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Episode 14: Autism & Sleep: Tips from a Certified Behavioral Sleep Specialist | FREE ABA CEU — Transcript

by Blossoming Together · 15,641 words · 2,166 segments · language en · Watch on YouTube

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0:00hello everyone welcome back to the
0:01blossoming together podcast today we
0:03have a guest speaker on her name is
0:05Emily and before we do a proper
0:07introduction mean Cur just want to go
0:09over the objectives so objective one
0:12participants will be able to identify
0:14and explain the prevalence and impact of
0:16sleep problems among autistic Learners
0:19and understand the importance of
0:20improving Sleep Quality for this
0:24population and objective two is
0:26participants will be able to apply
0:28specific behavioral strength iies and
0:30interventions to improve sleep hygiene
0:32and routine for autistic Learners across
0:34different age
0:37groups so we have Emily here Emily is a
0:41sleep educator and behavioral sleep
0:43specialist she's going to come and
0:45discuss how to improve sleep and
0:46autistic Learners yes so Emily I did the
0:51ceu course that you provided um through
0:55ready set sleep and there you kind of
0:57told me a little bit about how you've
0:59worked in the field since the 2000s and
1:01has been dedicated to improving sleep
1:03amongst autistic individuals since 2010
1:06can you tell us a little bit about that
1:08yes ma'am uh I entered the field in 2000
1:11so I've been in the field like 24 years
1:13but I had my babies uh between like 2008
1:182010 H and I just was suffering with
1:20sleep myself and the more digging I did
1:22into uh you know sleep support and sleep
1:26help just to get my own sleep and my
1:27kids sleep better I just realized it was
1:29all ABA and I started thinking about how
1:32can these things apply to our Learners
1:35because I mean I had infants so it was
1:38kind of easy all of the resources were
1:40out there for infants and like very
1:41young toddlers right like kind of up to
1:44the age of three maybe five a little bit
1:48um but there were there really wasn't
1:50anything out there for kids who were
1:52within our population which was that
1:54school population even into the teenage
1:57population even into the adult
1:58population so I did some digging and uh
2:02I learned just kind of trial and error
2:07that the same sorts of principles worked
2:09and the same sorts of principles applied
2:12but it did take a little finessing and
2:15um I I was able to play with it within
2:17the scope of uh the ABA services that I
2:20was providing for my ABA company they
2:22were super open to me working with
2:25families um you know as long as we were
2:28keeping it in our lane of ethics in ABA
2:31uh they just they were letting me kind
2:34of thore and I just kept looking for
2:37resources but there really weren't any
2:40out there Greg Hanley was the only one
2:43that had anything really going and that
2:45was sort of a 4our workshop that he
2:48would offer at conferences and things
2:50like that and it was great really
2:53lifechanging um but he left the sleep
2:56and then went to go do his magic with
2:59CFA and
3:02yeah I mean he was the Sleep guy before
3:04he was the PFA guy um it was really
3:08shortlived um and he had a Sleep Clinic
3:10in H Western Mass and he closed up shop
3:13and gosh by
3:152018 he was sort of 2017 even maybe he
3:19was kind of full full-blown uh PFA so I
3:23I got a little short window in there
3:26with um you know a mentor I mean so to
3:29speak just kind of watching what he was
3:32doing uh but I just sort of kind of took
3:34it on my own after that just enhanced
3:37what was going on and continue to do
3:39research into the Sleep Sciences um
3:41always keeping it you know within the
3:43lens of what we do as ABA practitioners
3:46and kind of went from there yeah I can't
3:49wait and a little bit like later we do
3:51want to talk about the ABA principles I
3:53just think it's so interesting I I find
3:55it that I found your course because I
3:57was a new mother who was struggling with
4:00sleep myself like I wasn't getting any
4:02sleep at the time that I did your course
4:04my one to three-month-old not getting
4:06any sleep and I I just remember
4:08struggling so much with her and it just
4:11reminded me of all the families that I
4:12work with who had come to me and said
4:14like oh I'm having these sleep
4:17difficulties um and there CH like
4:19children are like seven to 10 years old
4:21and I'm like oh my gosh I can't imagine
4:23struggling with sleep for the next seven
4:25years so then it inspired me to be like
4:27okay I need to make a change in this
4:29area be able to actually help because I
4:31feel like a lot of times what happens um
4:34is parents or you know people who are
4:36having sleep difficulties they'll come
4:37to us but sometimes we find like okay
4:39it's a little bit outside of our scope
4:40like I hear your Hing it's really big
4:42challenge let's target it by the
4:44function but outside of that I don't
4:45have a lot of resources to offer you so
4:48I'm really grateful for the resources
4:49you're providing our community yay so
4:52what's the difference between a sleep
4:53consultant and a sleep specialist okay
4:56yes what's the difference between a
4:58sleep consultant and a sleep specialist
4:59so out in kind of the the Big World
5:03there are certified Sleep Consultants
5:05and they are typically certified between
5:09uh birth from birth
5:11to um usually about five years so I've
5:15seen a few now coming up to six years uh
5:18but for for the most part it's birth to
5:20five some people call themselves sleep
5:22specialists the problem is is that if
5:24you go look for a sleep specialist it's
5:27going to come up with a medical sleep
5:28specialist so I'm really careful with
5:31our certification to make sure that
5:33we're putting ourselves as behavioral
5:36sleep specialists and that not just
5:38sleep specialists because that would be
5:40medical um if you look for a sleep
5:42specialist you're going to get someone
5:43who's going to rule out Apnea seizur you
5:46know breathing problems things like that
5:48yeah but we're also not just Sleep
5:49Consultants because a sleep consultant
5:51can go anywhere and get certified um you
5:54don't need to have any prerequisites you
5:56can be a high school graduate you can be
5:58a college graduate um that as a
6:00certified behavioral sleep specialist
6:02you have to be Master's level you have
6:03to be a board certified behavior analyst
6:05or an equivalent you could be qba or an
6:08IBA now that um the the bacb is sort of
6:11dissolving in in international markets
6:14it really requires a basic level of
6:16Education um and background so that
6:19everyone comes in on an even playing
6:21field uh and so I mean that's really
6:24what I consider the difference between a
6:26behavioral sleep specialist a sleep
6:28specialist and sleep consultant it's
6:31really and you want someone who you know
6:35if if you're talking behaviors you know
6:37and and you are a family that is you
6:40know struggling with your child with
6:42autism or any other diagnosis for that
6:44matter and you're already plugged in to
6:46Behavioral Services it sort of rings a
6:49bell a little bit and says like oh this
6:51is a behavioral okay well my kid is
6:54receiving Behavioral Services so yeah
6:57maybe that's in the same Lane
7:00that makes a lot of sense um kind of
7:03going off of that and like how we target
7:06it like typically like the population
7:07that I am using my specialization for is
7:10the autistic population so I really
7:12wanted you to kind of break down how
7:14important this is for our population and
7:16the Sleep issues that we see yeah so I
7:19think it's important first and foremost
7:21to understand how important sleep is for
7:23humans right um just from the general
7:27sleep Sciences we know that a poorly
7:30slept brain uh a poorly slept human with
7:34General um they're more
7:37impulsive they uh suffer with poor
7:40emotional
7:41regulation yes they tend to be more
7:45reactive um and they tend to be uh in in
7:49a little bit more uh poor health because
7:52they are eating fully because poor leads
7:55to poor uh feeding
7:57choices so given those basic things that
8:01we know about poor sleep in humans right
8:07um it's not a far leap into the autism
8:11population to say okay now we take the
8:14autistic brain which fundamentally as
8:17far as we know with the research we have
8:19and the information we have right now
8:21the autistic brain is no different than
8:23the human brain than the average they
8:26they have not found it to be
8:28fundamentally you know differently yeah
8:30shaped or or different uh neural
8:33Pathways or anything like that so far
8:35you know so assuming that the autistic
8:37brain looks physiologically like the
8:40human brain uh well the aage human brain
8:42right the
8:43non um we can make some assumptions here
8:46to say okay a poorly slept child with
8:48autism is also going to be reactive is
8:50also going to be impulsive is also going
8:52to have trouble with po emotional
8:53regulation is also going to have trouble
8:55with beeding and when we say it that way
8:58we go yeah that is pretty much every
9:00child that walks through our doors okay
9:02you the behavioral challenges yeah and
9:05all the yeah difficulties that we're
9:06seeing right and so then the question
9:09comes to me right as as the person who
9:13understands sleep and understands autism
9:15and understands the behavior world I go
9:19well why aren't we focusing on sleep as
9:21a first line of defense for these
9:23children at the very very very very very
9:27minimum getting them better sleep so we
9:30can see is this impacting their behavior
9:33are we seeing less intensity are we
9:35seeing less frequency are we seeing
9:37greater latencies are we seeing you know
9:40what are we seeing in light of better
9:43sleep thisis go if they're better sleep
9:46they'll probably be slightly better
9:49behaved if if anything they're just
9:52showing up as their best s
9:55exactly and i' never realized like the
9:57prevalence of like sleep problems in
9:59artistic Learners when we were doing the
10:01research for this episode I learned it
10:03was like 40 to 80% of Learners might be
10:06impacted and it's not a question I feel
10:08like that comes up when I was asking
10:10like parents anything like oh like how
10:12does your like learner sleep feel like
10:14it's a really important question to ask
10:16too because I mean if you've been doing
10:17it since like the newborn stage and
10:19you're like seven now you it might just
10:22be uh like your normal so you don't
10:25realize maybe you should share it with
10:26your bcba I was just going to note I
10:28think that like a big challenge with it
10:31like a lot of times that parents of
10:32autistic Learners to us aren't reporting
10:34it is because all parents I think are
10:36struggling with this which is like the
10:39challenge there's a lot of sleep issues
10:41and they're like oh this is just an
10:42issue outside of the ABA specialist with
10:44my autistic learner yep yep 100% and
10:47they're also told very early on that
10:50their child may never sleep well because
10:51of the diagnosis of autism which we now
10:53know to be 100% not true um it's it's
10:57rhetoric uh it's myth if you you know if
11:01we dare use the word myth but it really
11:04just is not substantiated by any kind of
