Sleep-related issues are frustrating and can be problematic for almost anyone who suffers from them. However, they are particularly troublesome for individuals diagnosed with autism spectrum disorder (ASD). Difficulty with sleep affects both adults and children with ASD by exacerbating related symptoms. As a result, sleep disorders may make it difficult for them to function on a regular basis. Understanding sleep disturbances and how to improve sleep for people with autism is crucial to avoid related problems that are likely to have a negative impact.
Sleep Disorders and ASD
A large percentage of people on the autism spectrum experience a problem with sleeping at some point in their lives. When these problems are persistent, they may indicate a sleep disorder. Sleep disorders, such as insomnia, are changes in one’s sleep that can impact health and quality of life. People with ASD may have:
Difficulty settling down when it is time to sleep
Trouble staying asleep at night
Problems falling asleep due to high anxiety
An inability to recognize the need to sleep in others living with them
An irregularity in their body’s sleep rhythm
A melatonin or sleep hormone irregularity
Epilepsy or some other neurological condition
An increased sensitivity to noise and light, including the blue light emitted from electronic devices such as smartphones
Food allergies that disrupt sleep
Problems with sleeping too much due to stress
Learning to Deal With Sleep Disorders
While sleep disorders are difficult for people on the autism spectrum, they are manageable. To successfully manage sleep-related issues, a number of strategies have proven helpful. The key is to find and implement the right ones.
To start, try explaining the need for sleep to children on the autism spectrum, particularly those who are having difficulty understanding why it is necessary. Discussing sleep not only helps them understand its importance but can also reassure them that it is safe to sleep.
Setting up and sticking to a routine is also crucial. A sleep routine should include actions such as limiting screen time starting at least two hours before bedtime. A routine provides reassurance to people with autism, particularly children, and reduces changes that may adversely affect their ability to sleep. Creating a sleep diary can help to establish a routine, as it can illustrate any problematic sleep patterns. A sleep diary can help doctors treat autistic adults and children and may even be useful when applying for certain disability benefits.
Another step is to create a sleep environment that reduces sensory problems that are likely to impact the sleep of individuals with ASD. To create a comfortable sleeping environment, reduce the amount of light in the room by using blackout curtains or blinds. Light, smells, and noise may be reduced by keeping doors completely closed during sleep time. To reduce the risk of disruptive smells, people should avoid cooking or using anything with a strong odor before bedtime or near the bedroom. Noise may be further reduced by having thick carpets in the home and moving beds away from walls that are adjacent to rooms with a lot of activity or traffic. Earplugs may also help to lessen the amount of noise that might hinder an autistic child or adult’s ability to sleep.
Other distractions that may impact sleep include excessive toys in children’s rooms and even certain colors or pictures on the walls. The feel of certain materials used for bedding and night clothes, tags, or labels may prove uncomfortable or too stimulating against the skin, and as a result, it may be necessary to switch them for a different fabric. Even one’s mattress may hinder their ability to sleep. A mattress should be changed if it’s too old or the wrong type to properly support their sleep position. In addition to creating a relaxing environment, a soothing bath, gentle music, or reading a calming book prior to bed may help people with autism to relax and settle down.
Diet and Medication
In some cases, changes in diet may cause discomfort that proves disruptive to one’s ability to sleep. When determining the cause of sleeping problems, people should consider what new foods have been introduced and avoid caffeinated drinks. While some foods may cause sleep issues, other foods may help improve the quality of one’s sleep. Pineapple and grapes, for example, contain natural melatonin, which is a hormone that regulates a person’s sleep-wake cycle. Other foods, such as chicken, beans, and bananas, contain the amino acid tryptophan, which also aids in sleeping.
Medication is often the last resort, particularly in helping children in the autism spectrum. In some cases, doctors may recommend a melatonin dietary supplement to help balance the sleep-wake cycle. Although natural remedies present another option in helping people with autism to sleep, one should check with a doctor before trying them.
Sleep for Parents and Loved Ones of People With Autism
When a person is taking care of a child with autism or living with an adult on the autism spectrum, it’s important to get proper rest. Sleeping while one’s child is asleep may seem ideal, but it isn’t always feasible. If circumstances or a lack of free time make it difficult to get restful sleep, caregivers and loved ones should seek help from family members who can step in, provide assistance, and allow them to rest. If that’s not an option, parents of autistic children may check if they are eligible for respite services or some other type of community care program.
Autism and Sleep Disorders: Learn more about autism and sleep disorders by clicking on this link to read an article on the topic from the Journal of Pediatric Neurosciences. The page includes in-depth information including sections on establishing sleep patterns, bedtime routines, and sleep training.
How to Get Children With Autism to Sleep: In this Scientific American article, readers will learn how a lack of sleep increases certain behaviors in autistic children and what’s needed to help them sleep.
Ambitious About Autism: Sleep: People interested in learning about sleep problems and autism can click this link for information on the common types of issues autistic children may face and what may cause them.
