Help Your Child Sleep Alone

The Goodnight Worry Program for Bedtime Fears

I want to hear from you! Please let me know if this is helpful. Tell me your story: david@ogradywellbeing.com.

If you want to help my research and help other families, please take this short survey before you start the Goodnight Worry program. Describe your child’s sleep problem and how it affects your family. I will not share your name, your child’s name, or your email address. TAKE THE SURVEY.

After you have tried the Goodnight Worry program, tell me about your results. One month after you finish the program, TAKE THE FOLLOWUP SURVEY to share your experience so I can continue to improve the program and help other families.

The Goodnight Worry program is designed to help school-age children (5-12 years old) learn to sleep alone. By developing their capacity to soothe themselves, our children master their fears. This mastery and independence will spread to other parts of their lives, adding to their sense of confidence and strength as they engage their world.

The problem.

Some children are afraid to sleep alone. Every night, a parent has to be with the child until he or she falls asleep. At a minimum, this is time-consuming. Often, the child sleeps in the parents’ bed. Or a parent has to sleep in the child’s bed. Understandably, parents eventually get frustrated with this routine—too many knees and elbows, too little privacy. Sharing a bed with a child every night can be maddening.  Maybe this was okay when the child was a toddler. But by the time the child is 7 or 8 years old, parents want to reclaim their bed. Moreover, parents feel that too much dependence on them is unhealthy. They want their child to be confident, not fearful. They want their child to sleep alone, and do so comfortably.

But when parents try to get the child to sleep alone, they run into trouble. First, they try reassurance – tell her she is safe, show her that all doors are locked, buy a new special pillow, and maybe promise a reward. But the reaction they get is intense resistance. No amount of reassurance works. It may only cause the child to feel more anxious and pressured. Mom and Dad try to be firm and set limits, but the child actively refuses to stay in bed. Parents resort to threats and anger. Things escalate. The child cries, pleads, yells, and bangs on her parents’ bedroom door. The child is awake for hours. Parents are awake for hours. The child is not just being stubborn—she is panicked. Eventually, parents throw up their hands. The child stays in the parents’ bed. Everyone feels discouraged and exhausted.

I developed the Goodnight Worry program in 2001 because I kept encountering this problem in my practice as a clinical psychologist. Over the years, I have refined this straightforward behavioral approach to solving the problem. By applying well-validated behavioral techniques, listening carefully to parents and kids, and lots of trial and error, I have discovered the specific strategies that children need to establish a habit of independent sleep.

Here is a common scenario. A child won’t sleep in her own bed. She’s afraid. Every night in order to fall asleep she needs a parent to be with her. Her parents tell her not to worry, but she stays worried. She asks, “What if burglars come?” Her parents suggest she think about something else. She says, “I tried that and I’m still scared.”

The parents grow weary. They lie down with her on her bed until she sleeps. Later, in the middle of the night, she awakens and cries and again needs her parents to help her fall asleep. Despite their misgivings, the parents allow the child to sleep in their bed every night.

This problem is actually very common. A surprising number of children—7 years old, 9 years old, even 12 years old—cannot sleep alone in their own beds the whole night.

If this is happening in your home, perhaps you worry it is because your child has an emotional problem, some deep insecurity. Perhaps you think you shouldn’t make her do what she’s not ready to do. Maybe this reflects a deep fear that she needs to work out. Can you be cruel to the poor child? Won’t pushing her away only traumatize her? Isn’t it natural for children to sleep with their parents?

But perhaps you have come to feel that this sleep problem is disrupting family life–it takes up a lot of time, robs parents of precious time to themselves, perhaps interferes with the relationship between husband and wife, and causes conflict between parents and child. Wouldn’t the child be more confident and self-reliant if she could face her fears and overcome them? Wouldn’t everyone in the family feel better if these fears could be mastered?

The Goal.

We want our children to feel confident and secure, able to relax knowing they are safe, able to seek help when they feel bad, yet able to soothe themselves when bothered by minor worries. We want our children to know their own feelings, identify anything wrong, and talk about problems. We want a balance of independence and closeness. When it comes to sleep, we want them to feel okay about coming to parents occasionally on an anxious night, yet comfortable sleeping alone on a regular basis.