11:06data or research that uh that improve
11:10that sleep improvements is not possible
11:13right so they're they're not they're not
11:17mutually exclusive right that uh sleep
11:20treatment and the fact that sleep
11:23problems are prevalent in the population
11:25like you said you it's 40 to 80% roughly
11:28it's like 43
11:30or
11:31something 40 to
11:3380% and I always say it's not
11:365% it's a large we know it's not five no
11:39it's a pretty big chunk
11:42right right it's it's it's it's pretty
11:45big um and and so what I mean about
11:48Mutual exclusivity is that you know just
11:50because kids have a diagnosis of autism
11:53a population that is known to suffer
11:56with sleep problems does not inherently
11:58mean that they are not curable that it
12:01is not treatable just because there's
12:03prevalence there right um and so that's
12:06kind of what what I combat against every
12:09day is like just myth busting this idea
12:12that just because it's a problem means
12:14that it has to be a lifelong problem
12:16means that there is no treatment means
12:18that we just have to suffer like this
12:21and families are suffering and it breaks
12:23my in your experience when you started
12:27like treating some of these sleep
12:28difficulties using the strategies that
12:30you were what were some of the um like
12:33improvements in your autistic Learners
12:34that you
12:36saw well I mean Behavior reduction first
12:39and foremost uh less impulsivity kids
12:42were calmer they were I mean their their
12:44goals starting to be uh metad with more
12:48consistent Cadence so we would go from
12:50this like wishy-washy up and down and up
12:52and down and up and down and every day
12:54looked totally different to just more
12:56linear progress I would say um and even
13:00if it was you know not always trending
13:03totally upward it wasn't up down up down
13:07up down up down up down up down right
13:09and you're seeing the progress more yeah
13:11you're seeing the
13:12progress um and just consistency with
13:16the kind of a human we're showing up to
13:19every day so you know we get these kids
13:22that it's like every day is a different
13:24day they show up some days and they are
13:26just not themselves and you can tell
13:28just like like you can tell with a
13:30coworker who hasn't slept well right um
13:33so these these emotional variabilities
13:35right they come into session and some
13:37days they're just a mess and some days
13:40they're ready to learn and and that's a
13:43really hard type of of student teach
13:46right in any environment so what we saw
13:50was more consistency right more
13:52predictability with progress a better
13:55Cadence with progress um we saw more
13:58family engage
13:59we saw parents being happier parents
14:02being more inclined to engage in parent
14:05trainings because their parent training
14:08for Sleep had been so successful they
14:10were more likely to say okay what more
14:13does this person have to offer me
14:14because don't forget the one service
14:17that is pervasively left on the table
14:20every month is parent training hours
14:22right right yeah it's just very engaging
14:25and we're not and we're not wondering
14:27why it's because we're not bringing
14:29anything value if you're not bringing
14:31anything of value to par training
14:33parents aren't going to wa why would
14:35they start bringing valuable parent
14:38training which was sleep and maybe
14:42feeding maybe toileting you know systems
14:46things that were really tangible Beyond
14:49how's your child doing let's check in
14:51let's have a casual conversation parents
14:53started to engage more because they I
14:56don't know it's just kind of proof that
14:57the the person coming in into your home
14:59every day knows what they're talking
15:01about you yeah it like gives them that
15:04buy and like again it's a commitment for
15:06them they're taking time away from their
15:08work their day to attend parent meetings
15:11it's got to be something that they're
15:12getting value from yeah and that's why
15:14they cancel all the time you get parents
15:16canceling all the time why I mean we
15:19have to check ourselves a little to tell
15:21you right now it's
15:22personal yes it's definitely it
15:25unfortunately and I think that's like
15:26such a good point we have to be willing
15:28to reflect on it yeah I mean like be
15:31open to that and say like what am I not
15:34offering this family that they don't
15:36have the Buy in that they don't want to
15:38meet with me um yeah that is a point
15:41it's I I don't see that as a them
15:43problem I see that as a mean problem if
15:46someone's you know cancelling on me all
15:48the time like I have to sit with that a
15:51little bit and go like why can I do
15:54differently to help like this family
15:56yeah just a moment of reflection yes
16:00absolutely well with that in mind um we
16:03kind of wanted to talk about the like
16:05recommended sleep for the different age
16:08groups and I know that we talked about
16:10this in the course and this is something
16:12that I feel like a lot of BB who aren't
16:15parents don't even realize because until
16:16I became a parent I didn't realize the
16:18importance of those wake windows and the
16:19different a wake windows for all the
16:21different ages um so if you could break
16:23that down and help us understand that a
16:25little bit Yeah so wake windows are uh a
16:29little bit of a a mystery but you can
16:32kind of categorize them and break them
16:34down a little bit by age um but the idea
16:37behind awake window is it's the amount
16:38of time that the body needs to be awake
16:41before it will be uh accepting of sleep
16:45so um you know you have to be awake a
16:48certain amount of time and that's
16:50different for every uh body a a little
16:53bit to some degree but these are
16:55averages yeah but these are averages but
16:58you have to be awake a certain amount of
16:59time to be able to generate sleep at
17:01some point at the end of the day or for
17:03a nap or something like that so these
17:05waking windows are constantly expanding
17:07in childhood and then into
17:09adulthood um and they sort of Flatline a
17:11little bit in adulthood for a very long
17:13time um but if you look at the Sleep
17:16needs of let's say a one-year-old and
17:18the Sleep needs of a 5-year-old and the
17:21Sleep needs of a nine-year-old and the
17:22Sleep needs of a 13-year-old they're all
17:25going to look different well what looks
17:27different about them is amount of time
17:29the body is able to tolerate being awake
17:32so if you look at a one-year-old we look
17:34at
17:35about roughly a five hour waking window
17:39now that's going to depend on if the
17:40child is 12 months 18 months 20 months
17:44right so why're still cting mon they're
17:47so close together right exactly and and
17:51you know the waking window might be
17:52different at each of those months right
17:55because they're still very young and the
17:56waking window is constantly expanding it
17:58in the first three or three to five
18:00years yeah right and then we look at the
18:022-year-old and maybe it's about six
18:04hours roughly and then the
18:06three-year-old the nap kind of drops
18:08around three years old now a
18:10three-year-old between three and four
18:11years old might be able to only tolerate
18:14six hours a week and might need that nap
18:17they might be able to tolerate 12 hours
18:19a week might not need a nap and might
18:21just be okay having just an earlier
18:24bedtime and they kind of fall into this
18:26sort of 12 hours awake 12 hours of sleep
18:3012 hours awake 12 hours sleep yeah that
18:32jum so tricky like it's like at three
18:36years old from six to 12 hours and you
18:38have to like range okay what's the
18:39perfect amount where's that like perfect
18:41s yeah and so this determines what time
18:44bedtime is going to be so the way this
18:47plays out in our Learners is that we
18:50have many Learners who are let's say 8
18:52years old 12 years old 15 years old and
18:57their parents are still trying to put
18:59them to bed at 8:00 well that's not
19:01going to work for a learner who's older
19:04yeah but because parents don't
19:06understand this this idea of waking
19:08windows and that my child needs to be
19:10awake longer and longer and longer as
19:12they get older and older and older it
19:15creates this sleep resistance bedtime
19:17behaviors and very often when we walk
19:20into a family we go oh they're 12 and
19:22you're putting them to bed at 8 well why
19:24don't we put them to bed at 10 and then
19:27you're not going to have to deal with
19:28all these squirrly behaviors for two
19:31hours every night that sleeply and see
19:35and we'll talk about like some of the
19:36common sleep CH so the family will say
19:38it takes them two hours to sleep and I'm
19:41like well what you know to fall asleep
19:43and I'll say Well they're 12 what time
19:44you're putting them to bed and they'll
19:46say like oh 8:30 and I'll say like yeah
19:48that tracks you're going to get really
19:51crummy behaviors from your 12-year-old
19:54if you're trying to put them to bed at
19:55eight sure protest they sure will
19:59protest in in any home it has nothing to
20:02do with the autism yeah or the down or
20:05the Prader Willie or the inulin syndrome
20:07or the fragile ex or whatever it is this
20:10is just people this is just people
20:13they're probably Cranky from the night
20:15before right like okay so you put them
20:17down really early and we had this like
20:19big resistance and now we finally go to
20:22bed maybe it's really late and we wake
20:24up and we still feel really crummy so
20:26then the parents are like let's put them
20:27to bed a little early
20:29to try to get them to sleep a little
20:31longer and it becomes this really long
20:33cycle Kristen knows I call it the toilet
20:35B swirl of problems it's just like one
20:38thing leads to the next and it just like
20:40flushes right down the toilet and we're
20:42all going down we're all going I wanted
20:45to pause for our first code word is
20:48actually gonna be sleep the question I
20:50have for you Emily is how can cargivers
20:52and practitioners identify if a child is
20:55getting enough sleep considering
20:58individual variability it's hard to
20:59guess I know we talked about the Wake
21:01windows but outside of that how can I
21:03know my my learner is getting the most
21:05sleep that they
21:07need yeah yeah so we kind of start with
21:10the Wake Windows just to give sort of an
21:12average so we would know that let's say
21:16a 5-year-old who's only getting six
21:18hours of sleep we would know that's not
21:20enough right so straight off the bat we
21:22can just say okay that's definitely not
21:23enough for a child that age um but
21:26beyond those sort of age Rel averages we
21:29look at daytime functioning we look at
21:32first of all happiness is the child
21:35happy are they making progress are they
21:38eating okay and and that's a little bit
21:40tricky um in our population because we
21:43do have some finicky eaters but you know
21:45are they um e worse or better than any
21:50certain day um and we can look at
21:53behaviors right um are they easy to get
21:56out of bed in the morning are we
21:58dragging them out of bed in the morning
22:01is wake up very difficult I mean morning
22:04wakeup time is the best way to tell if
22:06the child is or isn't getting enough
22:09sleep because if they're waking up on
22:11their own in the morning and they seem
