very ancient threat-detection module in the child’s brain that has been fine-tuned for the past 200,000 years. Danger nearby? Stick close to Mom and Dad. Just ignore those scary thoughts? Not a chance. For countless generations, kids did sleep with (or very near) parents. Kids with this module survived more often than those who wandered off alone. The must-not-sleep-alone alarm serves a good purpose. It protects kids in dangerous conditions. It doesn’t matter if the alarm is wrong most of the time (i.e., it gets kids to cling to parents when there is no real danger). It only matters if the alarm is right some of the time. If it is, nature keeps it.

It comes down to this. Given a choice, a scared child will always choose the comfort of a warm parent rather than rely on his or her own resources for comfort.

Comforting oneself is a skill one learns through experience, not rationality. Here is how the child learns: If the child thinks a scary thought but waits it out and nothing bad happens, the anxiety subsides and, with practice, the child learns that waiting and relaxing are good strategies. If a child does not try waiting and relaxing, there is no opportunity to learn that self-soothing works. But it is much easier to run to Mom or Dad than wait and relax, so for the child, this is not really a difficult choice. She’ll always rely on Mom and Dad as long as Mom and Dad offer comfort. Children who need a parent present to fall asleep have learned to depend on their parents for all their bedtime comfort and have not learned to rely on themselves.

Does this reflect a deeper problem?

Does anxiety at bedtime indicate some deep-seated insecurity? Does the fear mean there is some deeper psychological problem? Sometimes bedtime fears can be part of a bigger problem with anxiety that might need professional attention, but usually, the answer is no. Every child is afraid to sleep alone sometimes. Most kids who develop chronic anxious sleep patterns do so because a habit starts and gets perpetuated. Stress at school, arguments at home, worry about failure, a frightening movie–all these can contribute to an anxious night and increased dependency on parents.

For other children, bedtime anxiety is just one part of broader challenges with anxiety or difficulty self-regulating emotional reactions. The child might have separation anxiety, a tendency to worry a lot, fears about illness, a lot of temper outbursts, or difficulty managing transitions. Or the child might have ADHD or a learning disability. But that does NOT mean that the sleep problem cannot get better until all those other problems improve. Fixing the sleep problem can give everyone the energy and confidence to work on the other problems.

Your job is to provide the right kind and the right amount of reassurance. By developing his capacity to soothe himself, your child masters his fears. This mastery and independence will generalize to other aspects of your child’s life, adding to his sense of confidence and strength in whatever he undertakes. Kids who can comfort themselves are more self-reliant, more capable, and more self-confident.

So why do parents allow their kids to sleep with them?

Some examples of what parents say:

  • I want my child to feel secure. I just can’t stand the thought of my child being alone and feeling so scared. I’m afraid that if I push my child to sleep alone when he’s not ready, it will really hurt him psychologically. After all, sleeping together is natural, isn’t it? Maybe he’s just not ready.
  • I want my child to sleep alone but I don’t know what more I can do. She has always been a poor sleeper. My child puts up such a fuss! I’ve tried being reassuring and reasonable and firm but she gets so upset and so persistent. I get impatient and that gets us nowhere. I just end up giving in. We’ve created a monster!
  • It just seems like the only way anybody can get any sleep.

In most cases, this problem develops because parents do not have confidence in their child’s ability to self-soothe, worry that the fear is too much for the child to handle, are not effective in calming the child, and do not effectively set limits.

How do we solve the problem? The Goodnight Worry Program.

If you follow the Goodnight Worry Program, your child will learn to sleep alone, relying partly on comfort from you and partly on self-soothing.

The core of the program is getting your child to fall asleep without a parent present. You can be nearby, but your child must be alone when making the crucial transition into sleep. You will no longer be the signal that tells the child that now it is safe to sleep, so your child will stop needing you there to make that transition. Once your child gets started falling asleep without you, it will become a habit through simple repetition.

