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Background: Sleep coaches are individuals of various backgrounds who offer services to families struggling with behavioral childhood sleep problems. We conducted a survey of coaches to further elucidate scope of practice, practice patterns, geographic distribution, education, training, and beliefs regarding qualification requirements. Methods: A Web-based survey was completed by 142 individuals who identified as a sleep coach. Results: Coaches were distributed across 17 countries and 5 continents. Overall, 65% of coaches served clients in countries beyond their home country. Within the United States, coaches were generally located in more affluent and well-educated zip codes near large metropolitan centers, 91% served clients beyond their home state, and 56% served clients internationally. Educational background varied across coaches (12% high school degree, 51% bachelor's degree, 32% master's degree, 2% doctoral degree, 1.5% JD degree). Few coaches (20%) were or had been licensed health care providers or carried malpractice insurance (38%). Coaches usually provided services for children < 4 months of age to about 6 years of age, and were much less likely to provide services for children with comorbid neurodevelopmental (32%) or significant medical disorders (19%). Coaches reported an average of 3 new and 6 total clients per week and working 20 hr per week on average. Most coaches (76%) felt that a formal sleep coach training program was the most important qualification for practice. Conclusions: These results highlight a diversity of background, training, and geographical distribution of sleep coaches, and may help inform discussions regarding guidelines for training and credentialing of sleep coaches.
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A Survey of Practicing Sleep Coaches
David G. Ingram
Department of Pulmonary and Sleep Medicine, Childrens Mercy Hospital, Kansas City,
Missouri, USA
Jodi A. Mindell
Department of Psychology, Saint Josephs University, Philadelphia, Pennsylvania, USA
Sleep Center, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
Kristina Puzino
Department of Psychology, Lehigh University, Bethlehem, Pennsylvania, USA
Russel M. Walters
Johnson & Johnson Consumer, Inc., Skillman, New Jersey, USA
Background: Sleep coaches are individuals of various backgrounds who offer services to families strug-
gling with behavioral childhood sleep problems. We conducted a survey of coaches to further elucidate
scope of practice, practice patterns, geographic distribution, education, training, and beliefs regarding
qualification requirements. Methods: A Web-based survey was completed by 142 individuals who identi-
fied as a sleep coach. Results: Coaches were distributed across 17 countries and 5 continents. Overall, 65%
of coaches served clients in countries beyond their home country. Within the United States, coaches were
generally located in more affluent and well-educated zip codes near large metropolitan centers, 91% served
clients beyond their home state, and 56% served clients internationally. Educational background varied
across coaches (12% high school degree, 51% bachelors degree, 32% masters degree, 2% doctoral degree,
1.5% JD degree). Few coaches (20%) were or had been licensed health care providers or carried malpractice
insurance (38%). Coaches usually provided services for children < 4 months of age to about 6 years of age,
and were much less likely to provide services for children with comorbid neurodevelopmental (32%) or
significant medical disorders (19%). Coaches reported an average of 3 new and 6 total clients per week and
working 20 hr per week on average. Most coaches (76%) felt that a formal sleep coach training program
was the most important qualification for practice. Conclusions: These results highlight a diversity of
background, training, and geographical distribution of sleep coaches, and may help inform discussions
regarding guidelines for training and credentialing of sleep coaches.
Correspondence should be addressed to David G. Ingram, Department of Pulmonary and Sleep Medicine, Childrens
Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108. E-mail: dgingram@cmh.edu
Color versions of one or more figures in the article can be found online at www.tandfonline.com/hbsm.
Behavioral Sleep Medicine, 00:112, 2016
Copyright © Taylor & Francis Group, LLC
ISSN: 1540-2002 print/1540-2010 online
DOI: 10.1080/15402002.2016.1188394
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Behavioral sleep problems are common, may result in significant morbidity, and usually respond to
behavioral interventions (Mindell et al., 2006). Despite the common occurrence of these problems, the
supply of board-certified pediatric sleep specialists is low, with few pediatricians certified in sleep
medicine (Workforce Data,2014) or psychologists certified in behavioral sleep medicine. Sleep
coaching has emerged as a service provider to families struggling with sleep troubles.
