Rest Easy: Skills to Help Fall & Stay Asleep

0:04 Okay. Good evening and welcome. 0:06 Thank you so much for joining us for tonight’s webinar, Rest Easy, Skills to Help Fall Asleep and Stay Asleep, presented by Miss Gillian DeTiberius. 0:15 My name is Katie Delaney, and I’m the Family and Medical Outreach Coordinator for the New Jersey Center for Tourette Syndrome and Associated Disorders. 0:22 I will be your facilitator for this evening. Before I introduce our presenter, I want to go over some housekeeping notes. 0:29 The audience is muted. 0:31 If you’re attending the live webinar, questions can be submitted in the questions box at the bottom of your screen. 0:37 During the live Q &A, the audience will gain access to unmute themselves. 0:41 We will stop the recording right before this. 0:46 Oh, excuse me. 0:47 At the top right of your screen, you will see a paperclip icon. 0:50 There you will find a copy of the slides and upcoming events. 0:53 At the bottom of your screen, you’ll see a react button. 0:56 To the right of it is an arrow. 0:57 When you click the arrow, you will see a few emojis appear such as a heart, thumbs up, et cetera. 1:02 Throughout the webinar, feel free to use this feature to let our presenter know how they’re doing. 1:07 Give me a thumbs up, you guys, if this sounds good to you. 1:12 Beautiful. 1:14 Okay, good. 1:16 And then for those viewing the webinar recording, you will not have access to these features. 1:22 However, any questions you have for the presenter can be submitted through the chat box to the left of your screen. 1:27 The presenter will answer those questions on our webinar blog located on our website njcts.org under the programs tab. 1:35 This blog will be monitored until Tuesday, May 6th. 1:38 Any personal information will not be included in the post. 1:42 The New Jersey Center for Tourette Syndrome and Associated Disorders, its directors and employees assume no responsibility for the accuracy, completeness, objectivity, or usefulness of the information presented on our site. 1:55 We do not endorse any recommendations or opinions made by any member or physician, nor do we advocate any treatments. 2:02 You are responsible for your own medical decisions. 2:04 Now, it is my pleasure to introduce our speaker for this evening, Ms. Jillian DeTiberius. Ms. 2:12 DeTiberius earned her master’s degree at Caldwell University in applied behavior analysis. 2:18 She has worked in the area of sleeping skills for over six years, has received specialized training from FTF Consulting, and is a certified sleep science coach. Try saying that. 2:31 She is the resident sleep expert at Grand Behavioral Surgery. Miss D. Tiberius, the floor is all yours. Okay, hi. Hello everybody. 2:44 I am Jillian D. Tiberius. I am a BCBA and a sleep expert. 2:49 I love, love, love talking about sleeping skills so I’m gonna try to keep us on track and there are a of things that we’ll go over tonight. So we’ll talk about sleep problems. 3:00 We’ll talk about addressing those challenges and implementing those methods. So your future depends on your dreams. 3:07 So go to sleep. 3:09 It might sound like something that is so obvious for us to do that, A, we’re born knowing how to sleep, right? 3:16 But for some of our individuals that we work with, some of our kids, ourselves, some adults, we have a lot of trouble going to sleep. 3:26 So we’re gonna talk today about what common sleep problems are and what are some things that you can do to address those sleeping skills. 3:37 So why work on sleeping skills? 3:40 I talked to so many people and they’re like, oh no, that’s just the way my child sleeps. They just don’t sleep well or that’s just the way I sleep. 3:47 I sleep well, I’m constantly awake or I have a long a hard time falling asleep. 3:53 But ultimately we should work on developing our sleeping skills and the sleeping skills for our children. 4:00 It has a negative impact on cognitive functioning and learning. 4:04 So you’ll see even if you don’t sleep well at night, like if you’re up very late at night or you have a hard time sleeping, you’ll see an impact on difficulty concentrating in class for our kids or during instruction. 4:18 When you’re at work, if it’s you that had a hard time falling asleep, it’s during your work day. 4:24 Increased risk of academic struggles for our kiddos, decreases in focus, attention and problem solving skills. 4:31 So you’re really not at your best if you haven’t slept well. 4:36 And then there’s effects on behavior and emotional regulation. 4:39 So a higher likelihood of behavioral issues, challenges with self-control and social interactions. 4:46 So it could be harder. 4:48 And what I find if I don’t sleep well, it’s hard to tolerate different things that might be challenging to me. 4:55 You have a little less toleration and a little less ability to handle different things. 5:04 Same thing goes with our kids as well. 5:08 So, often people think that sleeping is not a behavior or not a skill that can be taught, but sleeping is a skill that can actually be taught just like any other behavior exhibited. 5:21 So you are not born knowing math or knowing how to read or even knowing how to speak, right? 5:28 Those are all things that kids learn and acquire over time. 5:33 And sleeping is the exact same thing. 5:36 Now, honestly, obviously, naturally, you’re gonna fall asleep. 5:41 But sleeping is actually a skill and a behavior that can be taught and can really, really be improved over time for our kids and also for adults and for ourselves. 5:52 Any diagnosis, any age, everybody can work on sleeping skills. 5:58 It is a skill and it’s so important to think of sleeping as a skill and as something that we’re gonna acquire. 6:08 Jillian, do you want me to launch the first poll? 6:10 Oh, sure. 6:11 Yes, that would be great. 6:14 Can I see the results of the poll once people are putting it in? 6:18 You should, if not, I can let you know. 6:21 So I’m launching it right now. 6:22 I can. You can see it? 6:23 Beautiful. 6:24 Yeah, so if everybody could, this is a perfect time actually. 6:29 What age do you think is appropriate to teach your child to sleep through the night? 6:34 We’ve got some options here like six months to one year old, one and a half to three years old, three and a half to five years old, or any time they’re ready. 