The Sleep Struggle is Real
By: Kat Donina, PsyD
You are in a deep, deep slumber. Suddenly, you hear faint footsteps down the hall, a slight creek at the door, and feel a tap on your shoulder. You are startled awake by a child-sized apparition at your bedside. This is not a horror movie; this is your kiddo having a hard time falling back asleep. Or maybe you have finally settled into a good book, started talking to your partner or friend, or fallen asleep following a long bedtime battle when you hear "Mommy!" or "Daddy!" You are then brought back to tackle bedtime all over again.
Sleep difficulties in children are widespread; 25-50 % of school-age children may exhibit sleep problems. Out of that 50%, a much smaller percentage will be diagnosed with a formal sleep disorder. (American Academy of Pediatrics, 2023). Sleep problems may include:
trouble falling asleep and winding down in the evening
difficulty staying asleep throughout the night
waking up too early
When you have an infant, sleep difficulty comes with the territory, but as your child grows, you hope they learn to fall asleep and stay asleep through the night. When your child struggles with sleep, it usually means your sleep is affected too, and everyone has a more challenging time regulating their moods, solving problems, and mustering energy throughout the day. Sleep problems leave many children and families feeling frustrated and helpless.
Why Is My Child Having Trouble With Sleep?
Some troubleshooting questions:
Does my child have a consistent, calming bedtime routine?
Is my child going to bed too early or too late?
Have there been any changes in my child's routine or environment?
Has my child been exposed to any stressful event/news?
Is there any stress at home?
Is my child having trouble learning or having difficulty with friends?
What was the sleep culture in your house growing up? How do you think it shapes your expectations and/or worries about your child's sleep now?
Behavioral and Psychological Problems Contributing to Sleep
Many factors have been found to contribute to sleep difficulties in children. Behavioral and psychological factors are often strong contributors. Nighttime fears, nightmares, and anxiety are widespread among school-age children. Fears of the dark, monsters, and robbers are expected as a child becomes more aware of the world around them (ages 5-10). Even age-appropriate fears can create enough distress to interfere with bedtime and require more support and intervention at home. Talking to your child about their worries and fears during the day is normalizing and validating for them and can be an opportunity to discuss coping strategies. Some ideas may include:
Use validating and normalizing language such as
"It makes sense you feel scared when you think about what might be hiding in the dark. What would help you feel more safe?"
"Lots of kids feel scared of the dark/monsters. There are no such things as monsters, but we can figure out ways to feel more comfortable going to bed."
Reading books about worries, fears and sleep. Some good ones:
"Pickles and Her Upstairs Brain" by Catherine Young.
"What to do When you Worry Too Much: A Kid's Guide to Overcoming Anxiety" by Dawn Huebner, PH.D.
"Listening to My Body" By Gabi Garcia.
Drawing/painting pictures of their worries/monsters/bad dreams.
Sometimes, changing the scary monster into a silly monster helps.
A night light.
A noise machine.
Can your child think of things they might want in their room that can help them feel safe and calm? Stuffed animals, special pictures they can hang on their wall
Create a worry box with your child: Your child can draw or write their worries on a piece of paper, close the box, and put it away somewhere safe. This way, the box holds the worry so your child doesn't have to. Your child can write or draw their worries before bed and put them away.
Talking about a calming and consistent bedtime routine
Listening to a guided sleep meditation or visualization with your child during the day so they can use these tools at night.
Keeping a sleep journal may help children track what works and doesn't work for them.
Teach your child positive sleep mantras, such as: "I'm a good sleeper," "Sleep is good for me", "I can fall asleep."
Nighttime Separation
When your child has trouble at bedtime or during the night, they may be relying on you to be close to them to fall asleep. Children often create nighttime hangouts when seeking more time and closeness with their parents. Regularly creating special time with your child is essential to the solution. However, once there is an adaptive routine, it can be hard to break. Many families find it helpful to create a slow transition out of their child's room after lights out. For instance, you may start by sitting near their bed on day one. On day two, you sit a bit further away. You do this every night or every couple of nights (depending on your child's comfort level) until you sit on a chair right outside their door, and then finally, they have grown accustomed to being in their room on their own. Creating a special chart to track and reward bravery every night is also a helpful tool. Consistency is key, so stick with whatever was agreed upon between you and your child. Praise effort, especially when progress isn't as fast as you would have hoped (i.e., "Even though you were so scared to close your eyes with me sitting across the room instead of on your bed, you did it! I am so proud of how hard you are working through this worry!").
When To Seek Professional Help for Sleep Problems
Having phases of sleep difficulty is normal in childhood, especially around significant transitions (back to school, back from holidays and vacations) or around big family events. However, if your child's sleep problems have been ongoing and interfere with their ability to learn at school and their overall day-to-day life, seeking professional help is essential. An underlying anxiety disorder, separation anxiety, exposure to stressful or traumatic events, school and learning problems, Attention Deficit and Hyperactivity Disorder, and other undiagnosed mental health disorders are also often associated with sleep problems. About 70% of children with ADHD also struggle with winding down at night, quieting their minds, and staying asleep (ADDitudemag.com). Seek support from a therapist to address potential underlying mental health concerns. Sometimes, additional evaluation may be necessary to rule out underlying learning problems contributing to overall stressors in your child's life and sleep. A neuropsychological evaluation is a comprehensive and helpful way to understand if your child is exhibiting underlying neuropsychological and learning challenges.
Medical issues such as Obstructive Sleep Apnea, Restless Leg Syndrome, bed wetting, or other potential physiological problems may also contribute to sleep difficulty. These issues require treatment and need to be ruled out. Some treatments for these medical issues may involve a special sleep apnea mask at night time, vitamin supplements such as iron, or other forms of treatment. Participating in a sleep study can be helpful (and sometimes essential) in tracking your child's sleep cycle and subsequently determining the cause of sleep disturbance (Sleep Foundation.org). You should consult your child's pediatrician to rule out any health concerns affecting their sleep.
A Few Parent Survival Tips for Child Sleep Problems
Accept that this is a problem right now. This is hard, but temporary, and you are working on it! It's easy to worry about your child and think, "This will never end," but usually, it does when we try to understand the problem and seek the appropriate solutions.
When we are tired, finding compassion for ourselves and our children at night is much more complicated. It may be helpful to have a positive mantra in mind to ease worry or frustration ("My child will fall asleep," "This is temporary," "This is hard, but I'm doing it").
If you feel frustrated and impatient during bedtime or because your child came into your room several times after lights out, that is normal. It is easy to fall into a frustration-guilt spiral when you're exhausted. This is where tag teaming with your co-parent or other caregiver (if you have one living with you) is helpful.
Take care of yourself and seek help from your community.
Talk to a professional when needed.
References:
Carter, Kevin A., Hathaway, Nathanael, E., Lettieri, Christine, F. (2014). Common Sleep Disorders in Children. American Family Physician.
https://www.sleepfoundation.org/children-and-sleep/sleep-disorders-in-children
https://www.additudemag.com/sleep-problems-childhood-adhd-diagnosis/