Getting a Good Night’s Sleep: As children on the autism spectrum suffer from sleep disorders at a higher rate than other kids, parents should click this link to learn about the importance of good sleep and find suggestions that can help establish a good sleep routine.
Autism and Sleep: This Psychology Today article outlines autism and sleep statistics from a study by the University of Helsinki Finland.
Sleep disorders that involve abnormal or disruptive movements or behaviors fall under the category of parasomnias. One of the most commonly known of these disorders is sleepwalking, which is a condition formally known as somnambulism. When a person sleepwalks, they don’t stay resting soundly in bed: Instead, they rise and unknowingly walk, sometimes performing complex activities such as unlocking a door or even driving a car. While they may appear to be awake, they are in a complete state of sleep while performing these actions. Studies have shown that an estimated 1 to 15 percent of people suffer from some degree of sleepwalking. While both adults and children of either gender may sleepwalk, it is more common in children.
In understanding why some people don’t stay in the comfort of their bed while sleeping, it’s important to first look at what causes sleepwalking and when it occurs. People who sleepwalk are in stage N3 of non-rapid eye movement (NREM) sleep. NREM sleep differs from rapid eye movement, or REM, sleep, which is the stage where people dream. Stage N3 is the deepest stage of NREM. Sleepwalking doesn’t have anything to do with the comfort of one’s mattress. In fact, it isn’t entirely known why it occurs; however, some researchers believe that it is caused when the brain attempts to jump from NREM to wakefulness.
Other conditions are also commonly thought to trigger sleepwalking in some individuals. These include using alcohol and other sedatives or taking hypnotics or certain medications used for the treatment of psychiatric disorders. Mental disorders thought to increase the risk of sleepwalking include depression, which is said to increase one’s risk by 3.5 percent, and obsessive-compulsive disorder (OCD) which can make one as much as four times more susceptible to somnambulism. Additional causes may include problems such as abnormal sleep breathing patterns, gastroesophageal reflux disease, restless leg syndrome, stress, and fever or fever-related illnesses. Because sleepwalking frequently occurs in people who have at least one parent with a history of sleepwalking, it is believed that genetics may also play a role in whether some individuals experience the disorder. Sleep deprivation and sleep apnea also potentially contribute to an increased risk.
People who sleepwalk may experience two or more episodes a month. During these episodes, they may be at risk of minor to severe injury while in the process of moving about. This is particularly true if they leave the home, as they may get lost or make their way onto a street where there are cars and other hazards. Inside the home, stairs can prove hazardous, as can engaging in activities that are dangerous, such as handling sharp objects.
When people first start sleepwalking, it is important that they see their doctor. A doctor can determine if there are any illnesses that may be causing it. There are ways to treat people who sleepwalk, but treatment is often unnecessary unless the behavior is ongoing or disruptive or one’s unconscious behavior indicates a heightened risk of injury. Often, children who sleepwalk will stop doing so by the time they become teenagers.
A doctor can help determine if treatment is necessary and what will be the most effective approach. Addressing any underlying causes is the first step. This may include starting or switching medications. Other steps may include self-hypnosis or waking up a person who regularly sleepwalks 15 minutes before an episode would normally start. This is called anticipatory waking, and the individual should be kept awake for approximately 15 minutes before being allowed to go back to sleep. Reducing stress and establishing a sleep routine that allows enough sleep time may also prove helpful.
To learn more about sleepwalking, click any of the links below:
All living things sleep, whether it’s a mammal, rodent, or reptile. While humans usually slumber in their bed on a mattress, animals may snooze in a variety of different environments depending on their instincts and location. From bears and rabbits to alligators, the shelters that animals create to get a little bit of shuteye is truly fascinating. Every creature requires adequate rest in order to hunt, migrate, and generally stay alive. With the right shelter, these animals can remain safe from predators until they wake up.
Many animals build their own homes so they can stay hidden away from potential predators. Bears are an excellent example of an animal that builds a den where they not only sleep but also raise their babies and keep them safe from harm. Dens are usually either buried deep underground or built by the animal to create a secret shelter. Beavers are one of the most prolific of the den-building animals, and they create shelters that can withstand rushing water and other harsh conditions. Many rodents also sleep in dens, like chipmunks and squirrels. Rabbits are another animal that creates a safe haven for babies inside a den, usually buried underground. This hidden world makes it safe for the animals to get some rest, though some use dens solely to raise their young and then move on.
In the reptile kingdom, the types of sleep spaces can vary greatly depending on the animal and the environment. Many reptiles prefer to slumber out in the open, usually on tree branches or even in the middle of the ground. In hot desert climates, several species of lizards bury themselves deep in the sand to stay cool and to avoid unexpected predators. Unlike bears and other animals that hibernate, creatures like the alligator go dormant when the temperature drops. They dig holes in the mud and create a secret space where they can sleep comfortably and hide. Once they leave their mud hole, other animals may take it over as their new home.