So why is this happening?

Sometimes the problem starts abruptly, like after seeing a scary movie. More often, however, the child has always been an anxious sleeper and has always needed a parent present to fall asleep ever since she was an infant or toddler. Such children have never developed the habit of independent sleeping. They have developed a strong association between sleep onset and the presence of a parent—the two always go together. It has become a habit. When a parent is absent, the child is anxious. When anxious, the child does anything and everything to get a parent to give in and provide the comfort needed to alleviate the anxiety.  That means crying, demanding, badgering, and yelling. And when those don’t work, they try wailing, begging, banging on doors, and screaming bloody murder.

As children grow their imaginations grow, including their capacity to visualize potential threats. Kids think about things that can GET them. “What if” thinking develops. (What if a burglar gets into the house? What if kidnappers try to get me?) Their expanding imagination can result in increased awareness of their vulnerability. And sleep is when they surrender watchfulness. Sleep is when they feel most vulnerable. If they feel anxious, they can’t sleep.

What are kids afraid of?

• Bad guys, intruders, kidnappers, burglars.
• Zombies, ghosts, witches.
• Storms, lightning, fire.
• Being the last one awake.

A child’s solution to this problem of vulnerability is to seek the protection of parents. When scared, all kids seek the comfort of their parents. Why doesn’t rational discussion work?  It doesn’t work because your modern adult brain is speaking to a sophisticated but very ancient threat-detection module in your child’s brain that has been fine-tuned for the past 200,000 years. Danger nearby? Stick close to Mom and Dad. Just ignore those scary thoughts? Not a chance.  For countless generations, kids did sleep with (or very near) parents. Kids with this module survived more often than those who wandered off alone. The must-not-sleep-alone alarm serves a good purpose. It protects kids in dangerous conditions. It doesn’t matter if the alarm is wrong most of the time (i.e., it gets kids to cling to parents when there is no real danger). It only matters if the alarm is right some of the time. If it is, nature keeps it.

It comes down to this. Given a choice, a scared child will always choose the comfort of a warm parent rather than rely on his or her own resources for comfort.

Comforting oneself is a skill one learns through experience, not rationality. Here is how the child learns:  If the child thinks a scary thought but waits it out and nothing bad happens, the anxiety subsides and, with practice, the child learns that waiting and relaxing are good strategies. If a child does not try waiting and relaxing, there is no opportunity to learn that self-soothing works. But it is much easier to run to Mom or Dad than wait and relax, so for the child, this is not really a difficult choice. She’ll always rely on Mom and Dad as long as Mom and Dad offer comfort. Children who need a parent present to fall asleep have learned to depend on their parents for all their bedtime comfort and have not learned to rely on themselves.

Does this reflect a deeper problem?

Does anxiety at bedtime indicate some deep-seated insecurity? Does the fear mean there is some deeper psychological problem? Sometimes bedtime fears can be part of a bigger problem with anxiety that might need professional attention, but often, the answer is no. Every child is afraid to sleep alone sometimes. Many kids who develop chronic anxious sleep patterns do so because a habit starts and gets perpetuated, but the problem is limited to bedtime. In the rest of their lives, they are confident, no more anxious than typical children.

For other children, bedtime anxiety is just one part of broader challenges with anxiety or difficulty self-regulating emotional reactions. The child might have separation anxiety, a tendency to worry a lot, fears about illness, a lot of temper outbursts, or difficulty managing transitions. Or the child might have ADHD or a learning disability. But that does NOT mean that the sleep problem cannot get better until all those other problems improve. Fixing the sleep problem can give everyone the energy and confidence to work on the other problems.

Your job is to provide the right kind and the right amount of reassurance. By developing his capacity to soothe himself, your child masters his fears. This mastery and independence will generalize to other aspects of your child’s life, adding to his sense of confidence and strength in whatever he undertakes. Kids who can comfort themselves are more self-reliant, more capable, and more self-confident.

So why do parents allow their kids to sleep with them?