22:13rather happy to get out of bed we can
22:15assume that they've probably gotten a
22:17decent amount of sleep and then you know
22:20on the other side if they're being
22:21dragged out of bed or families are
22:23saying they're just having a really hard
22:24waking them in the morning I would say
22:26that that's a red flag that they're
22:28really really not getting enough sleep
22:30um we have a lot of kids who have
22:32multiple night Awakenings who are still
22:34getting plenty of sleep and that's
22:37because they're waking up in their
22:39naturally light phases of sleep where
22:41waking would most likely occur um so
22:45even if a child is waking up multiple
22:47times a night it's very possible that
22:50they're getting enough total sleep and
22:52they're getting quality sleep um even
22:55though the caregiver is not yes
22:59that right now uh right but it's very
23:02possible that the child themselves might
23:04be getting okay sleep I mean we still
23:06want to get rid of those multiple night
23:08Awakenings because they're impacting the
23:10family quality of life um but we can't
23:13just look at that alone and say they
23:15make they wake up 27 times a night so
23:17they must be poorly slept um sometimes
23:20they wake up 27 times a night just to
23:22get back to sleep right and then they go
23:25back to sleep and it's it's the parrot
23:26that's up for another hour until they
23:29wake up I think that brings up a good
23:30point with like the multiple night
23:32Awakenings with um I think like you
23:36mentioned this before everybody has like
23:38these lighter faces asleep and we are
23:40all like adults and children alike are
23:41all waking in the night it's just we
23:43have the ability to independently fall
23:45back asleep whereas our kiddos like
23:48especially our autistic Learners might
23:49have these sleep dependencies that are
23:51interrupting them yeah yeah yeah we all
23:54wake up all night long we don't sleep
23:56like a rainbow Arc we don't like fall
23:58asleep at bedtime and then wake up at
24:01the treasure chest in the morning right
24:02like we don't just fall asleep and wake
24:04up and I think that's a big
24:05misconception about sleep in general is
24:08that you know parents will report to us
24:10yeah they fall asleep just fine but they
24:12wake up they won't stay asleep they wake
24:14up all night long right um and that's
24:17because of how sleep is designed and
24:19shapes up in the brain it comes down to
24:21sleep architecture where we have these
24:23light Awakenings all night long and like
24:25you said Chris we put ourselves back to
24:27sleep and when we look at the young
24:29child if they're falling asleep under
24:31certain conditions like you know the
24:33lights on or mom's laying with me or I'm
24:37drinking a bottle to sleep or something
24:38like that when they get into their
24:40lighter phases of sleep after like 1:00
24:42a. 2 am. um everything is gone so how
24:47are they going to fall back asleep it's
24:49sort of this assumption that because
24:51they fall asleep at bedtime they should
24:53just naturally stay asleep except nobody
24:56stays asleep we all wake up so really
24:59here's where it comes down to like okay
25:01bcba are you going to ABC that behavior
25:03and just like tell parents the child
25:05just needs to learn how to stay in bed
25:06so we just walk them back to bed so they
25:08learn I can guarantee you the child
25:10hasn't forgotten what their bed is for
25:12they're just trying to access the
25:14primary reinforcer that is sleep right
25:17so they get out of bed to go get a
25:19caregiver to say I need help getting
25:21back to sleep I want to access that
25:23primary reinforcer again I don't want to
25:26just be a dork in the middle of the
25:28night I want to be I don't want to play
25:31with you in the middle of the night I
25:32don't want to just like you know run
25:34around and and do whatever in the middle
25:36of the night I really want to just get
25:37back to sleep and because they couldn't
25:39do it independently in the beginning of
25:41the night they're not going to be able
25:43to do it multiple times throughout the
25:44night is that something you work on like
25:46trying to get them to fall asleep
25:48independently yeah without like the help
25:51of a
25:52caregiver yeah without the help of
25:54anything and it could be anything like I
25:56set a light on and it's so funny because
25:58around like 5 years old six seven years
26:01old kids develop these fears and they
26:03want to sleep with the light on and
26:05that's fine um but then once they fall
26:07asleep the caregiver goes in and they
26:09turn the light off well if you think a
26:12child is afraid of the dark at 8:00
26:14they're still gonna be afraid of the
26:16dark at 2 in the morning so why are we
26:19going in and turning the light out right
26:22well we want to be energy efficient we
26:23don't want fires to start like of course
26:26like it's the smart thing caregivers do
26:28that because they're smart and because
26:29they're thinking ahead but they're not
26:32thinking in the scope of sleep and sleep
26:34maintenance so you know that very action
26:37that very normal common happens in every
26:40house action can just destroy sleep
26:44yes yes that's so interesting take place
26:47at bedtime and not in the middle of the
26:50night
26:51yeah so what are some typical sleep
26:54steal Stealers or environmental factors
26:57that disrupt sleep patterns autistic
26:58indiv Learners or individuals I know you
27:00meant say like some of the the light say
27:03like the light was on versus off are
27:05there any other
27:07ones yeah so the light on versus off
27:10these sleep dependencies if we want to
27:13look at those as like kind of an
27:14isolated uh group of like SDS let's call
27:18them um you know just kind of this
27:22category those are the things that are
27:24really going to cause middle of the
27:25night Awakenings those are pretty
27:27certain to
27:28if the Sleep dependency is there at fall
27:30asleep time and then disappears after
27:33the child falls asleep whatever that is
27:34that's going to be your middle of the
27:36night Awakening recipe when we look at
27:39these other sleep complaints uh which
27:41are you know it just takes my child a
27:43long time to fall asleep um they they
27:47won't fall asleep unless they can't fall
27:50asleep unless um they need to blank
27:53before blank BL blah you know all that
27:56kind of stuff um the those come down to
27:59more like setting events that are
28:01preventing healthy sleep onset um which
28:04sometimes lead to these sleep
28:05dependencies but you know we look at
28:07things like screen time screen time is
28:10just awful for the human brain at
28:12bedtime because it just suppresses our
28:15melatonin production so the other sleep
28:17hormones never get the signal that it's
28:19time to sleep um so we get major sleep
28:23latency with our Learners who are screen
28:25dependent and who are falling asleep
28:26with their screens they tend to fall
28:28asleep 2 to three hours later than what
28:31their natural bedtime probably should
28:33have been their fall asleep time the
28:36other sleep stealer would be like up and
28:38down vestibular motion uh jumping or
28:41running crashing anything that falls
28:44into that very common myth of getting
28:47the Wiggles out before bed for whatever
28:49reason the run them around the
28:51house oh my gosh like the internet tells
28:55families to burn their energy off before
28:57bed but that's just it's just
28:59incompatible with sleep because it
29:01raises the core temperature it raises
29:03the heart rate it it brings adrenaline
29:06into the picture and all of those things
29:08sabotage that
29:11beautiful calming falling asleep body
29:14Readiness that you know our brains and
29:17bodies need in order to generate sleep
29:20and those are two things that are really
29:21pervasive in our community right screen
29:23time and up and down vestibular mushroom
29:26um but just because a learner engages in
29:29those things doesn't mean they can't
29:31learn to not do that so again it comes
29:34back to seeing the child's potential and
29:37saying okay we know that they're screen
29:39addicted or really screen dependent does
29:41that mean they're going to be screen
29:42dependent forever no that's where we
29:45come in because we're bcbas and we're
29:46awesome and we can teach and we can
29:49teach offset and we can teach
29:51relinquishment and we can teach cation
29:53and we could teach them to do it without
29:56you know having a meltdown we can teach
29:58it in a mindful compassionate way where
30:01we're easing the child out of that
30:03transitioning to it to like let's say a
30:05different kind of activity so if they're
30:08if they tend to have a lot of up and
30:09down vestibular motion we just do a
30:12preference assessment for alternative
30:13sensory experiences that are also going
30:15to be pleasing and they're also going to
30:17be tolerated um but that are more
30:19compatible with sleep let's say and then
30:22as you have examples sorry I think we're
30:26doing um oh Alternatives will squeezing
30:30rocking uh we can do like burrito rolls
30:34deep pressure
30:35massage um even fine motor sensory play
30:39you could do like rice and beans or you
30:41can do kinetic sand Play-Doh clay things
30:45like that um what about like Puzzles or
30:48those like closed ended mind activities
30:50so that is beneficial so I would
30:52consider that like okay so that would be
30:54an alternative to a couple things that
30:56would be an alternative to screen time
30:58and an alternative to up and down vular
31:00motion or any of that running around
31:01because it's
31:03incompatible right like you can't really
31:06very well put a puzzle piece together
31:08while you're running around I mean we
31:10try to do that in clinics right we
31:11always see the BT like running around
31:13after the child with like a Board Puzzle
31:16and they're running around the child's
31:17running around with a puzzle piece and
31:19we're like put in put in
31:22together together put together like it
31:25happens all the time we want to refrain
31:26from that and take that as a learning
31:28opportunity that hey this child has a
31:30sensory profile that um probably is an
31:33indication of a bigger sleep problem
31:35later at night so it's in the child's
31:38best interest in the family's best
31:40interest to teach them offset to teach
31:42them that they can feel okay in their
31:44bodies while they're sitting still but
31:46it takes some finessing and it takes
31:49some maybe collaboration with
31:50occupational therapy um and you know
31:54preference assessments and things like
31:55that what what kills me is when we make
31:58the assumption that the child likes it
32:01and that's all they like to do and that
32:04it's yeah um the only thing that makes
32:06them happy whether we're talking about
32:08screen time or this kind of like high
32:11high impact
32:13S I think we do the child a disservice
32:15by making that
32:17assumption right like it's on us to be
32:19def skills and those play skills we want
32:22them to feel happy and we want them to
32:24feel calm and we want them to be relaxed
32:26and just like Han said like hre right
32:29happy relaxed and engaged relax Eng how
32:31are you relaxed right how are you
32:33relaxed when you cannot stop your body
32:36at all where it feels irritating to be
32:39sitting still the body can learn to feel