Birds also need sleep, but their style and home can vary depending on the species. While these feathered creatures are in their egg-laying phase, they tend to sleep in the nest so they can keep their eggs and babies warm as well as protect them from predators. Certain species, like the hornbill, dig out their own private dens inside of tree trunks to keep their young ones safe and to get a bit of rest. Other birds may just simply make a temporary bed directly on a tree branch where they can get some rest. Of all animals within the animal kingdom, birds are some of the most fascinating when it comes to sleeping habits and locations. Each bird builds its nest in different ways, in different places, and using different materials. Every bird, from the hummingbird to large birds of prey like hawks and eagles, builds nests.
Domestic animals are the most similar to humans in terms of sleep. This is because we have helped to provide them a shelter throughout their evolution. Donkeys, sheep, horses, and cows typically sleep inside a barn, keeping them safe from predators like wolves or coyotes. When it comes to our pets, they’re even more protected. Most pet animals, like dogs and cats, have their own bed (or they just sleep on ours) inside our homes where they’re comfortable, safe, and sound. Domesticated animals are protected by humans, since we use them for food, companionship, and other purposes. Thanks to this evolution, these creatures really have it the easiest in the animal kingdom.
Clinical psychologist and Sleepopolis expert Dr. Shelby Harris has written a new book, and it hits the shelves today. The Women’s Guide to Overcoming Insomnia: Get a Good Night’s Sleep Without Relying on Medication approaches the subject of insomnia from a woman’s perspective, with a woman’s physiology in mind.
The book draws on Dr. Harris’s extensive experience as a sleep psychologist, first at Montefiore Medical Center’s Sleep Wake Disorders Center, and now in private practice in White Plains, New York. In chapters like The Nuts and Bolts of Sleep and Stomp Out the Sleep Stealers, Dr. Harris explores the impact of hormones, stress, parenting, and aging on women’s sleep cycles. Whether you grapple with occasional (and frustrating!) bouts of sleeplessness or chronic insomnia that good sleep hygiene can’t touch, Dr. Harris addresses the full spectrum of women’s sleep troubles.
Dr. Harris talked to Sleepopolis on the eve of her book’s publication, and gave us three essential takeaways:
Women have a higher risk than men of developing insomnia. Throughout their lives, women experience hormonal and lifestyle changes that men don’t, creating stressors that increase the risk of sleep difficulties. Many women struggle to find treatment other than medication, which can lead to daytime sleepiness and mental fogginess.
Cognitive behavioral therapy for insomnia (CBT-I) is the gold standard for insomnia, and should be the first-line treatment for the disorder before medication is prescribed. Studies show that CBT-I is useful for women of all ages and points in the life-cycle, from young adulthood to perimenopause and beyond.
The CBT-I protocol is relatively simple, but takes effort in the beginning. If CBT-I is not enough to alleviate insomnia symptoms, The Women’s Guide to Overcoming Insomnia discusses other options, from traditional medication approaches to integrative medicine.
Bottom line: women don’t have to live with insomnia, no matter what their circumstances or stage of life. As in all things, knowledge about women’s insomnia is power.
Buy or read more about the book, published by W.W. Norton & Company and available in softcover and ebook format. Learn about Dr. Harris and her psychology practice at her website and Twitter.
Seeking a sunny vacation spot to escape to? Sunshine duration measures the total number of sunshine hours for the entire year, giving a general impression of how cloudy a city is. By that measure, Yuma, Arizona, is the sunniest place on Earth! If you visit, you have a 90% chance of being greeted by sunshine, no matter the season. Yuma’s location at the confluence of the Colorado and Gila rivers makes for lush, fertile soil — every season is growing season here. The area’s agricultural industry produces 90% of the nation’s lettuce and accounts for more than a third of the state’s annual agricultural earnings.
The top 10 sunniest cities in the world by annual sunshine hours are:
Yuma, Arizona — 4,015.3
Marsa Alam, Egypt — 3,958.0
Calama, Chile — 3926.2
Dakhla Oasis, Egypt — 3943.4
Phoenix, Arizona — 3,871.6
Keetmanshoop, Namibia — 3870
Las Vegas, Nevada — 3,825.3
Tuscon, Arizona — 3,806.0
Kharga, Egypt — 3790.8
El Paso, Texas — 3,762.5
The top 10 least sunny cities in the world by annual sunshine hours are:
Totoró, Colombia — 637.0
Tórshavn, Faroe Islands — 840
Chongqing, China — 954.8
Dikson, Russia — 1,164.3
Malabo, Equatorial Guinea — 1,176.7
Buenaventura, Colombia — 1178.0
Lima, Peru — 1230
Ushuaia, Argentina — 1281.2
Reykjavik, Iceland — 1,326
Bogotá, Colombia — 1328.0
When you think about Colombia, you might imagine sunny beaches, vibrant emerald waters, and lush forests, and in truth, many places in Colombia offer just that. However, the varied topography and mountainous nature of the country make for dynamic weather patterns. Colombia experiences two seasons — wet and dry. The wet season occurs from around April to November, and during this period, it is not uncommon for it to rain for hours everyday.
