Not long ago, as I sat in my office across from my patient and her mother, I decided I was a fraud. A sleepless fraud. Thankfully I was wise enough in that moment to keep this epiphany to myself. The patient, who I’ll refer to here as “Amber,” was a sweet seven-year-old girl who had trouble falling asleep at night. Toward the end of our first appointment, I began to rattle off all of my clinical recommendations to help her sleep better. From having a consistent bedtime and wake time to using her bed only for sleep, I pulled out everything I could from the field of behavioral sleep medicine. In the middle of reading my recommendations, my voice slowly trailed off as I stopped in silence, staring at my notes. It was that very moment when I felt like a sleepless fraud. I remember thinking, “how can I possibly inspire this sweet little girl to improve her sleep when my own sleep patterns are a complete mess?” Moreover, I thought, “how can I genuinely engage and motivate her mother to help her daughter make the changes I’m recommending when I can’t even get a handle on my own sleep?” If there is one thing you should know about psychologist’s, it’s that we hate feeling like an imposter. I knew if I was going to continue specializing in helping children get better sleep, I had to take an honest look at my own sleep.
Around this time my own habits around sleep were poor to say the least. Where do I even begin? First off, I went to bed at a different time every night and arose out of bed at a different time every morning. When I did get in bed, no matter what time it was, I would watch TV for two hours before even trying to fall sleep. After I turned off the TV, I had to have a podcast playing on my phone while I tried to fall sleep. I rarely if ever was able to fall asleep during the podcast. After whatever podcast I was listening to finished, I would lie in bed for anywhere from 1-2 hours before finally falling asleep. All told, it would be about three to four hours from when I got in bed to when I actually fell asleep.
As a specialist in pediatric behavioral sleep medicine, I often preach to the children I work with that sleep is our superpower. Around this time, however, I couldn’t help but feel like a fraud every time I espoused the importance of sleep to a child or their caregivers. I knew something had to be done. Shortly after my appointment with Ms. Amber, I went to a local coffee shop armed with an old school composition book. I opened the first page and penned “Project Sleep First.” I thought that name accurately reflected my mission which was to make sleep my own priority first, before motivating children to make it theirs. As I mentally went through all my sleep difficulties, I noticed a common thread. Both my bed and my bedroom were being used for many activities not conducive with sleep. From watching thrilling Netflix shows to listening to true crime podcasts, the mere act of being in my bed had become associated with a level of physiological arousal that is diametrically opposed to sleep. This is where Stimulus Control Therapy (SCT) came in to play. SCT is a key component of any effective psychological sleep intervention for both children and adults. The overarching goal of SCT is to slowly form a new association between your bed and sleep. I made the difficult decision that I was no longer going to watch TV or listen to podcasts in bed. Moreover, a key part of SCT involves purposefully getting out of bed if unable to fall asleep within 10-15 minutes. Sound hard yet? It gets harder. Once out of bed, one is advised to engage in a rather dull activity (preferably in the dark) until they feel tired again before returning to bed. I knew this would be the most challenging piece.
That night I removed the TV from my room and was ready to put my plan into action. As my head hit the pillow on that very first night, I knew it was going to be difficult to fall asleep. After 15 minutes of being unable to fall asleep, I got out of bed and did some stretching exercises on my bedroom floor as I waited for the sensations of tiredness to creep back in. I repeated this cycle three times that first night until I finally fell asleep. I remember feeling so tired the next day and thinking, “aren’t I supposed to be getting better sleep.” I tried to tell myself that the next night would be easier, but I was wrong. The next two nights were just as difficult. I lost track of how many times I had to get out of bed after being unable to fall asleep. On the fourth night, I was tempted to revert back to my old habits. I stared at my unplugged TV, contemplating whether I should just throw in the towel and get in bed with the TV on like the old days. I thankfully decided to stay on the trail to what I believed was better sleep. As I climbed into bed and turned off the light on my nightstand, something magical happened: I felt tired. It was almost as if my brain said, “Oh I get it now! I’m supposed to feel tired when you get into bed.” Within five minutes I was asleep. It had been years since I was able to fall asleep that quickly.
My sleep is still far from perfect. There are still those occasionally nights when struggle to fall asleep. I also can’t say that SCT was the lone factor that helped me get better sleep. The truth is there are many components to a sleep improvement plan. However, teaching my brain to associate my bed with sleep was a critical piece to making sleep my superpower. Finally, I’d be lying if I said I’ve never felt like a fraud again, but at least now I feel like a fraud who’s had a goodnight sleep.