Here are the steps you will follow:

  • Develop a healthy bedtime routine.
  • Talk with your child about sleep, anxiety, habits, and how people change behavior.
  • Hold a family meeting to discuss the problem and how you’ll solve it together.
  • Start the Goodnight Worry program and follow the rules.
  • Enjoy your success.
What is a good bedtime routine?

The bedtime ritual can be comforting for everyone. The routine should be a relaxing ending to a full day, lasting about 20 to 30 minutes. Regularity is reassuring to children, so try to make a ritual of the same sequence of activities. Be sure to allow enough time so no one has to feel rushed and tense. Notice what your child does to soothe herself. Does she have a favorite place for a favorite stuffed animal? A special method of plumping her pillow? A favorite way of saying goodnight? Foster these rituals and enjoy them with her. Notice your tone of voice. Are you speaking in warm, soothing tones to create a relaxed, positive mood?

You want your child to feel that her bed is the coziest place in the world. Help your child develop positive associations to bed and sleep. Spend time with your child in their bedroom in enjoyable activities. Talk about how nice the bed is, how warm and perfect the blankets are, how everything in your child’s room has just the right place, how happy her stuffed animals are. You are creating and reinforcing positive associations to bedtime so she can feel cozy and secure.

1. Choose a bedtime and stick to it.

2. For one hour before bed, avoid TV, video games, and any stressful discussions.

3. Go through the preparing-for-bed steps. The routine should take 20-45 minutes, including 2-3 relaxing activities that naturally flow from to another. These steps might include:

    • Take a warm bath
    • Put on pajamas
    • Brush teeth
    • Lay out clothes for tomorrow
    • Get backpack ready for school
    • Read a story together

    4. Make sure all needs are anticipated so your child won’t need to get up again. Be sure your child has a glass of water by the bedside, has gone to the bathroom, has a favorite stuffed animal.

    5. Have some time for closeness with your child:

      • Talk about something pleasant that occurred today
      • Talk about the plans for tomorrow, especially positive things

      6. Hugs, kisses, and good night.

      Follow these same steps every night. Activities before bed should be relaxing, not stimulating. Avoid TV right before bed stopping is frustrating for some kids. Avoid arguments, angry conflicts, criticism, complaints, and discussion of problems. Bedtime is for relaxing!

      The Goodnight Worry Rules: The Standard Plan

      Here are the basic rules. The purpose of these rules is to communicate clearly to your child what you expect, what is allowed, and what is not okay. Remember, kids like rules. Rules create predictability, a sense of control and security. Follow these rules for a good night’s sleep. Stick to them and your child will see that she can rely partly on you and partly on herself for reassurance and comfort. The key is that she makes the transition into sleep without you present, which will then become the new habit.

      • Stay put. After bedtime, your child must stay in her own bed the whole night. She is not to leave her bed.
      • Enter the zone alone. You may be with your child until she is drowsy, but she must be alone when she falls asleep. You may sit on your child’s bed, but you may not lie down with her.
      • Lights out, no crying out. Your child must not call out, whine, demand, cajole, or bargain after saying good night or between “check-ins.” You will offer comfort and reassurance, but only when your child is in her bed, and only when you choose, not when she demands.
      • Back in 10. You return to your child’s bedroom every 10 minutes to check-in, soothe and speak reassuringly for up to two minutes, but no more. You tell her you’ll return in another 10 minutes to check on her, and you do so, again offering up to two minutes of soothing every 10 minutes as many times as necessary until she falls asleep. You return by the clock, not by crying or calling out.

      So, in summary, here is how it works: You go through your getting-ready-for-bed routine, which is relaxing and comfortable. Your child is in his or her bed. You kiss your child, say good night, turn out the light, and leave the room. In 10 minutes, you return to check on your child, who is probably awake and a bit anxious. You provide some brief reassurance, chatting in a relaxed way. You leave the bedroom, ignoring any protests. You return again in 10 minutes, again providing reassurance and re-directing your child’s attention for a minute or two. You keep repeating this check-in process every 10 minutes until you see that your child has fallen asleep.