6:43 And we’re talking about sleeping through the night. 6:47 What age do you think is the most appropriate? 6:49 So we’ve got a lot of people that say six months old, six months to one year. 6:55 Couple people say a year and a half to three years old. 6:59 And we’ll talk about what’s the answer to this, what’s the age at which individuals should be able to sleep throughout the night? 7:07 We’ll actually talk about some things that what sleeping through the night actually means. 7:15 It’s kind of funny because, yeah, we all feel like we sleep through the night when we have a good night’s sleep, right? 7:23 I see it’s kind of like split three and three between like six months. Oh, well, a year and a half to three years old is kind of winning now. 7:31 But I want to mention about sleeping through the night and what I think is really important for learning about that skill is that this is why when you are having a newborn, a new baby at home, you have to think about like, can they sleep through the night? 7:50 Now obviously, if they’re younger than six months old, they need to eat. 7:54 So can’t focus on sleeping through the night just yet, right? 7:58 Um, but as we think about, are our kids sleeping through the night, you have to think that every person, no matter how old or how young they are, you’re going to wake up overnight as you cycle through your sleep cycle. 8:13 So even myself, um, I’m going to wake up overnight. 8:17 Now, usually I don’t, I’m not disturbed. 8:21 So I wouldn’t even notice that I’ve woken up at night and I’m able to put myself back to sleep. 8:26 I just roll over or something like that. 8:29 For our kids who don’t know how to go to sleep on their own might be a little bit more challenging. 8:37 So we’re gonna talk about that a little bit tonight as well. 8:42 So let’s talk about what common sleep problems are. 8:45 And that really brings us into this. 8:47 What I had just mentioned, it brings us into this. 8:50 Difficulty falling asleep and then frequent night wakings or difficulty staying asleep. 8:54 So, difficulty falling asleep, like when initially going to bed, so individuals that might take a really, really long time to fall asleep, or get out of bed when they lay down for the night. 9:08 So, you lay down, you bid them good night, and then your kids are getting up frequently at night, and it’s taking a really, really long time for them to fall asleep. 9:18 Or frequent night wakings or difficulty staying asleep throughout the night. 9:22 Difficulty for the person to sleep throughout the night and to stay in bed and then difficulty falling back to sleep when the person wakes up overnight Anybody experience any of these things either themselves or for your kids? 9:37 I can get like a you guys can give a reaction like thumbs up if you’ve experienced any of these things You know, I don’t know what the other reactions are thumbs up or not. 9:49 It looks like a lot of thumbs up though that you probably you’ve experienced these things and that’s why you’re here to talk about these things tonight. So first step you want to complete a sleep assessment. 10:03 Now if you’re working with an individual that is going to do sleep consultation for you then they should start with an official sleep assessment. 10:11 If you are going to work through this on your own and you’re going to address this with your child on your own or even with yourself, you can also look at this sleep assessment. 10:22 So it is easy to complete, it’s functional, and it’s useful for all individuals because then you can get a feel for what is going on. 10:32 What are the challenges? 10:34 You might think, I know the challenges, I’m here, I’m experiencing it with my child who won’t stay in bed, who won’t go to sleep, but this sleep assessment helps you look at. 10:44 What are you asking of your child? 10:46 How are you setting up the sleep environment? 10:49 And I have some examples of what this looks like. 10:52 So here, this top one, now this is the middle of the sleep assessment, but this top one, identifying the sleep problems, this is the type of thing you might say like, no, I know the sleep problems. 11:04 I don’t need to do an assessment to determine the sleep problems. 11:08 But it helps you to really sort out What is going on? What are the specific things? 11:15 So what do you usually do to help your child get in bed? What usually works to get them to bed? And then what is the sleep interfering behavior? 11:25 So what you’re looking for here is are there things about the sleep environment that are preventing them or causing them to wake up overnight? Is that causing them to have a more difficult time? 11:40 I have a few more slides here. 11:44 So delayed sleep onset. 11:46 Once in bed, does your child have difficulty falling asleep or night awakenings here? 11:53 So some information about what do they do? 11:56 How often do they wake up overnight? 11:58 And then there is another little section on early awakenings here. 12:03 The really great thing about this sleep assessment. 12:06 Now, if you are working with a sleep consultation or a BCBA who’s doing sleep consult. 12:12 Obviously they should be familiar with this. 12:14 But the really great thing for families is that this is just available online for free. 12:19 So you can search this sleep assessment. 12:22 It’s not like special access or anything like that. 12:27 So families can just search this sleep assessment from Dr. 12:31 Hanley online for free and it can really help you sort out what is going on, what are the major challenges and what are my goals? What am I going to work on for my child? 12:45 And then identify the sleep problems from there. 12:47 So often what I advise families to do is keep and review a sleep journal of the individual of your child or whoever you’re working with. Record everything. 12:58 Nighttime routines, what time you start the nighttime routine, what time the person lays in bed, what time they fall asleep, the amount of time it took them to fall asleep, how often night wakings occur if there’s frequent night wakings, what time the person wakes up in the morning if early morning wakings is a concern, any other details about how the person goes to sleep, or what happens overnight. 