Some examples of what parents say:

• I want my child to feel secure. I just can’t stand the thought of my child being alone and feeling so scared. I’m afraid that if I push my child to sleep alone when he’s not ready, it will really hurt him psychologically. After all, sleeping together is natural, isn’t it? Maybe he’s just not ready.
• I want my child to sleep alone but I don’t know what more I can do. She has always been a poor sleeper. My child puts up such a fuss! I’ve tried being reassuring and reasonable and firm but she gets so upset and so persistent. I get impatient and that gets us nowhere. I just end up giving in. We’ve created a monster!
• It just seems like the only way anybody can get any sleep.

In most cases, this problem develops because parents do not have confidence in their child’s ability to self-soothe, worry that the fear is too much for the child to handle, are not effective in calming the child, and do not effectively set limits. When parents do try to get kids to sleep alone, kids can become very anxious and put up intense resistance, so parents end up avoiding the issue.

How do we solve the problem? The Goodnight Worry Program.

If you follow the Goodnight Worry Program, your child will learn to sleep alone, relying partly on comfort from you and partly on self-soothing.

The core of the program is getting your child to fall asleep without a parent present. You can be nearby, but your child must be alone when making the crucial transition into sleep. You will no longer be the signal that tells the child that now it is safe to sleep, so your child will stop needing you there to make that transition. Once your child gets started falling asleep without you, it will become a habit through simple repetition.

Here are the steps you will follow:

• Develop a healthy bedtime routine.
• Talk with your child about sleep, anxiety, habits, and how people change behavior.
• Hold a family meeting to discuss the problem and how you’ll solve it together.
• Start the Goodnight Worry program and follow the rules.
• Enjoy your success.

What is a good bedtime routine?

The bedtime ritual can be comforting for everyone. The routine should be a relaxing ending to a full day, lasting about 20 to 30 minutes. Regularity is reassuring to children, so try to make a ritual of the same sequence of activities. Be sure to allow enough time so no one has to feel rushed and tense. Notice what your child does to soothe herself. Does she have a favorite place for a favorite stuffed animal? A special method of plumping her pillow? A favorite way of saying goodnight? Foster these rituals and enjoy them with her. Notice your tone of voice. Are you speaking in warm, soothing tones to create a relaxed, positive mood?

You want your child to feel that her bed is the coziest place in the world. Help your child develop positive associations to bed and sleep. Spend time with your child in their bedroom in enjoyable activities. Talk about how nice the bed is, how warm and perfect the blankets are, how everything in your child’s room has just the right place, how happy her stuffed animals are. You are creating and reinforcing positive associations to bedtime so she can feel cozy and secure.

1. Choose a bedtime and stick to it.

2. For one hour before bed, avoid TV, video games, and any stressful discussions.

3. Go through the preparing-for-bed steps. The routine should take 20-45 minutes, including 2-3 relaxing activities that naturally flow from to another. These steps might include:

• • Take a warm bath
  • Put on pajamas
  • Brush teeth
  • Lay out clothes for tomorrow
  • Get backpack ready for school
  • Read a story together

4. Make sure all needs are anticipated so your child won’t need to get up again. Be sure your child has a glass of water by the bedside, has gone to the bathroom, has a favorite stuffed animal.

5. Have some time for closeness with your child:

• • Talk about something pleasant that occurred today
  • Talk about the plans for tomorrow, especially positive things

6. Hugs, kisses, and good night.

Follow these same steps every night. Activities before bed should be relaxing, not stimulating. Avoid TV right before bed; stopping is frustrating for some kids. Avoid arguments, angry conflicts, criticism, complaints, and discussion of problems. Bedtime is for relaxing!

The Goodnight Worry Rules: The Standard Plan

Here are the basic rules. The purpose of these rules is to communicate clearly to your child what you expect, what is allowed, and what is not okay. Remember, kids like rules. Rules create predictability, a sense of control and security. Follow these rules for a good night’s sleep. Stick to them and your child will see that she can rely partly on you and partly on herself for reassurance and comfort. The key is that she makes the transition into sleep without you present, which will then become the new habit.

• Stay put. After bedtime, your child must stay in her own bed the whole night. She is not to leave her bed.

