Case Example #1

“My child simply refuses to stay in bed and it takes anywhere from 30 minutes to four hours for them to fall asleep!”

Most parents that we see, feel deeply frustrated and distressed about the behaviors of their children before the finally fall asleep.  Marital distress and family discord are common features of long-standing sleep difficulties in children.

Our behavioral sleep provider has been specifically trained at a doctoral-level to address nearly all the behaviors associated with poor sleep in children.  These can include: difficulties falling asleep and staying asleep, bedtime resistance, frequent nighttime visits to parent’s bedroom, co-sleeping, nighttime anxieties, bed-wetting, sleep terrors, etc.

All pediatric patients are assessed to determine if there are any clinical indications of physiological sleep disorders during their initial consultation.  If there is any question that a physiological sleep disorder might be present, we will collaborate with your pediatrician to address any concerns.  If there are no obvious indications of a physiologically-based sleep problem, we will initiate behaviorally-based treatments to address the difficulties your child is experiencing at night.  The treatments we use are non-pharmacological, safe and effective.  Most pediatric patients are seen between 2 – 4 times with excellent outcomes seen in the majority of patients.

[Reference for content and link to related research article]:

•Meltzer, LJ, Mindell, JA. Systematic Review and Meta-Analysis of Behavioral Interventions for Pediatric Insomnia. Journal of Pediatric Psychology. (2014) 39 (8):932-948. Link

Night - Nighttime - Fear

Case Example #2

“My child has started to feel “stigmatized” by still wetting the bed every night, should we do something?”

The medical term for “bed-wetting” is nocturnal enuresis.  Nocturnal enuresis is involuntary urination that happens at night while sleeping, after the age when a person would ordinarily be expected to be able to control his or her bladder.  Currently, an estimated 7 to 8 million children in the United States have primary nocturnal enuresis (nighttime bed-wetting).In the absence of any daytime urological problems, nocturnal enuresis is an easily treatable disorder.  Treatment focuses on a very basic and simple behavioral conditioning technique with decades of strong research support as being the most effective method of elimination of the phenomenon.  Pharmacologic therapy includes Imipramine, anti-cholinergic medications and Desmopressin, but these drugs have varying degrees of success.

There are several misconceptions about primary nocturnal enuresis that tend to delay clinical attention and effective treatment.  These might include: that a child’s bed-wetting is caused by drinking too much fluid before bedtime; that the child is too lazy to get out of bed to urinate, of that the problem “will just go away.”

The American Psychiatric Association has defined ‘bed-wetters’ as children older than age five who are incontinent of urine at night.  It is now generally accepted that 15 to 20 percent of children will have some degree of nighttime wetting at five years of age, with a spontaneous resolution rate of approximately 15 percent per year.  Therefore, at 15 years of age only 1 to 2 percent of teenagers will still wet the bed.  The most recent research consensus is that nocturnal enuresis occurs at about equal rates for males and females.  Global Insomnia Solutions understands that each patient and family is its own individual culture of one that requires an individualized assessment and treatment plan.  The behavioral interventions used to treat nocturnal enuresis are very effective and appropriate for even children as young as five years old. [Please consult with your pediatrician before making an appointment for your child.]

PLEASE NOTE: Approximately 20 percent of nocturnal enuresis cases are accompanied by some daytime wetting. This group falls into a different category and warrants a different evaluation and treatment regimen: please consult with your pediatrician or family health care practitioner.

[Reference for content and link to related research article]:

• Mellon, MW, McGrath, ML. Empirically Supported Treatments in Pediatric Psychology: Nocturnal Enuresis. Journal of Pediatric Psycholology. (2000) 25 (4):193-214. Link

CBT-I- cbt-i- bedtime- cpap- syndrome

Case Example #3

“It’s impossible to wake up in the morning and I also have trouble falling asleep at night”

This is a very common presenting complaint that we receive from patients most typically starting after grade school but continuing to be common even through late adulthood.  Delayed Sleep Phase Syndrome (DSPS) is one of many circadian rhythm sleeping disorders, and is the most common form of all the “internal-clock” sleep disorder phenomena.  People with delayed sleep phase are very likely to be experiencing a natural (genetic) inclination to go to bed later and wake up later than what is typically considered “normal.”  Socially active people, those with evening-ness preference (aka “night owls”), and those who feel more awake or have improved mental clarity and attention during the evenings are at increased risk of manifesting an actual disorder of sleep that requires clinical treatment.

DSPS can lead to many nights of insufficient sleep for sufferers and a feeling of having chronically non-restorative sleep.  There is robust support in the sleep research literature that there is a strong genetic component to this natural tendency or inclination.  When Delayed sleep phase syndrome interferes with one’s ability to fulfill occupational, academic or social obligations, then it is called Delayed Sleep Phase Disorder (DSPD).  People with a delayed sleep phase are at increased risk of having their sleeping problems interfere with their necessary daily schedule. The associated chronic variability in sleep amount and frequent nights of sleep deprivation can negatively affect school or work performance and even social standing.

Patients with Delayed Sleep Phase Syndrome (DSPS) and the more-serious Delayed Sleep Phase Disorder (DSPD) are rarely aware that what they are experiencing can be ameliorated with effective and brief treatment.  A primary reason that sufferers do not seek treatment are often due to social factors where they may be labelled (or think so themselves!) as lazy, unmotivated or undisciplined.  However, when the circadian rhythm is appropriately changed and stabilized with behavioral treatment interventions, the low-motivation and low energy levels typical of this phenomenon rapidly improve. It becomes clear with sustained clinical improvement that many of the symptoms experienced by patients were largely the result of a sleeping disorder rather than them having any distinctive character traits that caused the problem.  CBT-I techniques aimed at shifting the internal clock (called “entraining the circadian rhythm) have excellent effectiveness at improving this phenomenon.  Delayed sleep phase syndrome has a prevalence rate of approximately 15% among teens and adults.  It often develops in adolescence and continues into early adulthood, though it may also begin in adulthood, especially post-retirement.  It affects both genders equally.

[References for content and link to related research articles]:

• Clark G, Harvey AG. The Complex Role of Sleep in Adolescent Depression. Child and Adolescent Clinical Psychiatry of North America. 2012; 21(2): 385-400. Link

• Kloss JD, Nash CO, Horsey SE. Taylor, DJ. The Delivery of Behavioral Sleep Medicine to College Students. Journal of Adolescent Health. 2011; 48: 553–561 Link