13:23 One of the most important things is that whatever happens when an individual goes to sleep should stay consistent overnight. So this is why I often advise against falling asleep with the TV on. 13:40 Now some people always say to me, no, no, no, I sleep with the TV on and that’s fine for me. Okay, that’s great. 13:47 This is not a catch-all rule for every person in the world. 13:50 Some people might be able to sleep with the TV on, but keep in mind having the TV on, it changes overnight. 13:57 The volume changes, there’s commercials, there’s other shows on other than what you were watching, and the lights go on and off when you’re watching the TV, right? 14:08 Sometimes it’s darker, sometimes it’s brighter. 14:11 All of those changes in your environment overnight could be a cause to wake you up overnight. 14:18 So if you are in between that sleep cycle and you wake up, that might cause you to wake up overnight. 14:24 So if you have something like there’s music playing or there’s a nightlight on for your child, you wanna keep those things on the whole night. 14:33 So, however they fall asleep, that’s what they’re gonna look for when they fall asleep again overnight. 14:40 This is an example of a sleep journal. 14:42 You don’t necessarily have to use this exact journal or sleep journal, but I find that it’s helpful for parents to see the things that they are doing to help their child fall asleep and what might be preventing them from either developing the skills to fall asleep on their own or sleep through the night. 15:04 Here’s an example of what it looks like once it’s completed. 15:08 So you can see some of the information that I was looking for here. 15:12 So what time they fell asleep or what time the nighttime routine started, what time they fell asleep, how many times they got up out of bed, and then there is some additional details over here. 15:28 Keep in mind, you want to have some for daytime sleep. 15:32 So in addition to any medical considerations, take a look at daytime sleep and the total overall sleep that’s appropriate for the individual’s age. 15:42 So if the child is getting too much sleep during the day, they’re gonna sleep less overnight. 15:48 Before starting the nighttime routine, establish through the assessment the time that the family would like their child or the individual would like to go to sleep, the time it would that they would like themselves to wake up. 16:01 Then make adjustments to the daytime sleep schedule if needed. 16:05 So start where you are and adjust the time to where your goal is. 16:09 So keep in mind that this is roughly how much sleep children need. 16:17 So for individuals from four to 12 months, we’re looking at 12 to 16 hours. 16:22 And this is including naps. 16:24 So this is including the daytime sleep. 16:28 And then as they get older, toddlers one to two years, 11 to 14 hours, including naps. 16:35 So that’s within a 24 hour period. 16:38 They’re looking for 12 to 16 or 11 to 14, 10 to 13 hours for preschoolers, nine to 12 hours for grade school and eight to 10 hours for teenagers and above. 16:52 Just so you guys know, adults should also get between seven and eight hours. 16:57 I know that seems kind of hard to believe, especially people have kids or people work full time or really people who are doing anything. 17:07 Can be hard to think that like, oh man, I should get eight hours of sleep at night also, but you should be. 17:17 But this is something to consider, especially as they’re transitioning from a year old to two years old or, you know, into a year and a half that look at how much the sleep is decreasing, 12 to 16 hours, 11 to 14 hours. 17:33 And to answer our poll from before to mention about it, what age should they be sleeping through the night? 17:41 It’s never too early to work on appropriate sleeping skills with your children. 17:47 It might be too early for them to sleep through the night. 17:50 I would say by at least a year old, you can have the expectation that they sleep through the night. 17:56 It might vary depending on how much they need to eat. 18:00 So I would say there’s almost no wrong answer one, 12 months or six months to three years, any of that time, you know, but even as young as four months, you can start working on developing healthy sleep habits and sleeping skills. 18:15 Even younger than that, even when you have a younger baby, two months or three months, yeah, they cannot sleep through the night. 18:24 That wouldn’t be developmentally age appropriate, but you wanna make sure that you are getting them set up with healthy sleeping skills. 18:32 And one of those major sleeping skills is gonna be self-soothing. 18:38 And I’m sure people have said that all the time. 18:41 Oh, don’t let them fall asleep on you. 18:43 put them in the crib when they are drowsy but still awake. 18:47 Yeah, I have three kids. 18:49 So I know that sometimes that’s easier said than done. 18:53 And also if my child ever fell asleep on me, I’m just gonna let them sleep on me for the nap because I loved it. 19:02 They get big so quick. 19:03 So I certainly understand people who are saying like, no, no, no, I’m not doing that. 19:09 Just keep in mind, you’re not gonna do that all the time. 19:12 the majority of the time you wanna develop those healthy sleeping habits for kids. 19:21 So from the journal and the assessment, identify some goals for yourself. 19:24 Try to get the top three goals and try to rule out any medical issues. 19:32 After medical problems are ruled out and you’ve identified sleep goals, ready to move forward with some interventions to help address sleeping skills. 19:44 So from the sleep journal information and the assessment, And here is an example of some goals that were from my sample that I gave you guys. 19:52 So reduce night wakings. 19:54 If he wakes up at night, have him go back to sleep in his own bed, make his bedtime earlier, reduce the amount he gets out of bed before he falls asleep, reduce the amount of time it takes him to fall asleep. 20:04 So this is all over the place. 20:06 There’s so many goals here. 20:08 So we refined it to three goals, reduce time to fall asleep, set an earlier bedtime and reduce night waking. 20:16 So these were the goals that we had with the most important one at the top and the major way, the main thing that I work on as a sleep coach is working on the nighttime routine. 