Sleep Anxiety and Behavioral Therapy (for Anxious Kids Who Can’t Sleep Alone)
We hear this a lot. Your kid won’t sleep on a separate floor of the house. You wake up and you find your child staring at you. Anger, anxiety, and avoidance behaviors are all super common in kids with sleep anxiety. You want to be accommodating and reassuring to keep the peace - but it’s not working, and it’s not sustainable. In fact, it can even sometimes make things worse.
You want your adult time, but you want your kid to sleep, too.
So that’s where a behavioral plan, paired with relaxation strategies, comes in handy.
St. Louis Counseling for Kids with Anxiety and Sleep Disturbance
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It probably comes as no surprise that specializing in anxiety work with kids means our therapists have tons of experience in addressing sleep disturbance and sleep anxiety. It comes up every single month during our phone screenings (schedule yours here!) and in sessions, too.
Sleep anxiety can be developmentally appropriate, and we even expect to see it in pre-school and kindergarten aged children.
As children get older, though, sleep anxiety should be less common, and children are expected to be able to sleep independently with minimal parent check in and support.
When is child sleep anxiety a problem?
In terms of considering sleep anxiety as problematic, you want to look at the level of disturbance it creates for your child individually, within the home, and within other outside settings. Ask yourself:
Is your child getting enough sleep, or are they receiving too few hours?
Are they irritable, cranky, or overly anxious - all due to being so tired?
Is this happening every once in a while, or is it a regular concern?
Is it disrupting your sleep, as a parent? Is it impacting your relationship with your partner, or even your relationship with your kid?
Is the sleep anxiety and minimal sleep leading to behaviors, including just tiredness, that are observable in a school setting?
As the issues start to ripple out, the problem becomes bigger and more concerning, and suggests that it’s time to seek outside intervention.
Behavioral Therapy for Sleep Issues and Sleep Anxiety
From a behavioral therapist perspective, you need to understand and normalize the problem, build relaxation skills to address the underlying anxiety, and then create a graduated exposure plan with the end target in mind of helping your child to sleep, independently, through the night.
Fear Heirarchy for Sleep Anxiety
One way to build the exposure plan is to create a fear heirarchy, called a “Fear Ladder” with your child, during our individual therapy session time. Our therapists never take a flooding approach. Instead, we want to slowly build up to the scariest experience, sleeping fully independently, using incremental steps and celebrating every small success along the way.
We collaboratively create the exposure plan with your child, so that they have a sense of ownership and feel proud of their accomplishments when they climb each rung of their fear ladder.
Start with the smallest version of the scary event.
What feels minimally scary to your child about sleep time, and what is a small baby step they can take?
For some kids, it might be letting you turn out the lights and staying outside their room for 10 minutes before checking in on them.
For others, it might be Falling asleep with you next to their bed rather than in their bed.
Next, talk about the ultimate goal, at the top of their ladder - falling asleep alone and staying asleep in their room all night.
Emphasize that this is the big goal, and you don’t need them to reach that goal just yet! You’re going to come up with all the steps in between, to help get them ready.
Then, work together to fill up all the rungs of the ladder.
What’s something in between that first rung and the ultimate big goal at the top of their ladder?
What’s something in between that?
And in between that?
Until you get to 5-10 steps from point A to point B.
Sleep Anxiety Exposure Plan Example
Fall asleep with Mom sitting next to my bed instead of in my bed.
Fall asleep with Mom sitting by my door, but in my room.
Fall asleep with Mom sitting outside of my door, but with the door open.
Stay alone in my room for 5 minutes, with the door closed, before mom checks on me.
Stay alone in my room for 20 minutes, with the door closed, before mom checks on me (if I’m asleep, she doesn’t wake me up).
Stay alone in my room for 1 hour, checking my clock. If it’s been 1 hour or longer, I can go to my parents room and sleep on the cot (not the bed).
Stay alone in my room until at least 3 am. If it’s 3 or after, I can go to my parents room and sleep on the cot (not the bed).
Stay alone in my room until it’s at least 3 am. If it’s 3 or after, I can go to my parents room and sleep on the floor (no more cot provided).
Stay alone in my room all night.
Each week of session, we check on how that step went, what changes we need to make to the plan, and review the relaxation skills your kid needs to use to successfully complete the next step.
If they didn’t get through their exposure plan, no worries! It’s scary and hard to do. That doesn’t mean we can’t try again this week, or try a smaller exposure for an in between step. For example, Step 4 may lead to a huge, anxious, angry melt down. So when you meet with your therapist, you might review ways to help your kid calm down, and your therapist might help your kid decide to start with 2.5 minutes instead of 5. It’s a living document, and it’s tailored to your kid, each week.
You don’t have to deal with sleep anxiety alone - and, if you’re interested in exposure therapy, you should reach out to an anxiety therapist.
Working hand in hand ensures that you and your child can get support each step of the way, and successfully achieve your goal rather than making any problems worse.
Sleep problems are solvable. We promise.
Let’s get started.
Spotlight On: Molly Shaffer
Molly is a certified TF-CBT therapist who enjoys providing behavioral therapy to kids and parents.
Kelsey Torgerson Dunn is the owner and founder of Compassionate Counseling St. Louis, and author of the self-help book for teens, “When Anxiety Makes You Angry.”
Compassionate Counseling St. Louis provides therapy for teens, kids, and young adults. We specialize in anxiety counseling, anger management therapy, and trauma therapy. Learn more and schedule a call right here.