• Enter the zone alone. You may be with your child until she is drowsy, but she must be alone when she falls asleep. You may sit on your child’s bed, but you may not lie down with her.

• Lights out, no crying out. Your child must not call out, whine, demand, cajole, or bargain after saying good night or between “check-ins.” You will offer comfort and reassurance, but only when your child is in her bed, and only when you choose, not when she demands.

• Back in 10. You return to your child’s bedroom every 10 minutes to check-in, soothe and speak reassuringly for up to two minutes, but no more. You tell her you’ll return in another 10 minutes to check on her, and you do so, again offering up to two minutes of soothing every 10 minutes as many times as necessary until she falls asleep. You return by the clock, not by crying or calling out.

So, in summary, here is how it works: You go through your getting-ready-for-bed routine, which is relaxing and comfortable. Your child is in his or her bed. You kiss your child, say good night, turn out the light, and leave the room. In 10 minutes, you return to check on your child, who is probably awake and a bit anxious. You provide some brief reassurance (less than a minute), chatting in a relaxed way. You leave the bedroom, ignoring any protests. You return again in 10 minutes, again providing reassurance and re-directing your child’s attention for a minute or so. You keep repeating this check-in process every 10 minutes until you see that your child has fallen asleep.

Here are a few key points:

• It is essential that you are not in the room when your child falls asleep. Your child must learn to make that transition alone.
• You avoid engaging the child in discussion of the rules, the fears, the unfairness of your treatment of the child, or anything else controversial. This is not a time for problem-solving or debate. This is a time for sleep.
• You did not let yourself get angry. You do not raise your voice.
• If your child persists in protesting or tries to break a rule, you calmly but firmly re-state what the rule is and say that you expect your child to abide by the rules.

Gradually, over the course of a few nights, your child learns that she can fall asleep alone. She also learns that if she awakens in the middle of the night, she does not have to go to your room and get in your bed – she can fall back asleep on her own. Pretty soon, this becomes an established pattern, a habit, something that happens easily and automatically, without any effort or stress.

 

Should I reward my child for sleeping alone?

Rewards for compliance will help motivate your child, get your child’s attention, and reinforce effort. However, the real rewards are security, independence, and a sense of competence. But you should consider rewards to recognize effort and encourage the child. Certainly, you should reward your child with praise. “I am so proud of you. I see you are really trying. It makes me feel so good to see you so confident!” Other rewards can include food, little prizes, and activities with parents. Best to think of the reward as a fun way to celebrate your child’s accomplishment. It is definitely not payment. Rewards that are too big will feel like bribes. Best to keep rewards small. Here are some ideas:

• Stickers or stars on the calendar for each successful night of obeying the Goodnight Worry rules (appropriate requests for “check-in” are okay).
• After 7 successful nights, celebrate success in some way–go out for ice cream, a pizza, or have a “games night” with Mom and Dad. 

What about punishments?

Forget about it. Punishments don’t work very well for this problem. One reason is that when kids are in the grip of fear, they are willing to pay almost any price to get relief. Go ahead, spank me. Take away my iPad.  Don’t make threats. But you definitely should show disapproval if your child breaks the rules. Be brief and pointed. The message is: “I am definitely not happy about this.” 

Variations on the Standard Plan For Very Anxious Children

The Standard Plan sometimes needs to be modified.  Some kids are just too anxious to tolerate separation from their parents for even 10 minutes. These variations are appropriate for kids who immediately get very agitated when you signal that you are about to leave them alone.

The Gradual Plan. This alternative is for kids who are very anxious or resistant to trying to sleep alone. The Gradual Plan delays the requirement that the child be alone when making that crucial transition into sleep at bedtime. Sit in a chair near your child’s bed until she falls asleep. Gradually, over several nights, move farther away from her until you have eased yourself out of her room, then into the hallway, then into another room. From then on, stick to “Enter the Zone Alone.”