20:32 And this might sound like the most basic advice and it is, but keep in mind that the nighttime routine is one of the biggest things that you can do for your child, for yourself if you’re working your own sleep. 20:48 The nighttime routine is routine that the person follows every night prior to bedtime. Routine will be similar each night and occur at a similar time. 20:58 It will help assist with longer and more consistent sleep. 21:02 This indicates that it’s time to go to sleep each time it’s started, so the schedule and routines are more effective at developing patterns and consistency of skills in addition to sleeping skills. 21:14 Nighttime routines help with a variety skills. So less struggles during nighttime, better quality sleep, night awakenings. 21:21 A nighttime routine, a strong nighttime routine can help you in so many ways. 21:26 I just was working with a family that they were having consistent sleep problems for a really, really long time. 21:33 And the child was about six years old, I think, and he was taking like two to three hours to fall asleep. 21:40 So he would go into his room, walk all around his room, disrupt his bed, like be jumping all over everything. 21:48 So I said, you know what, let’s just start easy. 21:51 Let’s work on the nighttime routine. 21:54 And all I did was make a schedule for them. 21:57 First, you brush your teeth, then you go to the bathroom, then you put on pajamas, then you lay down in bed. 22:05 I do a visual schedule for them and he was able to move the check mark down where he was supposed to go. 22:13 It took one night of him doing that routine. 22:18 One night and then that night he went to sleep within 20 minutes. 22:23 And this was about three months ago and they still use the schedule and he still sleeps, goes to sleep within 15 to 20 minutes. 22:32 He doesn’t jump around. 22:34 So just that nighttime routine, just that establishment of, hey, the expectation is you’re going to lay down because especially for individuals who are too young to understand that or they don’t have the ability to understand just when they’re told that night time routine is so important and by following that schedule he was able to go to sleep within a reasonable amount of time and at a reasonable time of day and it’s helped so immensely so I just tell that story to highlight how important a nighttime routine is. 23:13 If you do a picture schedule, if you do photos, if you do a written schedule, depending on the age of the individual, you’re going to do a nighttime routine that is consistent every night. 23:24 And this is something that people can implement without a sleep coach, without somebody even consulting. 23:31 Now, obviously, if you work together with a sleep coach, or if you are a sleep coach, this is something that you can do and you might feel like you know what I just want someone to come here and take a look at what’s going on and that is great but this is something that families can do immediately so think about how important a schedule and a routine is and something that’s going to be consistent night after night so what’s oh so it’s setting a nighttime routine this will set the occasion and indicate it’s time to sleep you’re gonna try to have it be the same or similar from night to night. 24:08 Activities should be enjoyable, but calming and start about 30 to 60 minutes prior to bedtime. 24:13 And the time there really depends on, are you doing baths? 24:17 Are you picking out clothes for the next day? 24:20 Are you taking a shower or something? 24:22 Like what are you doing that’s within that nighttime routine? 24:25 And I mentioned this before, but if a nightlight or a sound machine is used, just make sure it stays on throughout the night. 24:33 These are some things that should be included in the nighttime routine, like the necessary activities, like brushing teeth, bathroom, pajamas, even if that’s the whole of the nighttime routine, like I mentioned for my client, that was the whole of the nighttime routine. Brush your teeth, put on pajamas, go to the bathroom, get in bed. 24:52 That was the whole of the nighttime routine. So it doesn’t have to be more complicated than that. 24:58 But for some individuals, it might be a little different. 25:00 It might be taking a bath, Might include reading a book. 25:04 Might include having like a conversation about the next day or a lullaby. 25:10 Turning off the overhead light, turning on a nightlight, or turning on a sound machine. It could include any of those things. 25:17 You just don’t want to include in a nighttime routine anything that can be stressful like doing homework at the last second or reading a really difficult book. 25:27 Anything that’s likely to create a lot of excitement. 25:29 So some people feel like, Oh, you know what, they just have to get their energy out right before they go to bed. 25:37 And that is actually not the case. 25:39 So rough housing or exciting play, like jumping on a trampoline or something like that, um, or playing a video game, something, you know, that really should not be included in a nighttime routine. 25:51 You want to do everything. 25:52 Like sometimes I’ll say to my kids when they’re getting ready for bed, like now is our quiet time. 25:58 Now is the time that we talk in quiet voices, getting ready to go to bed. 26:03 You know, so I’ll just try to bring the energy level way down to that way they can get in bed and they’re ready to go to sleep. 26:11 So really, we’re trying to bring the energy level down instead of get them excited and really hyped up. 26:20 Electronics like watching TV or phone or tablet time. 26:24 Now, this one electronics, there’s a lot of information out there about electronics, about the blue light and all this stuff. 26:33 And it’s not really strong research-based, but there’s a lot of thoughts and opinions out there on if you should have your phone or have your electronics before bed. 26:45 And I would say I’m not a big advocate to have them or not have them. 26:50 I just think that you have to be able to calm down. 26:53 So if your phone is gonna make you really excited, stressed, anxious, nervous, if looking at your calendar or if watching TV for our kids is going to make them really, really stressed or anxious, we should just try to eliminate that from the nighttime routine. 27:10 And then eating like a large or a large meal or snacks or drinking a lot like dinner or dessert or having milk or a bottle, depending on the age of our This is my, one of my daughters. She should be asleep. 