I have asked my T if he ever gets tired and starts to fall asleep with clients and he says generally not. He says if he is feeling sleepy, he will put his hand up to his earlobe and pinch it hard to wake himself up. Try it, it hurts! Ha ha so now I know if I see my T put his hand up to his ear when I'm with him, he may be falling asleep. He also tries to have a couple snacks throughout the day because his blood sugar gets low and it's harder to focus. So I certainly don't mind if he has a snack while I'm there, because that means he will be more alert during my appointment.