The nightmare of insomnia – is sleep really that hard? 

Dr Andrew Leech, GP (FRACGP, MBBS, BSc, DCH)

Sleep. Pre children we took it for granted, post children it is one of the most underrated components of a happy family.

Anywhere up to 70% of children suffer sleep related problems in their lifetime. Not surprisingly, this can have a significant impact on the whole household (siblings included) and on daytime functioning whether it be concentrating at school or handling emotions.

Infants can have complex sleep patterns. Struggles with falling asleep or repetitive waking at night can cause great distress to families and are amongst the most common complaints to health professionals. It is common to develop strategies that just ‘work’, often from trial and error.

It can be helpful to move an infant from around 6 weeks of age, to their own room. This eliminates the noise of others whilst giving them their own space. Strategies that are often used by sleep schools can then be implemented more easily, whether it be sudden removal of parent from the room after resettling the child (known as extinction). Or to gradually withdrawing parental presence, known as ‘checking in’, usually every 5 minutes until your baby has settled. Both of these have proven efficacy but are challenging because they involve some protest or crying. If separation provokes significant anxiety for parents or your infant, it is suggested that ‘camping out’ in a child’s room whilst you support them to sleep is also a plausible option. There are sleep consultants popping up in every state. Consider your needs and whether you would benefit from the added support of someone else who has had experience in this field. Another source of support is the local mother-baby unit which often runs evidence based outpatient and inpatient programs.

Children can also be difficult to settle at night. This is very common and often tiring. Check out some ideas below for what might help. One small change can make a big difference.

Keep it consistent. Figure out the best bedtime for your child and stick to it. This should be before 9pm which can be hard in places where it is still light, so use darkness such as blackout blinds to create an atmosphere of relaxation and calmness.

Develop a regular routine. Start the routine well out from bed-time so it isn’t a mad rush. Continue that same routine when away on holidays or for sleepovers.

No electronics. Aim for a minimum of one hour ‘screen free time’ prior to sleeping. Screens not only stimulate brain activity, they switch off the essential hormone, melatonin.

Positivity and relaxation. Children argue and meltdown more when they are tired. Understandably, arguments can’t always be avoided, but make attempts to keep them away from bedtime as it is unlikely to go well. It also increases adrenaline and wakefulness. Try one of the new meditation apps that are out there, smiling mind has multiple wind down mindfulness programs for families and children. Mindful colouring and massage also works.

See your GP if you feel the problem is medical rather than behavioural. Problems like reflux and colic in babies, even teething, can throw out a sleep cycle. In older children, the list can be wider including sleep disorders (snoring, large adenoids), restless legs, nutritional deficiencies (iron), developmental concerns such as autism or neurological problems such as epilepsy.

With all this on board, it can still be a juggle to support a child to sleep. Understand that it may never be perfect and have expectations that it will improve even just slightly with time to keep a sense of optimism and hope. It is easy to become emotional around bedtime and fall in a heap. Struggling with your own mental health can have further impact on sleep problems in yourself and your child. Be aware of these feelings, breathe, and do your best to remain calm. Pick your battles, if they want 5 teddies, let them have it! If they’re ‘hungry’, come up with some sort of compromise. Some things are just not worth the argument. Above all, take care of yourself as can be tough, seek help early and stick to the basics.

References

Howlett, M. (2019). ABCs of SLEEPING Tool: Improving Access to Care for Pediatric Insomnia. Clinical practice in pediatric psychology.

Kahn, M. (2019). Behavioral interventions for pediatric insomnia: one treatment may not fit all. Sleep Research Society, 1-9.

Meltzer, L. J. (2014). Systematic Review and Meta-Analysis of Behavioral Interventions for Pediatric Insomnia. Journal of pediatric psychology.

Sadeh, A. (2009). Parenting and infant sleep. Sleep Medicine Reviews.