Most parents expect their newborns to wake them up in the middle of the night. But, sometimes interrupted sleeping patterns can continue on past infancy. It’s estimated that sleep difficulties affect up to 30% of children, and they can have a significant impact on their lives, not to mention yours. Their lack of sleep leads to your lack of sleep which in turn can leave you on an emotional rollercoaster, swinging from low mood to anger to guilt, for acting out because of the anger, and so on.
You’ve experienced the effects of sleepless nights yourself – the next day your brain is mush, you have trouble remembering things, completing tasks, learning, making decisions, and so on. Your children can suffer those same effects too, and in their case it’s happening when they’re trying to acquire the most fundamental baseline pieces of their academic and social education.
Insomnia in children doesn’t just effect their learning, it also (as I’m sure you know too well) leads to some astonishing levels of irritability, problems with behaviour, a lack of impulse control, and hyperactivity (e.g. fidgeting, disrupting others).
There are also health considerations. A lack of a healthy sleep pattern can lead your little one to have reduced autoimmune capabilities, an out-of-whack metabolism, and because they’re groggy they have reduced fine motor skills, which can lead to physical accidents.
Different types of sleep problems in children
Children having trouble getting to sleep aren’t always considered to suffering from an actual sleep disorder. For example it can be perfectly natural for children to have trouble falling asleep if something exciting like a birthday or Christmas looms on the horizon. Or on the flipside if they are suffering from some kind of stress, of feel worried/anxious. Sleep problems can also be related to your parenting style. Or on cultural heritage (different cultures place different levels of importance on sleep behaviour). Insomnia in children can also develop if there is a change in the sleeping environment, for instance if a child is used to sleeping alone, then has a sibling move into share their room with them.
Child sleep problems are clinically referred to as “Behavioural Insomnia of Childhood.” This term has three main branches – sleep-onset, limit-setting, and combined (a combination of the first two branches). For a psychologist to make a diagnosis of insomnia in children there has to be a certain number of specific symptoms present, and they all have to be of a certain level or intensity. These symptoms have to have been around for a specific amount of time and they have to have caused a significant negative impact on the child and/or the family.
What is sleep-onset?
Sleep-onset involves the actual moments of slipping into sleep. Here your child will need help falling to sleep with you rocking them, feeding them, being present, or any other method you use. This category also includes waking in the middle of the night. At that point in time, your child doesn’t have you to initiate the sleep-onset activity so they can’t return to sleep under their own power. This is when they send up the flare (e.g. crying) for Mum or Dad to come and help them.
Sleep-onset difficulties involve:
- Your child is unable to return to sleep without your help.
- Your child is only able to fall asleep after a long list of special conditions is met. He or she can be incredibly demanding about these conditions, and problematic if the conditions are not met.
- Your child will take much longer to go to sleep or won’t be able to go to sleep at all without the special conditions being met.
What is limit-setting?
Limit-setting problems are fairly familiar to all parents – your little one might ask for just one more bed-time story, through to throwing tantrums when it’s time for actual bed.
Limit-setting difficulties involve:
- You’re not able to set proper limits that encourage a proper sleep pattern.
- Your child has trouble either falling asleep and/or staying asleep.
- Your child refuses to go to bed or refuses to return to bed, especially after being woken by a nightmare.
Identifying the cause of sleep difficulties in children
In trying to understand causal factors, psychologists investigate the information that you, the parent/carer, provide. We exclude other factors, to make sure that the poor sleeping behaviours are not a result of some other cause like medicine, a physical cause, or a mental health problem in which sleep disruptions are a symptom. Clinically speaking children are identified as having a significant sleep problem if they show a consistent pattern that ticks the boxes for limit-setting association and/or sleep-onset problems described above.
How are sleep problems in children treated?
To return your child to a proper sleeping pattern a psychologist will work with you using behaviourally based interventions. You’ll learn techniques that come from three main categories – shaping, reinforcement, and extinction.