The Back-in-10 Flexible Plan. Instead of insisting that your child wait 10 minutes, ask her to quietly wait 1 minute. After she has waited alone in her room for 1 minute, check on her, praise her briefly. Keep it short. It’s good to have a phrase you repeat each time. For example:  “I love you, honey. It’s time for sleep.” Then repeat the check-in after 3 minutes, then 6 minutes, and then 10 minutes. If you want, you can change the intervals according to your judgment. There is nothing magic about 1-3-6-10-minute intervals. It is just that your child is learning that she can tolerate being alone and that you will always return.

The Special Tickets Plan.  This plan is best for kids who seem to get activated by the anticipation of check-ins. Instead of quietly relaxing and really trying to sleep, they stay alert and count the minutes until the next check-in. Sometimes kids stay awake for hours, frustrating everyone.

Create three “special tickets.” Your child keeps the tickets under his pillow. After saying good night, your child may politely request a check-in at a time of his choosing in exchange for one ticket. A check-in consists of a parent entering the room, talking no more than one minute in a calm and encouraging manner. The child must wait quietly at least 10 minutes between check-ins. Once the tickets are gone, no more check-ins or talking at all. Any unused tickets can be exchanged in the morning for a special prize (keep it small). Having more control in this way can reassure kids and end anxious questioning about when and if parents will return.

In each of these scenarios, it is important to pay attention to how much you talk to your child after you say “good night.”  You want to minimize talking.

Delay Bedtime for a Few Nights.  This will help your child to fall asleep faster. Don’t let your child sleep later in the morning.

Getting ready to start:  Examine your own part of the problem.

You’re almost ready to start the new sleep program, but first, you need to ask yourself a question. Are you part of the problem? You want the best for your child, but are your own emotional needs or marital dynamics getting in the way? Almost always the sleep problem arises, at least in part, because parents want to avoid distressing the child, so they accommodate the child’s wishes. But other factors may also contribute to the problem. Think hard about whether any of these apply to you.

1. Ambivalence: But sleeping together is natural, isn’t it? It’s hard to be firm in setting limits if you’re still feeling mixed about this basic issue. Are you still telling yourself that if your child is demanding to sleep with you it must be because she needs it? Try to set your doubts aside and accept that what you are doing is helping your child become a strong, confident and secure individual. Remember, when you act with confidence, you are giving your child a clear message that all is safe and there is no need to worry.
2. Parent’s need for affection. Is your need for affection being met by the child being in bed with you? You can have lots of cuddle time when your child is awake. Create moments of closeness by reading together, cooking together, drawing, or working on special projects. Don’t let your emotional needs rob your child of a sense of security and independence.
3. Guilt feelings. Do you feel guilty for spending too little time with your child because of work or other commitments? It’s hard to juggle all your responsibilities and hard to know the best way to divide your time. But if you give in to your child’s demands to sleep with you as a way of making up for missed closeness, you are not really helping your child. Instead, carefully review your schedule and see what changes can be made. Even small changes can feel very good to your child– and to you, too.
4. Sex avoidance. Parents need to deal directly with barriers to sexual intimacy. Find a safe way to talk to your spouse about your feelings. Don’t use your child as a shield.
5. Parental anxiety. Parents can be anxious, too. You might be anxious about separation, being alone, or “hurting” your child by rejecting or frustrating him. If you feel anxious, figure out what it’s about and find other ways to comfort yourself.
6. Avoidance of emotional intimacy or avoidance of conflict with your spouse. Do you feel awkward or uncomfortable being alone with your spouse? Kids shouldn’t be in the middle of parents’ conflicts and shouldn’t be used to keep peace. Figure out what you need to do to get things back on track so husband and wife can fit comfortably, just the two of you.

It’s time for a family meeting.

Now you are ready to introduce the new sleep program to your child. At a calm and unhurried time, hold a family meeting (or a meeting between parents and this child). In this family meeting you will:

• Define the problem and invite ideas for solutions.
• Set the goal.
• Outline the rules.
• Choose a simple reward.
• Obtain your child’s agreement.
• Convey your attitude that your child is able to succeed and will succeed.

