Sleep struggles don’t discriminate; they can affect everyone

A Delayed Sleep Cycle

Dr. Jennie Berkovich

A routine question on my checklist during any well visit is how a child is sleeping. Sleep struggles don’t discriminate; they can affect everyone, whether it’s a baby adjusting to a new schedule, a toddler starting to resist bedtime, or a teenager who stays up way too late. Implementing a routine with consistency and patience can tackle most of these issues. What if nothing you try is working? If all “sleep hygiene” avenues have been exhausted, it may be time to consider delayed sleep phase disorder or delayed sleep-wake phase syndrome (DSWPS) diagnosis.

DSWPS is characterized by a significant delay in the regular sleep-wake cycle, where individuals struggle to fall asleep and wake up at “normal” times, and are ready to fall asleep and wake up significantly later than most people. This disorder affects the timing of various biological rhythms, including sleep, alertness, core body temperature, and hormonal cycle. This diagnosis isn’t made lightly and usually requires some data like a sleep diary or an extensive sleep history. The distinguishing features of DSWPS is that an individual will only begin to feel tired very late at night and will find it very difficult to wake up early in the morning, and that even being sleep deprived will not help them fall asleep earlier. Whenever given the opportunity (such as on weekends, when they don’t have regular responsibilities), they will go to sleep late and wake up late.

The first line treatment — early entrainment — isn’t easy, but can be extremely effective. It involves moving the child’s weekend or “natural” wake-up time earlier and earlier. This may take a few weeks. As a result of this waking up earlier, the child’s circadian rhythm will naturally begin to shift earlier. This strategy aims to move the child’s natural “time zone” to one that more aligns with what the family schedule requires. For more extreme cases, it may be easier to advance the sleep phase forward. This involves progressively delaying sleep and wake times by delaying bedtime a little bit every day. This process continues through the following day until it loops back around to the next evening and ends at the desired bedtime.

Another approach is timed light exposure. The idea is that bright light can reset the circadian rhythm. This may be done either through light therapy boxes or outdoor light, ideally for a few hours between seven and nine a.m. Avoiding light exposure during the evening, especially from electronic devices, is critical for this to be successful.

While taking melatonin isn’t routinely recommended, it may be used under the supervision of a sleep specialist to help DSWPS. The dose and timing are very intentional and it’s not advised to trial without medical supervision.

Treatment for DSWPS is ongoing and may require adjustments. Using gradual shifts in sleep schedule and readjustment periods based on life-cycle events like simchahs, Yom Tov, bein hazmanim, or sleepovers may be needed.

Sleep hygiene shouldn’t be ignored, even if other approaches are being implemented. Consistent sleep habits like creating a calm, quiet sleep environment and limiting caffeine are still worthwhile efforts. As always, exercising (especially outdoors) is a powerful tool to help alleviate sleep challenges from newborns (dust off that wrap or stroller!) to young adults. Regular movement and fresh air have a multitude of benefits that extend beyond bedtime success!

Dr. Jennie Berkovich is a board-certified pediatrician in Chicago and serves as the Director of Education for the Jewish Orthodox Women's Medical Association (JOWMA)

Healing Beyond Habits

Shoshana Schwartz

I once dedicated hours to a project... when the program crashed, and I lost everything. With no backup and a looming deadline, I had to start over. It was my first professional project, and the pressure was immense.

That moment left a deep mark on me. After the incident, I developed a near-obsessive habit of hitting “save” with every tiny change. This habit has stayed with me for over 30 years, even though online collaboration has made it obsolete.

At first glance, hitting Control+S might seem like just a deeply ingrained habit. In reality, it’s a solution to anxiety. The stress and panic I experienced during that project left a lasting imprint, and I developed this behavior as a coping mechanism — a way to prevent another disaster. Even though the original circumstances no longer exist, the anxiety remains deeply embedded in my system.

This experience illustrates a broader concept about negative experiences — ranging from everyday stresses to significant trauma — and the coping mechanisms they create. Negative experiences shape how we respond to anxiety. When faced with anxiety, we may develop external behaviors — such as hitting Control+S, comfort eating, nail-biting, knuckle cracking, over-apologizing, or cleaning — as temporary solutions. These actions may soothe the anxiety for a moment, but they don’t resolve it. The underlying issue remains, and eliminating the behavior can leave us feeling even more vulnerable to the anxiety.

This is why relying only on behavioral tools to overcome habits often fails. Addressing the anxiety and releasing the root causes through deeper methods like mindfulness, journaling, EFT tapping, and EMDR is the key to real
healing.

Shoshana Schwartz specializes in overcoming compulsive behaviors, including emotional eating, codependency, and addiction. She is the founder of The Satisfied Self.

Spiraling with the Siblings

Abby Delouya

Sibling rivalry is universal. So is the negative flak it gets. When siblings fight with each other, parents can feel a range of negative emotions including anger, helplessness, exasperation, disappointment, sadness, powerlessness, and agitation.

Sometimes the fighting can bring up old memories or feelings from one’s own childhood experiences with fighting. We can sometimes subconsciously align ourselves with the child who most represents our personality or birth order, and get angrier with the one who most represents our own childhood aggressors.

Watch for this transference and try to stay in the here and now. Arguing between siblings is normal — it’s how kids figure out communication and problem-solving strategies. Focus more on teaching (and modeling) effective conflict management, rather than spiraling with negative emotions or childhood projections.

Abby Delouya, RMFT-CCC, CPTT, is a licensed marriage and family therapist in private practice with a specialty in trauma and addiction. She is also the Director of Intake and Care Management at Ray of Hope.

(Originally featured in Family First, Issue 933)