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CONSULTATION & EDUCATION
A consultation is first required for all teens to understand the concerns, to confirm the diagnosis, and to evaluate if investigations (ex. a sleep study) are required. After the consultation, education is provided and treatment options are discussed.
These services typically take place over 1-2 appointments*. The presence of a parent and/or caregiver is suggested for these appointments.
*Please note: During the current work-from-home circumstances, all new consultations will be arranged through the administrative staff at Dr. Ooi's other practice location, MedSleep Toronto Sleep Institute. All care is being delivered virtually.
STEPS AFTER CONSULTATION
THE FIRST THREE STEPS
There is a lot of sleep advice and it can be confusing to know where to start. There are often a number of things that need to come together for long enough to see improvement. When you are tired, overwhelmed and struggling to act consistently (which is often the case and very understandable when you are not sleeping well), you need a realistic plan and you need to know where to start.
The three steps below are, in my experience, always the best place to start. It is really tempting to skip past these steps.
If you skip past these first three steps, it's much harder or even impossible to benefit from other recommendations for sleep. While you may have to build habits and skills to sleep better, it's better to start with low-hanging fruit and lay a good foundation to make future changes.
The good news is that these first three steps alone can make a big difference!
STEP ONE: TIME SLEEP PROPERLY
One of the most common reasons you cannot sleep is that your body is not ready for sleep when you are trying to sleep.
This is often due to a body clock that is running later or not enough build up of sleepiness (or sleep drive) because of sleeping too late or napping.
Take a listen to this 8 minute podcast episode in which I talk about this common trap in more detail then talk you through how to estimate when you can expect sleep (i.e. you 'starting line for sleep').
While you while you will eventually need to take the steps to move your starting line for sleep (i.e. when your body will be ready for sleep) to an earlier time, it is easier to first start by better matching when you expect and try to sleep with your current starting line.
STEP TWO: SET UP AN ALTERNATE PLAN TO AVOID DEFAULTING BACK TO YOUR BED AND PHONE
One of the most powerful and common reasons you cannot settle in bed is that your bed has become paired with 'awake mode' instead of 'sleep mode'. Bed has become a cue for your body and mind to become more alert and have a hard time settling.
The goal is to not spend more than an hour (ideally less) in bed for any reason in a 24 hour period. This means not getting into bed until on the 'edge of sleep' (i.e. your eyelids are heavy, you feel as if you could fall asleep in the next few minutes), getting out of bed if you are awake for more than 10-15 minutes and and only returning once sleep, and cutting out all time awake in bed during the day.
These steps are really hard to follow in the moment. To set yourself up to be successful and consistent, you need a solid alternate plan set up ahead of time so that you do not default back to your bed and onto your devices
Download the this handout that teaches you how set up a Cozy Nook and Sleep Kit. The goal is to set things up that you will realistically use in the moment--even if you are exhausted and irritable.
QUICK LINKS
Please note that I have no affiliation with the following products. These links are just to help get the ball rolling on taking action. You can, of course, find objects around the home or choose the products that you think would work best suit your needs and your budget.
STEP THREE: GET LIGHT WORKING FOR AND NOT AGAINST YOU
Another powerful reason it is so hard to sleep well is that we have constant access to light and devices, making it very hard for our bodies to differentiate day from night.
Too much light in the 3-5 hours before bedtime (as well as overnight) results in suppression of melatonin production, make it very hard to settle, to get sleepy, and to have a good quality sleep. Too much light in the evening and not enough light in the morning can also result in a delay in the body clock. If your clock is running too late, it is almost impossible to advance your clock until you have set up
In order to better match your body clock with a schedule that works for you, you need to get the right light and dark signals at the right time. In the past, before we had access to light 24/7, we would get lots of light in the morning and during the day, less light in the evening and blackout conditions overnight. The goal is to move closer to these natural light/dark cues (even if you can't yet put away your electronics earlier just yet.
Download the this handout that walks you through how to set up better light/dark cues so that light is working for you (and not against you).
QUICK LINKS
Please note that I have no affiliation with the following products. These links are just to help get the ball rolling on taking action. You can, of course, find objects around the home or choose the products that you think would work best suit your needs and your budget.
Only if discussed. Do not use the following until we next meet.
WHAT NEXT?
Once you have taken the first few steps, you might see improvement and not need anything more.
There are 3 options moving forward.
GENERAL FOLLOW-UP AT THE TORONTO SLEEP INSTITUTE
The first options is that you can return to see me in clinic for general follow-up to check in on these recommendations and discuss other steps you can take. Follow-ups are booked every 3-4 weeks and are 20 minutes.
The downside to general follow-up is that I have found it is sometimes not enough. These changes can be very challenging and using a more structured, step-by-step approach with regular troubleshooting and ability to ask questions if often helpful. This is why I created the DECODE Insomnia Program which is delivered as an online program (see below).
Please contact the Toronto Sleep Institute administrative staff at 416-488-6980 to book a follow-up appointment.
GROUP INSOMNIA TREATMENT THROUGH THE DECODE INSOMNIA CLINIC
The second option is to obtain care through the DECODE Insomnia Clinic. This clinic will start running a 8-week group program starting in September 2022. This clinic is for those who are ready to invest in their sleep and consists of groups for both parents and teens. The group treatment integrates the DECODE ONLINE platform with video lessons and worksheets. There is a program/administrative fee of $100 to enrol in the upcoming though financial assistance options are available. Groups will be capped at 10 parent/teen units. Groups will run in September, January and May. To express interest in an upcoming group, please contact Melanie by emailing decodeinsomnia@protonmail.com.
NO CLINICAL FOLLOW-UP
The final option is to not return to see me in clinic or enrol in a program right now but rather to use the many free DECODE resources or to enrol in the DECODE ONLINE program (see below). The door is open to reconnect at a later time in clinic.
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If you are interested in joining one of the upcoming treatment groups run through the DECODE Insomnia Clinic, email Melanie at decodeinsomnia@protonmail.com
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If you want more support in clinic through Dr. Ooi but you are not wanting to enrol in a treatment group, please contact the Toronto Sleep Institute administrative staff at 416-488-6980 to book a follow-up appointment
DECODE ONLINE program: This online program is for those who are ready to invest in their sleep. It consists of an online platform with video lessons, worksheets, cheatsheets, and the ability to ask questions that will be answered in group Q&As. This program is intended for both teens as well as their parents. This is a paid program though financial assistance options are available. To find out more and to enrol in online program, click here. Please note this is an online educational program and does not include clinical follow-up with Dr. Ooi. This online program is, however, integrated into group treatment at the DECODE Insomnia Clinic.
OTHER RESOURCES
ARCHIVED WEEKLY NEWSLETTER FOR PARENTS
FIND THE EIGHT PODCAST
You can listen to me speak more about sleep in teens in the following interviews and on Instagram.
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4-PART VIDEO SERIES FOR PARENTS
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