      Here are a few key points:

      • It is essential that you are not in the room when your child falls asleep. Your child must learn to make that transition alone.
      • You avoid engaging the child in discussion of the rules, the fears, the unfairness of your treatment of the child, or anything else controversial. This is not a time for problem-solving or debate. This is a time for sleep.
      • You did not let yourself get angry. You do not raise your voice.
      • If your child persists in protesting or tries to break a rule, you calmly but firmly re-state what the rule is and say that you expect your child to abide by the rules.

      Gradually, over the course of a few nights, your child learns that she can fall asleep alone. She also learns that if she awakens in the middle of the night, she does not have to go to your room and get in your bed – she can fall back asleep on her own. Pretty soon, this becomes an established pattern, a habit, something that happens easily and automatically, without any effort or stress.

      Should I reward my child for sleeping alone?

      Rewards for compliance will help motivate your child, get your child’s attention, and reinforce effort. However, the real rewards are security, independence, and a sense of competence. But you should consider rewards to recognize effort and encourage the child. Certainly, you should reward your child with praise. “I am so proud of you. I see you are really trying. It makes me feel so good to see you so confident!” Other rewards can include food, little prizes, and activities with parents. Best to think of the reward as a fun way to celebrate your child’s accomplishment. It is definitely not payment. Rewards that are too big will feel like bribes. Best to keep rewards small. Here are some ideas:

      • Stickers or stars on the calendar for each successful night of obeying the Goodnight Worry rules (appropriate requests for “check-in” are okay).
      • After 7 successful nights, celebrate success in some way–go out for ice cream, a pizza, or have a “games night” with Mom and Dad.
      What about punishments?

      Forget about it. Punishments don’t work very well for this problem. One reason is that when kids are in the grip of fear, they are willing to pay almost any price to get relief. Go ahead, spank me. Take away my iPad. Don’t make threats. But you definitely should show disapproval if your child breaks the rules. Aim to be brief and pointed: “I am definitely not happy about this.”

      Variations on the Standard Plan For Very Anxious Children

      The Standard Plan sometimes needs to be modified. Some kids are just too anxious to tolerate separation from their parents for even 10 minutes. These variations are appropriate for kids who immediately get very agitated when you signal that you are about to leave them alone.

      The Gradual Plan. This alternative is for kids who are very anxious or resistant to trying to sleep alone. The Gradual Plan delays the requirement that the child be alone when making that crucial transition into sleep at bedtime. Sit in a chair near your child’s bed until she falls asleep. Gradually, over several nights, move farther away from her until you have eased yourself out of her room, then into the hallway, then into another room. From then on, stick to “Enter the Zone Alone.”

      The Back-in-10 Flexible Plan. Instead of insisting that your child wait 10 minutes, ask her to quietly wait 1 minute. After she has waited alone in her room for 1 minute, check on her, praise her briefly. Keep it short. It’s good to have a phrase you repeat each time. For example: “I love you, honey. It’s time for sleep.” Then repeat the check-in after 3 minutes, then 6 minutes, and then 10 minutes. If you want, you can change the intervals according to your judgment. There is nothing magic about 1-3-6-10-minute intervals. It is just that your child is learning that she can tolerate being alone and that you will always return.

      The Special Tickets Plan. This plan is best for kids who seem to get activated by the anticipation of check-ins. Instead of quietly relaxing and really trying to sleep, they stay alert and count the minutes until the next check-in. Sometimes kids stay awake for hours, frustrating everyone.

      Create three “special tickets.” Your child keeps the tickets under his pillow. After saying good night, your child may politely request a check-in at a time of his choosing in exchange for one ticket. A check-in consists of a parent entering the room, talking no more than one minute in a calm and encouraging manner. The child must wait quietly at least 10 minutes between check-ins. Once the tickets are gone, no more check-ins or talking at all. Any unused tickets can be exchanged in the morning for a special prize (keep it small). Having more control in this way can reassure kids and end anxious questioning about when and if parents will return.

