Sleep Problems

Is your child:

• Saying, “Mommy, I can’t sleep!”
• Having trouble getting to bed at night?
• Crying when you say the word ‘bedtime?’
• Knocking at your door 10 minutes after being put to bed?
• Bursting into your room in tears, reporting that he had a nightmare?
• Having a bedtime routine that takes too long?
• Showing poor sleep habits that cause everyone in your house to lose sleep and wake up grouchy?
• Insisting on sleeping in sibling’s or parent’s room?

Having a child who does not sleep well can be very stressful. You may find that your child always needs just one more thing before he can go to bed. For example, ‘I need a glass of water,’ ‘I need 6 stuffed animals in my bed,’ or ‘Mom, can I sleep in your room?’ may be frequent phrases around your house.

Parents may be frustrated and exhausted. Siblings may get annoyed by the sound of a little sister crying at midnight.

Your child’s daily functioning may be impaired due to poor sleep habits. He may fall asleep at school or have learning problems due to chronic drowsiness. Health problems may result due to lack of sleep. For example, some kids keep getting sick with every little bug that goes around due to poor sleep habits. Nightmares may prevent a child from falling asleep, for fear of recurrence.

Clinically, several reasons can explain why your child cannot sleep.

Circadian rhythms: Some children have difficulty with their circadian rhythms, which means that the typical patterns of when a person gets sleepy and wakes up in the morning are not working well. Gifted children often do not sleep well. Some typically developing children just do not sleep much.

Snoring: One common sign of sleep problems is snoring. Individuals who snore are much more likely to suffer from sleep apnea, particularly for obese people [7]. Signs of sleep apnea are: restricted breathing, gasping for air, and snoring. To test for sleep apnea, your local children’s hospital can conduct a sleep study to see whether or not your child’s sleep may be impaired due to breathing problems. Although dental devices and other surgical procedures may help treat sleep apnea, over-the-counter treatments are not recommended [7]. These issues should be explored with your child’s pediatrician.

Anxiety: Another very common sleep problem is anxiety. If your child worries a lot, it is likely his or her sleep will be impaired. If your child is sleepy or wakes up a lot, it is helpful to find out what he or she is thinking about before bed. Is there a test tomorrow? Are there friendship problems?

Nightmares: If your child is having bad dreams and can remember them, check in to see if the dreams have any particular theme. For example, the dreams may all be about showing up late for things or unprepared, or your child may have dreams about being embarrassed or made fun of at school. In the former case, your child may have generalized anxiety and a dose of perfectionism. In the latter, your child may have social anxiety. See ‘potential disabilities’ section for more on nightmares.

If your child can’t sleep, the most important place to start is with is your nighttime routine. Certainly, issues can be occurring beyond the routine, but parents are well advised to initiate a nighttime ritual as the first line intervention.

• Bedtime must be consistent. Your child’s bedtime should not vary by more than an hour. If your child’s bedtime is 8:30, then 8:00 is about the earliest he can fall asleep and 9:00 is about the latest. Pushing past your child’s bedtime or requiring your child to go to bed too early is asking for trouble as it disturbs your child’s sleep-wake cycle
• Limit or eliminate light. Light signals the brain to wake up. If devices such as an alarm clock or computer with a light are in the room, they must be removed or covered up so that your child can sleep. Night-lights can be used (if necessary), but darker rooms facilitate sleep
• Limit or eliminate all screens. Yes! Screens include computers and phones. Staring at a bright, changing, or moving screen will wake your child’s brain, making it much more difficult to fall asleep. The phone should be out of your child’s room for sleep-time. Receiving updates and text messages is extremely disruptive to sleep
• Utilize ‘sleep-onset association’ tools. Sleep-onset association refers to cues in our environment that signal sleep. Cozy pajamas, warm blankets, and fluffy pillows can all become associated with sleep. Reading a story, listening to soft music, or quietly drawing can be added to the bedtime routine to help your child’s body begin to wind down. This association is why kids with sleep problems should not do homework or eat in their beds. Beds are just for sleeping. They should sleep in their beds and not on the couch. Heavy or weighted blankets may be helpful. Pleasant sounds and smells can help trigger the body’s impulse to sleep. Find ‘sleep signals’ that work for your child, and provide them consistently as part of the bedtime routine
• Keep it brief and boring. If your child comes in reporting that she can’t sleep, comfort her briefly and put her back to bed. This approach may take many attempts before she eventually goes to sleep. However, a quick and simple ‘good night, honey’ and kiss on the cheek sends the message to your child that he or she is just fine and that you will be consistent in your expectations and follow through

If your child is struggling with a similar problem, not directly addressed in this section, see the list below for links to information about other related symptom areas.

• General anxiety: children who worry a lot tend to have difficulty falling asleep
• Phobias: children who are afraid of monsters, spiders, or the dark may have trouble sleeping
• Depression: children who have emotional symptoms of sadness or depression often sleep too much or not enough
• Non-compliance: children may refuse to sleep in their own beds or go to bed on time because they are in the habit of being defiant or disobedient. In this case, the child does not have a ‘condition;’ but rather, requires more clear rules, expectations, and follow through from parents to learn good sleep habits

Children who have significant problems in this area may have any of the following potential disabilities. *Note, this does not serve as a diagnosis in any way. See ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.