In an initial effort to characterize sleep coaches (also called sleep consultants) as a provider group,
a previous study examined Internet advertisements for services (Ingram, Plante, & Matthews, 2015).
Overall, there was substantial diversity in coachesbackgrounds, training, services offered, and
pricing. Coaches were distributed across the United States, but tended to cluster in population-dense
states. Based on information provided on their website, the majority of coaches did not report
previous health care experience, and 44% did not report any postsecondary education. Multiple
coach training programs were identified and typical cost of services was summarized.
While the above study served as a starting point in terms of describing coaches as a group, it also
highlighted many unanswered questions. Therefore, the aim of this study was to conduct a direct
survey of sleep coaches in an effort to further elucidate scope of practice, practice patterns,
educational background and health care experience, geographic distribution, and beliefs regarding
essential knowledge and training necessary to be a well-qualified sleep coach.
METHOD
Individual sleep coaches were identified via several methods, including (a) certifying or training
organization websites: The Sleep Lady (sleeplady.com/coaches), International Maternity Institute
(maternityinstitute.com/business-directory), Family Sleep Institute (familysleepinstitute.com/pro-
grams/graduates), International Association of Child Sleep Consultants (iacsc.com/members),
Association of Professional Sleep Consultants (internationalsleep.org/find-a-consultant), and Sleep
Sense (sleepsense.net/sleep-consultants); (b) Google search utilizing search terms sleep coachor
sleep consultant,and (c) via word of mouth. Each sleep coach that was identified was sent a Web-
based survey via e-mail or a website contact form.
A Web-based survey was constructed with questions regarding services provided, background,
education, training, and beliefs regarding qualification requirements of sleep coaches. An explanation of
the survey purpose was provided with an invitation to participate. Coaches were allotted two weeks to
complete the survey. Based on initial feedback provided after the initial survey was sent, minor changes
were made to a few questions and two questions were added to the survey. The follow-up survey was
sent again with instructions and an explanation of changes. All surveys were completed anonymously
and this study was approved by the Institutional Review Board at Saint Josephs University.
All data analyses were performed in SPSS (IBM Corp. Released 2014. IBM SPSS Statistics
for Windows, Version 23.0. Armonk, NY: IBM Corp.).
RESULTS
Participant Response Rate
Of the 361 sleep coaches contacted, there were 184 responses. There was a total of 42 questions on the
survey, and of those 24 questions required a simple, single response. Participants who left 10 (42%)
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of the 24 single response questions unanswered were excluded from analysis (n = 42). Thus, the final
sample included 142 respondents (39% response rate), with 24 from the second survey invitation.
Geographical Location
Sleep coaches were distributed across 17 countries and 5 continents (see Figure 1). There
were 77 (54% of the sample) coaches in the United States, 26 (18%) in Canada, 15 (11%) in
the United Kingdom, 10 (7%) in Australia, 2 (1.4%) in Ireland, and one each (.7% each) in
Angola, Belgium, Finland, Guatemala, Hong Kong, India, Israel, Mexico, Mozambique,
Namibia, Russia, and Sweden. Within the United States, 71 coaches provided zip code
information. Compared with the general U.S. population, sleep coaches live in zip codes
with older (39.1 ± 5.7 vs. 37.3 years), more educated (93.2% ± 6.7% with high school
education or greater vs. 86%), higher-earning (median household income $85,059 ± 35,040
vs. $53,046), and less impoverished (9.3% ± 7% individuals below poverty line vs. 15.4%)
citizens.
Overall, 65% (93/142) of coaches served clients in countries beyond their home country.
Among coaches in the United States, 90.9% (70/77) served clients beyond their home state and
55.8% (43/77) served clients internationally.
Practice Patterns
On average, coaches had been actively seeing clients for 5.1 ± 5.3 years (median = 4.0). They typically
consulted with 2.9 ± 2.6 new clients (median = 2.0) and 6.1 ± 5.5 total clients per week (median = 4.0).