Where are the gloomiest, darkest winters? In the Northern Hemisphere, the winter solstice occurs in December. Here are the five least sunny places in December by average monthly sunshine hours:
Dikson, Russia — 0.0
Tórshavn, Faroe Islands — 6
Yakutsk, Russia — 9.3
Iqaluit, Canada — 12.6
Moscow, Russia — 14
In the Southern Hemisphere, the winter solstice occurs in June. Here are the five least sunny places in June by average monthly sunshine hours:
Valdivia, Chile — 45.0
Totoró, Colombia — 47.0
Ushuaia, Argentina — 50.3
Lima, Peru — 50.6
Stanley, Falkland Islands — 57
How Does Sunshine Duration Affect Sleep?
Exposure to sunshine is a key part of sleep hygiene. Light rays influence the brain’s biological timekeeper, which has been true since humans slept outside and would rise with the sun. In fact, light is one of the biggest external factors that influence sleep. The National Sleep Foundation recommends cocooning your bedroom in blackout curtains or blinds during the night to block artificial light and opening them to the sunshine when you are ready to begin the day.
In some areas of the world, such as Dikson, Russia, people can experience an entire month with no sunshine whatsoever. The absence of a typical day and night cycle can have significant affects on the sleep and wake cycle and studies have shown it can lead to symptoms such as insomnia, decreased total sleep time, decreased sleep quality and efficiency, and instability of the REM sleep stage.
Look up the words “sleep hygiene,” and you’ll find countless suggestions for what to do and what not to do at bedtime. These simple behavioral changes — don’t eat, avoid caffeine, keep pets out of the bedroom, for example — may seem like a cure-all for any kind of sleep trouble. Sleep hygiene is often promoted on medical and sleep websites as the first line of defense against insomnia or a bad night of slumber.
But what if you’ve tried sleep hygiene? What if you’ve darkened your bedroom, put the clock where you can’t see it, turned off your electronics at night, and you’re still having trouble sleeping? What then?
Q: What does sleep hygiene mean?
A: Originally used to refer to clean bedding and bedclothes, sleep hygiene has evolved to mean sleep-promoting actions and behavioral changes.
Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t take the place of medical advice and supervision from a trained professional. If you feel you may be suffering from any sleep disorder or medical condition, please see your healthcare provider immediately.
What Is Sleep Hygiene?
Sleep hygiene recommendations are intended to help improve the quality and duration of sleep. (1) They were originally developed to relieve mild to moderate insomnia symptoms, though the term has since become a catch-all phrase for a variety of actions intended to promote healthy sleep.
The term “sleep hygiene” was first coined in the late 1930’s. The protocol has only recently become popular as a magic bullet for everything from occasional trouble sleeping to chronic insomnia. Thesleep hygiene checklist may consist of the following suggestions:
Go to bed and wake up at consistent times, even on weekends (2)
Create a quiet, dark, and cool sleeping environment
Avoid eating heavy meals or drinking caffeine or alcohol in the hours before bedtime
Reduce or eliminate naps
Keep children and pets out of the bedroom overnight
Turn off all sources of blue light, including computers, smartphones, televisions, and tablets, at least one hour before bed
Reserve the bed for sleep and sex only
Most sleep hygiene suggestions are supported by scientific research. Yes, naps can reduce the drive to sleep at night, and a bedroom that is too warm can make sleep more difficult. But research on sleep hygiene demonstrates its effectiveness only for relatively normal sleepers. Sleep hygiene is not a proven treatment for chronic insomnia, which is insomnia lasting three months or longer, at least three days each week. (3)
If you’re a faithful follower of sleep hygiene but still struggle to fall asleep, stay asleep, fall back to sleep, or a combination of all three, you may require a different type of treatment.
Normal sleeperSomeone who routinely is able to get sufficient sleep -- typically between seven and nine hours each night -- without difficulty or anxiety.
What Causes Insomnia?
Short-term insomnia, or transient acute insomnia, last less than three months and has a number of possible causes. (4) These include:
A major life transition, such as a move, new job, new school, or the birth of a child
Insomnia is considered chronic when it lasts for three months or longer. (5) Insomnia of this duration is considered to be insomnia disorder. Though depression and other mood disorders may be a factor, chronic insomnia usually has one primary cause: negative associations with sleep and the sleeping environment.
This conditioning may begin with an episode of transient insomnia that leads to the fear of being unable to sleep. Once anxiety begins, it can become associated with anything related to sleep, such as showering and switching off lights. Behaviors like lying in bed trying to sleep and watching the clock can worsen anxiety and reinforce a negative response to bedtime. (6)
The brain, circadian rhythm, and nervous system are designed to be sensitive to anxiety and other mood changes, and serve a protective purpose. Human ancestors once slept outdoors and were vulnerable to predators, making it important to remain awake under stressful conditions. Modern stresses and fears are typically less urgent, but no less disruptive to sleep and wake cycles.
Q: What is the definition of insomnia disorder?
A: Trouble falling asleep, staying asleep, falling back to sleep, or unrestorative sleep. Any combination of these symptoms may occur, but must persist for three months, at least three days each week, to be considered insomnia disorder.
