What Does a Behavioral Sleep Specialist Actually Do All Day?

I get asked about my work fairly often, and I've realized that “I'm a clinical psychologist who specializes in sleep” doesn't really explain what I do all day.

For one thing, I'm not only a clinician anymore.

I run ThinkSleep, my clinical practice, as well as ThinkNapSleep, my consulting and education business focused on sleep across the family—from pregnancy and newborn sleep through childhood, adolescence, and parent sleep.Between the two, my work can include seeing patients, developing programs, writing, consulting, speaking, keeping up with research, and all of the less exciting things involved in running a business.

And, like everyone else who owns a business, a surprising amount of time is spent doing things that were definitely not covered in graduate school.

Some half-days, though, are reserved entirely for clinical care.

Those are still some of my favorite parts of the week, and they probably give the best glimpse into just how different one sleep problem can look from the next.

So here's what one of those mornings might actually look like.

Before the First Patient

My clinical time starts before the first appointment.

I prepare for sessions. I know not every therapist works exactly the same way, but I've always liked going into an appointment having refreshed my memory about where we left off.

I'll review my notes from our last session, look at any sleep data we're following, and remind myself what we were working on. If something specific came up last time, I may pull up a paper or do some reading before we meet.

Sometimes I have a pretty good idea of where we're headed.

And sometimes the patient logs on and says, “So...a lot happened this week.”

There goes the plan.

That's part of what I like about clinical work. There is structure and science behind what I'm doing, but there is also a real person sitting across from me whose life did not organize itself around our treatment plan.

9:00 A.M.: A New Mom Who Is Exhausted...and Can't Sleep

Her baby is waking several times a night, so of course her sleep is disrupted.

But that's not actually the whole reason she's here.

Sometimes the baby goes back to sleep and she doesn't.

She lies awake wondering how much time she has before the next feeding. She's listening for movement from the bassinet. Maybe she's thinking, I have two hours. I HAVE to fall asleep now.

So we're really talking about two sleepers.

The baby may be doing something completely developmentally normal. Mom, meanwhile, may be developing insomnia during a period when sleep is already understandably vulnerable.

We might talk about the baby's sleep. But I'm also paying close attention to hers.

10:00 A.M.: An Athlete Who Actually Sleeps Pretty Well

My next patient may not have insomnia at all.

They're training hard and want to know whether they're sleeping enough to support performance and recovery.

Now the conversation is completely different.

We may be looking at training times, travel, competitions, naps, morning light, sleep opportunity, or what happens after a late game when their body is exhausted but they're still physiologically and mentally activated.

We might also talk about what their wearable is telling them—and how much attention it deserves.

Sleep matters enormously for athletic performance and recovery. But trying to achieve “perfect” sleep can very quickly become another performance goal.

That's usually not particularly helpful.

11:00 A.M.: A Pregnant Woman Who Suddenly Doesn't Recognize Her Sleep

She used to sleep well.

Now she's uncomfortable, she's getting up to use the bathroom, maybe she has reflux, and when she wakes at 3:00 a.m. her brain has apparently decided that's an excellent time to think about everything that needs to happen before the baby arrives.

Some of this is normal pregnancy physiology.

That doesn't mean the answer is, “Well, you're pregnant. Good luck.”

We can separate out what we may not be able to change right now from the things we can. And I'm particularly interested in preventing a temporary period of disrupted sleep from turning into a more persistent sleep problem.

12:00 P.M.: Someone Who Hasn't Slept Well in Years

Maybe she's an elementary school teacher who has struggled with falling and staying asleep for a decade.

By the time she sees me, she has tried everything.

Melatonin. Magnesium. Blackout curtains. No screens. Earlier bedtime. Later bedtime. A new pillow. Probably several podcasts.

She may have an impressively elaborate nighttime routine.

And yet she's still not sleeping.

This is where we may spend surprisingly little time talking about traditional “sleep hygiene.”

I want to know what happens when she can't sleep. What time does she get into bed? Does she sleep later after a bad night? Does she nap? Is she watching the clock? Has bedtime slowly become something she dreads?

I'm trying to understand how her insomnia works, because that's what tells me how we're going to treat it.

And Then Comes the Glamorous Part

Notes.

Every session needs documentation. There may be messages to return, treatment plans to update, other providers to coordinate with, referrals to make.

This is the portion of behavioral sleep medicine that has yet to make anyone's “day in the life” Instagram reel.

And I'm comfortable predicting that it never will.

I write my notes, close approximately 37 browser tabs, and clinical care is done for the day.

Then I Change Hats

This is probably the part of my work that's changed the most over the years.

When clinical care ends, my workday doesn't necessarily end. It just looks completely different.

I might switch over to ThinkNapSleep and work on something about pregnancy or newborn sleep. I might be writing an article like this one for ThinkSleep, reviewing research for something I'm developing, preparing for a talk, working on a course, answering business emails, or having a meeting about something entirely unrelated to the patients I just saw.

Some days I'm thinking about chronic insomnia at 10 a.m. and newborn sleep at 2 p.m.

Other days I'm working on a corporate presentation, writing an Instagram post, reviewing a research paper, and then spending 45 minutes trying to figure out why something on my website isn't doing what it's supposed to do.

Again: graduate school did not prepare me for all of this.

Why I Still Find This Work So Interesting

The thing that has kept sleep interesting to me all these years is how different it can look depending on the person sitting in front of me.

The new mom and the athlete might both tell me they want to “sleep better.”

So might the CEO who wakes at 4:30 thinking about work, the pregnant woman who can't get comfortable, and the teacher who has had insomnia for 10 years.

But those aren't five versions of the same problem.

Sleep is biological, but it also intersects with our health, psychology, behavior, work, families, schedules, environment, and whatever else happens to be going on in our lives.