Sleep Information sheet Many parents experience difficulties getting their child to bed. A wide range of behaviours would be considered a sleeping difficulty including: A reluctance to go to bed. Children will often make lots of excuses, take a long time to do their final tasks before bed or go to bed but creep out and get distracted by toys and books in their room. Not being able to go to bed without a parent being close by Getting out of bed repeatedly, once put to bed Insisting on sleeping with someone else (e.g. siblings) Waking in the night to go to their parent s room If your child has a sleeping difficulty that continues for a long period of time, it can have a negative effect on your child and your family. Effects on child Irritability/ Aggression Hyperactivity Sleepiness during the day Decreased attention and concentration Increase in challenging behaviour during the day Decreased ability to learn and remember information Effects on family Increased stress levels Negative impact on relationship between parents and child Negative impact on relationship between parents Increase in tiredness amongst all family members
As you know, it is not possible to make your child sleep but you can help your child improve their bedtime behaviour and sleep more easily. It is important for you to understand that developing a new routine and breaking an old habit will take some time so, you will need lots of patience and persistence. Your child s behaviour will almost always get worse before improving. Don t be put off by the initial worsening of the problem. Children with special needs are likely to take longer to adapt to and learn new routines compared to other children. It is important that they are given enough time to understand the changes that you have made. Give them enough time to practice the new ideas.
Sleep Diary A sleep diary is a really helpful way to monitor and identify patterns of sleep. Often, parents are very sleep deprived and it can be difficult to spot why their child may sleep for 6 hours one night and wake every hour the following night. Try to use a sleep diary for at least a week and record as much information as possible (e.g. activities during the day, sugar consumption, naps during the day etc.) Sleep diaries can be found using internet searches but a good example is in the image below.
Routine It is really important, even for teenagers to have regular, clear routines for bedtimes that are consistent even over the weekend so, they stay in sync with their sleep-wake cycle. Routines provide clear visual and physical signals to your child that bedtime is approaching. A simple example is: - Watching a favourite TV show (but nothing too stimulating) - Having a bath - Drinking a small glass of warm milk (no sugar or honey) - Having a short chat with mum and/or dad while in bedroom (i.e. about worries) - Putting pyjamas on - Simple stretches - Reading a story while in bed - Lights off The routine should always be carried out in the same order. A visual timetable to outline the order of your child s sleep routine will aid to relieve their anxiety and ensure it is consistent every day. It may also be helpful to give your child a verbal warning that it is time to sleep ten minutes before you expect your child to go to sleep (e.g. when we are finished this story it will be time to turn the lights off ). Over time your child will slowly learn to calm themselves down and start relaxing in preparation for going to sleep.
Routine It is really important, even for teenagers to have regular, clear routine for bedtime that is consistent even over the weekend so they stay in sync with their sleep-wake cycle. Routines provide clear visual and physical signals to your child that bedtime is approaching. A simple example is: Watching a favourite TV show (but nothing too stimulating) Having a bath Drinking a small glass of warm milk (no sugar or honey) Having a short chat with mum and/or dad while in bedroom (i.e. about worries) Putting pyjamas on Simple stretches Reading a story while in bed Lights off The routine should always be carried out in the same order. A visual timetable to outline the order of your child s sleep routine will aid to relieve their anxiety and ensure it is consistent every day. It may also be helpful to give your child a verbal warning that it is time to sleep, ten minutes before you expect your child to go to sleep (e.g. when we are finished this story it will be time to turn the lights off ). Over time, your child will slowly learn to calm down and start relaxing in preparation for going to sleep.
Key points for every child Temperature Make sure the bed and bedroom is not too hot and not too cold. If your child is sensitive to their surroundings they may become fidgety to reach their optimum temperature and as a result, be unable to settle. Their bed Are there teddies/ dolls on the bed? Is the mattress too soft/ hard? These are some factors that may be preventing your child from sleeping in their bed and cause a preference to sleep in your bed because they are unable to get comfortable in their own. Noise Is your child sensitive to specific sounds? If they can hear the TV or an older sibling still up playing and talking with you they may be less likely to fall asleep. Maybe consider letting your child sleep with ear plugs or ear defenders. Lights Try keeping lights dim at night to prepare your child for sleep. Some children may have a concrete association that light means day and dark means night, so replicate this in your home. Food and drink Try not to give your child any food at least two hours before bed, especially if it has sugar in it. Children can be very sensitive to the food they eat and as food is an energy source it could make them more hyperactive just before bedtime. It is also not very good for their digestion. Try to give your child as little to drink as you can in the evening and may cause them to wake in the night to use the toilet. Technology The white light from the television, computer games or mobile phones can keep your child alert and their brain active. Try to avoid them for 90 minutes before bed.