Trouble sleeping for three months or longer may indicate a number of sleep difficulties or disorders. Sleep disorders are best diagnosed by a sleep specialist, who will typically request a sleep and medical history. (7) In addition to information about your symptoms, a doctor may:
Ask about your sleep habits and social environment
Suggest you keep a sleep diary to track your sleep patterns and identify factors that might contribute to your insomnia issues
Ask that you take one or several insomnia tests to better understand your sleep habits. These might include questionnaires such as the Insomnia Severity Index or a mental health examination
Because people undergoing sleep studies often sleep less than they would in their usual environment, such studies are rarely helpful for diagnosing insomnia disorder. Once a diagnosis is made, appropriate treatment can be discussed.
Treatment of Insomnia: Sleep Hygiene Vs. CBT-I
In the case of transient insomnia, symptoms usually resolve on their own and treatment is rarely necessary. If the sufferer of transient insomnia has bedtime habits that make sleep more difficult, sleep hygiene may help.
Chronic insomnia persists despite the use of sleep hygiene, and generally does not go away on its own. (8) Chronic insomnia is often treated with cognitive behavioral therapy for insomnia, also known as CBT-I. CBT-I is a multi-session treatment usually conducted by a sleep professional, such as a psychologist who specializes in the treatment of sleep disorders.
Sleep hygiene may incorporate some aspects of cognitive behavioral therapy, but is not a specific protocol designed for sufferers of chronic insomnia. When suggested for more than mild sleep troubles, sleep hygiene may delay treatment and become an ineffective substitute for CBT-I and related methods. Unlike sleep hygiene, CBT-I is proven in multiple studies to be more than 80% effective in improving chronic insomnia. (9)
Chronic insomnia sufferers who try sleep hygiene may find the results disappointing, further increasing anxiety and exacerbating the disorder. Frustration with sleep hygiene may make patients more reluctant to engage in CBT-I treatment, and less confident about the chances of success once they do.
Sleep professionals generally suggest CBT-I as the primary treatment for insomnia disorder. Basics of the protocol include:
Sleep restriction therapy. Sleep restriction therapy limits time in bed to the average number of hours spent sleeping (10)
Stimulus control therapy. Stimulus control therapy is designed to strengthen associations with the bed as a place to sleep
Relaxation training. Relaxation training can help insomnia sufferers reduce anxiety and physical tension, allowing the nervous system to relax and making sleep more likely
Cognitive behavioral therapy. The therapy component of the protocol addresses negative attitudes and misconceptions about sleep
CBT-I usually requires time and patience, and may take several sessions before results become apparent. Though the effects aren’t immediate, the protocol can be remarkably effective, even for those who’ve suffered from insomnia for months or years. (11)
Stimulus controlA behavioral psychology term that refers to a predictable pattern of behavior that occurs in the presence of a certain stimulus, and another pattern that occurs in the absence of that stimulus.
Last Word From Sleepopolis
Sleep hygiene is a popular set of behavioral changes and suggestions that are intended to make sleep easier and more efficient. Though sleep hygiene may be helpful for those with poor bedtime habits and mild sleep difficulties, there are few if any studies demonstrating its efficacy for chronic insomnia.
Most people who experience insomnia typically try many behavioral changes in an effort to fall asleep faster and stay asleep. If sleep hygiene doesn’t work, difficulties with sleep may be more responsive to proven insomnia treatments such as CBT-I. Studies show that CBT-I is effective for most people with protracted insomnia, improving symptoms and making sleep more efficient.
David F. Mastin, Assessment of Sleep Hygiene Using the Sleep Hygiene Index, Journal of Behavioral Medicine, June 2006
Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH., The Role of Sleep Hygiene in Promoting Public Health: A Review of Empirical Evidence, Sleep Medicine Reviews, Aug. 1, 2016
Sharon Schutte-Rodin, M.D., Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults, Journal of Clinical Sleep Medicine, 2008
Chien‐Ming Yang, Shih‐Chun Lin, Chung‐Ping Cheng, Transient Insomnia Versus Chronic Insomnia: A Comparison Study of Sleep‐Related Psychological/Behavioral Characteristics, Journal of Clinical Psychology, June 24, 2013
Roth T., Insomnia: Definition, Prevalence, Etiology, and Consequences, Journal of Clinical Sleep Medicine, Aug. 15, 2007
Bonnet MH and Arand DL. Hyperarousal and Insomnia: State of the Science. – PubMed – NCBI, Feb. 14, 2010
Saddichha S.Diagnosis and treatment of chronic insomnia, Annals of Indian Academy Neurol. 2010 Apr.13
Sharma MP, Andrade C., Behavioral interventions for insomnia: Theory and practice, Indian Journal of Psychiatry, Oct-Dec. 2012
Kalyanakrishnan MD, Scheid MD, Treatment Options for Insomnia, American Family Physician, Aug. 15, 2007
Simon D. Kyle, Towards standardisation and improved understanding of sleep restriction therapy for insomnia disorder: A systematic examination of CBT-I trial content, Sleep Medicine Reviews, Feb. 2015
Morin, CM, Cognitive-Behavior Therapy, Singly and Combined with Medication, for Persistent Insomnia: Acute and Maintenance Therapeutic Effects, JAMA, Mar.8, 2011
The U.S. Labor Department just released its annual American Time Use Survey, and it shows that men are sleeping more and working less… while women do the opposite.
