Do you often wonder what's going on with your teenager's sleep? Does the following scenario sound familiar?

Every morning, your child struggles to get out of bed. Somehow, she manages to leave the house barely on time, or maybe she skips the first period. She begins to feel more alert towards noon, and is able to participate in all of her afternoon and evening activities: team practices, theater rehearsals, seeing friends, etc. Several days a week she comes home from these activities after the family’s dinner time. Long day, right? But somehow, when bedtime arrives, she is wide awake, chatting with friends on her phone, scrolling through social media, doing homework, and is basically as far from sleep as it gets. You tell her to turn everything off and go to sleep, so she could wake up on time the next morning. But she’s just not feeling sleepy yet, and has better things to do, anyway.

The American Academy of sleep Medicine recommends that teenagers 13-18 years of age get 8-10 hours of sleep regularly, to promote optimal health. The health outcomes associated with getting enough sleep include improved memory, attention, learning, and in general, better mental and physical health. Despite these recommendation (and the actual need for sleep), many adolescents don’t get enough sleep, especially on school nights. Why? 

A combination of factors is to blame:

1. A physiological development that occurs at this age allows teenagers to delay bedtime more easily. That doesn’t mean they need less sleep; it is just easier for them to stay awake longer.
2. During adolescence, timing of alertness and sleepiness shift to a later time of day. That means that a typical adolescent becomes fully alert a little later in the morning than a primary school student. Similarly, a typical adolescent doesn’t feel sleepy until later at night.
3. Compared with younger children, adolescents are more likely to use electronic devices later in the evening. They also have more responsibilities and interests. All of these become possible due to the reduced sleep propensity in the late evening and also due to an increase in autonomy.
4. Early school start time: since adolescents go to bed late at night (due to the reasons mentioned above) but are still required to wake up early for school, they often end up getting insufficient hours of sleep during school nights.
   

​Insufficient and ill-timed sleep in adolescence can have serious consequences, including depression and anxiety, weight gain, behavioral problems, and car accidents.
 
What can be done about this? While parents can’t control physiological maturation processes or social norms, some steps may still be taken. The following tips are meant for adolescents, their parents, and anyone who would like to adopt an earlier bedtime:

• Reduce light exposure in the evening. Artificial light in the evening can trick our brain to believe it’s earlier than it truly is.
• Similarly, stay away from phones and computers close to bedtime. Electronic devices emit light that seems to our eyes and brains as sun light. 
• Increase light exposure in the morning. Timing is everything! Natural sunlight at the right time can make it easier to start the day.
• Don’t use social media in the evening. In general, it’s better to avoid emotionally triggering content prior to bedtime, and instead focus on calm and relaxing activities.
• Advocate for later school time in your district 

Not all teenagers are affected by these factors in the same way. For some, the natural delay of bedtime may be minimal and easy to cope with. For others, it may be so significant that it leads to serious academic and emotional problems. If your teen is experiencing emotional distress, seek professional help. 

References:
 
Blake MJ, Sheeber LB, Youssef GJ, Raniti MB, Allen NB. Systematic Review and Meta-analysis of Adolescent Cognitive-Behavioral Sleep Interventions. Clin Child Fam Psychol Rev. 2017 Sep;20(3):227-249. doi: 10.1007/s10567-017-0234-5. 
  
Crowley SJ, Wolfson AR, Tarokh L, Carskadon MA. An update on adolescent sleep: New evidence informing the perfect storm model. J Adolesc. 2018 Aug;67:55-65. doi: 10.1016/j.adolescence.2018.06.001. 

Parents know that tired children can be difficult to deal with. When tired, children tend to get fussy, cranky, whiny, more likely to have a tantrum, and less likely to cooperate with their caretakers. This is understandable: it is hard for kids (and adults) to pay attention and do what is expected of them when they are tired or sleepy. And while this is true for most children, it might be especially true for those with ADHD.
 
An article published in the November 2017 issue of the Behavioral Sleep Medicine journal describes some of the ways in which poor sleep impacts children with and without ADHD.
 