Coaches worked with families 4.5 ± 5.0 weeks (median = 3.0) past the initial consultation and reported
an average of 10.4 ± 9.4 sessions or contacts per client (median = 8.0). During a typical week, coaches
reported working 20.5 ± 14.8 hr (median = 18.5). Figure 2 presents the modality of services, with the
majority of coaches reporting providing services by phone (92%, 131/142), over the Internet via video
conference (82%, 117/142), and in person at a clients home (85%, 121/142).
Sources of client referral included pediatrician or primary care provider (69%, 98/142), other health
care provider (64%, 91/142), word of mouth from other families or clients (96%, 137/142), website/
Internet search (94%, 134/142), and other (25%, 36/142), with the most common response being
Facebook or other online media). While a majority of coaches reported providing a written sleep plan
or report for the parent (82%, 117/142), only 26% (37/142) and 8% (12/142) reported provided a letter
or clinical report, respectively, to the childs primary care provider. A large majority (84%, 106/126) of
coaches reported that they were solo practitioners. A minority of coaches (38%, 50/131) reported that
they had malpractice insurance, but a majority (67%, 88/131) reported they have business liability
insurance.
Scope of Practice
A majority (53%, 76/142) of coaches responded that they would see infants younger than 4
months of age in their practice, although only 13% (19/142) would recommend sleep training
for that age group. The youngest age that they would for recommend sleep training was
typically 45 months (45%, 65/142) or 612 months (39%, 56/142). Conversely, only 22%
(32/142) of coaches would see a child older than 6 years of age. A minority of respondents
would coach clients with neurodevelopmental disorders (32%, 46/142) or significant medical
A SURVEY OF PRACTICING SLEEP COACHES 3
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disorders (19%, 28/142). Almost all coaches (99%, 141/142) reported that they ask their
clients if they have discussed with their primary care provider their childs sleep problems
and whether they have ruled out any underlying medical conditions that may affect sleep
prior to starting coaching. More than half of coaches (51%, 72/142) refer 10% or more of
FIGURE 1 Geographic distribution of sleep coach respondents internationally (a) and within the United States (b).
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their clients to their primary care provider because they suspected a medical problem
contributing to sleep difficulties.
Finally, many respondents endorsed offering additional services beyond sleep coaching.
Common additional services included parent support (50%, 12/24), child behavior consults
(20%, 5/24), feeding consults (16%, 4/24), toilet training (16%, 4/24), doula services (8%, 2/
24), and lactation consults (4%, 1/24).
Training, Education, and Health Care Experience
Ninety percent of respondents reported participating in a sleep coach training program, with the most
common being the Gentle Sleep Coach (39%, 55/142), followed by Sleep Sense (18%, 26/142), and
the International Maternity and Parenting Institute (14%, 20/142). Ninety-two percent of coaches felt
that their coach training program prepared them wellor very wellfor independent practice.
Coaches were lesscommonly members of coaching associations, with only 26% (37/142) belonging
to the International Association of Child Sleep Consultants, 27% (39/142) belonging to the
Association of Professional Sleep Consultants, and 42% (60/142) not a member of any coaching
association.
A high proportion of coaches reported postsecondary education, with results presented in Figure 3
and Tab le 1. The most common undergraduate majors were psychology (14%, 10/69), business (11%,
8/69), child development (11%, 8/69), education (11%, 8/69), and nursing (10%, 7/69). Of sleep
coaches with listed undergraduate degrees, 26% (18/69) were not clinically relevant to coaching
(business, American studies, economics, political science, architecture, engineering, European studies,
and marketing). The most common areas of study for masters degrees were social work (23%, 10/43),
education (14%, 6/43), and child development (11%, 5/43), with 18% (8/43) having a mastersdegree
that was not clinically relevant to sleep coaching (MBA, political science, landscaping, environmental
FIGURE 2 Percentage of respondents that offer services via various modes of contact with clients.