32:42good that way it can we see it all the
32:45time um we just need to pay attention
32:48and some of these things like you want
32:50to think about are like as bcbas when
32:52we're helping families who do have these
32:54sleep challenges before you jump into um
32:58maybe like sleep training or anything
32:59these are those prerequisite skills and
33:01things that we need to work on like the
33:03ability to eliminate screen time an hour
33:05before bed um those Alternatives if we
33:08can't do those things your sleep
33:10training isn't going to be worth it yeah
33:12yeah no we can't just walk in there and
33:14put something together in isolation
33:16without looking at the whole picture um
33:19and and sleep is no different you know I
33:21always say like we wouldn't teach a
33:23child to cross the street at a major
33:25intersection on day one of treatment no
33:28we're gonna work on stop and go in the
33:30living room right we're not gonna take
33:32them out to the street but so often we
33:35look at sleep as this sort of I don't
33:38know this like special thing that kids
33:41should just want to be calm at bedtime
33:43they should just want to sleep um but
33:47it's a rein it's not always the
33:49case right because it is a reinforcer
33:52and it is susceptible to manipulation
33:55and it can become devalued so if you're
33:57devaluing the reinforcing value of
34:00sleep uh it's going to be really hard to
34:03put a sleep plan
34:05in without all those without all those
34:08other variables being controlled for
34:11yeah are there any other sleep Ste
34:13Stealers or barriers you would consider
34:15I know when we talked a little bit you
34:17had mentioned like puberty and medical
34:18issues as well right oh yeah yeah and so
34:22like you know puberty there's a huge
34:24sleep phase shift in puberty that people
34:27just don't know about about um it's been
34:29researched since the 70s people think
34:31it's just because kids are on their
34:32phones and kids are you know engaging in
34:35more screen time and I think that's a
34:37factor nowadays you know I can say that
34:39because I'm an old lady but you know you
34:41can see that you now
34:43nowadays these days the kiddos are on
34:46their
34:49phone exactly I I do think that that is
34:52a growing variable and I do think it's
34:54more significant now than it was let's
34:56say 10 years ago but if we go before 10
34:59years ago if we go to the late 70s early
35:0180s teenagers were still going to bed
35:03closer to 11 o' or later um because of
35:06this sleep phase shift because of the
35:08hormonal problems that are problems I
35:10call them problems because I have two
35:11teenagers it is a problem problems are
35:15problematic um but there is a a sleep pH
35:18shift there and so we have to have these
35:19reasonable expectations for teenagers
35:21right it's like the 12-year-old the
35:2313-year-old that is being put to bed at
35:258 o00 right like it's just not going to
35:27work yeah under anybody's re if if I put
35:30my 14 and my 16y old to sleep at 8 they
35:32would be Mutiny they would just revolt
35:35and they would lock me in my bedroom and
35:37say you know you go to
35:40sleep you go to sleep you do it right um
35:44so yeah I mean so there there is this
35:46leap fiship that happens in in
35:47adolescence and then you know we do look
35:49at these medical comorbidities that we
35:51always want to be very um aware of but I
35:56don't ever look at a Co a medical
35:58comorbidity and say okay we shouldn't
36:01treat because of that medical
36:02comorbidity because everything we're
36:05doing really falls into the ethical Do
36:07no harm category where we're changing
36:10sleep schedules you know maybe we're
36:13offering sleep at a better time we're
36:15restricting iPad time which I have yet
36:18to find a medical diagnosis that is like
36:21reliant on iPad consumption before bed
36:23right so we're just're we're just
36:25fostering these healthier
36:28sleep habits sleep hygiene if you will
36:31that you know a calming bedtime routine
36:33everybody needs that I don't care what
36:35diagnosis you have you need a calming
36:37bedtime routine can you provide an
36:39example of what like I know that every
36:41sleep routine for a kid's going to be
36:43different but like what would like a
36:45general idea for some parents who might
36:47be listening or bcbas to recommend what
36:48would that routine look like yeah what I
36:51will say is myth myth mythbust number
36:54you know 27642
36:58um is that you don't have to read at
36:59bedtime I think a lot of families get
37:02stuck in there has to be books at
37:06bedtime um because that's what the
37:08internet tells them but many of our
37:11Learners and many average toddlers out
37:14in the universe uh they won't sit for a
37:19book right and so if they're not sitting
37:22for a book they're probably running
37:24around the
37:26room in my
37:29observation um so a calming bedtime
37:32routine at any age right a calming bed
37:35time routine at any age could be um a
37:38long bath a nice warm bath a lot of our
37:42population really enjoy water um and
37:46enjoy that time in the bath even if it's
37:48active that's okay they're not running
37:50and jumping and really pumping out that
37:52adrenaline from some excitement in the
37:54bath so it's okay if the child gets a
37:56little excited in the bath um but a warm
37:59bath will actually cool our core
38:01temperature uh it's it's one of the
38:04beauties of our whatever it is
38:05sympathetic or parasympathetic nervous
38:07system I always forget which one
38:09controls which but basically when we
38:11heat our skin it cools our core and when
38:14we cool our skin it Heats our core um
38:17it's just how we're designed so a nice
38:20warm bath is really great um for some of
38:23our Learners that are very screen
38:26dependent and you know vestibular motion
38:28dependent we can teach those one-step
38:31play skills they can do putins they can
38:33do matching they can do folder task they
38:36can do some sensory input we can do some
38:39coloring we can do Wiki sticks we can do
38:42uh clay or Play-Doh or kinetic sand we
38:44can do building we can do cars as long
38:47as it doesn't escalate child um we just
38:50want to kind of do that play repertoire
38:53that simple play repertoire for anything
38:55that's incompatible with running jumping
38:56crashing
38:57uh and screen time and and that will
39:00build up to a nice calming bedtime
39:03routine order doesn't much matter unless
39:06we have children who have a really
39:08difficult time transitioning away from
39:10those things in which case we want to do
39:13some kind of a descending preference
39:15hierarchy where we're starting with
39:17maybe the most the most exciting
39:19activity and then sort of decrease to
39:22value and engagement kind of easing
39:25closer and closer towards at time some
39:28kind of a
39:29de what do you consider like I don't
39:31know like depending on how old the
39:33learner is like a chore in between that
39:34really like highly preferred activity to
39:37more of V descending activity like hey
39:39let's go put our dirty clothes in the
39:40laundry basket before we get ready to
39:42bed would that be
39:43one um I would say it depends on the
39:46learner and this is where this is where
39:48the beauty of ABA comes in because we're
39:51not like onetick ponies we can look at
39:54the learner and go okay that's going
39:56putting the laund away is going to cause
39:58behavioral escalation in this child so
40:00we wouldn't want to do that right
40:02whereas like my own kids were like
40:05helper Von helper pants like they wanted
40:08to do anything to be helpful when they
40:09were little so putting a laundry away
40:12cleaning up was fun for them they loved
40:15it they loved helping they loved TI we
40:18never called it cleaning up we called
40:20tidying up let's tidy up before bed so
40:23our whole body can feel nice and
40:25organized and I don't know I mean I
40:28think a lot of it comes down to spin
40:33I but yeah I mean there are some
40:35Learners were some chores I mean
40:37especially the kids who might respond
40:39very well to heavy lifting yeah that's
40:42kind of where I was thinking wait yes so
40:45heavy work can be really great for
40:48bedtime
40:49absolutely um but if they're aversive to
40:52it you know you got to do that reference
40:54assessment that hierarchy but yeah I
40:56mean putting cloth away unloading the
40:59dishwasher you know if they're able to
41:02and families feel good with that yeah
41:04those things can be relaxing to some
41:07people I think it just comes down to
41:09what really works for the family what
41:11works for the child what what falls into
41:14the either neutral or preferred category
41:18it doesn't have to be highly preferred
41:20it doesn't have to be exping it doesn't
41:22have to be like top of the list um I I
41:25aim for neutral as long as neutral it's
41:28going to work I'm helping families
41:30establish their bedtime routines I've
41:31been like not cautioning but yes
41:33cautioning parents away from is a lot of
41:35parents that I'm working with still
41:37offer like with my younger Learners like
41:39they have a bottle before bed so like
41:41okay if you're still providing bottles
41:43at bedtime I always have them do it
41:45earlier in the bedtime routine so that
41:47we um help them avoid that sleep
41:49dependency of falling asleep on the
41:51bottle um because in the night they're
41:53going to wake up like with those
41:54multiple night Awakenings and seek out
41:56the bottle to fall back asleep because
41:58they're dependent on it yeah 100% 100%
42:01yeah I mean think about the bottle the
42:03bottle they drink the bottle then the
42:04bottle's empty but they've fallen asleep
42:06on the bottle and now they wake up at 2:
42:09in the morning and they're like I need
42:10to St to sleep again because that's how
42:12I feel asleep at bedtime uh so yeah the
42:15bottle can very quickly become a a
42:17deficient sleep dependency over four
42:20months yeah I mean four months between
42:23four and six months is when the bottle
42:25goes from awesome to like oh my God why
42:28is my child up every hour and this is
42:31that why people start sleep training
42:33around four to five months kind of you
42:36know yeah yeah no 100% in fact really
42:41like when we look at the Sleep Sciences
42:42where the research has been done on um
42:46sleep training and now we're talking
42:48when we're talking about sleep training
42:49in the traditional sense we're talking
42:51about like a Ferber which would be like
42:53a graduated Extinction or a full EX I
42:57mean it doesn't really matter The Sweet
42:59Spot for doing that is really four to
43:01six months um because here's where the
43:04Sleep sciences and the behavioral
43:06sciences kind of co-mingle a little bit
43:09is what happens around six months
43:12behaviorally Behavior becomes
43:17contingent right I'm learning
43:20that right and so we don't want the
43:25child to necessarily uh this is going to
43:27be I I'm trying to think about how to
43:29say this without being like
43:31controversial but we don't want the
43:33child developing the habit of crying to
43:36get the attention just for the sake of
43:39going to sleep we want to be able to
43:41determine and this isn't to say you
43:43should ignore your baby when they cry I
43:45not saying that that is not what I'm
43:47saying um but these these Cried Out
43:51methods have a shelf life and they have
