Sleep problems in children

Sleep problems in children

This article looks at sleep problems in children aged four and upwards. For younger children I recommend this article and The Baby Whisperer book (which was a lifesaver when my daughter was tiny!). I will be writing a similar article to support parents of teenage children with sleep difficulties, very soon.

Quality and quantity are both important. If you are not sure how much sleep is enough for your child’s age, this NHS guide will be helpful.

Sleep problems in children: Quality and quantity

Sometimes children have significant problems getting to sleep, but sleep deeply once sleep happens. Other children fall easily to sleep but have disturbed sleep and/or wake frequently. The recommendations below should help with both getting to sleep, and getting better quality sleep.

Good quality (and quantity of) sleep is crucial for a child’s brain and body, providing rest and recovery time. This is particularly important during times of stress (for example, during exams or other times when academic demand is high), as the nervous system needs to recover from the intense pressure placed on it. Chronic lack of sleep is associated with a range of mental health difficulties (as well as physical ill health).

Feeling safe is more important than independence when it comes to sleep problems in children

As with any area of child development, children progress with learning to soothe themselves to sleep at different rates, and regression is very common even into the teenage years.

It is very important that you do not force your child to sleep alone if she is too anxious to do so. This can cause sleep disturbance and higher anxiety. If a child is feeling insecure or frightened her body will produce cortisol, the stress hormone. Cortisol is designed to keep us awake and alert. So, either she will remain awake, or she may fall into a fitful sleep of poor quality which will leave her exhausted. This applies to children of any age, whether four or fourteen. Instead, you need to help her feel safe by sitting with her (not all night, but until she is feeling safe again), and trying to “contain” her fear or worry to produce a safe base which will allow her to switch off and go to sleep. Try these listening strategies, which will help your child feel heard and contained.

Gradual withdrawal

Of course, your rest and recuperation time is important too. You don’t want to feel that your evenings have been “hijacked” by your child’s sleeping problems, but a little bit of time spent with your child will pay dividends. If your child is going through a period of feeling vulnerable or stressed and needs extra reassurance at bedtime, try gradual withdrawal. This will look different depending on the age of your child. In essence, it means staying with your child for extra reassurance, and gradually retreating out of the room, either to sit outside whilst she falls asleep, or agreeing a plan with your child to come in and check on her regularly, for example every twenty minutes until she is in a deep sleep.

Circadian rhythms

Sleep problems in children may mean that the body’s sleep-wake cycle, the circadian rhythm, has become out of sync. To add to this, in the teenage years, the circadian rhythm shifts significantly so that it does not neatly fit with our society’s current “normal” timetable. Teenagers will be ready for sleep much later than when they are younger, but still need more sleep than adults. Many teenagers therefore find it extremely difficult to get up in the mornings for school.

If your child’s body has become “out of sync”, you need to train her brain back into a clear rhythm so that it can tell the difference between day and night, sleeping and waking. You should aim to have a really clear distinction between waking time and sleeping time:

Regulating the circadian rhythm

• Try to ensure your child wakes up at the same time in the mornings and goes to sleep at the same time every night.

• When she wakes up, help her get as much direct light as she can. Ideally, ensure she spends some time outside. This will increase production of cortisol, the hormone which wakes us up and needs to be highest in the mornings. Consider using a “light therapy” desk lamp in Winter mornings or on days when sunlight is in short supply.

• Exercising during the day, particularly outside, balances brain chemicals such as serotonin and melatonin to aid sleep.

• Eat breakfast soon after waking, to raise blood sugar and aid the brain in differentiating between day and night. Ensure your child’s breakfast contains protein (eg peanut butter on toast) for slow-release energy, and try to eat regular slow-release energy foods during the day, as this will help establish the circadian rhythm.

• Try to ensure your child is getting enough magnesium in her diet. Magnesium is essential for calming the body and brain (it keeps the nervous system healthy) but many children are deficient in magnesium in the UK. As well as foods, putting Epsom salts in a bath or using a “magnesium spray” directly on your child’s skin can raise magnesium levels.