A SURVEY OF PRACTICING SLEEP COACHES 5
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science, literature, and not specified). Two of the three individuals with doctorates had their degree in
psychology; the others did not report their field of study.
In terms of previous health care experience, defined broadly, 31% (44/142) of coaches did not
report any. Reported experience included education (23%, 34/142), newborn care specialist
(13%, 19/142), social worker (11%, 16/142), doula (9%, 14/142), psychologist (8%, 12/142),
nurse (7%, 10/142), lactation consultant (5%, 8/142), nurse practitioner (2%, 4/142), PT/OT/ST
(2%, 4/142), and sleep technologist (2%, 4/142). Twenty percent of respondents (27/131) were
current or former licensed health care providers.
Beliefs Regarding Essential Knowledge and Training
Coaches were asked what they felt were necessary criteria for individuals who offer sleep coaching
services. Over half of respondents felt that the following were necessary criteria: participation in
formal sleep coach training program (78%, 112/142), continuing education classes (76%, 109/142),
ongoing access to and mentoring from an experienced sleep coach (75%, 107/142), over-the-phone
or Internet supervision of live cases with feedback (59%, 84/142), passing a criminal background
check (56%, 80/142), and passing a written sleep coach examination (52%, 75/142). In contrast, a
minority of respondents felt that a bachelors (49%, 70/142) or masters (12%, 17/142) degree would
be necessary, and only 13% (19/142) felt previous health care experience was necessary. Coaches
were also asked to rate the top three most important qualifications, and results are presented in
Figure 4.
Regarding what should be a part of the essential knowledge base for a well-qualified coach, >
70% of respondents felt the following were essential: basic sleep physiology, bedtime problems,
breastfeeding, child growth and development, counseling and communication skills, ethics, infant
safe sleep, medical conditions that affect sleep, nightmares, nighttime fears, night wakings, post-
partum depression and mood, sleep development across age ranges, sleep hygiene, twins and
multiples, medication effects on sleep, nonbehavioral sleep disorders, couple relationships and
family dynamics, temperament, and cosleeping. In contrast, 4060% of respondents felt that
FIGURE 3 Distribution of coachesterminal educational degree.
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introductory psychology, anthropology, nutrition, parasomnias, and sleep in children with neurode-
velopmental disorders were essential. Finally, 2040% of respondents felt that biology, anatomy,
physiology, and health science research methods were essential.
TABLE 1
Sleep Coach Self-Reported Education
High School or GED (n= 16)
Undergraduate (n= 69)
Psychology (n= 10)
Business or Business Administration (n=8)
Child Development or Human Development (n=8)
Education (n=8)
Nursing (n=7)
Biology, Chemistry, or Physics (n=3)
Communications (n=3)
Social Work (n=3)
American Studies (n=2)
Economics (n=2)
International Relations or Political Science (n=2)
Occupational Therapy (n=2)
Social Science (n=2)
Anthropology (n=1)
Architecture (n=1)
Child Studies (n=1)
Engineering (n=1)
European Studies (n=1)
Liberal Arts (n=1)
Marketing (n=1)
Nutrition (n=1)
Speech (n=1)
Masters(n= 43)
Social Work (n= 10)
Education (n=6)
Child Development or Human Development (n=5)
Business or Business Administration (n=3)
Counseling (n=3)
Nursing (n=3)
Psychology (n=3)
Educational Psychology (n=2
)
Occupational Therapy (n=2)
Biology, Chemistry, or Physics (n=1)
Environmental Science (n=1)
International Relations or Political Science (n=1)
Landscaping (n=1)
Language or Literature (n=1)
Not specified (n=1)
PhD or PsyD (n=3)
Psychology (n=2)
Not specified (n=1)
Juris doctorate (n=2)
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Motivations and Challenges
On the second survey sent, coaches were asked what led them to start coaching. The most
common responses were that they had a professional interest (50%, 12/24), their own child did
not sleep (45%, 11/24), they wanted a business where they could work from home (37%, 9/24),
sleep coaching changed their life and they wanted to help others (33%, 8/24), to add to offerings
as a professional (29%, 7/24), and to supplement income (25%, 6/24).
