Sleep is a common problem area discussed by parents and families. There are a number of reasons why sleep may be more challenging for some children. We will look at a few areas that impact sleep/wake cycles and some ideas on how to address them.
Four areas we often see as challenges for families are early waking, the bedroom environment, bedwetting, co-sleeping.
Early Waking
We often hear of parents stating that their children are often waking up early (e.g. 5 am) and before everyone else. While reasons for early waking do vary, there are a few things that can be tried to support early waking. - Sensory Diets. You may have had an OT discuss these or suggest these for home and school. Some children require extra sensory input in their day, and Sensory Diets are essentially sensory and movement based diets that aim to provide structured and specific extra sensory input to a child’s day, to help them stay more alert and at a ‘just right’ level of arousal. Having sensory diet activities (particularly before bed) can help support regulation and lower arousal, so children go to sleep calmer and can often lead to longer sleeps. - Before bed routines (such as the sensory diet) can help support sleeping routine and sleeping quality. A clear routine can provide predictability and further lower arousal prior to bed time. - Social Stories can be useful for those with difficulties sleeping (e.g. scared of dark). They can be read before bed and added to a routine. - A clock in the room will show children the time when they wake. If you say ‘you can come out at 7’, you can establish this so children know when they can wake up. - Having an alarm in room, like the clock idea, encourages children to know that they can’t come out until it goes off. As they may still wake early, they can be encouraged to stay in their bed, read a book, play with a few simple toys, until the alarm has gone off. - Lighter curtains can provide natural early morning light. This allows children to wake to normal light patterns and support natural circadian rhythms. - Going to sleep later can also be useful (i.e. putting children to sleep later). Gradual exposure to this is important, so slowly increasing time frames (e.g 15-30 min increments)
Regulation + Bedroom Environment
As mentioned, the Sensory Diet can help with regulation and calming before bed and throughout the day. In addition, other regulation factors and environmental factors are important. - The Bedroom Environment is often overlooked. This can include: - If the space or position of the room is appropriate - Is the room dark enough at night, so too much light doesn’t interfere with sleep? Or is it too dark and require a night light? - Is it free from excessive noise? - Is there an understanding that the Bed and Bedroom is predominantly for sleep? Don’t associate bedrooms with play rooms (e.g. Don’t have lots of children’s toys in their room)
- Also, don’t put children in their bedroom for negative reinforcement (e.g. punishment for something they have done). This can reinforce a negative view of the room, and further create challenges with sleep.
- NO SCREENS IN THE ROOM. Screen time can further cause stimulation before bed due to unnatural screen light, and reduce sleep quality as a result.
- Using white noise or consistent low level dull noises can further support sleep. This will allow children to go to sleep with some noise, as sleeping in complete silence is not natural and can also cause sleeping issues.
- Some children have difficulty producing Melatonin – as such, Melatonin supplements can help. These should first be discussed with your child’s doctor.
Bedwetting
This is often a complicated area, and often multi-faceted. Some possible reasons include: - Social and emotional elements. Some children may be impacted by a number of factors in their life, which can result in physiological changes, such as bed wetting. - In addition, big changes and unexpected outcomes in a child’s life and environment (e.g. new children, changing houses etc.) can lead to sleep difficulties, and being more unsettled in routines, such as toileting. - There may be some truth to a ‘genetics of bedwetting’, where if parents wet bed, their children often appear to have an increased risk of this too. - A few things to support this can include, again, ensuring routine is consistent. This includes the bedtime and toileting regime before bed, which can help reduce anxiety around sleep. Ensuring a set routine of taking children to toilet before bed can further support this. - Some suggestions also include, reducing intake of liquids can be effective (e.g. 1hr before bed) to reduce the desire to seek the toilet during sleep. - On the other hand, there is also some evidence to suggest that increasing fluids before bedtime can increase bladder fullness and desire to release bladder before bed. - Other ideas include scheduled awakening of going to toilet at a set time during the night. Waking the child at a time just before wetting frequently occurs, and taking them to the toilet.
There are many other ideas and strategies for bedwetting, and further support should be sought if problems continue, despite adoption of many strategies.
Co-sleeping
This is often seen and means children who sleep with their parents in the parents bed. It important to note that there are some cultural beliefs and practices that support this and continue to co-sleep, which can be quite appropriate. Therefore, this are of discussion is more about times when children are requiring more independence in sleep, and should be more able to sleep alone. A few quick strategies include:
- Gradual distancing. Where children are put to bed in their own bed, and parents wait with the child until they are asleep, then gradually distance themselves from settling the child to bed. If the child wakes, the parent starts out as being close to them, then resettles them in their own bed, before gradually distancing themselves again. This is a very brief description of the technique, and more information cam be sought through sleep programs and sleep education information.
- Social Stories + Rewards chart. As mentioned, Social Stories can be used to support sleep (e.g if a child is scared of the dark, develop a social story about this). Rewards charts can also be used to support positive reinforcement of sleep practices, and encourage pride and independence in sleep. Our recent blog on Social Stories can provide more information on how to develop a sleep social story.
- Scents (smell of mum’s perfume) and sensory options to support sleep (e.g. night light, white noise) can further provide good sleep environments.
This is a brief introduction to sleep practices and some ways to support sleep. Sleep programs and sleep support information should be sought to provide greater insight into sleep practices and how to support your child with sleep challenges.