1. Define the problem. We need to find a way for you to feel safe in your own bed. Sleep is one of the best parts of the day! I know you’ve had scary thoughts and worried feelings, but I bet you’d feel a lot better if we could think of some ways to help you feel comfortable sleeping in your own bed. I know you’ll feel a lot more grown-up. Listen with understanding and patience. Help your child suggest some solutions, and agree to try at least some of them. Help your child take ownership of the problem. You want to motivate your child and help him think about how much better things will be if he can get over these fears.

2. Set the goal. We want you to be able to sleep in your own bed the whole night. We want you to feel safe and be able to fall asleep on your own without Mom or Dad in your room. Be definite and direct. Your child can make suggestions on how best to achieve this goal, but the goal itself is not negotiable.

3. Outline the rules.

• Stay put. After bedtime, you must stay in your own bed the whole night. You are not to leave your bed (except to go to the bathroom).
• Enter the zone alone. At bedtime, we’ll have time to talk and read. Then we’ll kiss good night and you can doze off on your own.
• Lights out, no crying out. After you go to bed and we say good night, we don’t want you to cry out or yell. If you want, we’ll come back to check on you in a little while. Tell us if this is what you want.
• Back in 10. I will check in with you in 10 minutes to see how you are doing. I’ll stay for a little bit to help you relax. I promise to keep coming back to check on you until you fall asleep. But you must wait quietly and trust that I will come back. And you must try your best to relax on your own.

4. Choose a simple reward. Remember, it is best to think of the reward as a fun way to celebrate your child’s accomplishment. Think small and think of shared activities. After you’ve gone to sleep on your own and slept in your own bed for 7 nights, I think we should celebrate. What do you think would be fun?

5. Obtain your child’s agreement.  Kids want to keep their promises.  We want you to promise that you will try your best to obey the rules and get to sleep on your own.  You don’t have to perfect, but you must try.  Do you agree?

6. Convey your attitude that your child is able to succeed and will succeed. Your child has the capacity to sleep on his own and master his anxiety. You convey to your child through word and deed that you believe he is safe, that he has the capacity to calm himself, and that his anxiety will not hurt him. You believe that sleeping alone will help your child become a strong, confident and secure individual. Remember, when you act with confidence, you are giving your child a clear message that all is safe and there is no need to worry. I feel really good about this new plan, honey. I know you can do it! This is going to feel so much better.

Key points you want to emphasize:

• You will always come back in 10 minutes.
• You expect your child to try to relax quietly and fall asleep alone.
• You believe that in the difficult first night or two, your child can tolerate some distress and can manage okay. It will get easier with practice, just like any new habit.
• After succeeding in sleeping alone on a regular basis, your child will feel really good—safe, relaxed, and proud.

Tips on how to calm a scaredy-cat.

Trying to calm a scared child can make parents feel pretty helpless and frustrated. Remember, your attitude, manner, and tone of voice are what is most important. Stay relaxed, patient, and confident. Here are some suggestions.

• Have a talk about the reality of potential threats.  (But you’ve probably already done this!)  Talk about burglar alarms, the creaky noises that houses normally make at night, the zombies that exist only in movies.  But don’t expect this talk to make a lot of difference.  The real intruder is worry!

• Sympathize. I know it’s scary, honey. I’m sorry. I wish you could feel better. Accept your child’s feelings as they are. Keep your tone warm and soothing. Give a hug and a kiss. Be brief. If you feel pulled into a lot of talk about the fear, pull out. Avoid engaging in debate, argument, or lengthy discussion. Show by your actions that you feel comfortably settled with such issues. Keep it short.

• Reinforce positive associations to your child’s room and bed. You have got such a great room. I love your room! Look at this perfect spot for your teddy bear! Aren’t these blankets deliciously soft? You are so lucky.

• Redirect attention to something else. Don’t tell her to think about something else–get her to think about something else. Prattle on about the details of your world–your dog’s face when he feels guilty, your plans for planting petunias, the pros and cons of buying a new set of tires next Saturday. You are redirecting her attention subtly, naturally. You don’t announce it: “I’m now going to distract you so you can quit thinking those scary thoughts and I can go to bed.” You simply shift the topic to something ordinary. If your child goes back to talking about fears, don’t get frustrated or impatient, just sympathize again. Then resume redirecting. Try getting her to help you with some small decision. If she can help you, then she can feel useful and competent. I’m trying to decide which tablecloth to use when Grandma comes to dinner. The one with red flowers is pretty, but the blue one looks good with our china. What do you think?