43:54a sweet spot because Behavior becomes
43:57tingent over six months okay I think
43:59that's a better way of saying it it and
44:02that makes
44:03sense yeah so you know doing it before
44:06then we're likely to get less curring
44:09less behavioral feedback less push back
44:12you know less of that aversive response
44:16and we're likely to get more of it over
44:18six months so yeah so to your point e
44:21that's why we we encourage families to
44:23do it between four and six months it's
44:26possible to do it over six months of
44:28course people do it all the time but we
44:29get big behaviors we get um bigger
44:32abandonment of the process parents just
44:35abandon it because it becomes too
44:37behavioral and intolerable for them um
44:40and for that reason us awesome ABA you
44:44know special you know bcba is Aba you
44:47know fans we go okay it doesn't always
44:50have to be Extinction it could be fading
44:52shaping it could be you know uh all
44:56kinds of different
44:57um easing in you know de
45:02escalating
45:04methods skill right uh we have a a much
45:09wider uh toolbox like we just have a
45:11much more robust toolbox to work from
45:14even though I think a lot of bcbas
45:16always fall back onto Extinction when it
45:18comes to sleep stuff anyway but they
45:20don't have to the sleep well until today
45:23until
45:24your until Kiren and like that's kind of
45:28what I always thought as well I was like
45:30oh yeah just leave them in their bed
45:32they'll figure it
45:33out yeah which which isn't untrue for
45:37for very young children and and instant
45:40it's not
45:41untrue and you you had success with um I
45:44think the Ferber method when you when
45:47Kino was I think six months yep no we
45:50did that like right at four months when
45:52her four month
45:54birthday and it was very successful for
45:56us I think like the first the first day
45:58took 30 minutes and after that we were
46:00like Smooth
46:03Sailing yeah yeah and it is that quick
46:06in the younger population and I think
46:08where we get into a pickle as bcbas is
46:12that we're not we never treat infants
46:15like we don't we treat kids right and so
46:19we get into this pickle of okay I was a
46:22parent that worked for my kid that's
46:25what's in all the books that's what's
46:26the most most popular thing and that's
46:28what makes the most sense because when
46:30we look at these bedtime behaviors right
46:32we look at the seven-year-old who comes
46:33out of bed 600 time instead of assuming
46:37that maybe they're just not tired yeah
46:39we assume that it's a behavior and we go
46:42oh well they're coming out for attention
46:43let's just walk them back to bed walk
46:45them back to bed walk them back to bed
46:46walk them
46:47back right and it's like are we really
46:52setting the child up for the best
46:53success are we setting the parents up
46:55for the best success by doing method
46:57without looking at hey he's 7even he
46:59shouldn't be going to bed at 6:30 right
47:02he shouldn't to bed at 7 o' or shouldn't
47:05be you know jumping up and down right
47:08bed or he shouldn't be watching the iPad
47:11you know whatever um you know we look at
47:13these other sleep Stealers and go okay
47:16what's in control of the manip of the
47:18reinforcing value of sleep and how can
47:20we manipulate that to avoid sleep
47:22training altogether so we don't ever
47:25have to it up for success yeah and and
47:28very often we can Implement a huge bleep
47:33plan that never even includes sleep
47:36training because you can avoid it all
47:37together by just arranging the
47:38environment in a certain way so that
47:40sleep is more valuable yeah that's a
47:43really good point I'm going to pause for
47:45a second code word so for your guys cus
47:48today your second code word is Wake
47:50windows so I guess technically it's two
47:52words but word we windows
47:58um kind of talking about those
48:00behavioral approaches um that like you
48:03kind of teach the ready set sleep what
48:05are some specific strategies that bcbas
48:07can Implement to improve improve excuse
48:09me sleep hygiene before having to get to
48:11that um like sleep training yeah so
48:15sleep hygiene is kind of this I mean
48:19it's a very broad definition it just
48:21basically means the systems that we
48:22build up that are going to contribute to
48:24healthy sleep okay so that's sleep
48:27hygiene basically uh some things fall
48:30into good sleep hygiene and some things
48:32fall into bad sleep hygiene um and
48:35really the good and the bad in it really
48:38comes down to how your current sleep is
48:41so I get a lot of people that say like
48:42oh I know I shouldn't you know be on my
48:45phone but you know I fall asleep at
48:4711:00 and I sleep through the night and
48:49I sleep until 7 7:30 in the morning and
48:52I'm getting you know 8 8 and 1 half
48:53hours of sleep every night so to them I
48:56say
48:57doesn't sound like it's a problem for
48:59you that's fine H does it fall into the
49:02healthy category of sleep hygiene no is
49:05it GNA you know are there Alternatives
49:08sure but if you don't have a sleep
49:10problem you don't have a sleep problem
49:11right your hygiene is working for your
49:13body um but when people come to us with
49:16a sleep problem we want to look at that
49:17sleep hygiene and that starts at morning
49:19wake up we want to make make sure that
49:21they're waking up at the same time every
49:22day whether they're an adult or a child
49:25um sleeping in on the weekends is not
49:28doing us any good we don't make up sleep
49:31you cannot just uh make up those lost
49:34REM cycles and lost deep you can't catch
49:37up on the wake them
49:39up you cannot catch up on the Z I'm like
49:42the the bear of bad news the like here
49:45comes Emily and all her bad news but um
49:48yeah I mean look uh sleeping in you
49:51can't make up as sleep you will feel
49:53refreshed I mean it is kind of like you
49:56you do refreshed but there is a
49:58cumulative effect of poor sleep that
50:01occurs across months across years so if
50:04you're constantly sleep deprived during
50:06the week and constantly making up on the
50:08weekend you are de you are complicit in
50:14the deterioration of your health yeah
50:17right you need all the Cycles all the
50:19nights you just do um you're not making
50:22up those sleep cycles on the weekends so
50:24if you're sleep deprived you're sleep
50:25deprived and it it is going to take a
50:27toll on your health and wellness mental
50:30health your anxiety depression your gut
50:33health your heart health your everything
50:36your brain health it's wild to think
50:38that like honestly before the course I
50:40didn't realize that like yes I knew that
50:42sleep was important for our health but I
50:43didn't realize how many like like
50:45explicit effects it has yeah on it you
50:48know un like our heart health I can't
50:50imagine oh yeah heart attack obesity
50:52stroke dementia all of those things
50:54point back to poor sleep
50:57yeah uh and that's just from the Sleep
51:00Sciences you know and that's been proven
51:02over and over and over again and so
51:04that's why look I mean the American
51:05Heart Association just two years ago I
51:08think just added sleep as their I think
51:10fifth pillar sixth pillar cardiac health
51:14wow yeah I don't know how many I don't
51:16know how many pillars they have but they
51:17added a they added a new the newest
51:20pillar is is sleep sleep yeah absolutely
51:25there's a direct correlation I'm not
51:26even correlation causation really yeah
51:29um so start with like that wake up high
51:32yeah so we start sorry back to sleep
51:34hiding so we start with that wakeup time
51:35we want to make sure that uh look people
51:38who don't need to nap don't need to nap
51:41right uh and you know there's a lot of
51:45there's a lot of
51:46um talk out there about the benefits of
51:49a quick catnap and that's not not true
51:52but we also have to look at our total
51:54sleep because if you're taking a cat nap
51:57and you're having trouble falling asleep
51:59before midnight I would say you probably
52:01shouldn't take that cat now if you take
52:04a cat nap and are able to fall asleep by
52:0710 11 o'clock and still achieve eight
52:09hours or so overnight um then that
52:12catnap is working for you what I find is
52:14that people nap but they're not napping
52:17for 18 or 19 minutes which is the sweet
52:20spot for an adult nap they're napping
52:22for an hour and a half or two hours and
52:24then they're like yeah I just can't fall
52:26asleep right um well one of my closest
52:30friends falls asleep every single night
52:31on the couch at 7 o' and then she wakes
52:34up at like 8:30 and then she gets into
52:36bed and she's like yeah I was up until 2
52:38I'm like it's because you that's not a
52:41nap at 7
52:43o'clock it's like you're going to bed
52:46yeah what are you doing what are you
52:47doing
52:48um so I I always say if you're having
52:52trouble with your sleep try not napping
52:57okay and would you say the same for our
52:59early Learners as
53:02well I mean I would say if they're
53:04having trouble with overnight sleep and
53:06bedtime I would say yeah we're we have
53:08to look at that nap now okay for our
53:11two-year-old or our one-year-old um we
53:15might just want to look at the timing of
53:16that nap right because as the weing
53:18window expands like back to our very
53:21first question as the weaking window
53:23expands nap gets later so we have a of
53:26two and threeyear olds who might not be
53:28going down for their nap until 2 or
53:313:00 because their waking window has
53:33expanded and now they're sleeping until
53:354 or 5:00 and now bedtime is like
53:4010 and parents are like they don't go to
53:42sleep until 10: and I go yeah because
53:44they're not waking up from their nap
53:45until 5: that
53:47track yeah that track and even those
53:51like car naps on the way home from
53:52school like that you don't realize
53:54theing away from your yeah yeah oh my
53:57gosh I'm battling that on my 40 minute
53:59drive home from daycare right now I'm
54:00like stay awake back
54:03there you're
54:05like the
54:07windows I can't reach back there because
54:09I'm really short so we we decided as a
54:12family like we can do screen time in the
54:14car so we've been sticking like like a
54:16zipline bag with Miss Rachel in it like
54:19this this will help as
54:22sleep yes and that's what we do too oh
54:25my gosh I just it was Prime day and I
54:27ordered my like um little Amazon Fire
54:29tablet I was like this is Athena's
54:31little uh car ride sleep interruptor
54:34yeah yeah look there's a time and a
54:36place for screen time it's not to say
54:38that there's no place for screen time in
54:39the day there is it's just not like in
54:42the hours before you want to fall asleep
54:45um but yeah so I mean like so that would
54:46be like for younger Learners it's it's
54:49making that judgment helping the
54:51families make that judgment as to okay
54:54do you want the nap
54:56and have a late bedtime and there's
54:59nothing unhealthy about that if the
55:00child's getting an hour and a half nap
55:02and then not falling asleep until 10:
55:04and then sleeping until 7:30 or 8
55:06they're probably getting the right
55:07amount of sleep in 24 hours but a lot of
55:10times families want that time to
55:12themselves in the evening which is fair
55:13enough um but we we just give the
55:16families information saying like Okay