The study, which was done in the United Kingdom with 32 children aged 5-11, found the following:

1. Children diagnosed with ADHD take longer to fall asleep compared to children without ADHD. They also tend to have more sleep problems, such as nightmares, sleepwalking, or bedwetting.
2. When children without ADHD sleep poorly, they are more likely to display daytime ADHD-like behaviors, such as hyperactivity or impulsivity (but not inattention).
3. Sleep problem among children with ADHD are predictive of greater inattention.

 
According to the study’s authors, these findings may suggest that some children diagnosed with ADHD may in fact suffer from sleep problems, and once their sleep issues are addressed and resolved, the inattention and hyperactivity would also resolve.
 
In summary, this and other studies have shown that non-ADHD kids who sleep poorly are more likely to have challenging behaviors (in a way that resembles ADHD symptoms). There is also evidence that for children with ADHD, insufficient sleep worsens some of their symptoms.
 
So what does it all mean for your child? If your child is diagnosed with ADHD, or has ADHD-like behaviors and symptoms, improving his or her sleep should be considered. Addressing sleep issues is a worthwhile intervention, with potential positive impact on your child’s behavior and attentional skills. This, in turn, could improve your child’s quality of life at home and at school and also lead to better school performance.

Reference:
Frances Le Cornu Knight & Dagmara Dimitriou (2017) Poor Sleep Has Negative Implications for Children With and Without ADHD, but in Different Ways, Behavioral Sleep Medicine, DOI: 10.1080/15402002.2017.1395335

​Most pregnant women report feeling fatigued at some point during pregnancy, especially in the first trimester and again in the final weeks leading to labor. This is understandable: your body works really hard to create a nourishing environment for your little one, while expending additional energy on the development and growth of your child’s organs. Other factors, such as dramatic hormonal changes, the rise in blood volume, and a drop in blood pressure are also contributing to fatigue. You probably feel even more tired if there is already a child in the home and you have other responsibilities, such as a physically demanding job.
 
With that in mind, it may seem ironic that sleep difficulties are a normal part of pregnancy. Many expectant mothers feel that just when they need sleep the most, it is not available to them, or is not as good as they are used to. In this article I will provide a brief overview of the common issues that impact sleep during pregnancy. In part II, I will offer suggestions to help improve your sleep, so you could get to your due date feeling a little more rested.
 
Factors that impact sleep during pregnancy
 
First, hormonal changes lead to changes in your typical sleep pattern, changes that impact your feeling in the morning and functioning during the day.
 
Second, mood swings, which are very common in pregnancy, can also cause difficulty sleeping while directly impacting your energy levels during the day. Anxiety is also common: some women feel anxious about being pregnant, the healthy development of their fetus, weight gain, and labor. This anxiety can easily keep you up at night. Further, ongoing stress and anxiety can be draining and directly contribute to daytime fatigue.
 
On a more positive note, many expectant mothers experience anticipation and excitement – but these positive feelings may also interfere with sleep. For example, you may think about baby names, plan the baby shower, or shop online for cute newborn outfits. Add to the mix the wealth of information available online on pregnancy and labor, including helpful and supportive message boards and Facebook groups, and you get a recipe for disaster: you can easily get sucked into this wealth of information, keeping you up much later than planned. 
 
In addition to hormonal and psychological influences, there are a number of physiological factors that can impact your sleep during pregnancy, some more common than others. If you are especially lucky, you will not experience any of them. More likely, though, you will experience at least one or two, if not more.
 
In the first trimester, it is common to wake up at night due to the frequent need to urinate, and for some due to nausea. The former will become an issue in the third trimester as well.
 
While the second trimester is considered “the best” for sleep (and better than the other two in terms of overall feeling), it is also a time when women begin to struggle finding a comfortable sleeping position, resulting in more restless sleep. Some experience leg cramps that wake them up at night as well as heartburn.

