Stories about: dennis Rosen

Help! What do I do if my toddler refuses to sleep?

The mother of a 3-year-old who has trouble falling asleep at night wrote our sleep expert Dennis Rosen, MD, the following email asking for help. The answer seems fairly universal, so we want to share it with Thriving readers who may be having the same difficulties.

Dear Dr. Rosen,

Not-tiredI am hoping that you can help me.  I don’t know of a pediatrician in my area that specializes in child sleep issues.  I have a three-and-a-half-year-old, and for the past six months, getting her to go to sleep at night has been a nightmare. I’ve always had trouble getting her to sleep—she didn’t sleep through the night until she was almost two.  And even up to two-and-a-half she would wake up in the night and tell me she was bored and wanted to get up and play.

When she turned three I moved my daughter into a regular bed but she won’t stay there long enough to fall asleep. (She gets up and plays, or wanders around upstairs if she can do so without me hearing her downstairs).

I’ve tried the Super Nanny approach and kept putting her back to bed until she fell asleep. But a week of doing this for what felt like 50 or 60 times a night was too much, especially for a single mom who needs to get up at 5:30 a.m. to go to work.

I started taking everything out of her room that she may play with, taking away privileges, (I even threatened making a call to Santa to talk about her placement on the naughty list), but nothing worked. Finally, I started locking the door to her room.  At first she kicked the door and yelled but now she stays in her room and plays/talks to herself until around 9:30 or 10:30 at night. I usually have to unlock the door several times so she can go to the bathroom, (sometimes she doesn’t really have to go, she just wants my attention).

Once she is asleep she generally stays asleep.  She normally gets up between 5:30 and 6:30 a.m. in the morning.  On a rare day she will sleep until 7:00, and sometimes she up as early as 5:00 a.m.

I thought perhaps her afternoon naps were the problem, but when she doesn’t nap during the day she still goes to sleep around the same time, and still gives me a hard time about it. (She’s also pretty grumpy in the evening when she doesn’t nap.)

I now try to limit her nap to 1 or 1.5 hours in the afternoon, unless she is not well.  At night we start getting ready for bed around 7:00 p.m. (pajamas, bathroom routine, stories, and soft songs) and I try to get her into bed no later than 8:00 p.m. I tell her she can talk to her babies softly in her bed, but she isn’t allowed to get up unless she needs to go to the bathroom. It doesn’t seem to be helping.

Do you have any advice?  I would really like to get her into a better bedtime routine and any help or pointers would be appreciated.

Sincerely,

Single Mom Desperately in Need of Sleep

 Dear Mom Desperately in Need of Sleep,

It certainly sounds like you have your hands full! While it’s not possible to provide child-specific advice, there may be some general things you can try that may help both you and your daughter to sleep better.

RosenDennis-1-PreviewlargeTo start, it sounds like her schedule isn’t as regular as it could be, if even during the week her wake-up time ranges between 5 and 7 a.m. Keeping to a regular schedule, both weekdays and weekends, helps to synchronize the body’s internal (circadian) clock, making it easier to fall asleep at the same time each evening. With her wake-up time spanning a two-hour range, it is easy to see how some nights she might be ready to settle down and go to sleep at 8:30 p.m., while on other nights that only happens at 10:30 p.m.

You also mention that she naps 1.5 hours during the day. Kids that age generally need around 11 hours of sleep, so that leaves 9.5 hours left for her to get at night. (Of course, there are others who need less than that; every child is different.)

The first thing I would suggest doing would be to put her on a regular wake-up time and keep to it, seven days a week. If you chose 6 a.m., that would mean putting her down at 8:30 p.m. You’d want to make sure, too, that she isn’t getting more sleep at daycare than you are being told. While easier for the daycare staff, this can create lots of problems for parents whose kids simply aren’t sleepy enough at bedtime because they’ve slept during the day.

As for her behavior, I’m not a big fan of locked doors, which can create stress for both child and parent.  A gate at the door should do the trick just as nicely. Providing a dim reading light and books that she can look at if she’s not sleepy, as well as dolls or toys, will help to keep her from getting bored. While she may ask to come out, you need to decide if that is acceptable, and to be consistent. One possibility might be to give her a “pass” that she can use once to come out for a drink of water, or a kiss, etc.