Coaches were asked what they felt was most rewarding and challenging about sleep coaching.
Common themes with respect to the rewarding aspects of their job included being able to help
and make a difference in the lives of struggling families, building relationships with families,
working from home, empowering parents, being able to help families in the same way that
others have helped them, helping moms adjust in the postpartum period, and seeing families
succeed in their efforts. Common themes regarding challenges included working alone and
feeling isolated, worklife balance, unrealistic parental expectations, competition, having parents
follow through with recommendations, finding new clients and marketing, miseducation and
information about sleep that parents have previously received, sleep problems in children with
special needs, sleep and breastfeeding, being emotionally drained, and misinformation about
sleep coaching. Selected example responses are listed in Table 2.
DISCUSSION
Sleep coaching is becoming more common as a service offered to parents, although there are no
national or international guidelines as to what constitutes a provider. To our knowledge, there is
only one previous study that has examined coach characteristics, and this was an analysis of
Internet advertisements (Ingram et al., 2015). Therefore, the current study is an important
FIGURE 4 Percentage of respondents that endorsed each factor as within the top 3 most important criteria for
individuals who offer sleep coaching services.
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advance in our understanding of sleep coach characteristics and practice patterns, and represents
the first report that we know of that is a direct survey of sleep coaches.
Knowledge of sleep coach education and health care experience provides information regard-
ing training experience and background. It is important to note that 12% of sleep coaches report
only a high school education, with the majority (51%) having a bachelors degree, with 22
different majors endorsed. Almost half (47%, 33/69) of coaches with a bachelors degree
majored in social serviceassociated fields of child development, education, nursing, psychol-
ogy, and social work. Similarly, over two thirds (67%, 29/43) of coaches with masters degrees
had degree programs in child development, education, nursing, occupational therapy, psychol-
ogy, or social work. In terms of previous health care experience, 31% of coaches did not have
any previous experience. There were 35% with a potentially relevant bachelors degree and 26%
with a potentially relevant graduate degree, either at the masters or doctoral level, for a total of
61% of coaches having relevant postsecondary education. For comparison, in order to sit for
examination to become a certified lactation consultant through the International Board of
Lactation Consultants Examination (IBCLC), one must have completed 14 health science
courses or be a recognized health professional (Pathways,n.d.).
Related to coach background, respondents had clear opinions with respect to what criteria are
necessary to be a well-qualified sleep coach. By far, formal sleep coach training with continuing
education and mentorship was endorsed as the most important criterion. About half of coaches
felt that postsecondary education was necessary, and a small minority felt health care experience
was necessary. These opinions were also reflected in what coaches felt were a part of an essential
knowledge base to be a well-qualified coach, with most sleep-specific topics highly endorsed,
whereas nonsleep health sciences (e.g., biology, anatomy, physiology, research methods) were
felt to be essential by only a minority of respondents. Importantly, a majority of coaches felt that
TABLE 2
Selected Responses Regarding Rewarding and Challenging Aspects of Sleep Coaching
What do you find most rewarding about sleep coaching?
I faced sleep challenges with my first child and the ability to help others avoid or correct similar problems is extremely
rewarding.
Building relationships and supporting families.
I feel like I am saving families. I love to watch parents become more empowered, better rested, happier! I love that I am
helping children get the rest and loving care they deserve. I LOVE this work!!!!!
I love working with families and I am passionate about sleep! I love having my own business and controlling my work
life.
The happy parents! How the parents tell me over and over again how they have their life back. How they can finally
work and be themselves, and have a relationship with their spouses. Bringing back sleep and rest and peacefulness in
their house. I LOVE IT!
What do you find most challenging about sleep coaching?
Clients who ask for help then do not put recommendations into practice.
I often found the conversation around breastfeeding and sleeping to be challenging, which is why I became a lactation
counselor. I still find it difficult to deal with children with special needs, because Ive not had enough training.