55:18well if you want an earlier bedtime
55:21we're going to want to either control or
55:23drop the nap um but if you're okay with
55:26the later bedtime then we keep the nap
55:28but hey Mom and Dad I I'm not going to
55:30be able to help you achieve
55:32both I can't I can't help you keep the
55:36nap until 4 o'clock 5 o'clock and have
55:39them fall asleep by seven or 8 I'm not
55:41going to be able to help with that we're
55:42not going to be able to achieve that
55:44goal um so I'm out right like gota you
55:48know just sort of lay it on the line a
55:50little bit is that kind of can't have it
55:52both ways with sleep but yeah so I mean
55:54that would be another Factor so taking
55:56into consideration the nap nap timing
55:59nap duration age age in relationship to
56:02that nap if it's a seven-year-old taking
56:04a nap I would say that's seven-year-old
56:07is probably having garbage sleep I could
56:09predict that if we have a 12-year-old
56:12who's falling asleep during their four
56:13o'clock session I'm gonna posit that
56:16their sleep is
56:17garbage yeah so it's a red flag right
56:20it's just a little red flag and we use
56:22it to open up a conversation with them
56:25exactly but
56:27um I wanted to ask about I feel like
56:29this is a common question I've been
56:30getting a lot recently with wake up time
56:34I have some families and they often
56:36bring to me that their children are
56:37waking up in those hours before like
56:40it's not a very consistent wakeup time
56:41it's like around the same but it's very
56:43early like say they have a 6:30 wake up
56:45time that's like what they prefer but
56:47their child's waking up at like 5:30 to
56:50like
56:515:15 um how do you kind of recommend
56:54going about those early wakeups and
56:56getting to that consistency yeah I mean
56:59morning wakeups um are are more
57:02challenging because you have to figure
57:03out is the child getting all the sleep
57:06they need and they're waking up at 5:30
57:09because it's the end of their sleep
57:11cycle and you're not going to squeeze
57:13much more juice out of the bottle right
57:15yeah um so we have to make that
57:18determination if if you know if 5:30
57:21a.m. ends up to be 10 hours after they
57:25fell asleep I I'm gonna tell family like
57:28there there's not much we can do you
57:30need to start easing easing yeah sorry
57:33uh we either not need to start easing
57:35towards a little bit of a later bedtime
57:38and they're like no no no no no we love
57:39bedtime I'm like okay well then you're
57:41going to have a 5:30 wake up okay um so
57:44there's that so sometimes if the child
57:46has had their full night of sleep and it
57:48just ends up at 5:30 um we can make
57:52bedtime a little later like
57:54systematically maybe 15 or 20 minutes
57:56every other night every third night and
57:58then after maybe s to 10 days uh their
58:01morning weights up will start easing a
58:02little bit later it's not like a direct
58:04correlation where if I put them to bed
58:06an hour later they're going to wake up
58:07an hour later
58:10sleep um okay so like you know so having
58:13enough sleep is one problem and then
58:15they're just done sleeping that's one
58:16thing sure the other thing is that is
58:19that 530 a.m. wake up coming after a a
58:23whole night of disruptive Awakenings and
58:26then they've just lost their sleep drive
58:28and now they're not going to fall back
58:30asleep because they've been up four
58:31times already um and they're just their
58:34body's just in the habit of waking up
58:36and then their final wake up for the day
58:37is 5:30 and there's just no way they're
58:39going back to sleep for that we go back
58:41to the bedtime and the bedtime routine
58:44and sleep hygiene and what time are we
58:46offering bedtime and sleep dependencies
58:48and all of that so for the child who's
58:51waking up at you know that early uh time
58:54frame but it's after you know a night of
58:56multiple Awakenings we go okay there's
58:58probably some sleep dependencies here uh
59:01and so we want to clean that up and they
59:04should naturally start you know
59:05connecting their sleep cycles and most
59:08likely they'll start sleeping later in
59:09the morning uh once they start
59:11connecting those sleep cycles overnight
59:13so those are the two kind of culprits of
59:16early morning wakeup um the other
59:19culprit is sometimes families get out of
59:21bed mom gets up to go to the bathroom
59:22child wakes up maybe they're co-s
59:23sleeping somebody is snoring someone
59:26sleep talking uh someone has to wake up
59:29for 5:00 a.m. to get out of the house
59:31and it's waking the child up so those
59:32are more controllable variables we just
59:34need to figure out and we briefly
59:36touched on some of those sleep
59:38dependencies we you know we talked about
59:40bottles um can you mention because I
59:42feel like sometimes families don't
59:43realize that they're um have one
59:46dependent on some sleep things rocking
59:48and things like that so can you mention
59:50some of those s dependencies that we
59:51might see with oh oh the conversation
59:54where we have to say it's a you problem
59:56um
59:58okay we would never say that because
1:00:01we're nice people but um no but we we
1:00:04educate on sleep dependency so parents
1:00:06laying down with their child that's
1:00:08that's the number one and it's not the
1:00:10laying down that's the problem it's the
1:00:12laying down then leaving yeah that's the
1:00:16problem co-s sleeping is not inherently
1:00:19bad there's nothing wrong with Co
1:00:20sleeping if the caregiver is going to
1:00:22stay there all night the problem is if
1:00:24it works for them right absolutely
1:00:26there's nothing inherently wrong with
1:00:27that but what usually happens is that
1:00:30they're not co-sleeping the child is you
1:00:33know being supported to fall asleep
1:00:35parent lays down with them and then they
1:00:37leave the room and that's the deficient
1:00:39sleep dependency it's not the laying
1:00:41down it's you were there when the child
1:00:43fell asleep uh and then you're gone so
1:00:47that to me is the number one culprate uh
1:00:50across the board not just in our
1:00:52community I mean it does shape up in our
1:00:55community sometimes because of safety
1:00:57issues um sometimes because in an effort
1:01:01to calm the child down because they had
1:01:03po sleep hygiene because they were up
1:01:05and down jumping around and crazy at
1:01:08bedtime and families feel like they have
1:01:11to lay down with their child to get them
1:01:13to sleep um you know that turns into
1:01:16this defici and sleep
1:01:18dependency uh and so we can clean things
1:01:20up and get parents out of the falling
1:01:22asleep equation very easily by
1:01:23controlling some of those environmental
1:01:25variables
1:01:26um so I would say laying down with the
1:01:28kid is is the is the most consistent one
1:01:32that we see and the other thing is
1:01:34things that turn off after bedtime so
1:01:36the white noise that's on for a duration
1:01:38and then turns off music that's on for a
1:01:40duration then turns off the light that's
1:01:42on for a duration and then turns off um
1:01:45sucking in the bottle to sleep and then
1:01:46the bottle drains and then they need the
1:01:48more bottle um usually when kids have
1:01:51disruptive middle of the night
1:01:53Awakenings it's almost 100% likely that
1:01:56they're coming to the parent to get
1:01:58access to whatever it was so the child
1:02:01who was sucking the bottle goes back and
1:02:03needs more bottle the child who has a
1:02:04caregiver laying down wants the
1:02:06caregiver to come lay down the child
1:02:08that was being held wants the parent to
1:02:10come back and hold them the you know the
1:02:12child who fell asleep on the couch uh
1:02:14wants to go back to the couch because
1:02:16they were transferred after they fell
1:02:17asleep um so we usually see a
1:02:20revisitation to exactly what was going
1:02:22on at
1:02:23bedtime yeah that exact thing back you
1:02:27watch that exact same thing and that
1:02:28goes back to the idea that they're not
1:02:31trying to just come out of bed and just
1:02:33be dorks they're trying to come out of
1:02:35bed and like get back to sleep like
1:02:39please can someone just help me get back
1:02:41to that primary reinforcer I want to go
1:02:43back to bed I just don't know too and I
1:02:46think that goes back to just kind of the
1:02:48importance in touching on um like when
1:02:51we're looking at a lot of times we do
1:02:53look at sleep by the function as BCP
1:02:56education so can you kind of reiterate
1:02:59that to our community of like how we
1:03:02function and how it might not be
1:03:04applicable yeah usra did you have a
1:03:06question I'm sorry we kind of oh that's
1:03:07exactly what I was about to ask so not
1:03:10NE like because I always look at like
1:03:12let's look at the function but it's more
1:03:14important look at what reinforcer they
1:03:17might be com like different a little
1:03:20different yeah what the function what
1:03:23the function man uh that's what I say
1:03:26about this function based sleep
1:03:28intervention I mean look you can look at
1:03:32a bedtime behavior and let's just take
1:03:33the most basic one child comes out of
1:03:35bed a 100 times right that that's the
1:03:37most obvious one whether it's in the
1:03:39middle of the night or whether it's at
1:03:40bedtime child won't stay in bed so we go
1:03:44in and we go okay well what happens when
1:03:47they come out of bed what do you do oh
1:03:49okay I walk I I I sit with them I lay
1:03:51with them I walk them back to bed I yell
1:03:53at them whatever it is you know
1:03:56we go attention attention or or you know
1:04:00they'll say well we don't do anything we
1:04:01don't give it any attention we just walk
1:04:03them back to bed and then we go oh
1:04:04Escape Escape Escape there must be
1:04:06Escape right um and we can look at that
1:04:09behavior 5,000 times we can videotape it
1:04:12we can record it we can look at it in
1:04:15slow motion it will always probably look
1:04:18like Escape or attention right yeah but
1:04:22what we neglect in that contingency
1:04:25management right what we neglect in that
1:04:27assessment is the reinforcing value of
1:04:30sleep right we forget about that we
1:04:33forgot okay what is controlling why
1:04:35isn't the child tired enough to fall
1:04:38asleep why isn't the bed reinforcing
1:04:41enough why why isn't the Readiness there
1:04:44why aren't they accessing that primary
1:04:47reer and so walking them back to bed is
1:04:51like just a Band-Aid on the problem it
1:04:54doesn't actually address the Poe problem
1:04:57that the schedule's off that they their
1:05:00sleep hygiene needs to be adjusted that
1:05:02they're waking up at different times
1:05:03every morning like dependent on
1:05:06something um it just that that basic ABC
1:05:09really ignores how sleep works in the
1:05:12brain um and all the stuff that's going
1:05:14on outside of of the ABC think those
1:05:18things that we don't consider thank you
1:05:20y for breaking that down because I think
1:05:21almost all of us are going to look at it
1:05:23that way without having this education
1:05:25on the sleeve yeah yeah look it's not
1:05:28wrong it's not inherently wrong we're
1:05:29doing our job right I mean we are I mean
1:05:32and that's what we were taught to do
1:05:33like what it's our training yes yes yes
