Sleep Problems

Sleep is essential for balance and development. Normal everyday functioning and academic progress entail a good night’s sleep, since a child, who has not slept enough the previous night, is tired, irritable, hyperkinetic and inattentive throughout the following day. Understandably, many parents hold considerable worries regarding their child’s sleep pattern and seek professional advice acknowledging the impact bad sleep habits could have on his/her physical and mental health.

Is my child’s sleep pattern a problem? It could be if the erratic sleep pattern has become an obstacle to the child’s behaviour and a reason for frictions between you and your child. As noted above, lack of sleep due to difficulties (falling/staying asleep/waking up very early) provokes an inability to concentrate, behavioural problems (moody child) and constant complaints that eventually affect relationships and family life.

Research on developing ‘good sleeping habits’, as the above term denotes, has provided the following tips on how to enhance good sleeping promoting general health. It is highly recommended that families should implement the following strategies to improve sleep since they represent long-term solutions for relevant difficulties.

On the contrary, medication for sleep difficulties may be effective for a brief period, but there is the risk that the child will become tolerant of it and the problem will be prolonged and perpetuated. Sometimes, ‘sleep hygiene’ strategies can be combined with medication with the view that the sleeping pills will be stopped after a while, when the child gets into good sleep habits.

• Train the child to have a regular sleep schedule: that is, train him/her to go to bed and get up at the same time every day (weekends and days off included).
• Decide on a bedtime and stick to it.
• Encourage the child to go to sleep when he/she feels tired and sleepy.
• Teach the child what ‘sleepy’ means for example, droopy eyes, head dropping, etc.
• Train the child to use the bedroom only for sleeping so he/she will link the bed only with sleep and not with stimulation. Therefore, the child can play, read, study, text/talk on the phone, watch TV, search the web, etc. while in another room (preferably not in the bedroom). This strategy is difficult to be implemented with adolescents, who tend to spend a considerable amount of time in their bedrooms.
• Give the child a glass of warm milk or hot chocolate and encourage him/her to engaged with a calming activity 30 minutes before bedtime (for example, reading a book, listening to relaxing music).
• ‘Stimulus control’: Advice the child to refrain from watching TV or playing on the computer/tablet/phone an hour before bedtime. This is because the electronic screens activate the brain instead of helping it to ‘switch off’.
• Avoid heavy dinners before bedtime. Choose a light and balanced diet that will contribute towards undistracted sleep.
• Ensure the child’s bedroom is the right space for a good night’s sleep: quiet, dark and cool enough with a comfortable bed and soft blankets to keep warm.
• Keep the child’s daytime routine the same: even if the child has not slept enough and is tired, try to keep up with usual, daily activities. Do not avoid them, because the child will learn that he/she can get away with complaints about tiredness, while there are more chances for a physically tired child to go to sleep earlier.
• Distract the child and avoid daytime naps.
• Sleep routine: Teach the child a series of activities that lead up to bedtime by reminding him/her that the time has come to prepare for sleep. These activities can be a warm bath after which the child will put his/her pyjamas on; a warm drink; teeth brushing; subdued lights; bedtime story/reading. The routine should not exceed 30 minutes in time and must have a definite end point that would signal sleeping time (say ‘goodnight’ or turn off the lights).
• Reward for good bedtime behaviour (small toys, stickers, pleasurable activities with you). Make sure the child knows what he/she must do regarding sleep to get the reward and give it to him/her as soon as possible when he/she deserves it. The child must be rewarded every time he/she achieves certain goals, for ex.: going to bed when asked to; staying in bed until feeling sleepy, not using lit, electronic screens, etc).
• Avoid getting the child in your bed
• What if the child cries alone in the bedroom not being able to sleep or wakes up during the night? In this case, try to wait for several minutes before going to give comfort. It is always best to give the child the chance to settle into sleep alone without your help. Stay in the room and soothe the child in his/her own bed by patting, stroking, cuddling but do not interact too much and do not start a conversation, because your behaviour will become a hard habit to break later. In other words, be as ‘boring’ as you can avoiding playful behaviour. Leave the room a soon as he/she settles for sleep. Always ensure, the child is not too cold or too hot, has a rash, has no other unspoken worry/fear that you must know about.
• If problems persist, consider keeping a sleep diary, in which you can note what seems to trigger the child’s difficulty, what works and what seems to aggravate the problem, etc.
• Be consistent and persistent: Do not forget that children learn what they are taught. Your child will learn very quickly if you behave the same every time (same bedtime routine).

Some children cannot get into a sleep routine and keep on waking up during the night or do not fall asleep at all calling the parent(s) to go to them. Some others leave their beds wandering in the house looking for company, interaction or play. In these events, guide the child back to bed and try to re-settle him/her gently but firmly by being ‘boring’ as described above and by repeating the behaviour that your child has associated with the definite end point that signals sleeping time (say ‘goodnight’ or turn off the lights). Do not hesitate to repeat as necessary.

Despite the above strategies, some children will not settle without the parent(s). In this case, stay with the child in his/her bedroom, but gradually increase the distance between you and him/her for ex.: sit beside the child without cuddles, sit on the bed near child’s feet and gradually move away, stand beside the bed, sit on a chair in the room, go and stand near the door, stand outside the room using your voice to reassure the child, etc. Hopefully, at a point, he/she will no longer need you to be there for him/her in order to fall asleep.

However, all children are different and each one of them will respond differently to the above strategies. Some children will settle easily into a sleep routine, while others will need more time and effort. We must have patience and allow time and space for the child to develop the desired sleep hygiene.

If your child/adolescent is experiencing sleep problems, please call our expert team on 01273 059700 to book an appointment with one of our Child & Adolescent Psychiatrists.