27:33 It’s kind of funny to have her here. Okay. It’s kind of funny to have her here when I’m talking about sleeping. 27:43 She popped in here to say, I want a hug. So she could probably hear my voice. 27:50 You guys got to see like behind the curtain a little bit. My husband is home. 27:55 Her dad is home and he be watching her. 28:00 But anyway, but anyway, you kind of want to try to avoid eating a large meal or snack or drinking a lot. 28:08 Even for our kids that are younger that are wearing diapers at night, we’re not trying to have them fill up that diaper overnight. 28:15 Or for our kids that are potty trained at night, we’re not trying to have them get up a bunch of times to go to the bathroom. 28:24 Here’s an example of what a nighttime routine might look like. 28:29 I kind of mentioned all of these things, but starting at 7, ending at 7.30, and this depends on their age, of course. 28:40 When to start. 28:41 So sleep schedules can be started with babies as young as 10 to 12 weeks old. 28:45 Would it be developmentally appropriate for a behavior this young, a child this young to sleep through the night? 28:51 We kind of mentioned that. 28:52 But starting a sleep schedule this young can really lay the groundwork for healthy sleeping as the individual ages. 28:59 So this is what I was saying, that if you want to try to start healthy sleep habits, you can start this behavior really young to let the baby know, hey, we’re getting ready for bed now, right? 29:12 But on the other hand, it’s never too late to start a nighttime routine, even if the individual is older. So just get started as soon as possible. 29:20 Implement the schedule the current time the individual goes to sleep to get it established. 29:25 If the bedtime is later than you would like just move the bedtime earlier. This is a process called bedtime fading. 29:33 I don’t go too much into bedtime fading but it might be an option for an individual who goes to sleep late already or is taking a very long time to fall asleep. 29:45 So if your bedtime or your child’s bedtime is seven o ‘clock but they’re taking till nine o ‘clock to go to sleep then their bedtime is actually nine o ‘clock right um so depending on their age so if you want to move them up earlier you’re going to implement the schedule at the time to get it established or implement it at the time they’re already falling asleep then you can move the bedtime earlier and this process is called bedtime fading so if the bedtime is currently at 11 pm but a more appropriate bedtime for your client’s age or your child’s age would be 730. 30:22 Implement the schedule at 11 PM first. 30:26 So once you get consistent success with that schedule, you can move the bedtime earlier and earlier. 30:32 And then continue to move the bedtime earlier once you reach your goal. 30:41 Ultimately with a nighttime routine and establishing a routine, whether you use photos or you use a schedule, consistency is key. 30:49 So consistency from night to night is the most important feature of a nighttime routine. 30:54 The consistency will create comfort with sleeping and a calming atmosphere. 30:58 Consistency helps to establish the routine. 31:02 So really consistency, and if you think about things that we do as adults or as individuals, think about the things that we do and we do them with consistency as well. 31:13 So you follow a routine and a schedule for work, for the things that you do. 31:19 Probably your daily schedule is pretty consistent across the board. 31:24 And consistency is needed to develop it for our clients and our children as well. 31:32 So what about deviations from the routine? 31:35 This is one of the major things that people ask me, like, no, I can’t be consistent all the time. 31:41 What about the weekend? 31:42 What about times that we go on vacation? 31:44 What about times that we have a little bit of a different schedule? 31:49 Occasionally, there might be times that you need to deviate from the nighttime routine. 31:55 Sleepovers, vacations, different person like a babysitter or a grandparent, they’re not deal breakers for your progress with the nighttime routine. 32:04 These situations keep some parts of the routine the same or similar if you can. 32:09 Keep the order of the routine the same, even if the location or the person are different. 32:14 carry over things that you can for a vacation, like a nighttime book, nightlight. 32:20 So my twins sleep with a nightlight and I carry that nightlight everywhere, plays music and it has lights and I just carry that. 32:30 It’s like a little whale. 32:31 I just travel with it. 32:32 I bring it all around. 32:33 So that way, if something is different, I always have that nightlight and it can help them and it makes them feel a little bit more comfortable about where we are and how they’re sleeping. 32:48 Okay, the other major area that we’re going to talk about tonight are sleep dependencies. 32:52 So these are certain parameters which are required to be able to fall asleep and stay asleep. 32:57 So these might be music, lights, stuffed animals, or a pacifier, or a parent laying or sitting next to the child in bed. 33:08 So are sleep dependencies always a bad thing, keep in mind everybody has sleep dependencies. 33:14 These are the things that help you fall asleep and get a restful night’s sleep. 33:18 These are things that help you fall back asleep when you wake up overnight. 33:22 So for myself, I like to sleep in the room with the fan on. 33:26 It’s really, really cold or as cold as I can make it reasonably. 33:29 I have my blanket all the way up to here and it’s really, really dark and it’s quiet. 33:35 That’s my sleep dependency, dark room, cold, quiet. 33:39 If it starts to get like a little bit hot, I can’t sleep. 33:44 I wake up, move all around because I like to sleep with my blankets on. 33:48 And those would be my sleep dependencies, right? 33:52 So everybody has them, but they can become challenging when a client has too many sleep dependencies to be manageable. 34:01 They’re dependent on the parent’s presence or they have dependencies on unusual items or they’re dependent on anything in a way that’s preventing their sleep, something that is not sustainable. 34:15 How to assess them. 34:16 Continue to collect data using the sleep journal. 