Its emotionally draining to work so closely with families who are in crisis, and hold new parents through their emotions
and anxieties while sleep training. Im very good at it, but I cant do it more than 23x a month because I give 110%.
Managing the expectations of parents. Some think by contacting you that their child should magically sleep overnight.
So they are impatient and flustered and that just takes more coddling and hand holding.
The lack of overall support in the sleep coaching community.
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passing a criminal background check was necessary; this requires special mention given that
coaches are frequently serving families and their children directly in the home setting. Finally, a
majority of coaches felt that passing a written examination was necessary to offer sleep coaching
services. While what constitutes a well-qualified coach is inherently subjective, it appears that a
majority of coaches have postsecondary education with a focus in social servicerelated fields,
and the majority feels that sleep-specific education, passing a written examination and criminal
background check, and real-world mentorship are overridingly important. A majority of coaches
did not feel that graduate-level education or health care experience were essential. While these
data are informative with respect to sleep coach views, it would be interesting to ask the same
questions of other sleep provider groups; it may be that a given providers background
influences his or her views about requisite background and training, as well as differences in
perceived parent needs and expectations.
A remarkable number of coaches reported serving clients beyond their home state and
country. This practice is made possible by technological advancements with widespread avail-
ability of videoconferencing and other forms of electronic communication. Indeed, the remote
provision of services has also been explored within health care, including psychology (Herbert
et al., 2012). Within psychology, the provision of remote services brings up challenges with
respect to state licensure laws; specifically, the majority of state boards feel that the location of
the patient is considered to be where the service is taking place, rather than the physical location
of the psychologist. Therefore, psychologists are prohibited from providing services to patients
in another state unless they are licensed there (Herbert et al., 2012). While those geographic
limitations apply to licensed health care professionals, sleep coaches report not providing formal
psychotherapy, making medical diagnoses, or billing insurance, at least in the United States. In
addition to licensing and legal obstacles, providers should be cognizant of cultural differences
when providing services internationally. Previous studies have demonstrated important cross-
cultural differences with respect to sleep patterns, sleeping arrangements, and parent-reported
sleep problems in children (Mindell, Sadeh, Kwon, & Goh, 2013; Mindell, Sadeh, Wiegand,
How, & Goh, 2010; Owens, 2004).
In terms of scope of practice, coaches in the current survey typically provided services from
infancy to approximately age 6 years. While most see infants under 4 months in their practice,
they reported that they would not recommend sleep training typically until about 45 months of
age. We speculate that anticipatory guidance constituted the bulk of services for this younger
infant age group. Initiating sleep training at around the 46-month mark is consistent with
previous literature suggesting that this is when most children no longer require a nocturnal
feeding and may begin to sleep through the night (Meltzer & Crabtree, 2015). Almost all
coaches reported having parents check with their primary care provider prior to sleep training
and only a minority of respondents coach children with neurodevelopmental or significant
medical problems; however, the fact that only a minority provide a clinical report or letter to
the childrens primary care providers highlights the need for greater cross-discipline commu-
nication. Finally, there appears to be a demand for coaches, with respondents seeing about 6
clients and working 20 hr per week coaching.
Coaches seem to derive satisfaction from their work with families and face frustrations similar to
other providers. The most rewarding parts of coaching were not surprising, namely, a sense of
accomplishment from helping families overcome challenges and satisfaction from helping parents.
Many coaches reported that this was particularly important given their personal struggles that they
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had faced in the past with their own children. Similarly, the frustrations coaches faced are also not
surprising, and most commonly revolved around unrealistic parental expectations and difficulty
with parents adhering to treatment recommendations. One less expected result was the feeling of
isolation and lack of support within the sleep coaching community, which may reflect the fact that
coaches are typically in solo practice and may benefit from more national and international
organizational involvement to further develop their network. Overall, however, the qualitative
responses provided suggested that coaches enjoy their work.
