Table 1.

Examples of Behavioral Techniques to Address Insomnia and Sleep Disturbances in Youth

Target	Technique	Examples for Practice
General Sleep Health	Sleep Education	Information about sleep (e.g., need, architecture, homeostasis), circadian rhythms, and their interaction Importance of sleep for health, cognition, achievement American Academy of Pediatrics Guidelines: 9–12 hours/night (School-age), 8–10 hours/night (Adolescents)22
	Sleep Hygiene	Set/maintain regular bed- and wake-times Set/maintain regular bedtime routine Avoid stimulating play, electronics 1 hour before bed Eliminate napping Ensure dark/quiet sleep environment Exercise daily, but avoid exercise close to bedtime For children, ensure child falls asleep in own bed For adolescents, eliminate caffeine, nicotine, and alcohol, particularly in evenings
	Goal Setting/Tracking	Set specific goal (e.g., 10 pm bedtime each day) Tailor to personal sleep need and circadian preference, as appropriate Monitor adherence to goal using sleep logs
	Motivational Interviewing	Assess ambivalence about changing sleep behaviors Explore pros/cons Experiment with changing a sleep behavior Explore consequences
	Sleep Extension (Adolescents)	Assess current sleep schedule using sleep logs Advance bedtime 5 minutes per night until desired sleep length is achieved
Clinical Sleep Complaints (e.g., Insomnia)	Stimulus Control	Increase association between the bed and sleep; reduce association between bed and other activities Use bed only for sleeping If cannot sleep, leave bed for 15 minutes and engage in calming activity in a different space Return to bed when sleepy
	Sleep Restriction (Adolescents)	Assess amount of actual sleep occurring each night using sleep logs (e.g., 6 hours of sleeping during 9 hours of time in bed) Restrict time in bed to equal current sleep amount (e.g., 6 hours), typically by going to bed later Monitor using sleep logs until 85% of time in bed is spent asleep (sleep efficiency = 85%) Gradually advance sleep time until desired sleep length is met while maintaining sleep efficiency
	Bedtime Fading (Children)	Assess current sleep schedule using sleep diaries Determine bedtime based on when child will likely fall asleep within 15 minutes Set bedtime earlier after several successful nights until reaching the desired bedtime Avoid sleeping outside prescribed times
	Graduated Extension (Children)	For children sleeping with parents, gradually separate parent from child (e.g., move parent from bed to sitting next to bed, next to door, outside door, etc.)
	Parenting/Behavioral Management Training (Children)	Positive attention Differential attention Effective instructions Token economy system
	Relaxation	Progressive relaxation techniques (e.g., body scan) Deep breathing techniques
	Cognitive Restructuring	Recognize emotions associated with sleep (e.g., anxiety) Identify sleep-interfering thoughts (e.g., “If I don’t fall asleep soon, I won’t do well at school tomorrow!”) Assess evidence for/against thought Replace with coping thought (e.g., “Sleep will happen when it needs to happen.”) Nightmare rescripting (e.g., change anxiety-provoking elements of nightmare, rehearse altered dream script while awake)
	Mindfulness	Short meditation practices (e.g., 3-minute breathing space)

Note: strategies included in the table are consolidated from studies included in this review.