1:05:36that's what we're talking to do so it's
1:05:38not wrong it's just uh
1:05:41incomplete
1:05:43right so I kind of have to ask I know
1:05:46you've been doing this a very long time
1:05:48can you share a success a success story
1:05:50or an example of where like behavioral
1:05:52interventions you use significantly
1:05:55significantly improve like the outcomes
1:05:57for your learner and like how help
1:05:59family
1:06:01maybe we love a good success story yes
1:06:04okay I just I actually just shared this
1:06:07one on LinkedIn uh last week or was it
1:06:09earlier this week it's my favorite
1:06:12favorite I know it's my very favorite
1:06:15story um because I have a lot of
1:06:17colleagues that like listen to the
1:06:19podcast I'm on and like follow me on
1:06:20LinkedIn all old colleagues from my
1:06:23early days in clinic and stuff and
1:06:25everybody knew this kid this kid was
1:06:28just everyone in clinic knew him
1:06:30everybody like we had probably four or
1:06:33five different BCBS on his case across
1:06:35the 10 years that you know we worked
1:06:37with him we got him real young um mom
1:06:40was like super awesome I mean like just
1:06:45just a really complicated kid a lot of
1:06:47scratching screeching shouting yelling
1:06:52very low verbal output he was turned
1:06:54into a big kid across the time that we
1:06:57were working with him um and it didn't
1:07:01come out until he was almost 12 that he
1:07:03had a sleep
1:07:04problem oh um and yes and so we had all
1:07:09been working on him we all knew this guy
1:07:11I mean he was just no because he would
1:07:12flop down on the ground it and he's big
1:07:15right like he he was probably five foot
1:07:19probably two or three at 12 years old
1:07:21and easily 150 lbs easily bigger than me
1:07:25and you
1:07:27easily 150 160 if not bigger and you
1:07:30know he had trouble cutting his nails
1:07:32mom refused to cut his nails because it
1:07:35would end up in so he had real long
1:07:37nails and he was a scratcher so people
1:07:39were real afraid of him and his
1:07:40behaviors you know he would you know
1:07:42punch holes in the walls I mean his
1:07:45escalations were really severe um but
1:07:48the sweetest kid on the face of the
1:07:50planet but very
1:07:51volatile um and so it didn't come out
1:07:53until maybe like probably seven years
1:07:55after we had started working with him
1:07:57that he had a really bad problem and Mom
1:07:59reported that you know uh eventually he
1:08:03ended up sleeping in the bed in between
1:08:05her and her husband uh at 12 at this
1:08:09huge
1:08:11size and I was like are you guys
1:08:13sleeping and she's like no we don't
1:08:15sleep no but she said every time we try
1:08:18to put him in his bed he freaks out he
1:08:21doesn't want to go in his room he won't
1:08:22even go in his room at night right if we
1:08:24try and guide
1:08:26his bedroom even if we have his favorite
1:08:28music playing he'll go in there for like
1:08:30a minute and then he'll leave because he
1:08:31kind of knows what's going on next right
1:08:34so we so I took this kid out and I was
1:08:37like all right this is my project we're
1:08:39GNA get him better sleep and um I worked
1:08:42with Mom and we first and foremost
1:08:46worked on sensitizing him to his bedroom
1:08:48we got him happy his room we did session
1:08:51at his room we did playing in his room
1:08:53we had him sitting on his bed we had him
1:08:56laying on his bed during the day during
1:08:58the day when sleep is not expected um
1:09:01and then we had mom kind of and move it
1:09:04closer and closer and closer to
1:09:05bedtime we um made it really preferable
1:09:09just the environment was uh pleasing to
1:09:13him it took about two or three weeks to
1:09:15get the environment to where he would
1:09:16set foot in there at bedtime
1:09:20um and yeah and we then had M uh
1:09:26co-sleep with him in his room where she
1:09:29put a mattress on the floor so she co-s
1:09:32sleeped with him in his room got him
1:09:33sleeping in his bed which he had never
1:09:36done oh my gosh right so we eased it
1:09:40right we didn't just s in there mom was
1:09:42mom was there too so he tolerated
1:09:45sleeping in the bed uh with Mom and then
1:09:48we slowly faded mom out using some quiet
1:09:50base visiting some scheduled exit and I
1:09:54would say within a month mon total he
1:09:56was completely going into bed falling
1:09:59asleep by himself sleeping that's
1:10:01amazing at all like that's amazing quick
1:10:06that was my that's quicker than it takes
1:10:07some baby and I love it most because a
1:10:09lot of my old colleagues that I talked
1:10:11to they all know who this guy is and
1:10:13it's just like so much as their heart
1:10:15yes and they all saw the progression too
1:10:17and then they also saw the progression
1:10:20after he started sleeping through the
1:10:22night of him being able to tolerate nail
1:10:24cut a of him being able to tolerate
1:10:28changes his flopping on the Floric
1:10:30Clinic decreased um I mean all the
1:10:34things just started going better because
1:10:35he was now getting better quality of
1:10:37sleep because think about being a large
1:10:39person in a bed with two other large
1:10:42people like the quality of sleep is just
1:10:45not good right sometimes I don't even
1:10:47want to share B with my husband I want
1:10:50get out I agree I agree like come on
1:10:54you're snoring that's it I'm going into
1:10:56the guest
1:10:57room so anyway that's my success story I
1:11:01love but that's amazing story that's
1:11:04just one of that's just one of many and
1:11:08uh you know I I love telling stories
1:11:11about my old PL but he oh he's my
1:11:13favorite but I've got lots for that name
1:11:15it's just you know it's just significant
1:11:17there aren't any kids who just can't
1:11:20sleep right they all everyone has the a
1:11:23potential and possibility to it's just
1:11:25knowing the strategies Emily what are
1:11:27some of the like common challenges that
1:11:29you think bcbas might encounter when
1:11:31they're starting to implement some of
1:11:32the um strategies for sleep and like how
1:11:35can we overcome
1:11:37them so if we are really conscious about
1:11:43what we're doing there really shouldn't
1:11:46be any behavioral escalations there
1:11:49shouldn't be any complexities coming
1:11:51from the
1:11:53child sometimes we get get caregivers
1:11:56who just aren't bought in um so getting
1:12:00that buy in and I find that just through
1:12:02education just through helping them
1:12:04understand how sleep works in the brain
1:12:06the importance of sleep what those sleep
1:12:09dependencies are um waking Windows
1:12:12sometimes just giving them the context
1:12:13they have more Buy in um very often
1:12:17caregivers automatically think it's
1:12:19going to be quite behavioral um and so
1:12:22sometimes if we come in with like guns
1:12:24blazing and we're like we have a sleep
1:12:26plan for you sometimes they won't even
1:12:28look at it or they they won't even
1:12:30listen to you because they just assume
1:12:32because they have tried absolutely
1:12:34everything on the face of the planet
1:12:36like what do you have to offer me I've
1:12:38literally tried everything um and so
1:12:42sometimes there's a little resistance
1:12:43there at the beginning um and some of
1:12:45that has to do with you know Rapport
1:12:47building and uh really asking a lot of
1:12:49questions and not making too much
1:12:52questions I would say is kind of first
1:12:56way to overcome any push back but really
1:13:00like as far as um setbacks any kind of a
1:13:04setback could happen I mean sleep is
1:13:05really volatile the child could get sick
1:13:08you know one of the caregivers could go
1:13:10could get sick you know someone could go
1:13:11away they might get a new BT in the
1:13:13middle of the process they might um you
1:13:17know Grandma might move in for a week or
1:13:19something like that you know sleep is
1:13:21just volatile it's the one thing that
1:13:23suffers no matter you know know no
1:13:25matter what no matter who you are sleep
1:13:27is always the thing that goes off track
1:13:29but yeah yeah I mean those are I think
1:13:31the most common things is the stuff we
1:13:33can't control which would be like
1:13:35illness you know something like that you
1:13:38know children are always going to get
1:13:39sick right in the middle of when you
1:13:41start your
1:13:42plan this is something that you can
1:13:44Enlighten us on because it's what you
1:13:45enlightened me on because when I was
1:13:46doing your course you and I met and I
1:13:49was also doing sleep training with my
1:13:51daughter and every single time I would
1:13:53start sleep training she got an ear
1:13:55she had a band diaper rash she had this
1:13:58that the other thing and you were like
1:14:00Kristen it's okay if she's sick that you
1:14:02put it on hold and you still promote
1:14:03those sleep dependencies it's okay to
1:14:06still do those things you can always
1:14:08repair and I think that it's important
1:14:10for families to know that like you're
1:14:12GNA cuddle your kid when they're sick
1:14:13it's okay yes we're not bcba holes right
1:14:17is not what they say cuddle your child
1:14:21like you know if they're s hug them
1:14:23don't like not hug them you know this
1:14:25comes up as a very common question that
1:14:27parents have and some push back is what
1:14:30parents hear when we say like sleep
1:14:32dependencies and laying down with your
1:14:34child is you know probably causing all
1:14:36those middle of the night wakings what
1:14:37they hear is oh I can't cutle my child I
1:14:42can't lay down with my child and that's
1:14:43not what we're saying um I think it's
1:14:46really important because for many of our
1:14:47families bedtime is the only time they
1:14:49get that physical connection with their
1:14:51child right um it's the only time they
1:14:53get that loving engagement throughout an
1:14:55entire day perhaps so I would never take
1:14:57that away from the family but it comes
1:14:59down to timing right are you going to do
1:15:01that all the way until they're asleep or
1:15:04do you have the capacity and the tools
1:15:06to leave just a minute or two before
1:15:08they actually fall asleep so that you're
1:15:11giving them all that love and cuddles
1:15:12and awesomeness uh but then leaving
1:15:15strategically at the time when their
1:15:16eyes are going to close and they're
1:15:18actually going to fall asleep so there
1:15:20isn't there's a difference and we don't
1:15:21want parents to not be parents right we
1:15:23want them to do all that awesome stuff
1:15:26and we don't want to be those people who
1:15:27come in and be like don't lay down with
1:15:28your child that's awful like it's not
1:15:31awful it's amazing no um we just want to
1:15:33we just want to time it better so that
1:15:35it doesn't become this you know
1:15:37dependency that's then going to lead to
1:15:39frustration in the middle of the night
1:15:40for everything yeah right it makes a lot
1:15:44of sense so in your role have you had
1:15:48experience with collaborating with other
1:15:51professionals like speech and OT when it
1:15:54comes to like your sleep intervention
1:15:56and how important is
1:15:58it oh absolutely I would say less so
1:16:01speech and more so OT I mean I let
1:16:04everybody when I was in the clinic
1:16:06setting and I worked side by side with
1:16:08speech and OT we just collaborated
1:16:11naturally um but I'll be honest most of