34:19 So sometimes you might not realize that there’s a sleep dependency for your child or for the person that you’re working with, but keep in mind you have to write it in on the sleep journal. 34:30 Include specific information about what occurs prior to the person falling asleep and when they wake up overnight. 34:36 Be specific about the setting in which they’re in the individual’s room, the items they’re bringing to bed, and the things the parents do for the individual while they’re falling asleep. 34:47 Any other information that may be important no matter how small it may seem. There’s no detail for sleeping that is too small. 34:57 So I worked with a client once who he had so many sleep dependencies. 35:02 The door had be at like two inches open the window had to be the blinds had to be completely shut but one inch up mom had to be there patting his back laying beside him he had to bring his like five sleep dependency items five stuffed animal items to bed he had to have it completely quiet he had to have all these different things here’s the other twin sorry i don’t know why everybody okay Go to bed, please. I don’t know why everybody is up right now. Yes, go ahead. 35:45 So anyway, so he had all of these sleep dependencies going on, all of these things. 35:54 So mom didn’t even realize that all of these things were happening. 35:58 And then when I started talking to her about like, well, what’s what’s going on with the door? And then what’s going on with the window? 36:03 She’s like, oh, it has to be this way. 36:05 I’m like, okay, those are sleep dependencies. 36:09 And at this point, they’re probably becoming problematic. 36:13 They are reaching a level that is problematic. 36:19 So here are some examples of sleep dependencies. 36:21 These are things that could be really positive. 36:23 These are things that any individual could use like the sound machine or the fan. 36:30 I already mentioned that I like to sleep with the fan on. 36:35 Potentially challenging though, could be a parent or somebody present, unusual items brought into bed to help fall asleep, a bottle or a drink depending on their age. 36:47 An important note, which I’ve mentioned already and I’ve alluded to this, all sleep dependencies could become challenging to sleeping if they’re present when the person falls asleep, but not present when they wake up overnight. 37:01 And this will make it difficult for the person to soothe themselves back to sleep when they wake up overnight. 37:09 So for times when an individual falls asleep and then something is different when they wake up, like the night light goes out or the parent is there laying with them. 37:37 times when like the parent is laying with them and then the parent gets up to go into bed in their own room if the person wakes up overnight and their parent is not there with them anymore that’s why they start to have difficulty falling back asleep right because if i’ve fallen asleep and my mom is patting my back and holding my hand and then when i wake up they’re not doing that anymore. 38:03 That could be really, really challenging for me to go back to sleep, right? 38:07 So that’s when sleep dependencies become challenging and really prevent us from being able to fall asleep and stay asleep throughout the night. 38:18 So ways to improve sleep dependencies. 38:20 Since sleep dependencies are a functional way to soothe yourself to sleep, there are some initial ways to help improve ones that already exist. 38:29 Start to plan for things that will occur and be available throughout the night. 38:48 So start to plan for things that are able to stay in bed throughout the night. 38:53 So there are some initial ways to help improve some sleep dependencies that already exist. 39:04 Some white noise or a sound machine or soft music, just make sure it’s something that’s able to stay on throughout the night. 39:11 Say goodnight and leave before the individual is all the way to sleep. 39:15 This might be really, really challenging. 39:18 But this will help teach the ability to self-soothe, allowing the child to put themselves back to sleep without a parent needing to go in if they wake up overnight. 39:29 And this might be one of the most challenging things that you work on with your kids, but having them go to sleep and really able to put themselves to sleep. 39:42 So you wanna be bringing them in when they are drowsy, but they’re still awake overnight when they lay down. 39:51 So you’re gonna build this sleep dependencies on a nighttime routine. 39:56 So in addition, a strong and consistent nighttime routine will aid in decreasing sleep dependencies that are causing an inconsistent night’s sleep. 40:04 So, you want to make sure even if additional methods are required to fade sleep dependencies, a consistent nighttime routine should always be established first and then built on once sleep dependencies begin to be decreased. 40:28 You want to make sure that the nighttime routine is established first before you start to work on sleep dependencies. 40:39 If you identify that the items or activities the person is dependent on to fall asleep are inappropriate or causing difficulties, you may want to replace these with sleep dependencies that are more appropriate. 40:54 If the person doesn’t have an item that is a sleep dependency but depends on the parent to rub their back or put them to sleep, to stay in the room, or to lay in their bed until they asleep suggested to incorporate a new sleeping item, a nightlight or music into bedtime routine to help with the replacement of the parent’s presence. 41:14 It is one of the most challenging things, but to have the child fall asleep without the parent there in the room is one of the most important things that you can work on because that’s really going to allow them to fall asleep on own and then that’s going to be able to reduce nighttime waking, because then when they ultimately wake up overnight, they’re able to go back to sleep on their own without getting their parent. 41:56 In order to replace an inappropriate item like a bottle for bedtime or a pacifier or to replace a parent’s presence in the room, a great first step is to associate a new item as part of the time, but it should stay on throughout the night. 42:14 You can also choose to introduce a preferred stuffed animal or a blanket. 