The Department of Labor recently released its annual ATUS report for 2018, revealing that women are working more and sleeping less, while these same trends move in the opposite direction for men. The findings declare that women in 2018 worked about 7.5 hours in a given weekday, the highest figure for this demographic since the survey began back in 2003.
Men, conversely, worked an average of 7 hours and 54 minutes, which is down more than thirty minutes since 2017. While these numbers still point to longer business hours for men, the survey also shows that women spend 25% more time on childcare and household obligations, and less time on “personal care.” All statistics considered, men reportedly enjoy over an hour more of daily leisure time as compared to women.
So, what about sleep? Well, women still clock in a few more minutes per night than men, but that gap is steadily closing. Nearly two decades of ATUS reports show that women’s nightly sleep average is declining, while men have seen a consistent uptick in shuteye for the last several years.
So… Why Are Men Sleeping Better Than Women?
The Department of Labor is not the first organization to examine the “gender bias” in sleep health. In fact, many experts believe that sleep disorders are hereditary, and women are particularly vulnerable to insomnia. But when it comes to women’s sleep health, are genetics the only factor at play?
To gain a better understanding, I reached out to Dr. Shelby Harris, clinical psychologist and author of The Women’s Guide to Overcoming Insomnia. She told me that while insomnia is a big problem for both men and women in America, women are at greater risk of developing the disorder:
Women are more susceptible to hormonal and lifestyle changes throughout their lives, with these fluctuations and stressors frequently impacting a quality night’s sleep. However, most women power through day after day, with many struggling to find an appropriate treatment.
Dr. Harris went on to tell me that women are increasingly experimenting with prescription sleep aid in an attempt to alleviate symptoms of insomnia, but the treatments frequently result in mental fogginess and daytime sleepiness (which often exacerbates the problem).
Family history and hormonal changes aside, the Labor Department’s recent survey might suggest that the correlation between more work and less sleep is not a coincidental trend, and the two actually feed into each other. Countless studies have linked work-related stress to sleepless nights, which might explain why men have been snoozing better ever since their work hours decreased.
So how do women reverse the trend? Well, while research regarding the biological component is ongoing, prioritizing a healthy nighttime routine might be a good place to start. After all, sleep affects just about every part of your life, and is not something to place on the back burner. In the meantime, we at Sleepopolis will be very interested to see the ATUS results for next year, and find out if women are re-staking their claim to a good night’s sleep.
If you’ve ever wanted to pull a pillow over your head when your child wakes up for the second, third, or fifth time in a night, you aren’t alone. Many of the parents sleep specialist Dr. Whitney Roban coaches can’t hit the hay without a hefty dose of guilt. But Dr. Roban, clinical psychologist and author of the Devin and Evan children’s book series, is all about making slumber a priority — and refusing to feel bad about it.
Join me as I chat with Dr. Roban about the link between sleep and behavior in kids, the three pillars of health, and what happens when children dictate the family sleep schedule (hint: fewer Zzz’s for all).
You were a psychologist early in your career, but turned your focus to healthy sleep for children and families. Was there a defining moment that led you to make the jump?
One of my sons was a horrible sleeper as a newborn. He’d start screaming, but as soon as he saw me he’d smile through his tears. There was an obvious connection between his behavior and what I was doing. A child’s sleep is a byproduct of things the parents do. Kids need the opportunity to self-soothe, which they do very quickly if we let them. It’s like taking the training wheels off a child’s bike. You have to let go and allow them to do it.
Clinical Psychologist, Family Sleep Specialist, and author Dr. Whitney Roban
Once a child starts sleeping, do you see it reflected in other ways?
Parents often notice that their child’s development improves. I sleep-trained a child who wouldn’t eat in preschool, but he was so exhausted he couldn’t focus and eat. Once he started sleeping well, he started eating. Children who are considered difficult can see big behavioral changes. Their frustration tolerance gets better when they sleep enough. You’ll never see sleep deprivation lead to anything positive, or healthy sleep lead to anything negative.
In your experience, do childhood sleep habits usually continue into adolescence and adulthood?
They can, but they don’t have to. I’ve developed an elementary school curriculum to educate kids about sleep for this very reason. Once children understand why sleep is important, they start relating the good things in their lives to healthy sleep. Kids who’ve been taught good sleep habits have the confidence to make positive changes in their behavior.
What’s the number one mistake parents make with their children’s sleep habits?
They let children take control of the family’s sleep schedule. It creates anxiety for children when parents aren’t in control. It’s okay for kids to be included in the family’s decisions about sleep, but they shouldn’t be in control of the whole process. When you’re consistent with sleep, kids know what’s coming next. If kids know what’s going to happen, they have a sense of consistency. It’s the same with anything with parenting.