• Ensure you are getting enough omega 3 into your child’s diet. Omega 3 essential fatty acids help us release melatonin, and research shows increasing omega 3 can increase length and quality of sleep. (It also helps concentration). As with magnesium, many people are deficient in the UK and it is possible to take a supplement eg fish oil, flaxseed oil or algae oil capsules as well as increasing the amount in your diet.

Bedtime routine

  • Around one hour before your child goes to sleep, work on calming each one of her senses in turn, to give the correct message to her brain that it can wind down. For example, turn down the volume on the TV or music, talk in a softer voice, dim the lights, consider using relaxing smells (eg candles, oils) or tastes (eg hot chocolate).
  • Avoid caffeine at night time (eg hot chocolate or tea) as this will be too stimulating.
  • Ensure she stops using electronic devices at least one hour before bedtime.
  • Don’t allow her to do anything too exciting or stimulating in the evening, as her brain may become over-active. Pay attention to the types of books she is reading at night. All reading should be encouraged, but if the story is too exciting it may not be conducive to sleep and will give mixed messages to the brain.
  • There is some evidence that certain foods can increase production of melatonin, the sleep hormone. These include: Montmorency cherries (you can buy cherry juice or capsules from health food shops); kiwi fruits; bananas; or a mixture of a small amount of protein with a small amount of carbohydrate eg piece of toast with cheese. This article provides a few more options.

Buzzing before bedtime?

If your child seems overactive or wide awake at bedtime, it could be a result of overtiredness, or anxiety. It’s that “running on an empty tank” sensation. Worries or deep thoughts can become rampant at night, when children have quiet time to reflect. These can trigger anxiety. Try a worry diary or a worry box.

A worry diary is simply a note book kept by the side of your child’s bed. Every time she has a worry she writes it down. Once out of her head, she should be encouraged to put it aside until the morning. This can create a great sense of relief and allow the mind to be at peace.

A worry box is almost exactly the same. Your child can decorate a special shoe box, and make a little slot in the top. Worries can be written down on little pieces of paper or post-it notes, and posted in the slot. Once posted, the worries can be put aside.

If your child is buzzing at night and you don’t think it is down to deep thoughts or worries, then your child may be chronically overtired. You will need to follow the strategies in this article, paying particular attention to lifestyle factors (regular sleep and wake times, diet, exercise). It will take a few weeks for the effects of your hard work to show, but you will start to see your child becoming noticeably calmer in the evenings. This will lead to more, and better, sleep.

In the meantime, calm a busy brain by doing ten minutes of Mindfulness, for example using the apps Calm or Headspace. Mindfulness will also teach her how to “respond rather than react” to thoughts or worries. Your child will learn to become an observer of her thoughts rather than reacting automatically to them. As an observer she will be able to choose whether/how to respond, and will feel more in control.

The bedroom environment

The way a bedroom is set up for sleep is crucial for length and quality of sleep. Here are some tips:

  • Ensure there is absolutely no technology in your child’s bedroom. I know this may sound impossible for some parents of older children. I have a 14 and 11 year-old. This is just about the only hard and fast house rule we have, because it is so important. The only exception to this is their “read only” kindles. Technology is generally too overstimulating and exciting, but of course just the blue light in itself interferes with sleep, inhibiting the sleep hormone, melatonin.
  • Ensure the bedroom is very dark. Melatonin is essential for sleep, and it is triggered by darkness. Blackout blinds are very helpful in the Spring and Summer months, and can help prevent early morning waking. If your child is frightened of the dark, try to work on this gradually. For example, have the door open and landing light on, but close it a tiny bit more each night.
  • Minimize clutter. Your child’s brain will not be able to calm itself and prepare for sleep if the bedroom is too busy. If your child’s bedroom is cluttered, set a date for a clear-out or see if you can re-think her bedroom storage systems.

Don’t try to change everything at once.

When dealing with sleep problems in children, small changes will be more realistic than trying to radically change everything at once. Do stick with it and give these ideas a chance. Persistence is the key.

When and how to seek more help for sleep problems in children

If nothing is improving and you are concerned there might be an underlying reason why your child is not sleeping well, consult your GP. Your GP may refer your child to a paediatrician, who will check for underlying causes of the sleep problems. They may consider medications such as melatonin (a synthetic version of the hormone we produce in our bodies to trigger sleep). The paediatrician may also refer your child to an NHS sleep clinic.

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