1:16:15what I learned early on came from the OT
1:16:19I was co- trading with the unal
1:16:22therapist that was in my ecosystem that
1:16:25I saw every single day actually the team
1:16:27there was three of them um I would spend
1:16:29a lot of time in their office just
1:16:32asking them about up and down vestibular
1:16:34Motion versus back and forth vestibular
1:16:36motion um high impact sensory input uh
1:16:41versus that calming sensory input I
1:16:43would ask them about the impact on sleep
1:16:45what is that du to the brain what are
1:16:47the hormones that are getting released
1:16:48they know that information so very early
1:16:51on I collaborated with them just in
1:16:53general so I could get more knowledge so
1:16:56that I could really understand and make
1:16:58sure that I was doing things that were
1:17:00ethical and Do no harm with the children
1:17:03when I was changing some of those
1:17:04sensory experiences for them um I got a
1:17:07lot of Enlightenment on on again off
1:17:09again sensory input intermittent input
1:17:13because that is going to be the most
1:17:14effective and these kids that are just
1:17:16constantly seeking that input it's
1:17:19actually not good for their sensory
1:17:21system to just be in constant sensory
1:17:23seeking mode we want to offer that
1:17:26offset um so I learned a lot um early on
1:17:30from occupational therapists and then as
1:17:32we went moved into treatment like
1:17:34co-treating with the particular
1:17:37Learners I always had them come up with
1:17:39the sensory diet or the sensory
1:17:41experience I always had them do the
1:17:42preference assessments just because it
1:17:43was easier because it was more within
1:17:45their wheelhouse but they taught me how
1:17:47to do that same thing it's no different
1:17:49than a preference assessment you know if
1:17:50you tickle a child you know lightly on
1:17:52their arm some children are going going
1:17:55to like give you the look of death and
1:17:57run from you and some kids are going to
1:17:59like almost fall asleep right they're
1:18:01going to be like oh that awesome um and
1:18:03I think that's true for all of us my my
1:18:05husband hates when I scratch his back in
1:18:08a tickly way he likes me to like dig the
1:18:11skin off of his back right um and and
1:18:14it's just like all of our sensory
1:18:16systems are just slightly different
1:18:18right to what we um like as far as Touch
1:18:20goes and sensory input and what we don't
1:18:23like um you know I go on a Carousel and
1:18:26I want to vomit and it's like my kids
1:18:28want to go on the whirly spinning thing
1:18:30because they think it's awesome so you
1:18:33know we do have to do those preference
1:18:34assess so as SM collaboration early on I
1:18:36would have the OT do that sometimes I
1:18:38get permission from occupational
1:18:39therapists to do a certain kind of
1:18:42treatment um sometimes families will do
1:18:45things like they'll keep the weighted
1:18:47vest on their child all day long and so
1:18:49I'll say something like hey maybe run
1:18:51that by your OT I'm not sure that that's
1:18:54how it's in deped on being used my
1:18:56understanding is that it's supposed to
1:18:58be on and off and on and off will you
1:19:00just run it by or would you like me to
1:19:02reach out to your OT and talk about that
1:19:05um so sometimes it's about like
1:19:07dispelling some myths and like that the
1:19:09idea that more is better I think even in
1:19:12the ABA world we sometimes think more is
1:19:15better um jumping will make them more
1:19:18focused or something like that or more
1:19:20rate will make them more responsive um
1:19:24but what we end up doing is we end up
1:19:26just desensitizing the sensory system to
1:19:29those sensory experiences and they just
1:19:31need more and more and more and more
1:19:32because they just their threshold
1:19:34increases and again that's I learned
1:19:36that from an OT I didn't learn that from
1:19:38me like right I worked side by side with
1:19:41the team so that I can bring this
1:19:42information to other people just these
1:19:45things are just not well known and I I
1:19:47always go back to like hey if you don't
1:19:49know ask hey if you're not sure ask your
1:19:51pediatrician hey if you're not sure ask
1:19:53your OT you know there's always places
1:19:55to get the information if you don't the
1:19:57information so yeah exactly and like
1:20:00knowing that like we're bcbas we have a
1:20:02ton of information we don't have it all
1:20:03yes yes we just need to know where to
1:20:06get it yeah
1:20:08exactly with that I just kind of wanted
1:20:11and thank you so much for joining us and
1:20:13I wanted to talk a little bit about your
1:20:16um ready set sleep and kind of to like a
1:20:18little two questions where do you see
1:20:20ready set sleep going as far as like
1:20:22sleep specializations and then the
1:20:24future of Behavioral sleep treatments in
1:20:26general what are you like hoping for in
1:20:28the future um I am hoping my my dream is
1:20:33that every bcba has access to this
1:20:36information um because sleep is so
1:20:40pervasive of course sleep is so
1:20:42pervasive in our in our field uh no
1:20:46matter what area we're working on like I
1:20:48work side by side with a lot of bcbas
1:20:50who are working in the health and
1:20:51wellness as SPI they're not even
1:20:54treating the Autism Spectrum which is
1:20:56fine like there's a lot of things we can
1:20:58do with our Ava you know superpowers um
1:21:02but in the health and wellness space
1:21:03you're going to deal with adults with
1:21:05poor sleep right your care system we're
1:21:07going to be dealing with kids with poor
1:21:09sleep uh in the neurotypical population
1:21:12in the school-based treatment we're
1:21:13going to be dealing with humans with
1:21:15poor sleep um but we're uniquely
1:21:18position to be able to work side by side
1:21:20with these families using behavioral
1:21:22strategies to improve enhance Sleep
1:21:25Quality sleep onset um and sleep Health
1:21:29in general so my dream dream dream is
1:21:32that ready set sleep touches every bcba
1:21:35in some way so that people at least have
1:21:37a basic understanding of sleep so that
1:21:39they can go out and treat uh I mean
1:21:42that's my goal is to equip other bcbas
1:21:45to do the treatment I don't want it all
1:21:46for myself I can't treat all the
1:21:48children on know but I wish right whole
1:21:51world not that's not that's not the
1:21:54business model I'm not I I'm probably a
1:21:56little too you know I give my
1:21:59information to everybody like right I
1:22:01just want everybody to have it um they
1:22:04think getting certified is really
1:22:06important uh you know that's why I came
1:22:08up with the Sleep Collective that's why
1:22:10I going through accreditation now that's
1:22:12why I have a sleep certification program
1:22:14so that everyone has access to ongoing
1:22:17resources so that if the answer is I
1:22:20don't know and I encourage that a lot
1:22:23like I don't want every to have the
1:22:25answers I want people to know where to
1:22:26go to find the
1:22:28answers I think trying to have the
1:22:30answers in your head is slippery slope
1:22:33right um so through the Sleep Collective
1:22:35we have our resource Vault we have an
1:22:37internal community of certificates so we
1:22:40can communicate with each other stay up
1:22:42on Research group research and alun
1:22:44research um myth busting we do a lot of
1:22:47myth busting I share a lot of
1:22:50podcast um say I know well um I share a
1:22:53lot of podcast and resources I I just
1:22:55think we're in a field that's constantly
1:22:57changing and sleep Sciences are
1:22:59constantly changing and we're always
1:23:01finding new ways and new methods and new
1:23:04information uh and I think I'm just
1:23:06really you know um passionate about
1:23:09giving that information away and making
1:23:11sure my certificants have all the
1:23:12information at their cooler tips um and
1:23:15that my certificants are equipped to go
1:23:16out and disseminate this information to
1:23:18other
1:23:19bcba I don't care take the Sleep
1:23:21Collective don't take the Sleep
1:23:23Collective but if you just take this
1:23:24sleep Collective I want you to be able
1:23:26to go out and do good and go into
1:23:29Cemetary uh and really just eradicate
1:23:31those sleep problems in our
1:23:35community is a is a better slept world I
1:23:38just feel like be so much happier if
1:23:40they were getting more
1:23:44sleep really I feel like some people are
1:23:47so mean I just like I look at them with
1:23:49passion the compassion and I'm just like
1:23:51oh honey you just didn't have
1:23:56love that oh honey you just didn't sleep
1:23:59good oh honey you just didn't sleep well
1:24:01it's okay I I'll take all your meanness
1:24:04if you're going to be mean that's okay
1:24:05like I understand you're probably just
1:24:11tired I love that you're sharing all
1:24:13this information with the whole
1:24:15Community the world and I do hope it
1:24:18reaches everyone cuz you brought so much
1:24:21knowledge to me in like the short time I
1:24:23know cions take the collective so she
1:24:25knows a lot more than me I really
1:24:27appreciated your Insight so one last
1:24:30question I have for you is what advice
1:24:31would you give to BCBS who are just
1:24:33starting to incorporate sleep
1:24:34interventions into their
1:24:36practice Yeah I would just say ask
1:24:39questions ask a lot of questions try not
1:24:41to make assumptions especially when it
1:24:43comes to ABC the Bedtime behaviors um
1:24:47Reach Out do Google searches about
1:24:49waking Windows if you're not going to
1:24:50get the information from me get the
1:24:52information from somewhere else but try
1:24:54and you know just uh elevate your level
1:24:58of information just keep learning right
1:25:00I mean I don't know everything I tell
1:25:02people in the Sleep Collective I don't
1:25:03know everything but I'm curious enough
1:25:05to go find the answers um I because I
1:25:09never want to make a wrong assumption
1:25:10you know because we're on the Assumption
1:25:12to bad out um and we don't want bad
1:25:15outcomes for our families we want solid
1:25:17outcomes
1:25:20for um so I just say be curious and just
1:25:23keep asking questions and uh yeah keep
1:25:26learning I love it sleep is just I love
1:25:29learning about sleep Christian knows I'm
1:25:30like constantly like oh look at this
1:25:33book I found look at this I found look
1:25:36at this blog I found there's so much to
1:25:39learn about there really so much so much
1:25:42out there so much out
1:25:44there um with that I wanted to give our
1:25:46last code word to our listeners who are
1:25:48trying to get a little bit more
1:25:49education on sleep so night wakings
1:25:53another tww word for you night weak
1:25:56GES all right and then on that note
1:25:59Emily thank you for coming on talking to
1:26:02us about sleep it was amazing and we
1:26:05hope to Jo maybe you can come on again
1:26:07as you learn more and then we'll talk
1:26:10you guys on later it would be my
1:26:12pleasure thank you guys so much for your
1:26:14time thank you so much see you all right
1:26:17guys thank you so much for listening
1:26:19please don't forget to like And
1:26:20subscribe and if you want your ceu
1:26:22credits go to our website at Blossom
1:26:23children center.com come talk to you
1:26:25later see you

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