42:17 Now this is going to definitely depend on how old the individual is. 42:22 So you don’t want to be introducing a stuffed animal for an individual that’s like 14 or 15 years old. 42:27 It might not be as appropriate, but you’re going to work on really getting them to fall asleep without you there in the room. 42:36 Really any age of learner, of child, of individual that you’re working with you could do it to help them fall asleep on their own. 42:47 This can be especially useful introducing a preferred stuffed animal or a blanket for an individual that’s able to sleep with that item throughout the night. 42:58 Now keep in mind for individuals extremely young you want to keep the crib clear of any toys or any blankets anything like that. 43:05 So we’re really talking about at that, like after a year old. 43:10 Earlier than a year old, it’s not recommended to have anything in the crib. 43:16 Sometimes just providing a new item will help the person use it as a tool to help them get to sleep. 43:21 However, sometimes it needs to be paired with something that’s already preferred and associated with sleeping. 43:27 To establish it as an item that can be used to fall asleep, begin by pairing or associating it with the parent or the current item that’s helping them fall asleep. 43:36 So you could pair it with yourself if the parent is the thing that is making them, helping them fall asleep. 43:44 So you can pair it together with them. 43:50 Okay. 43:51 I don’t know if you should do the other poll. 43:54 So I think we’re, we have about 15 minutes left or so. 44:01 Yes, I can do the poll now. 44:02 Right now it’s currently 7.5. 44:05 Okay. 44:07 and I just launched it. 44:10 Okay so what’s the best way to help someone fall asleep who is trying to learn to fall asleep on their own? 44:15 So our options here are read a book before bedtime, follow a schedule to get ready for bed, jump around to get out their energy, or play for 10 minutes prior to bed. 44:31 Looks like follow a schedule to get ready for bed is pretty high up there. 44:51 Or read a book before bedtime. That’s a good option. 44:54 So I like what you guys are are like selecting right now, which is not selecting jump around to get out their energy and you’re not selecting play for 10 minutes prior to bed. 45:06 A lot of people are choosing follow a schedule or read a book before bedtime. And reading a book is a great option. 45:14 You can incorporate reading a book within following a schedule. So awesome. That’s so good. I feel like, yay. 45:23 This is like we’ve had success with everybody doing a nighttime routine, thinking of that. Okay. 45:33 So putting it together. 45:34 So establish a nighttime routine, include setting an appropriate and consistent bedtime, managing sleep dependencies. 45:40 These should be done at the start of any sleep Intervention. So if you’re here on this training and you’re thinking like what can I do for myself for my child? What can I do? 45:50 Immediately to start helping them get to sleep a little bit better You can start with a nighttime routine. You can start to look and assess. Okay, do they have sleep dependencies? 46:02 Am I as their parent? 46:04 Making them dependent on me to go to sleep Sometimes sleep issues can be treated solely by establishing a night nighttime routine and by just managing the sleep dependencies. 46:16 Problems still persist there are numerous additional strategies. 46:19 Two that I just want to mention are proximity fading and time-based visits. 46:24 So I’m just going to mention these things quickly. 46:27 So proximity fading can be used when the person is unable to put themselves back to sleep overnight. 46:33 It takes the parent out of the room gradually over the course of several nights so the parent fades their distance from the person until they’re completely out of the room. 46:42 This time have the family continue the sleep journal so you can keep track of where you are. 46:48 So if you previously laid in bed to get your child to fall asleep then you might sit up next to them in bed until they fall asleep and then you’re going to fade yourself out of the room in that sense. 47:00 Here are the steps for this. 47:02 I just want to introduce time-based visits. 47:06 So time-based visits could be used when the individual is unable to put themselves back to sleep overnight, but time-based visits are a little different because they take the parent out of the room immediately, will have set visits back to the individual until they fall asleep. 47:20 So each visit lasts about one to two minutes and then the schedule would be faded until the individual is falling asleep on their own. 47:28 So here are the steps for time-based visits. 47:31 The important thing about these two time-based visits and proximity fading is proximity fading is taking you out of the room slowly. 47:41 You’re literally fading your proximity or how close you are to the child when they are falling asleep. 47:49 So you’re always in the room for proximity fading. 47:52 For time-based visits, you are exiting and coming back in. 47:57 Exiting and coming back in. 48:00 either one could be used and families could use these like I said you can take this and say like okay I’m gonna establish a nighttime routine I’m gonna try to look at sleep dependencies and then I’m gonna use time-based visits with my child you can follow these steps and you could do this and try it out on your own or proximity fading what I always suggest is proximity fading so you’re staying in the room the entire time and fading your distance that could really helpful for a child that just will not stay in bed if you’re not there. 48:35 For time-based visits, it’s helpful if the child is okay staying in bed if you just go back and forth and check on them. 48:43 You might say something to them like, I’m going to go to the bathroom, I’ll be right back, as long as you always come back until they fall asleep. 48:55 A lot of people, when I do sleep consultation with them, they say like, just don’t make me do cry it out. 49:00 And I am never gonna make you do cry it out with our kids. 49:04 So overall of recommendations, lay the child in bed when they’re awake, but drowsy, look for appropriate bedtime based on the age of the person. 49:13 Choose a bedtime when they’re indicating signs of sleepiness, which are rubbing their eyes, yawning, crankiness, or crying. 