“Is sleep a behavior?” I hear this from BCBAs and families all the time.

Short answer: The state of sleep is biological.
Also true: The patterns that lead into sleep and help maintain sleep (wind-down, separating from caregivers, resettling between cycles) are behaviors and that’s where BCBAs make meaningful, ethical change. When we say “view sleep as a behavior,” we’re using shorthand for “target the behavioral chain that culminates in and sustains the sleep state.”

If you work with families long enough, you’ll hear it: “We’ve tried everything, and the bed is still wet.” Nighttime wetting (nocturnal enuresis) sits at the intersection of development, biology, and behavior—and when we treat it like a purely behavioral problem, everyone gets frustrated. This post offers a practical, scope-aligned approach for BCBAs: what’s typical, what warrants medical input, and where our work truly moves the needle.

If you’ve ever launched a thoughtful sleep plan only to watch it stall by week two, the issue usually isn’t the science—it’s how the conversation landed. By the time families reach us, they’re tired, cautious, and carrying a long history of “we tried that.” Our job is to make the first step feel doable, show a quick win, and build trust for the next step.

If you’ve ever sat with a caregiver of an older learner who whispers, “We thought it would be better by now,” you know sleep isn’t just a technical problem—it’s an emotional one. Sleep struggles often carry years of missed evenings, exhausted mornings, and a heavy dose of guilt or shame. When we lead with humility, we make space for something families need as much as a good plan: to feel seen, supported, and safe trying again.

Sleep is often talked about as a behavior. But sleep is also biology. And unless BCBAs understand the biological systems behind it, we may find ourselves recommending strategies that sound good behaviorally—but don’t align with the science of how sleep actually works.

In this post, we’re surfacing key sleep science that wasn’t covered in our coursework, but should absolutely inform our practice—especially when supporting autistic learners and their families.

Sleep is often treated as an isolated issue: something to be addressed only when a caregiver brings it up, or when a learner’s nighttime behavior becomes disruptive enough to impact daytime services. But what if we’ve been underestimating just how foundational sleep is to everything else we care about?

Many families find themselves battling what looks like a sudden uptick in bedtime resistance. But for BCBAs supporting autistic learners with sleep challenges, the critical question isn’t always how to reduce the behavior—it’s when the behavior is happening in the first place.

Too often, we focus on modifying bedtime behaviors without first asking the simplest question of all: Is this bedtime biologically aligned with the learner’s current sleep needs?

If you've ever helped a family move from chaotic nights to restful sleep, you know what a triumph it can be. That first stretch of uninterrupted sleep. The caregiver who finally feels like themselves again. The child who’s better regulated, more engaged, and thriving during the day.

But what happens next?

It’s one of the most common frustrations I hear from both BCBAs and caregivers:

“We’ve been following the sleep plan for weeks… and it’s just not working.”

Maybe the learner is still resisting bedtime.
Maybe the night wakings haven’t improved.
Maybe the whole family is even more exhausted than when they started.

If you’ve ever had a caregiver tell you, “We’ve tried everything and nothing works,” when it comes to sleep—you’re not alone. For many families, bedtime has become a battleground, full of rituals, regressions, and desperation. But for BCBAs, this frustration is also an opportunity. Because the truth is: many of the barriers to healthy sleep are both observable and modifiable. We just have to know where to look.

When behavior analysts talk about essential skills, we often think in terms of language, independence, or emotional regulation. But there’s one foundational skill that quietly underpins every one of those outcomes—sleep.

And yet, most of us didn’t receive meaningful training in sleep science as part of our graduate coursework. We learned how to assess skill deficits, shape new behaviors, and design interventions with surgical precision. But sleep? That was someone else’s domain. Or so we thought.

For families facing persistent sleep challenges, the goal is often summed up in one desperate wish: I just want them to sleep through the night. But here’s something most people don’t realize—we all wake up multiple times each night. The difference is, as adults, we know how to fall back asleep independently. For many children—especially those with developmental differences—that’s the missing skill.

Dropping the nap is a major milestone for both kids and caregivers—and one that often comes with mixed emotions. On one hand, it can open up more consistent bedtimes and easier nighttime routines. On the other, it can feel like losing a much-needed window of quiet during the day. For behavior analysts and families alike, the key is knowing when the nap is no longer serving its purpose—and how to phase it out in a way that supports the learner’s overall sleep health.

When sleep concerns intersect with safety risks, it’s necessary to seek the fastest possible solution. For many families, that solution may come in the form of a “safety bed” like the Cubby Bed. These enclosed beds are designed with features like soft walls, zippered enclosures, and sturdy frames—making them highly effective at preventing elopement, property destruction, and certain forms of self-injurious behavior. For children with significant safety needs, they can provide much-needed peace of mind for exhausted caregivers.

When families turn to us for help with sleep challenges, they’re often exhausted, overwhelmed, and desperate for relief. Many have already spent months—sometimes years—trying to “fix” sleep, only to feel like they’re stuck in a cycle of short-lived progress and long-term frustration. But here’s the reality: with the right focus and support, even the most stubborn sleep problems can see significant improvement in just 5-6 weeks.

We’re often asked to help families "fix" sleep—especially when bedtime battles, middle-of-the-night wakeups, or nap refusals start impacting the child’s behavior and the family’s wellbeing. But here’s the truth: sleep isn’t a problem you fix once and never revisit. It’s a dynamic system that will shift and change over time. That’s why our goal shouldn’t just be to solve the current problem—it should be to equip families with a sustainable system they can rely on every time sleep becomes disrupted.

As sleep continues to earn its rightful place in the conversation around behavioral health and autism services, more BCBAs are finding themselves in unfamiliar territory: supporting families through bedtime battles, night wakings, and inconsistent sleep patterns. And naturally, one of the most common questions I’m asked is, “Can we bill for this?”

As behavior analysts—and especially as Certified Behavioral Sleep Educators—it’s our responsibility to support healthy, functional sleep for the learners and families we serve. But here’s the challenge: sleep isn’t one-size-fits-all. The way families sleep, when they sleep, and with whom they sleep are all deeply influenced by cultural norms and values. When we walk into a home or clinic with a rigid definition of what “normal” sleep looks like, we risk missing the mark—and doing more harm than good.

As behavior analysts, we’re trained to spot patterns, build systems, and write precise behavior plans. But when it comes to sleep, the science only goes so far. Sleep is personal. Emotional. Often wrapped in layers of guilt, fear, and frustration—especially for families of autistic learners who have tried everything and are still running on empty.

That’s why effective sleep support doesn’t start with a checklist. It starts with connection.

When it comes to providing full-day ABA services for younger learners, daytime sleep isn’t just a bonus—it’s a biological necessity. But unlike preschools, where group nap times are the norm, many ABA clinics struggle with scheduling and supporting naps in a way that aligns with each learner’s developmental and biological sleep needs. And for autistic children, whose sleep can already be unpredictable, finding the right rhythm requires a collaborative, informed approach.