      In each of these scenarios, it is important to pay attention to how much you talk to your child after you say “good night.” You want to minimize talking.

      Delay Bedtime for a Few Nights. This will help your child to fall asleep faster. Don’t let your child sleep later in the morning.

      Getting ready to start: Examine your own part of the problem.

      You’re almost ready to start the new sleep program, but first, you need to ask yourself a question. Are you part of the problem? You want the best for your child, but are your own emotional needs or marital dynamics getting in the way? Almost always the sleep problem arises, at least in part, because parents want to avoid distressing the child, so they accommodate the child’s wishes. But other factors may also contribute to the problem. Think hard about whether any of these apply to you.

      1. Ambivalence: But sleeping together is natural, isn’t it? It’s hard to be firm in setting limits if you’re still feeling mixed about this basic issue. Are you still telling yourself that if your child is demanding to sleep with you it must be because she needs it? Try to set your doubts aside and accept that what you are doing is helping your child become a strong, confident and secure individual. Remember, when you act with confidence, you are giving your child a clear message that all is safe and there is no need to worry.
      2. Parent’s need for affection. Is your need for affection being met by the child being in bed with you? You can have lots of cuddle time when your child is awake. Create moments of closeness by reading together, cooking together, drawing, or working on special projects. Don’t let your emotional needs rob your child of a sense of security and independence.
      3. Guilt feelings. Do you feel guilty for spending too little time with your child because of work or other commitments? It’s hard to juggle all your responsibilities and hard to know the best way to divide your time. But if you give in to your child’s demands to sleep with you as a way of making up for missed closeness, you are not really helping your child. Instead, carefully review your schedule and see what changes can be made. Even small changes can feel very good to your child– and to you, too.
      4. Sex avoidance. Parents need to deal directly with barriers to sexual intimacy. Find a safe way to talk to your spouse about your feelings. Don’t use your child as a shield.
      5. Parental anxiety. Parents can be anxious, too. You might be anxious about separation, being alone, or “hurting” your child by rejecting or frustrating him. If you feel anxious, figure out what it’s about and find other ways to comfort yourself.
      6. Avoidance of emotional intimacy or avoidance of conflict with your spouse. Do you feel awkward or uncomfortable being alone with your spouse? Kids shouldn’t be in the middle of parents’ conflicts and shouldn’t be used to keep peace. Figure out what you need to do to get things back on track so husband and wife can fit comfortably, just the two of you.
      Getting closer yet: It’s time for a family meeting.

      Now you are ready to introduce the new sleep program to your child. At a calm and unhurried time, hold a family meeting (or a meeting between parents and this child). In this family meeting you will:

      • Define the problem and invite ideas for solutions.
      • Set the goal.
      • Outline the rules.
      • Choose a simple reward.
      • Obtain your child’s agreement.
      • Convey your attitude that your child is able to succeed and will succeed.

      1. Define the problem. We need to find a way for you to feel safe in your own bed. Sleep is one of the best parts of the day! I know you’ve had scary thoughts and worried feelings, but I bet you’d feel a lot better if we could think of some ways to help you feel comfortable sleeping in your own bed. I know you’ll feel a lot more grown-up. Listen with understanding and patience. Help your child suggest some solutions, and agree to try at least some of them. Help your child take ownership of the problem. You want to motivate your child and help him think about how much better things will be if he can get over these fears.

      2. Set the goal. We want you to be able to sleep in your own bed the whole night. We want you to feel safe and be able to fall asleep on your own without Mom or Dad in your room. Be definite and direct. Your child can make suggestions on how best to achieve this goal, but the goal itself is not negotiable.