Licensing and liability are important issues raised by the results of our survey. Currently, sleep
coaching is not considered an allied health profession requiring state licensing and professional
liability insurance. In line with this lack of requirement, a minority of coaches surveyed (20%) were
licensed health care providers, and most did not have malpractice insurance. Furthermore, currently
there is no formal sleep coaching malpractice insurance available, at least in the United States.
Anecdotally, some coaches purchase life coaching malpractice insurance if it is available, while
others purchase business liability insurance if that is their only option. According to this survey,
about two thirds of coaches carried business liability insurance. This issue has also emerged with
lactation consultants, and some have suggested that lactation consultants ought to obtain profes-
sional liability insurance even if not required to by their state (Smith, 2002); furthermore, at least
one lactation consultant educational program requires its students to obtain liability insurance in
order to participate in clinical activities within health care settings (Breast Feeding Education |
Frequently Asked Questions,n.d.).
This survey is not without limitations. First, response bias may substantially alter results; that
said, we had a fairly good response rate at almost 40%, a relatively large number of coaches from
across the United States and internationally, and coaches invited from both established associations
as well as from Web searches. Second, we made changes to the survey between the first and second
invitation. While these changes were minor and done in response to feedback from survey
participants, we cannot rule out the possibility that this confounded our results. Third, while we
put forth substantial effort to try to invite as many sleep coaches to participate in the survey as
possible, there are undoubtedly coaches whom we did not identify from our search procedures.
Despite its limitations, this study provides novel and clinically important information regard-
ing sleep coaches and their practices that may help inform future discussions regarding potential
certification criteria and when advising families considering their services.
ACKNOWLEDGMENTS
We wish to thank Kim West, LCSW-C, director of the Gentle Sleep Coach, for her input into the
development of the survey and assistance in participant recruitment.
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This paper reviews the evidence regarding the efficacy of behavioral treatments for bedtime problems and night wakings in young children. It is based on a review of 52 treatment studies by a task force appointed by the American Academy of Sleep Medicine to develop practice parameters on behavioral treatments for the clinical management of bedtime problems and night wakings in young children. The findings indicate that behavioral therapies produce reliable and durable changes. Across all studies, 94% report that behavioral interventions were efficacious, with over 80% of children treated demonstrating clinically significant improvement that was maintained for 3 to 6 months. In particular, empirical evidence from controlled group studies utilizing Sackett criteria for evidence-based treatment provides strong support for unmodifi ed extinction and preventive parent education. In addition, support is provided for graduated extinction, bedtime fading/positive routines, and scheduled awakenings. Additional research is needed to examine delivery methods of treatment, longer-term efficacy, and the role of pharmacological agents. Furthermore, pediatric sleep researchers are strongly encouraged to develop standardized diagnostic criteria and more objective measures, and to come to a consensus on critical outcome variables.
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Sleep problems are common in children. Between 25–40% of youth experience sleep difficulties such as sleep anxiety, insomnia, frequent waking, delayed circadian rhythm, night terrors, and nocturnal enuresis or encopresis at some point during childhood or adolescence. Yet, most healthcare providers receive little if any training in pediatric sleep problems — and most training that does exist tends to emphasize medical rather than behavioral interventions. This book presents highly effective behavioral interventions for common pediatric sleep problems. Step-by-step instructions show readers how to clinically assess and treat children from toddlers to teenagers, and case examples apply the instructions to real-life scenarios. The authors also provide more than 30 handouts and worksheets for parents and children, including sleep logs and directions for a series of creative, at-home interventions.
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Sleep coaches are an emerging group of pediatric providers whose scope of services and regional distribution have not been well characterized. This descriptive analysis used Internet data to identify sleep coaches and certification programs in the US; we found a sizeable diversity of backgrounds, training, services offered, and pricing. Copyright © 2014 Elsevier Inc. All rights reserved.