The very first psychological approach introduced to help work with insomnia was the extinction method. This basically means that you ‘ignore’ your child’s cries for your attention (barring of course accidents or injuries). Extinction is often referred to as ‘cry-it-out.’ The big drawback to this method is that it makes parents feel wretched. To counter this a modification was offered – parents stay in the room with the child until they fall asleep but they ignore/do not respond to the stalling demands made by the child.
If the extinction method is deemed unworkable, another option can be to take a look at graduated extinction. The difference here from the regular old extinction method is that the cut-offs are of a graduated nature, and feel less severe. Graduated extinction has been shown to work within a few nights.
The idea is that parents can ignore calls for attention (crying, tantrums, etc.) for a set amount of time. This set time is as much for the benefit of parents as they are for the child. The time can either be according to a fixed schedule (e.g. you check in once every 10 minutes) or they can progress in length from 5 to 10 to 15 minutes and so on during the night, or across multiple nights.
When you do check in it’s for a very limited time (no more than a minute) and it’s not so you can concede to the child’s demands, or be drawn in. It’s purely a check to make sure everything’s okay, you lay the child down, or tuck them in, and then you’re out the door again. The point is to keep interaction minimal, and as boring as possible.
The goal with the method of gradual extinction is to wean your child off of parent-soothing behaviours (e.g. rocking, stories, etc.) and to help the child develop their own self-soothing methods. This doesn’t necessarily mean that the child should learn to cry themselves to sleep, but it is an opportunity to integrate self-soothing activities into a good bedtime routine, upon which they can become reliant, rather than relying solely on you to get off to sleep.
This technique is mainly used for children who have a problem with night waking. It requires you to first schedule your child’s usual waking patterns in a night. Next, you wake the child 10 to 15 minutes before they usually wake on their own, breaking their rhythm. You lull the child back to sleep in the usual manner (e.g. rocking, nursing, etc.) but you begin to extend the space between the deliberate awakenings, fading them out over time, and the hope is that the child will stop night-waking of their own accord.
Positive Routines and/or a Faded Bedtime
Positive routines can actually help your child enjoy the prospect of bedtime because you share a pleasurable (quiet) activity with them as bedtime draws near.
A faded bedtime deals with sleep difficulties in children by removing the child from the bed when they can’t fall asleep. Bedtime is also pushed until later so that your little one is good and tired by the time his or her head hits the pillow. This method also associates positive activities with bedtime.
In both methods the main focus is to associate sleepy-time with positive rather than negative behaviours. As sleeping becomes easier the bedtime is stepped back so it comes 15 minutes earlier one night to the next until a proper bedtime becomes the norm.
Parental Education and Prevention
Preventing disturbances before they ever have the chance to start and take hold is another strategy. Instead of training the child, this focuses most of the training on you to establish positive bedtime behaviours from the get-go. So you’ll work on creating a solid plan, with a high quality sleep schedule, how you should respond to awakenings, what you should be doing as you put your child to bed, and so on. A big part of this method is the goal of consistently putting your child to bed when they’re drowsy but still awake enough that they get the rest of the way into dreamland on their own, growing their own self-soothing methods along the way.
Some parents do seek help, particularly when sleep problems become complex, and difficult to manage. There are various ‘sleep coaches’ which will, more often than not, tend to use the extinction methods. If you are struggling, you can seek support from a Clinical Psychologist who has experience of sleep difficulties in children. It might seem a bit odd to you to want to talk to see a psychologist about insomnia in infants or young children – aren’t they too young? But remember these two points – first, psychologists are also talking to and working with you, the parents.
Second, little ones are complex, growing, beings and part of that growth includes behaviour change, and adaptation. A psychologist can be just the person to help you instill the most positive behaviours in your child right from day one, that alleviate anxiety for both the parent and the child, and lead to a future of successful sleep behaviour.
If you have questions please don’t hesitate to get in touch with us via our contact page.