• Create a positive mood by talking about things you like and things that make you feel good. Then talk about things the child likes. Be careful not to over-do it, or else the child may feel manipulated. Be gentle. If this increases her protests, stick to neutral topics.

• Encourage acceptance of the problem. Your child might feel that he must sleep and may just get more tense and frustrated the longer sleep eludes him. When you give your child permission to remain quietly wakeful, you end the battle, thus helping him relax. It’s okay if you don’t sleep right now, honey. It’s restful to just lie quietly in your bed. You can let your mind drift and think about anything you want.

• Use humor. Make up a story that exaggerates the feared object and transforms it into something silly and funny. That scary robber with the chainsaw you keep thinking about–what if you threw water balloons at him and he slipped and fell on his butt and he landed in thick, gooey mud and he got so mad his face turned bright red and a bull saw it and started charging at him and that silly old robber had to run and run and run all the way to Nebraska.

• Meditation and relaxation exercises. Try watching our Three-minute Mindfulness Meditation on Youtube.  It’s very calming.

You are ready to start!

At this point, you have taken the necessary steps to prepare for the new sleep program. You have:

1. Gotten the bedtime routine into a healthy pattern.
2. Examined your own feelings about the problem.
3. Held a family meeting to discuss the problem: you’ve set the goal, established the rules, chosen a reward, and obtained your child’s agreement to try hard.
4. Expressed a positive and confident attitude that your child will conquer his fears and will succeed.

So choose a night to begin, and start!

So what should we expect?

Most kids respond very positively right away. You’ll return for a check-in to see your child is sleeping soundly. There may be some initial protest and anxiety, but if you remind kids of the rules, stick to the rules yourself, help kids take ownership of the problem, and act with a positive attitude, you will probably achieve success within a few nights. Many kids are able to fall asleep alone within 15 minutes by the second or third night.

“Back in 10” check-ins can gradually be extended to longer than 10 minutes. For example, on the second night of the program, after saying good night you might check back in 10 minutes, and then check in a second time 15 minutes later. (You don’t need to announce to your child that you will be doing this.)

Often, children quickly learn to fall asleep alone at bedtime, but every night awaken at 12:00 or 1:00 and want help falling asleep again. This happens because the old habit is strong and it takes several nights to firmly establish the new routine. Handle these middle-of-the-night wakings the same way you would at bedtime—provide brief reassurance, tuck her in, and check in every 10 minutes until she falls asleep. Once the new sleep habit is firmly established, the night wakings will stop.

Relapses will occur. Do not be worried or discouraged. Simply stick to the program and its rules and good sleep behavior will resume. Don’t backslide into old behavior by letting your child sleep in your room “just this once” because you will very quickly have the problem every night all over again. Similarly, be sure to avoid prolonged talks to calm your child or else you will be reinforcing his anxiety. After bedtime, keep such talks brief and you will communicate by your actions that you are confident he is safe and can manage just fine by himself.

The toughest part is making the decision to start dealing with the problem. You have to make up your mind that now is the time to start, that you are ready and your child is ready. You will probably worry that your child will protest, cry, wail, rebel and demand that you keep doing what you’ve been doing. More often than not, parents expect much more difficulty than actually occurs. In reality, parents are usually surprised at how smoothly and easily the child adapts.

What do I do about…? Problems, problems, problems!