Do you think every child can be a “good sleeper?”
Every child can be a good to great sleeper as long as there isn’t a medical reason that causes them to lose sleep. Given the right sleep environment, schedule, and routine, every child can sleep well. I’ll tell parents, this is the ideal, now let’s talk about reality. Moving, family trauma, illness, vacation — I ask, what’s the best you can do? Let’s start with what you can strive for and go from there.
What do you wish everyone knew about children’s sleep?
That it’s a health issue, and should be prioritized the same way nutrition is. Parents have so much guilt about just wanting to sleep. They need to change that from “want” to need. That helps them prioritize sleep rather than feeling bad about it. The three pillars of health are nutrition, exercise, and sleep. Sleep should be part of every family’s health and wellness plan.
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The Goods – GhostBed’s signature model uses a combination of latex over memory foam layers to provide the classic pressure relief of memory foam, without the drawbacks of overheating or feeling stuck in the mattress. The GhostBed Luxe model has a super plush feel that puts an emphasis on sleeping cool.
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The Goods – Tempur-Pedic is known for their classic memory foam contouring around the sleepers body and the LuxeAdapt does not disappoint. Side sleepers can look forward to sinking deep into bed on the LuxeAdapt for great pressure relief.
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The Goods – The Cocoon Chill is a no frills foam mattress with a firm feel that I think is a nice fit for the back and stomach sleepers out there. The Chill part comes in from the phase change material in the cover which gives the chill a cool to the touch feeling.
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The Goods – Eight Sleep is a company that focuses on the science side of sleep. The Saturn mattress that I tested has a firmer feel to it and pairs nicely with the tracker so you can better learn where you can improve your sleep habits.
One of the essential elements of cognitive behavioral therapy, or CBT-I, is stimulus control therapy. Often referred to as SCT, stimulus control therapy is part of the protocol designed to reduce negative associations regarding sleep and the sleep routine. (1)
SCT has been found in studies to be effective for all types of insomnia, including long-term insomnia lasting months or even years.
Cognitive Behavioral Therapy for InsomniaThe non-drug protocol of behavioral training and therapy designed to reduce symptoms of chronic insomnia and improve sleep efficiency.
Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t take the place of medical advice and supervision from a trained professional. If you feel you may be suffering from any sleep disorder or medical condition, please see your healthcare provider immediately. Stimulus control therapy is best practiced in combination with the rest of the cognitive behavioral therapy protocol and under the guidance of a therapist who specializes in treatment of sleep disorders.
What Is Stimulus Control?
Stimulus control is a behavioral psychology term that refers to a predictable pattern of behavior in the presence of a certain stimulus, and another pattern in the absence of that stimulus. “Discriminative stimulus” refers to anything that can modify behavior or cause a physical or emotional response.
The concept of stimulus control is also used in training and behavioral therapy of animals. Animals and human beings learn to associate certain situations, objects, or experiences with a particular response that doesn’t occur at any other time. A person is considered to be “under the control” of a stimulus when they stop for a stoplight or feel hungry at the sight of a favorite restaurant. Stimulus control also underlies the mechanism of addiction to substances and certain behaviors. (2)
Q: What's the definition of discriminative?
A: That which has particular distinguishing characteristics.
Stimulus Control Therapy for Insomnia (SCT)
SCT adapts the well-known behavioral concept of stimulus control to the treatment of insomnia disorder. In the case of insomnia, “stimulus” is any behavior or thought that can activate the nervous system, cause anxiety, or serve as a cue for wakefulness. (3) A brief bout with insomnia may lead the brain to develop negative associations with the bed and bedtime routine. The attempt to sleep can cause emotions that trigger the release of stress hormones such as adrenaline and cortisol, making sleep more difficult.
Stimulus control therapy is part of the cognitive behavioral therapy protocol for sufferers of insomnia lasting three months or longer, at least three days each week. (4) CBT-I and SCT are designed to help deactivate the nervous system and retrain the brain to respond positively to sleep-related stimuli.
Other components of the therapy include:
Sleep restriction therapy. Sleep restriction therapy limits time in bed to the average number of hours spent sleeping (5)
Relaxation training. Relaxation training can help insomnia sufferers reduce anxiety and physical tension, allowing the nervous system to relax and making sleep more likely
Cognitive behavioral therapy. The therapy component of the protocol addresses negative attitudes and misconceptions about sleep (6)
The CBT-I protocol has been well-studied for years, and is considered very effective as a non-pharmacological treatment for persistent insomnia.
