Sleep issues are incredibly common in childhood. “The American Academy of Pediatrics estimates that sleep problems affect [25% to 50% of children and 40% of adolescents].” While prescription medication or setting strict bedtime might offer temporary relief, they often don’t address the root causes of insomnia. A highly-effective research-backed method that can help children overcome sleep issues is Cognitive Behavioral Therapy for Insomnia (CBT-I). Learn how CBT-I can help your child overcome sleep challenges, why it’s so effective, and tools to help them get restful sleep.
What Is CBT-I?
CBT-I is a structured program designed to treat chronic insomnia in children by retraining the brain and body to sleep. Unlike sleeping medication which can mask what’s going on, CBT-I helps you overcome the underlying causes of their sleep difficulties. CBT-I is a collaborative yet structured approach that helps children’s brains and bodies associate the bed with sleep, not with play or anxiety.
How Does CBT-I Work for Kids?
Our CBT-I therapist will work with your family to discuss tools and strategies to improve your child’s sleep environment and help them build a healthier relationship with sleep.
1. Sleep Restriction (Bedtime Fading)
For example, if your child goes to bed at 8:00 PM, but doesn’t fall asleep until 10:00 PM, the bed can start to feel like a place of restlessness rather than sleep. This is where bedtime fading comes in. By temporarily moving your child’s bedtime closer to when they naturally fall asleep, it helps build up “sleep pressure” so they can fall asleep more easily. Once falling asleep becomes easier, their bedtime is gradually moved earlier to build a consistent sleep routine.
2. Stimulus Control
The stimulus control technique trains the brain to associate the bed with sleep rather than wakefulness. For kids, this means:
- Using the bed for sleep only, so no reading, tablet time, or playing with toys in bed.
- Leaving the bedroom if they can’t sleep after 20 minutes and doing a quiet activity until they feel sleepy again.
- Keeping a consistent wake-up time, even on weekends.
3. Cognitive Restructuring
Children, especially those aged 6-12 often have anxiety about sleep. At this age they may worry about daily stressors or stressful life events. They might be worrying about not sleeping, which is counterintuitive and could be affecting how quickly they fall asleep. They could be worrying about a test at school the next day or about monsters under their bed. Cognitive restructuring helps them identify these worrying and scary thoughts and replace them with healthier, more realistic ones. For younger kids, this might involve using “worry dolls” or a “worry box” to put their fears away before bed.
4. Relaxation Training
An overactive nervous system makes it very difficult for a child to fall asleep. When a child is stressed, anxious, or overstimulated, their body stays in a state of hypervigilance which releases stress hormones that keep the brain awake. Even if they feel tired, this heightened state can make it hard to relax, fall asleep, or stay asleep. CBT-I teaches kids specific techniques to calm their bodies such as:
- Deep, calming breaths using the diaphragm
- Progressive muscle relaxation to help release tension by gently tightening and then relaxing each muscle group, moving from their toes up to their head
- Using visualization to imagine a relaxing place or scene to promote calm
Why CBT-I Is Effective For Children?
Research consistently shows that CBT-I is highly effective. Behavioral interventions for pediatric insomnia have been shown to significantly reduce the time it takes children to fall asleep and decreases how often they wake during the night. CBT-I is effective because it gives children agency over their sleep. Instead of sleep being something parents force upon them or is something that causes nightly worry, it becomes a skill they can practice and master. It gives them tools to self-soothe, which builds confidence and reduces bedtime anxiety.
Tips For Parents On How To Improve Your Child’s Sleep
CBT-I can feel challenging at first, especially during bedtime fading when your child may be tired for a few days as they adjust to their sleep schedule. Here are tips for how you can support the process.
Be Consistent
The success of CBT-I depends on consistency. For example, if your child is expected to leave the room after 20 minutes of being awake, it’s important to follow through every time, even if it’s really early in the morning. Skipping or bending the rules can unintentionally reinforce the sleep habits you’re trying to change.
Model Good Sleep Hygiene
Children learn by watching. Children notice when rules don’t match actions, so if you expect your child to avoid screens at bedtime but them yourself, this can feel inconsistent and confusing. Create a nightly wind-down hour by lowering the lights and effecting a no screens policy so everyone can relax.
Create A Sleep Sanctuary
Create a sleep-friendly bedroom for your child. If they’re afraid of the dark, use a red-hued nightlight because a red light interferes less with melatonin production than blue or white light. Clear the room of distractions like toys or laundry piles, which cast scary shadows at night.
Celebrate Small Wins
CBT-I isn’t easy for kids, so celebrate small victories. A sticker chart or small rewards can celebrate each step, and rewarding progress helps the process feel supportive, not punishing.
What Are The Long-Term Benefits Of CBT-I
Good sleep is the foundation for a child’s development and overall health which helps:
- Emotional Regulation⎯Kids that get a good night sleep have fewer tantrums and manage frustration better.
- Academic Performance⎯Getting adequate sleep helps kids to remember what they learn and stay focused in class.
- Physical Health⎯Restful deep sleep plays a key role in growth because it’s when the majority of the body’s growth hormone is produced.
- Immune System Function⎯Sleep helps the body fight off illness.
Helping your child with good sleep habits now, reduces the risk of chronic insomnia as they grow into adolescence and adulthood.
Los Angeles CBT-I Insomnia Therapists For Children In Los Angeles & Virtually
Childhood insomnia isn’t forever. Sleep is something that can be taught, and habits can be changed. CBT-I is an effective, research-backed way to help your child’s insomnia. Contact our Los Angeles or Beverly Hills office for more information or to schedule an appointment with one of our CBT-I therapists.