Good luck!

Dennis Rosen, MD, is the associate medical director of The Center for Pediatric Sleep Disorders at Boston Children’s Hospital and author of Successful Sleep Strategies for Kids. If you have a sleep-related question to ask, please email it to Thrive@childrens.harvard.edu.

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6 ways your child’s bedroom may be sabotaging her sleep

Dennis Rosen, MDLet’s face it: we all know that sometimes getting our kids into bed is only half the struggle when it comes to having them fall asleep. They may lie there, tucked in but not sleeping, or toss and turn for hours. But is your child’s bedroom the reason she’s not getting enough rest?

Here are a number of things to look for in your child’s bedroom, which may be interfering with her ability to fall asleep at night:

Too much light.

Bright light, especially in the evening, has a very powerful awakening effect on the brain. Make sure the bedroom lights are dim, or better yet turned off completely. If your child reads before going to bed, use a low-wattage lamp. If a night-light is needed, use the lowest wattage you can find (no more than 7 watts) and make sure that the light it casts does not shine directly on the bed. In the summer months, when you may be trying to put younger kids to bed before the sun has set, consider using light-blocking shades or curtains.

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How can I get my scared of the dark toddler to sleep with the lights off?

Dennis Rosen, MD is the associate medical director of The Center for Pediatric Sleep Disorders at Boston Children’s Hospital and author of Successful Sleep Strategies for Kids. If you have a sleep-related question to ask, please email it to Thrive@childrens.harvard.edu.

RosenDennis-1-PreviewlargeQ: My 2 year old daughter is very afraid of the dark the moment we leave her alone. She will happily turn off the lights so we can use a flashlight for shadow puppets, but when I’m ready to leave her and let her go to sleep she gets very upset, insisting I turn on both her ‘low intensity’ light AND her overhead light (or ‘big’ light as we call it).

I have tried everything to convince her that there’s nothing to be afraid of, but she still screams if I don’t leave the big light on. Unfortunately leaving the light on is starting to take its toll—she will sometimes lie awake for three hours after being left to sleep. We’ve tried to compromise by leaving the big light off while keeping the bedroom door open so light from the hallway can make its way into the room, but she insists its still too dark. What can we do to help her?

A: Your concern that your daughter’s exposure to all that light at night may be having an adverse effect on her sleep is well founded: exposure to bright light in the evening sends a powerful message to the brain that it’s still day time, which can delay the body’s desire for sleep. What’s more, the amount of light needed to trigger this response isn’t all that bright.

Fortunately there are a couple of ways to approach your problem. One method would be to simply to put your foot down and force the issue. Even if leads to several hours of crying the first couple of nights, she will eventually learn that nothing in the dark can harm her and drift off on her own.

Another, likely easier way to deal with the issue, would be to start downsizing the light bulbs in both the “big” and “low intensity” lights. For example, if currently you have the equivalent of 100 and 75 watt light bulbs in the lamps, you might switch to 75 and 40. Then in time you can gradually lower their intensity to 40 and 25, until you are able to turn one off completely, then both.

Good luck!

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Could starting high school later be healthier for teens?

Lack of sleep can affect academic performance in teens.

According to experts, teenagers need a little more than eight hours of sleep per night. Unfortunately, (surprise, surprise) most teens aren’t listening. The Centers for Disease Control and Prevention report that only 31 percent of high school students get eight or more hours of sleep on an average school night.

This is upsetting news because poor sleep is tied to a lot more than a teenager having a bad attitude when she’s tired. Insufficient sleep is linked to an increased risk for chronic diseases, such as hypertension, diabetes, depression and obesity. Sleepy drivers are more likely to get in an accident, and sleepy students tend to do worse on tests than their well-rested peers. Teens who average less than eight hours of sleep per night are also more likely to drink, do drugs and indulge in inappropriate sexual behavior.

Clearly our teens need more sleep. But as any parent will tell you, telling a teenager to go to bed earlier is one thing—getting her to actually do it is something else all together.

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