      3. Outline the rules.

      • Stay put.After bedtime, you must stay in your own bed the whole night. You are not to leave your bed (except to go to the bathroom).
      • Enter the zone alone.At bedtime, we’ll have time to talk and read. Then we’ll kiss good night and you can doze off on your own.
      • Lights out, no crying out.After you go to bed and we say good night, we don’t want you to cry out or yell. If you want, we’ll come back to check on you in a little while. Tell us if this is what you want.
      • Back in 10.I will check in with you in 10 minutes to see how you are doing. I’ll stay for a little bit to help you relax. I promise to keep coming back to check on you until you fall asleep. But you must wait quietly and trust that I will come back. And you must try your best to relax on your own.

      4. Choose a simple reward. Remember, it is best to think of the reward as a fun way to celebrate your child’s accomplishment. Think small and think of shared activities. After you’ve gone to sleep on your own and slept in your own bed for 7 nights, I think we should celebrate. What do you think would be fun?

      5. Obtain your child’s agreement. Kids want to keep their promises. We want you to promise that you will try your best to obey the rules and get to sleep on your own. You don’t have to perfect, but you must try. Do you agree?

      6. Convey your attitude that your child is able to succeed and will succeed. Your child has the capacity to sleep on his own and master his anxiety. You convey to your child through word and deed that you believe he is safe, that he has the capacity to calm himself, and that his anxiety will not hurt him. You believe that sleeping alone will help your child become a strong, confident and secure individual. Remember, when you act with confidence, you are giving your child a clear message that all is safe and there is no need to worry. I feel really good about this new plan, honey. I know you can do it! This is going to feel so much better.

      Key points you want to emphasize:

      • You will always come back in 10 minutes.
      • You expect your child to try to relax quietly and fall asleep alone.
      • You believe that in the difficult first night or two, your child can tolerate some distress and can manage okay. It will get easier with practice, just like any new habit.
      • After succeeding in sleeping alone on a regular basis, your child will feel really good—safe, relaxed, and proud.
      Tips on how to calm a scaredy-cat.

      Trying to calm a scared child can make parents feel pretty helpless and frustrated. Remember, your attitude, manner, and tone of voice are what is most important. Stay relaxed, patient, and confident. Here are some suggestions.

      • Have a talk about the reality of potential threats. (But you’ve probably already done this!) Talk about burglar alarms, the creaky noises that houses normally make at night, the zombies that exist only in movies. But don’t expect this talk to make a lot of difference. The real intruder is worry!
      • Sympathize. I know it’s scary, honey. I’m sorry. I wish you could feel better. Accept your child’s feelings as they are. Keep your tone warm and soothing. Give a hug and a kiss. Be brief. If you feel pulled into a lot of talk about the fear, pull out. Avoid engaging in debate, argument, or lengthy discussion. Show by your actions that you feel comfortably settled with such issues. Keep it short.
      • Reinforce positive associations to your child’s room and bed.You have got such a great room. I love your room! Look at this perfect spot for your teddy bear! Aren’t these blankets deliciously soft? You are so lucky.
      • Redirect attention to something else. Don’t tell her to think about something else–get her to think about something else. Prattle on about the details of your world–your dog’s face when he feels guilty, your plans for planting petunias, the pros and cons of buying a new set of tires next Saturday. You are redirecting her attention subtly, naturally. You don’t announce it: “I’m now going to distract you so you can quit thinking those scary thoughts and I can go to bed.” You simply shift the topic to something ordinary. If your child goes back to talking about fears, don’t get frustrated or impatient, just sympathize again. Then resume redirecting. Try getting her to help you with some small decision. If she can help you, then she can feel useful and competent. I’m trying to decide which tablecloth to use when Grandma comes to dinner. The one with red flowers is pretty, but the blue one looks good with our china. What do you think?
      • Create a positive mood by talking about things you like and things that make you feel good. Then talk about things the child likes. Be careful not to over-do it, or else the child may feel manipulated. Be gentle. If this increases her protests, stick to neutral topics.
      • Encourage acceptance of the problem. Your child might feel that he must sleep and may just get more tense and frustrated the longer sleep eludes him. When you give your child permission to remain quietly wakeful, you end the battle, thus helping him relax. It’s okay if you don’t sleep right now, honey. It’s restful to just lie quietly in your bed. You can let your mind drift and think about anything you want.
      • Use humor. Make up a story that exaggerates the feared object and transforms it into something silly and funny. That scary robber with the chainsaw you keep thinking about–what if you threw water balloons at him and he slipped and fell on his butt and he landed in thick, gooey mud and he got so mad his face turned bright red and a bull saw it and started charging at him and that silly old robber had to run and run and run all the way to Nebraska.
      • Meditation and relaxation exercises. Try watching our Three-minute Mindfulness Meditation on Youtube. It’s very calming.
      You are ready to start!

