When Sleep is Difficult

Sleep is an essential part of human life. It is necessary for proper immune function, memory, and learning. It affects growth and stress hormones, blood pressure, and cardiovascular health.  Sleep deprivation has been linked to serious health issues, including obesity, diabetes, ADHD, and mental health problems such as anxiety and depression. It affects personal relationships, school performance, and driving ability. 

Unfortunately, not many of us get the recommended amount of sleep to allow our bodies to function at peak performance. There are many different reasons for this, but today we will focus on potential ways to fix the problem in our children. 

General sleeping tips

The AAP recommends “The 4 B’s of Bedtime” to help provide young children with a soothing nightly ritual that promotes independent sleep. These “4 B’s” are:

• Bathing – a soothing way to promote hygiene and provide a definitive separation between daytime and nighttime activities.

• Brushing – every child should have clean teeth and gums prior to going to bed.

• Books – reading to your child nightly promotes sleepiness. As an added bonus, it is a special time to bond with your child AND is helpful in language development. 

• Bedtime – Allow your child, young or older, to go to bed independently and learn to self-soothe to fall asleep. This is the hardest part of the process but worth it for long term mental health and sleep hygiene. 

In addition to “The 4 B’s” there are many other things that can affect healthy sleep in your child (and family as a whole), including:

• Room temperature – cooler temps promote deeper sleep. 

• Keep it dark – some young children may feel fearful without a night light, but in general keeping the room as dark as possible helps to regulate natural release of melatonin, a hormone important in sleep and wakefulness cycles. 

• Remove electronics from bedrooms – no child should have a TV, tablet, or other mobile device in the bedroom. Use of electronics at night wakes up the brain and will prolong the time to fall asleep. 

• Avoid screens before bed – ensure there is at least 30-60 minutes of screen-free time prior to bedtime if your child struggles with falling asleep. The blue light emitted by electronics interferes with natural sleep/wake cycles. 

• Soothing sounds – soft white noise can mask background noises and contribute to ease of falling asleep. 

• Aromatherapy – lavender and chamomile have soothing properties that promote sleep. 

• Limit naps – toddlers usually drop to 1 nap a day, while school-aged children and beyond rarely require naps. If daytime sleepiness is excessive, limit naps to 30min per day. 

• Exercise – being active during the day promotes healthy sleep at night. 

Specific tips by age

Infants

• Establish a bedtime routine early on. Use sleep training methods to promote self-soothing skills starting between 4-6 months. 

• Keep room temperatures comfortable, as this age is not recommended to have blankets

• ALWAYS place infants in their own sleeping space (ie, basinet, crib)

Toddlers and Preschoolers

• Consistent bedtimes and routines are key. This age thrives on schedules and routines, and sleep is no exception. Bedtime meltdowns can be avoided if your child knows what is coming next. 

• Sleeping with a “lovey” or other comforting item can increase comfort and help manage bedtime fears. 

Older children and Teens

• Consistent bedtimes are still important to regulate sleep/wake cycles. 

• Set screen time limitations. Set parameters so that devices turn off or become unusable after a certain time of night. 

• Many teens have very late bedtimes, due to social activities, sports, or large homework loads. Help your teen set up a schedule and be organized, so that last-minute work doesn’t keep him or her up late. 

A note on melatonin

Melatonin is a chemical produced by the brain at night that acts like a hormone and regulates sleep. It is sold as a dietary supplement and is NOT regulated by the Food and Drug Administration. Melatonin is not a sleeping pill – it will not make a person fall asleep like other sleep aids can. However, in consultation with your child’s Pediatrician, it can be used on a short-term basis to help establish regular sleep routines. Studies have shown that such short-term usage is safe but we need more information about the possible effects of long-term usage before it can be recommended. 

Final thoughts

A good night’s sleep is essential, and this is true of children as much as it is of adults. If you have tried everything to help your child fall asleep and stay asleep and nothing is working, reach out to your Pediatrician. Sometimes there is a medical reason, such as restless leg syndrome or obstructive sleep apnea, that needs to be addressed. Once children are sleeping well then parents can sleep well, and this enables the entire family to be more productive and less stressed throughout the day. 

Resources

The 4 B’s: https://www.healthychildren.org/English/healthy-living/sleep/Pages/The-4-Bs-of-Bedtime.aspx

Learn more about melatonin: https://www.nccih.nih.gov/health/melatonin-what-you-need-to-know

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