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Background The aim of our study was to characterize cross-cultural sleep patterns and sleep problems in a large sample of preschool children ages 3–6 years in multiple predominantly Asian (P-A) and predominantly Caucasian (P-C) countries/regions. Methods Parents of 2590 preschool-aged children (P-A countries/regions: China, Hong Kong, India, Japan, Korea, Malaysia, Philippines, Singapore, Thailand; P-C countries: Australia-New Zealand, Canada, United Kingdom, United States) completed an Internet-based expanded version of the Brief Child Sleep Questionnaire (BCSQ). Results Overall, children from P-A countries had significantly later bedtimes, shorter nighttime sleep, and increased parental perception of sleep problems compared with those from P-C countries. Bedtimes varied from as early as 7:43 pm in Australia and New Zealand to as late as 10:26 pm in India, a span of almost 3 h. There also were significant differences in daytime sleep with the majority of children in P-A countries continuing to nap, resulting in no differences in 24-h total sleep times (TST) across culture and minimal differences across specific countries. Bed sharing and room sharing are common in P-A countries, with no change across the preschool years. There also were a significant percentage of parents who perceived that their child had a sleep problem (15% in Korea to 44% in China). Conclusions Overall, our results indicate significant cross-cultural differences in sleep patterns, sleeping arrangements, and parent-reported sleep problems in preschool-aged children. Further studies are needed to understand the underlying bases for these differences and especially for contributors to parents’ perceptions of sleep problems.
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In addition to biological mechanisms, cultural factors are also important determinants of sleep practices and behaviors in infants, children, and adolescents, and influence both the type and frequency of sleep problems found in the pediatric population. Although many sleep practices are unique to the cultures in which they are embedded, there are also many similarities in the kinds of sleep behaviors and problems found across widely divergent cultures. The following review provides an overview of the scope and impact of sleep problems in children as they occur within a cultural context, and provides specific examples of sleep practices as they appear in different cultural settings, including western and Asian countries. Some of the key sleep practices most influenced by cultural practices and beliefs are discussed; co-sleeping, bedtime rituals, the sleeping environment, napping, and parental expectations regarding 'normal' sleep in children. The importance of clinical and educational cross-cultural collaboration, and the need for future research which uses culturally sensitive and comparable methodologies to explore cultural differences and similarities is emphasized.
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To characterize cross-cultural sleep patterns and sleep problems in a large sample of children ages birth to 36 months in multiple predominantly-Asian (P-A) and predominantly-Caucasian (P-C) countries. Parents of 29,287 infants and toddlers (predominantly-Asian countries/regions: China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, Philippines, Singapore, Taiwan, Thailand, Vietnam; predominantly-Caucasian countries: Australia, Canada, New Zealand, United Kingdom, United States) completed an internet-based expanded version of the Brief Infant Sleep Questionnaire. Overall, children from P-A countries had significantly later bedtimes, shorter total sleep times, increased parental perception of sleep problems, and were more likely to both bed-share and room-share than children from P-C countries, p<.001. Bedtimes ranged from 19:27 (New Zealand) to 22:17 (Hong Kong) and total sleep time from 11.6 (Japan) to 13.3 (New Zealand) hours, p<.0001. There were limited differences in daytime sleep. Bed-sharing with parents ranged from 5.8% in New Zealand to 83.2% in Vietnam. There was also a wide range in the percentage of parents who perceived that their child had a sleep problem (11% in Thailand to 76% in China). Overall, children from predominantly-Asian countries had significantly later bedtimes, shorter total sleep times, increased parental perception of sleep problems, and were more likely to room-share than children from predominantly-Caucasian countries/regions. These results indicate substantial differences in sleep patterns in young children across culturally diverse countries/regions. Further studies are needed to understand the basis for and impact of these interesting differences.
The lactation consultant in private practice: the ABCs of getting started
  • J A Owens
Owens, J. A. (2004). Sleep in children: Cross-cultural perspectives. Sleep and Biological Rhythms, 2(3), 165-173. Pathways. (n.d.). Retrieved December 1, 2015, from http://iblce.org/certify/pathways/ Smith, L. J. (2002). The lactation consultant in private practice: the ABCs of getting started. Sudbury, MA: Jones & Bartlett Learning.