      At this point, you have taken the necessary steps to prepare for the new sleep program. You have:

      1. Gotten the bedtime routine into a healthy pattern.
      2. Examined your own feelings about the problem.
      3. Held a family meeting to discuss the problem: you’ve set the goal, established the rules, chosen a reward, and obtained your child’s agreement to try hard.
      4. Expressed a positive and confident attitude that your child will conquer his fears and will succeed.

      So choose a night to begin, and start!

      So what should we expect?

      Most kids respond very positively right away. You’ll return for a check-in to see your child is sleeping soundly. There may be some initial protest and anxiety, but if you remind kids of the rules, stick to the rules yourself, help kids take ownership of the problem, and act with a positive attitude, you will probably achieve success within a few nights. Many kids are able to fall asleep alone within 15 minutes by the second or third night.

      “Back in 10” check-ins can gradually be extended to longer than 10 minutes. For example, on the second night of the program, after saying good night you might check back in 10 minutes, and then check in a second time 15 minutes later. (You don’t need to announce to your child that you will be doing this.)

      Relapses will occur. Do not be worried or discouraged. Simply stick to the program and its rules and good sleep behavior will resume. Don’t backslide into old behavior by letting your child sleep in your room “just this once” because you will very quickly have the problem every night all over again. Similarly, be sure to avoid prolonged talks to calm your child or else you will be reinforcing his anxiety. After bedtime, keep such talks brief and you will communicate by your actions that you are confident he is safe and can manage just fine by himself.

      The toughest part is making the decision to start dealing with the problem. You have to make up your mind that now is the time to start, that you are ready and your child is ready. You will probably worry that your child will protest, cry, wail, rebel and demand that you keep doing what you’ve been doing. More often than not, parents expect much more difficulty than actually occurs. In reality, parents are usually surprised at how smoothly and easily the child adapts.