49:20 Then continue with the sleep journal for data collection and provide reinforcement. 49:24 and tell them that they’re doing a great job for progress on sleeping skills. 49:30 Some considerations, and then I swear I’ll wrap it up and we could take questions. 49:35 Keep in mind sleeping is a skill, super sensitive to families. 49:39 And I only ever begin working on this skill when the family is really, really ready. 49:44 Be sensitive and aware that it might get worse before it gets better. 49:48 So it might be harder before it gets easier. 49:51 It might impact the parent’s sleep in a negative way before the child’s sleeping skill starts improving. 49:57 I always try to encourage families in that sense as well. 50:04 Medication use, so oftentimes pediatricians prescribe medication to assist in sleeping. 50:09 Just make sure that you know that medications do not teach the skill. 50:14 So medication might help somebody fall asleep or stay asleep longer, but it’s not teaching the skill of sleeping. 50:21 Remember what I said in the beginning? 50:23 Sleeping is a skill. 50:24 Sleeping is a behavior that can be taught, that we can work on. 50:29 So if they’re able to avoid medication or if they take medication, you could still work on teaching the skill of sleeping. 50:39 Then you wanna provide reinforcement. 50:41 So you wanna tell them, great job. 50:42 You wanna do something that they really, really like, like reading a favorite book or doing something else that they really like overnight or at night when they’re going to bed. 50:54 And then throughout the whole process and for at least two weeks following, try to keep on with the sleep journal that will see the maintenance of progress and it allows you to know when to move to the next step if you’re working on something. 51:07 And even though progress can feel slow, having the data in the sleep journal will help you see the progress, show the parents and show yourself how things are moving. 51:17 Remember the goals that were set at the beginning of the process. So keep track of them as you get closer to achieving those goals. 51:24 Meet with the parents regularly. It’s okay if new goals come up. You can begin working on them. 51:29 Just try to keep the original goals in mind. I want to make sure that we have time for questions. 51:41 So Let’s go with questions now because we have about eight minutes left. 51:50 I’m trying not to go over. 51:52 No, you’re totally fine. 51:54 Thank you so, so much. 51:55 Yes. 51:57 No, that’s perfect. 51:59 So, yes. 51:59 So, one of the questions that we have that was submitted says, are things like time-based visits? 52:05 Oh my goodness. 52:06 I’m so sorry. 52:06 I’m getting ahead of myself. 52:10 That’s okay. 52:14 Okay, so I just wanted to thank you, Ms. D. Tiberius. 52:18 Before we hop into Q and A, I’m going to ask somebody questions first, and then we’ll switch to the verbal Q and A, which is when I will stop the recording. 52:29 So, okay, so one question that we have is, are things like time-based visits or other strategic or other strategies appropriate for an elderly person with sleep difficulties? 52:41 Yeah I’m so glad that somebody asked that question because it’s such a good question and the answer is yes. 52:48 Sleeping is a behavior and I know oftentimes we associate teaching sleeping skills with really young learners but you can use this for older learners or geriatric people because you’re teaching sleeping like a skill. 53:05 So yeah if you Always have to stay next to the person, no matter their age. 53:09 If you always have to stay next to them to help them or get them to fall asleep, yeah, you can certainly use time-based visits. 53:17 Really, age is not dependent on that. 53:19 And you can say the same thing like, hey, I’m just gonna run and get a drink of water. 53:23 I’m just gonna run and go to the bathroom and I’ll come right back. 53:26 And like I said, always go back. 53:30 So make sure that the person knows you’re not lying to them. 53:33 You will come back. 53:34 You don’t actually have to get a drink of water, but you will come back. 53:39 And hopefully while you are away, the person is gonna be able to fall asleep. 53:47 Okay, and then another question we have is, okay, another question that was submitted is, how do you start teaching someone to sleep throughout the night? 54:10 would say I know it sounds so basic and like oh no that’s not gonna work but a nighttime routine is the most important thing that you could do for a learner or for a child right away. 54:25 Start with that nighttime routine and the more consistent you can be the more you offer that nighttime routine and that consistency the more that you help them fall asleep on their own the more likely it is that they’re going to be able to sleep throughout the night. 54:40 So that really is the very first step of what you can do. 54:44 And if you feel like I already have a strong nighttime routine, um, that part is not a problem. 54:50 They fall asleep really quickly, then start to look at the pieces of the nighttime routine. 54:55 Are you there with them while they fall asleep until they fall asleep? 55:00 Then you might have to look at some other types of procedures. 55:05 Before we switch to verbal questions, for those that are watching the recorded version, thank you so much for attending. 55:13 Please complete the exit survey and archive recording of this webinar will be posted to our website njcts.org under the programs tab. 55:20 That blog is now open and accessible under the archive webinar. 55:24 All questions submitted during the recorded viewing will be posted there. 55:28 Our presenter will be answering all questions posted until Tuesday, May 6th. 55:31 Any personal information will not be included. 55:33 Our next presentation will be mindful monitoring a parent’s guide to supporting children with ticks presented by Ms. 55:41 Morgan Iscovitz Scheduled for Wednesday, May 28th at 7 30 p.m Not 7 o ‘clock. So 7 30 p.m. 55:50 Eastern Standard Time with the recording the following day Thursday, May 29th at 2 p.m we offer professional development certificates for school professionals and school nurses that attend the live or recording of the webinar. To register for other time, please visit njcts.org. 56:05 And with that, I’m going to stop the recording.