​The third trimester brings its own challenges, often related to the size of your growing uterus. Feeling shortness of breath is not uncommon. Another very common breathing-related concern, that may in fact occur at any point during pregnancy and negatively impact your sleep, is nasal congestion (also known as pregnancy rhinitis), which can be especially inconvenient at night. Other breathing-related phenomena that must not be ignored are snoring and sleep apnea, which is a condition characterized by pauses in breathing during sleep that can occur multiple times a night. If you or your bed-partner suspect you might have sleep apnea, consult with your healthcare provider. Other experiences likely to interfere with your ability to sleep well include your baby’s movements (which are typically welcomed, just not in the middle of the night when you are trying to get some rest), back and other aches, and restless leg syndrome, another condition you should bring up with your doctor. Restless leg syndrome, or RLS, is a sleep disorder that causes an urge to move your legs, usually in an attempt to relieve some discomfort, an itch, or a burning or tingling sensation.
 
To summarize, there are many factors that can impact your sleep during pregnancy, making sleep troubles during those nine months extremely common. Yet, there are some steps you can take to improve your chances of getting a good night sleep. To read more, click here.
 
Additional reading:
Pregnancy rhinitis
Sleep apnea
Restless leg syndrome

In Sleep During Pregnancy - Part I: Why Is It So Hard To Get A Good Night Sleep?! I reviewed some of the factors that get in the way of sleeping well during pregnancy. Part II focuses on simple strategies you can adopt to increase your chances of sleeping better. Please note you may need to consult with your health care provider prior to adopting some of these suggestions.

1. Limit your caffeine consumption. Keep in mind that caffeine is found in chocolate, tea, and sodas, not just in coffee. If your doctor says you can have caffeine, have as little as possible, and only in the morning.
2. Stick to a regular sleep schedule (go to bed at about the same time every night) and make sure you devote enough time for unwinding and relaxation before bedtime. For example, you can do some yoga poses, talk to a friend or your partner, or read a book as part of your pre-bedtime routine.
3. Make sure your sleeping environment is comfortable, quiet, and dark.
4. Don’t worry in bed. If you tend to worry, think, or plan at nighttime, try the following strategy: plan to devote 30 minutes each day to the thoughts that bother you the most. Use a journal or notebook to list your concerns or plans, and make sure to do so well before bedtime. If additional concerns come up during the night, acknowledge them and remind yourself that there will be time to consider them the next day. Then, as soon as you can, address your concerns with your partner, a trusted friend, or a healthcare provider. For example, if you are concerned about labor pains and how you will cope with them, be sure to sign up for a childbirth prep class. In case you find your anxiety debilitating, consider consulting with a mental health professional.
5. For nighttime nausea, remain hydrated; keep a light snack (such as biscuits or crackers) by your bed in case you wake up feeling nauseous; try one of several natural remedies, such as ginger tea before bedtime or ginger gummies in the morning.
6. If you experience heartburn, avoid laying down thirty minutes after meals. Also, avoid big, heavy meals, and have your last meal of the day at least 2-3 hours before bedtime.
7. Exercise on a regular basis, as long as you’re feeling well enough and your doctor approves. Prenatal yoga and walking are mild and beneficial activities, but pick whatever exercise you enjoy and likely to continue doing. It is advised not to exercise too close to bedtime, though.  
8. Experiment with different sleeping positions, including those you don’t typically go for. Add a pillow or two to see if that helps, too. Propping up your head can help alleviate symptoms of heartburn as well as nasal congestion. If you lie on your side, placing a pillow between your knees can be comfortable, and if you are a back sleeper, a pillow underneath your knees or feet can relieve some pressure from your lower back.
9. To address pregnancy rhinitis (nasal congestion), try saline sprays or gels; use a humidifier in the bedroom to keep your nose from drying out; drink lots of water during the day; and, if necessary, ask your doctor about using antihistamines or decongestants.
10. Discuss all of your health concerns with your obstetrician or midwife, as some conditions require medical attention. For example, sleep apnea should be diagnosed and treated to maintain the health and well-being of the mother and developing baby. Restless leg syndrome may indicate some mineral-deficiency, which can be detected by a simple blood test. Similarly, leg cramps can be caused by shortage of certain minerals (among other reasons) that can be tested for.

