What does science-based help for adult sleep problems tell us about baby or toddler sleep problems?

What is the most effective way of helping adult sleep problems?

A third of adults experience insomnia or sleep problems at some time in their life, not taking into account the period of time when we might be woken by a baby or child.

The research shows that the most effective help for insomnia, much more so than medication as a general rule, is a treatment which addresses our thoughts and our behaviours concerning sleep. This treatment is known as Cognitive Behavioural Therapy for Insomnia (CBT-I).

It's helpful to know the things CBT-I tells us about healthy sleep when you're finding your way through baby or toddler sleep challenges. They are directly science-based and proven to help. That's why I've put them here for you.

You might be surprised to find that many of the recommendations you hear about baby and toddler sleep either don't take into account, or even contradict, these sleep facts below.

We often have inaccurate and unhelpful beliefs about adult sleep

The research shows us that we have a natural tendency to exaggerate

• How little sleep we've had at night

• The impact of not-enough sleep on our daily lives and function.

Just knowing that this is how our brains work can help us maintain perspective when sleep isn't going as well as we might like!

Here are two other inaccurate or unrealistic beliefs about sleep, which are widespread in our society.

• We need seven or eight hours of sleep at night for normal good health and function

• It's abnormal to wake up in the night.

Highly variable durations of sleep from night to night in the one adult, and waking regularly during the night (even when you don't have a small child in the house), are normal. There is more on this here.

We can work with our biological sleep regulators to create better sleep

Working with the body clock and sleep pressure have been proven to help with adult sleep problems. If you had adult sleep problems (without having a baby or toddler), CBT-I would require that you

• Get up at the same time each day. This is very important, because getting up at the same time each day resets the body clock

• Don't try to lengthen the amount of time you spend in bed when you're tired

  • Spend less time in bed overall than you've been sleeping recently, as you get started on making changes

  • Stay in bed for roughly the amount of time you've been sleeping at nights, no more, as a general rule going forward

• Don't take naps during the day. If you really need to nap, keep it brief (perhaps 20 minutes) and in the early afternoon, not late afternoon. Daytime napping can perpetuate night-time sleep problems

• Only go to bed when you're feeling tired.

We can make behaviour changes which help with better sleep

Here are the other things you would do to create what's referred to as good sleep hygiene, if you were an adult who has sleep problems (without this being triggered by a baby or toddler).

• Try to exercise as much as possible during the day. You can also exercise in the evening, just avoiding high intensity exercise (such as interval training) in the hour before you plan to go to bed

• Practice some relaxation training, such as conscious and progressive muscle relaxation

• Don't drink coffee late in the day. You'll know what your own threshold is. For instance, I can't drink much green tea, since it contains caffeine, after about two o'clock in the afternoon without it impacting upon my sleep

• Don't drink alcohol before bedtime, and keep alcohol use moderate or less. Alcohol can seem to make us feel drowsy, but actually results in increased fragmentation or difficulty with sleep

• Create some nightly rituals, which dial down your sympathetic nervous system as you relax and prepare for sleep. For many of us this might be a shower or bath, cleaning our teeth, turning off the main bedroom light and turning on the bedside light, and then some kind of pleasant reading (not using a device), perhaps a reading that is inspirational and helps us remember what matters in our life

(This adult bedtime routine helps adults with insomnia but doesn't extend into a need to create routine for babies and toddlers, the way you might hear. Dialling down our little ones' sympathetic nervous system requires very different input to adults, with a focus on feeds, depending on your child's age, and physical closeness. Attempts to create adult-like sleep routines for babies and toddlers often spectacularly backfire!)

• Avoid blue screens and devices more generally in the couple of hours before bedtime, including TV, the computer and your phone. Turn off your devices 15-30 minutes before bedtime

• Get up if you've been lying in bed for 15 or 20 minutes and haven't gone to sleep. Do something pleasant, such as reading, until you feel tired again. This avoids associating the bed with lying awake for long periods

Because The Possums Sleep Program is genuinely evidence-based or science-based, you'll notice that it includes information learnt from the research into CBT-I.

Selected references

De Crescenzo F, D'Alo GL, Ostinelli E. Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis. Lancet. 2022;400:170-184.

Eigl E-S, Hauser T, Topalidis P, Schabus M. On the efficacy of a CBT-I-based online program for sleep problems: a randomized controlled trial. Clocks & sleep. 2023;5:590-603.

Feng S, Dai B, Li H. Efficacy of cognitive behavioral therapy for insomnia in the perinatal period: a meta-analysis of randomized controlled trials. Sleep and Biological Rhythms. 2023;22(2):207-215.

Finucane E, O'Brien A, Treweek S. Does reading a book in bed make a difference to sleep in comparison to not reading a book in bed? The Peope's Trial - an online, pragmatic, randomised trial. Trials. 2021;22:873.

Herteinsteine E, Trinca E, Wunderline M. Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: a systematic review and meta-analysis. Sleep Medicine Reviews. 2022;62:101597.

Messman BA, Wiley JF, Yap Y. How much does sleep vary from night-to-night? A quantiative summary of intraindividual variability in sleep by age, gender, and racial/ethnic identity across eight-pooled datasets. Journal of Sleep Research. 2022;31(6):e13680.

Muench A, Vargas I, Grandner MA, Ellis JG. We know CBT-I works, now what? Faculty Reviews. 2022;11(4):https://doi.org/10.12703/r/12711-12704.

Quin N, Tikotzky L, Astbury L. Preventing postpartum insomnia: findings from a three-arm randomised controlled trial of Cognitive Behavioural Therapy for Insomnia, a responsive bassinet, and sleep hygiene. Sleep. 2024:https://doi.org/10.1093/sleep/zsae1106.

Stutz J, Eiholzer R, Spengler CM. Effects of evening exercise on sleep in healthy participants: a systematic review and meta-analysis. Sports Medicine. 2019;49:269-287.

Trauer JM, Qian MY, Doyle JS. Cognitive Behavioral Therapy for Chronic Insomnia. Annals of Internal Medicine. 2015;163(3):191-204.

Recommended resources, acknowledgements, and selected references for articles in the Caring for you section of The Possums Sleep Program are also found here, including selected research evaluations of both Acceptance and Commitment Therapy and Compassion-focused Therapy in the perinatal period.