For many people with chronic insomnia, the bed has become a place for activities such as reading or television-watching, as well as planning or worrying about upcoming events. Bed and the bedtime routine may have become psychologically linked with the inability to sleep. Stimulus control therapy is designed to strengthen associations with the bed as a place to sleep. (7)
To alleviate anxiety and negative conditioning, the following behavioral changes are recommended:
Go to bed only when sleepy. Many people suffering from insomnia feel sleepy during the day or in the evening, but become “tired but wired” as bedtime approaches. “Sleepy” describes the feeling of being unable to stay awake, similar to the feeling of falling asleep on the couch during a movie or while reading a book
Go to sleep and wake up at the same time every day, even on weekends. To help regulate the circadian rhythm and stem the release of the sleep-promoting hormone melatonin, expose yourself to bright light as soon as possible after you wake up. If going to bed later than usual, set an alarm for your usual wake time to help maintain your sleep schedule and prevent disruption of your body clock
If unable to sleep after approximately ten-fifteen minutes, get up from bed and wait to feel sleepy in another room. Keep the lights dim and engage in a quiet activity such as reading. Avoid electronics, which emit stimulating blue light and may keep you awake longer. Return to bed only when you feel ready to sleep. Once in bed, get up again if you don’t fall asleep within ten minutes. Repeat as often as necessary until you sleep (8)
Use the bed for sleep and sex only. Do not watch TV, study, use electronics, read, play video or other sorts of games, or work in bed. Talking and any other activity that might encourage wakefulness are also discouraged
No watching the clock. Put the clock across the room and cover it if necessary. Once in bed, don’t look at it until the alarm goes off, even if you wake during the night or close to morning
Do not nap. Naps can lower the drive to sleep at a normal time and further disrupt the circadian rhythm. Even if you didn’t get sufficient sleep the night before, avoid napping to help regulate sleep patterns
Be patient. Like any sort of stimulus control training, stimulus control therapy for insomnia requires consistency. It takes time to change the associations the brain makes with sleep-related cues, such as showering, preparing clothes for the next day, and turning off the bedroom light
Sleep driveThe natural urge to sleep that increases gradually throughout the day, peaking in the mid-afternoon and at night.
The Effects of SCT
Stimulus control therapy may take days or a few weeks to show results. To maximize chances of success, prepare for the protocol and have realistic expectations. Know that at first, you may get even less sleep than usual for you. Have a robe available on cold nights in case you need to get out of bed and wait to feel sleepy in another room.
Though stimulus control therapy may result in short-term sleep loss, the training help to regulate the circadian rhythm and build the natural drive to sleep. Increasing the natural sleep drive will result in falling asleep more quickly, particularly when practiced in concert with sleep restriction therapy.
Falling asleep faster helps the brain develop positive associations between the bed and sleep, reinforcing a new and beneficial pattern of behavior. (9) As stimulus control continues and sleep becomes easier, sleepiness often shifts to earlier in the evening. This allows for more sleep time without lying in bed awake and anxious. More time in bed may be allowed as long as insomnia symptoms don’t return and sleep remains efficient. (10)
Most sleep specialists suggest that the protocol be continued even after insomnia symptoms subside. Occasional sleep-ins or late nights are permitted once sleep returns to normal, but in general, the protocol should be followed indefinitely to maintain progress. Extended wake periods in bed are strongly discouraged. If insomnia symptoms begin again, a return to the protocol is often recommended.
Last Word From Sleepopolis
Stimulus control therapy can help reduce the symptoms of chronic insomnia and increase sleep efficiency. It helps to alleviate the persistent anxiety and nervous system activity that can result from negative conditioning regarding sleep.
As part of the cognitive behavioral therapy for insomnia protocol, SCT can replace psychological associations that disrupt sleep with positive responses to sleep and the bedtime routine. Proven effective and long-lasting, SCT can restore healthy sleep patterns and improve insomnia symptoms for many long-term sufferers of the disorder.
Baillargeon L, Demers M, Ladouceur R., Stimulus-control: nonpharmacologic treatment for insomnia, Canadian Family Physician, Jan. 1998
Nader, Michael, Chapter 1 – Animal models for addiction medicine: From vulnerable phenotypes to addicted individuals, Progress in Brain Research, 2016
Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW., Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison, Archives of Internal Medicine, Sep. 27, 2004
Harris J, Lack L, Kemp K, Wright H, Bootzin R., A randomized controlled trial of intensive sleep retraining (ISR): a brief conditioning treatment for chronic insomnia, Sleep, Jan.1, 2012
Maurer LF, Espie CA, Kyle SD., How does sleep restriction therapy for insomnia work? A systematic review of mechanistic evidence and the introduction of the Triple-R model, Sleep Medicine Reviews, Dec 2018
Richard R Bootzin, Understanding and Treating Insomnia, Annual Review of Clinical Psychology, Apr. 2006
Richard R. Bootzin, Dana Epstein, James M. Wood, Stimulus Control Instructions, Case Studies in Insomnia
Zwart, Cheryl A., Analysis of stimulus control treatment of sleep-onset insomnia, Journal of Consulting and Clinical Psychology, 1979
Miller C, Espie C, Kyle S., Cognitive behavioral therapy for the management of poor sleep in insomnia disorder, Dovepress, Aug. 29, 2014
Reed, David, L, Measuring Sleep Efficiency: What Should the Denominator Be? JCSM, 2016