 
What if you have tried all of these suggestions, and still can’t sleep as well as you’d like? Don’t worry! Remember that having sleep problems during pregnancy is normal, albeit annoying. Also, keep in mind that the issues described above tend to resolve on their own (in most cases) shortly after delivering the baby. Then, your baby will keep you up at night, but you will already be used to it!


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Sleep is such a fundamental part of life – we spend about a third of our life sleeping. But why do we sleep, and is sleep necessary?
 
Try this – ask a friend why she goes to sleep every night, and she might say “because I’m tired” or “it’s bedtime.” Now try asking her what is the purpose of sleep, and your friend will most likely not have an answer. However, if you ask your friend (or yourself) how she feels when she can’t get a good night’s sleep, she’d likely say she feels lousy in the morning. Indeed, sleep loss (due to occasional stress, jet lag, or a fun night out with friends) often results in difficulty concentrating, slower reaction time, frustration and irritability, and difficulty doing one’s job properly. 
 
While science has not fully answered the question “why do we sleep exactly?” we do know sleep is essential to our physical and mental health and well-being. It is believed that sleep plays important roles in maintaining the body and mind (for example, the repairmen of damaged bodily tissues). Sleep conserves energy, improves immunity, and regulates body temperature. In addition, sleep deprivation studies have shown that different sleep stages (or “types” of sleep) serve different functions and purposes. For example, some sleep stages are involved with the restoration of physical energy and help us feel refreshed in the morning, while other stages are involved with storing and retaining new memories.
 
 People often wonder if they are getting enough sleep. The amount of sleep a person needs varies widely by age and from one person to the next. Some people do fine with just 4-5 hours of sleep a night, while others need 10 hours to feel and function their best. In general, though, the average adult needs 7-9 hours of sleep per night.
 
If you feel refreshed and alert in the morning, you’re probably getting enough sleep. If, however, you experience any of the following, your sleep may be insufficient in quality and/or quantity*:

• Not feeling refreshed in the morning
• Feeling like you didn’t get any/enough sleep
• Dozing off when you need to stay awake, such as during a work meeting or while driving.
• Falling asleep when you want to stay up, such as when watching TV

 
To summarize, even if we don’t fully understand the processes involved with sleep, we do know that good, sufficient sleep is necessary for one’s physical and mental health, for optimal cognitive functioning, for learning, as well as many other essential functions.
 
*This list is non-comprehensive and is not intended for diagnostic purposes; if you suspect having a sleep disorder, you should consult a health-care provider.

Cognitive-behavioral therapy for insomnia, or CBT-I, is a brief, effective, and proven treatment of insomnia. It focuses solely on  sleep difficulties and the steps to take now to solve them.
 
CBT-I offers a long-lasting alternative to sleep medications. Sleep meds seem like a great solution in the short-term – you take a pill and fall asleep. However, not everybody can or wants to use sleep meds due to their side effects, possibility of becoming dependent, and other reasons. The effects of CBT-I are long-lasting because the factors that maintain the insomnia are addressed, not just the symptoms. Recently (July 1, 2016), the American College of Physicians (ACP) has recommended cognitive-behavioral therapy for insomnia (CBT-I) as first-line therapy for chronic insomnia.
 
Like most therapies, CBT-I begins with a thorough evaluation. Your therapist would want to confirm the diagnosis before starting treatment. The assessment will not only cover the current nature of your sleep and sleep difficulties, but will also include other areas of your life, including psychological, biological, social, and occupational aspects. You may be asked about your job and work hours, stressors you might be facing, past or current emotional difficulties, who you live with, your medical history, etc.
 