• Anxiety: pervasive worries are often to blame for the inability to fall asleep or to stay asleep
• Depression: often, depressed individuals either cannot sleep or sleep too much
• ADHD: many children with ADHD have difficulty slowing down and falling asleep, particularly children who take stimulant medications
• Autism: although not directly a symptom of autism, many children with autism have difficulty with sleeping, eating, or both
• Gifted: many gifted children have difficulty shutting their minds off at night. Sometimes, gifted children are highly sensitive emotionally, and they may struggle with worries or emotional symptoms that make it hard to sleep
• Behavior disorder: some children will not sleep because they are simply refusing and disobeying their parents. This type of sleep problem needs to be met with consistent expectations and follow through on the part of the parents
• Typical development: some children will simply go through phases where they do not sleep well. Young babies (0-9 months) may not sleep through the night consistently and this is probably not of concern. Toddlers may have periods where they do not sleep as well. In this case, parents need to stay firm and consistent with the bedtime routine. Even older children may have periods where they sleep in their parents’ room or have trouble getting to bed at night. Try some of the ‘what to do’ strategies above and if the problem persists, it may be time to see a specialist
• Insomnia: difficulty initiating sleep, maintaining sleep, or early morning awakening [5]
• Narcolepsy: may have sudden loss of muscle tone with precipitating laughter (cataplexy), irresistible need to sleep, and/or napping several times per day [5]
• Hypersomnolence (excessive sleepiness): falling asleep many times per day, difficulty waking up; sleeping more than 9 hours without feeling refreshed [5]
• Obstructive Sleep Apnea: breathing disturbances during sleep, snoring, gasping, breathing pauses and/or, daytime sleepiness and unrefreshing sleep in spite of sufficient opportunity to sleep [5]. Sleep apnea is fairly common (approximately 25% of the general population). Sleep apnea is very common in obese people (80% of the obese population), which is why weight loss is an evidence-based treatment for the condition [7]. Promising surgeries and treatments for sleep apnea are coming out of University of Pennsylvania that are reducing snoring, increasing airflow, and minimizing risk factors of sleep apnea [7]
• Circadian Rhythm Sleep-Wake Disorders: persistent sleep disruption that is mostly due to ‘alteration of the circadian system’ (natural sleep-wake cycle); may also have inability to fall asleep and wake up at ‘conventionally acceptable times.’ [5]
• Non-REM Sleep Arousal Disorders:
  • Sleep-walking – regular instances of getting out of bed and walking around; stares blankly at others, does not respond when others attempt to communicate, and difficult to awaken [5]
  • Sleep terrors – “recurrent episodes of abrupt terror arousals from sleep, usually beginning with a panicky scream.” Child will show intense fear and arousal with rapid breathing, sweating and are often unresponsive to efforts by loved ones to comfort him or her [5]
• Nightmare Disorder: Regular instances of extended, emotionally distressing and well-remembered dreams. The dreams generally involve ‘threats to survival, security, or physical integrity’ and usually occur during the second half of a longer period of sleep. When awakened by the nightmare, the person becomes very quickly awake and alert [5]

If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.

• CLEAR Child Psychology: to obtain a customized profile of concerns for your child or to consult ‘live’ with a psychologist
• Occupational Therapist (OT): to help with general adaptive skills, including sleep
• Psychologist or neuropsychologist: to help with anxiety, depression, ADHD; may conduct sleep study; may provide therapy for phobias that restrict sleep
• Pediatrician or neurologist: Consult with your child’s doctor for medical conditions such as sleep apnea or unexplained extreme drowsiness
• Children’s Hospital: Your local hospital can conduct a sleep-study, prescribe medication, or provide sleep tools like CPAP machine

These professionals may recommend the following tests for this symptom:

• Sleep Study: for sleep apnea, snoring, or disrupted sleep patterns
• RCMAS-II: for anxiety-related sleep problems
• CDI-II: for depression-related sleep problems

[1] Rocky Mountain Pediatric Neurology & Sleep Medicine: rockymountainkidsneuro.com

[2] Huebner, Dawn & Matthews, Bonnie (2008). What to do when you dread your bed: A kid’s guide to overcoming problems with sleep (What to do guides for kids).

Amazon: https://www.amazon.com/What-When-You-Dread-Your/dp/1433803186/

[3] Peters, Daniel (2013) From worrier to warrior: A guide for conquering your fears.

Amazon: https://www.amazon.com/Worrier-Warrior-Guide-Conquering-Fears/dp/1935067249/

[4] American Psychiatric Association (2013) Diagnositic and statistical manual of mental disorders, Fifth edition (DSM-V).

[5] Richard Schwab (2016) Professor of Medicine: University of Pennsylvania. Wharton Business Radio XM: Episodes: 10/11/2016 @12:00 PM, 7/19/2016 @12:00 PM. https://businessradio.wharton.upenn.edu/programs/the-business-of-health-care/guests/

[6] Gates, Mariam & Hinder, Jane (2015). Good Night Yoga. A pose by pose bedtime story.

Amazon: https://www.amazon.com/Good-Night-Yoga-Pose-Pose/dp/162203466X/

Image Credit:
Description toddler girl closing her eyes in the bed perhaps she is seeing bad dreams
Stock Photo ID: #42948022 (Big Stock)
By: oocoskun
Solve-your-child’s-sleep-problems
Previously Licensed on: Sep 21, 2016
Stylized by Katie Harwood exclusively for CLEAR Child Psychology

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