      What do I do about…? Problems, problems, problems!
      • What if my child keeps demanding check-ins every 10 minutes for hours? Do I have to stay awake all night? Parents often worry about this, but it seldom happens. After the first night or two, kids learn that the routine won’t change and settle down. But if this becomes a problem, you can switch to the Special Ticket Plan.
      • My child keeps calling out. Firmly repeat the “don’t cry out” rule, saying you know he can wait and you expect him to try. Keep it very brief. Be stern, but do not discuss, threaten, or get mad. Then ignore any further calling out. Stick to “Back in 10.” Remember, your child needs to be quiet and wait to get your attention. This way, your child begins to learn how to rely on his own self-soothing.
      • My child tries to bargain with me and demands I come back in 5 minutes or 2 minutes. Repeat the 10- minute rule. If you sound like a broken record, that’s good. Don’t negotiate. Again, communicate to your child that you are confident he can handle it. But you can also consider the Back-in-10 Flexible Plan.
      • My child wants me to stay upstairs until he falls asleep, but I want to be downstairs. Try not to bend on this one. Repeat the rules. Again, tell your child that you will check in and provide reassurance every 10 minutes if necessary, but you expect him to stay put and stay settled while you are downstairs. Again, you convey this with confidence that he will succeed. In some cases, however, you may need to start by staying near the child for the first few nights, but you have to move progressively farther away within a few nights.
      • My child gets up and comes into my bedroom, really scared, and gets in my bed. Do the no-talk walk. Take her hand and walk her back to her bed. On the way, keep talking to a minimum. Re-state the “stay put” rule in a firm but neutral voice. Offer one minute of comfort, then leave. Offer a “back in 10”. If your child wakes you in the middle of the night you will of course be sleepy, but don’t give in to the temptation to let your child climb into your bed. Wise up and get up!
      • My child now falls asleep alone at bedtime. But every night she wakes up at 12:00 or 1:00 and wants help falling asleep again. This is common. The new habit of falling asleep alone at bedtime is the hardest and most important step. It takes several nights to firmly establish the new routine. Handle these middle-of-the-night wakings the same way you would at bedtime—provide brief reassurance, tuck her in, and check in every 10 minutes until she falls asleep. Once the new sleep habit is firmly established, the night wakings will stop.
      • Sometimes we don’t even wake up when our child gets into our bed. Do what is necessary to be sure you do wake up: keep your bedroom door closed (maybe even locked) hang a bell or frying pan from your doorknob to make noise if the door is opened.
      • What if my child has a nightmare? Can she sleep in our bed? No. Stick to the rules. Offer comfort in her room when she is in her bed.
      • What if our child is ill and feverish? I want her to be close to me. She must sleep in her own bed. Check on her periodically if you like.
      • When my husband is away on business my child is scared, and I enjoy the comfort of my child in bed. Is this okay once in a while? Letting your child sleep with you “once in a while” only reinforces the problem. Sticking to bedtime routines creates feelings of security. Teach your child to be secure and confident by helping him master his fears and showing him that you feel safe yourself.
      • My husband and I are divorced. When my son spends weekends with his father and his new wife, he sleeps in their bed. Can this Goodnight Worry program still succeed at my house? Yes. Kids are used to having different rules in different situations. First, establish independent sleeping at your house, and then work with your ex-husband to establish it at his house.
      When is it time to get professional help?

      Seeing a psychologist can be a big help. You should consider it if:

      • You have tried the Goodnight Worry Program for 3-4 weeks and you are not making any progress.
      • Your child has other problems besides the sleep problem–a lot of anxiety about going to school or separating from parents, a lot of irritability and temper tantrums, learning disabilities, or a lot of family stress and conflict.

      Therapy sessions with a psychologist can result in pretty rapid improvement. Here are ways a psychologist can help:

      • The psychologist can help you see mistakes you’re making.
      • The psychologist can help your child learn to use tools for managing anxiety (relaxation skills, talking back to the fear, self-distraction, positive self-talk).
      • The psychologist can help build your child’s motivation to face the problem.
      • The psychologist can help parents set limits.

      The first session is usually just with the parents to provide background information. Then there is a meeting with the parents and child together. Then up to three visits with the child alone or with the parents. The total number of visits to resolve the sleep problem is typically 6-8, often fewer, rarely more. Additional visits might be needed to deal with other issues.

      Getting help via Zoom.

      For families who do not live in the San Francisco Bay Area, I offer consultation for sleep problems via Zoom sessions. Feel free to call or email me to discuss options.
      925-256-9696. [email protected]

      About Dr. David O’Grady

      Dr. David D. O’Grady is a clinical neuropsychologist practicing in Walnut Creek, California. He trained as a postdoctoral fellow in the Division of Behavioral Pediatrics at UCSF Medical Center. Dr. O’Grady works with children, adults and families. He has a special interest in helping kids and adults overcome problems of anxiety and worry. As a board-certified neuropsychologist, Dr. O’Grady also performs neurocognitive evaluations to understand how problems in brain functioning affect learning, memory, concentration and other thinking skills. He is an assistant clinical professor at the University of California at Berkeley.

      All rights reserved © David D. O’Grady, Ph.D., ABPP

      Dr. Susan J. O’Grady is a Certified Gottman Couples Therapist