After completing the evaluation, your therapist will create a treatment plan tailored specifically to you, based on your unique sleep difficulties, lifestyle, and work schedule. The treatment plan typically consists of several of the following components:
 
Matching your time in bed with the time you actually sleep.
Most individuals with insomnia spend a lot of time in bed, but sleep for only a portion of that time. With your unique sleep needs and sleep behaviors in mind, your therapist may instruct you to spend less time in bed. The goal is not to sleep fewer hours, but to decrease the time you are in bed yet fully awake.
 
Making sure you use your bed for its intended purpose, and only that purpose.
A lot of people with insomnia use their bed in creative ways. In addition to sleeping (when they can), they eat, read, watch TV, read work emails, play on their phones, and sometimes just hang out in their beds. This makes the bed associated with activities other than sleep. The goal of treatment is to eliminate associations that are not conducive to sleep while strengthening the association between one’s bed and sleep. Taking into consideration any health concerns and other variables, your therapist will instruct you to only use the bed for sleep (and sex, too).
 
Improving your sleep hygiene.
Sleep hygiene refers to various habits and practices that are needed to have a good night sleep. Your therapist will review your daytime and nighttime behaviors that are related to the wake-sleep cycle and make sure you maximize your chances of a good night sleep. Common guidelines include not consuming caffeine after a certain time, increasing daytime physical activity (but not right before bedtime), timing meals so they don’t interfere with your sleep, and making sure your bed and bedroom are as comfortable and sleep-conducive as possible.
 
It is important to keep in mind that CBT-I is a multi-component treatment. In addition to the components described above, other interventions are often utilized, including cognitive therapy. It is proven to work in the majority of chronic insomnia patients who adhere to the treatment plan.
 
Those who begin CBT-I should also know that it usually involves a commitment to 4-8 sessions (weekly or biweekly). And, while improvements can be seen fairly quickly (compared to having lived with insomnia for years), many patients find the   initial 1-2 weeks of treatment challenging. The reason is that patients are instructed to avoid some compensatory habits they have adopted to cope with their insomnia, but have actually helped maintain their insomnia. For example, you may be asked to drink less coffee during the day, which – initially - could make you feel more sleepy at work (but also more sleepy at bedtime). Or, you may be instructed to postpone your bedtime, which might be extremely difficult if you have been up since early morning. Keep in mind that these strategies can feel very hard to implement in the short-term but lead to results in the long-term, if followed on a daily basis.
 
 
Sources
Cognitive Behavioral Treatment of Insomnia: A Session-by-Session Guide. Michael L. Perlis, Carla Jungquist, Michael T. Smith, Donn Posner, Springer (April 1, 2008).
http://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2016.6b19

The following information might help you by shedding light on the process of psychotherapy and answering some of your questions.
 
There are many ways to do therapy. Clinicians are trained in various disciplines (such as psychology and social work) and adhere to one or more of several theoretical orientations (psychodynamic therapy and cognitive-behavioral therapy are the best-known ones). Despite differences in educational and professional backgrounds, it has been consistently found that the most important factor in the effectiveness of therapy is the therapeutic relationship.
 
The therapeutic relationship is the unique relationship that is being formed over time between clinician and client, therapist and patient. It is this relationship that allows the client to better understand her thoughts, feelings, unconscious motivations, conflicts, behavioral patterns, and relationships with others. Therefore, when considering starting therapy, finding the right therapist for you is key to the success of your therapy.
 
What to expect once you start therapy? There are multiple ways to answer this question, as different therapists conduct therapy in different ways. Here is my approach:
 
Your initial session with me will focus on an initial evaluation. This means I will be gathering information on your current concerns and the current reasons you are interested in therapy. I will also ask some questions about your background and other details from your history that may be relevant to your current challenges. The initial evaluation is typically completed in the first session, though at times it may take longer. The first meeting with me is also your opportunity to get a sense of my style of working and whether we are a good fit.
 
Another purpose of the first meeting is to establish your goals for treatment and for us to discuss how we can work together toward helping you achieve them. Once we have done this, we can begin to work on your goals in our regular sessions.