• What if my child keeps demanding check-ins every 10 minutes for hours?  Do I have to stay awake all night? Parents often worry about this, but it seldom happens. After the first night or two, kids learn that the routine won’t change and settle down. But if this becomes a problem, you can switch to the Special Ticket Plan.
• My child keeps calling out. Firmly repeat the “don’t cry out” rule, saying you know he can wait and you expect him to try. Keep it very brief. Be stern, but do not discuss, threaten, or get mad. Then ignore any further calling out. Stick to “Back in 10.” Remember, your child needs to be quiet and wait to get your attention. This way, your child begins to learn how to rely on his own self-soothing.
• My child tries to bargain with me and demands I come back in 5 minutes or 2 minutes. Repeat the 10- minute rule. If you sound like a broken record, that’s good. Don’t negotiate. Again, communicate to your child that you are confident he can handle it. But you can also consider the Back-in-10 Flexible Plan.
• My child wants me to stay upstairs until he falls asleep, but I want to be downstairs. Try not to bend on this one. Repeat the rules. Again, tell your child that you will check in and provide reassurance every 10 minutes if necessary, but you expect him to stay put and stay settled while you are downstairs. Again, you convey this with confidence that he will succeed.  In some cases, however, you may need to start by staying near the child for the first few nights, but you have to move progressively farther away within a few nights.
• My child gets up and comes into my bedroom, really scared, and gets in my bed. Do the no-talk walk. Take her hand and walk her back to her bed. On the way, keep talking to a minimum. Re-state the “stay put” rule in a firm but neutral voice. Offer one minute of comfort, then leave. Offer a “back in 10”. If your child wakes you in the middle of the night you will of course be sleepy, but don’t give in to the temptation to let your child climb into your bed. Wise up and get up!
• Sometimes we don’t even wake up when our child gets into our bed. Do what is necessary to be sure you do wake up: keep your bedroom door closed (maybe even locked); hang a bell or frying pan from your doorknob to make noise if the door is opened.
• What if my child has a nightmare? Can she sleep in our bed? No. Stick to the rules. Offer comfort in her room when she is in her bed.
• What if our child is ill and feverish? I want her to be close to me. She must sleep in her own bed. Check on her periodically if you like.
• When my husband is away on business my child is scared, and I enjoy the comfort of my child in bed. Is this okay once in a while? Letting your child sleep with you “once in a while” only reinforces the problem. Sticking to bedtime routines creates feelings of security. Teach your child to be secure and confident by helping him master his fears and showing him that you feel safe yourself.
• My husband and I are divorced. When my son spends weekends with his father and his new wife, he sleeps in their bed. Can this Goodnight Worry program still succeed at my house? Yes. Kids are used to having different rules in different situations. First, establish independent sleeping at your house, and then work with your ex-husband to establish it at his house.

When is it time to get professional help?

Seeing a psychologist can be a big help.  You should consider it if:

• You have tried the Goodnight Worry Program for 3-4 weeks and you are not making any progress.
• Your child has other problems besides the sleep problem–a lot of anxiety about going to school or separating from parents, a lot of irritability and temper tantrums, learning disabilities, or a lot of family stress and conflict.

Therapy sessions with a psychologist can result in pretty rapid improvement.  Here are ways a psychologist can help:

• The psychologist can help you see mistakes you’re making.
• The psychologist can help your child learn to use tools for managing anxiety (relaxation skills, talking back to the fear, self-distraction, positive self-talk).
• The psychologist can help build your child’s motivation to face the problem.
• The psychologist can help parents set limits.

The first session is usually just with the parents to provide background information. Then there is a meeting with the parents and child together.  Then up to three visits with the child alone or with the parents.  The total number of visits to resolve the sleep problem is typically 6-8, often fewer, rarely more. Additional visits might be needed to deal with other issues.

Getting help via Zoom.

For families who do not live in the San Francisco Bay Area, I offer consultation for sleep problems via Zoom sessions.  Feel free to call or email me to discuss options.
925-256-9696.  david@ogradywellbeing.com

About Dr. David O’Grady

Dr. David D. O’Grady is a clinical neuropsychologist practicing in Walnut Creek, California. He trained as a postdoctoral fellow in the Division of Behavioral Pediatrics at UCSF Medical Center. Dr. O’Grady works with children, adults and families.  He has a special interest in helping kids and adults overcome problems of anxiety and worry.  As a board-certified neuropsychologist, Dr. O’Grady also performs neurocognitive evaluations to understand how problems in brain functioning affect learning, memory, concentration and other thinking skills.  He is an assistant clinical professor at the University of California at Berkeley.

All rights reserved   © David D. O’Grady, Ph.D., ABPP