Stories about: sleep problems

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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Back-to-school health: going from a summer to school year sleep schedule

It’s just about time for the kids to head back to school, which means a sudden change in schedule and environment. These changes may be a secret source of joy for summer weary parents, but in certain situations the switch can cause health problems in children. For instance:

  • Asthma related hospitalization spike around the second week of school for thousands of children
  • Readjusting to school sleep schedules after summer vacation can cause children to get less sleep, which in turn can lead to poor school performance and behavior, increased risk for obesity and other mental health concerns

Over the next few weeks Thriving will identify a few of the more common back-to-school health problems, and provide parents with tips on how to avoid them.

How to smoothly transition your child from a summer to school sleep schedule.

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Sweet dreams

“We couldn’t consider it from a more favorable perspective.”

That’s how Kathy and Michael Cunningham describe their feelings about polysomnography (sleep study), now that their 5-year-old son, Elijah, has recently undergone the procedure at the  Boston Children’s Hospital Sleep Laboratories. The praise is even more compelling when you consider the source: Elijah’s dad is Michael J. Cunningham, MD, FACS, Boston Children’s otolaryngologist-in-chief.

In addition to talking in his sleep, Elijah had been waking repeatedly throughout the night—a potential symptom of what is called a “non-REM parasomnia” (sleep disruption that occurs outside of the deep, rapid-eye-movement stage of sleep), possibly related to obstructive sleep apnea syndrome (OSAS). After an initial examination, Cunningham’s colleague in Otolaryngology, Mark S. Volk, MD, DMD, FACS, referred Elijah to see Sanjeev Kothare, MD, interim medical director of Children’s Center for Pediatric Sleep Disorders. Kothare agreed that Elijah’s sleep pattern was unusual, and recommended a sleep study to determine whether there was any underlying OSAS that would make a tonsillectomy necessary.

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Behavioral issues in children could be linked to snoring

If you’ve ever lived with a person who snores, you know the noise can be enough to keep you up at night. It’s an annoyance for sure, but new research shows that when young children snore it could lead to more serious behavioral and emotional problems.

A new study, published in the journal Pediatrics, shows that young children who have sleep-disordered breathing (snoring or other breathing issues during sleep) could be more likely to develop conditions like attention-deficit/hyperactivity disorder or anxiety by the time they’re seven years old. The study followed 13,000 children, from infancy to the age of 7, and found that those who snored or had some form of breathing problem while asleep were far more likely to develop behavioral or emotion problems than children who had no breathing issues while asleep.

So how are the two related? The answer is going to be different for each child, but it often comes down to how a child’s nighttime breathing affects his rest.

“When you have sleep-disordered breathing, you wake up momentarily when your breathing drops,” says Sanjeev Kothare, MD, interim medical director of the Center for Pediatric Sleep Disorders at Children’s Hospital Boston. “So if a child is waking up 50 times a night he’s not getting the proper amount of rest, and that could manifest itself in hyperactivity or other behavioral problems.”

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