Other points to consider Exercise Ensuring your child is active during the day will help them to feel tired at bedtime. Depending on your child s age (4 upwards), try to eliminate naps during the day or have them in the early afternoon before more exercise to ensure they are tired enough in the evenings for bedtime. Exercise can be sought through a full day at school, running around a park or a friend s party- anything that will create some form of physical exertion. However, try to avoid rough or stimulating play (i.e. hide and seek, chasing, wrestling), loud or scary TV programs or discussing worrying or scary things before bed. Be aware that as your child gets older the amount of exercise your child would need to feel tired at bedtime may increase or decrease because of hormones, physical development and even medication. Relaxing For some children, relaxing activities can signal that they are getting ready for bed. After a busy day with lots of activities and excitement, some more simple relaxing activities can be calming or soothing. Why not try to add some slow, gentle stretches, a deep massage, a tight hug, warm bath/ shower, reading a book or listening to calming music into your child s sleep routine. Worry time Some children have a lot of worries. It may help them to relax before bed if you set an allocated time to talk to your child about their worries. As much as possible, try to do this way before bedtime. Here are some ideas of how to address their worries, away from bedtime. Worry Post box To create a worry post box, just cover a shoebox in wrapping paper or paint it together and cut a hole large enough to post paper through.
Throughout the day, your child can write and post their worries into the post box. At the end of the day open the box and talk with your child about some of the worries they have posted, offering reassurance and advice about the worry. Worry Doll If your child is at an age where they believe in the tooth fairy and Father Christmas, you could introduce them to a worry doll. Talking about some of their worries may help them to feel more relaxed to sleep. What if my child wakes in the night? Some children have difficulty staying in bed and settling themselves if they wake in the night. Some children have associated their own ability to fall asleep with the presence of their parent. Firstly, you need to consider your own worries and anxieties when implementing these strategies Is it easier to give into your child to avoid confrontation? Is it difficult to be firm with your child without feeling guilty yourself? Why is it difficult to leave your child to settle themselves? What early experiences have your shared with your child that makes some of these suggestions difficult to put into place? Parents of children with special needs can sometimes have feelings and experiences that leave them feeling overwhelmed by their baby s or child s vulnerability and fragility; feeling they have to watch over their child constantly; feeling unable to leave their baby or child in case something happens when they are not there; feeling uncertain about having the skills to look after a baby or child with their unique needs; and being unsure about setting up regular routines around every day needs due to the priority of physical and medical needs.
Points to consider If your child calls out once put to bed or in the night, try to ignore their calls at first (assuming they aren t ill or hurt in any way) in order to give them a chance to learn to settle themselves. If it is too difficult to ignore your child s cries or protests, you may want to try a more gradual approach. You may want to check on your child after 5 minutes of crying or calling out. When checking on them, re-settle them with a minimum of contact before leaving again. Keep checking every 5 minutes until they fall asleep. Extend the time period between checking (say to 7mins, 10mins, 15mins) over the following days until your child is able to settle themselves without your presence. If your child comes out of their room after they have been put to bed, return them to bed with minimum fuss and stimulation. For example, pick up your child or guide them back to their room with little eye contact, no discussion, avoid noisy or negative interactions, be as quiet as possible and avoid brightly lit rooms. Older children may be taught to carry out alternative actions, rather than calling out or getting out of bed to find a parent. This will lead a child towards being able to settle themselves in the absence of a parent. Some examples may include listening to soothing music (on a tape or CD that will turn itself off), engaging in muscle relaxation, counting sheep. You may be able to stick fluorescent shapes (such as stars or animals) on your child s ceiling that they can to count, to help them fall back to sleep. Try to introduce or use a love object or security object that helps them feel safe and secure when you are not present. Try to include this object when you are cuddling or comforting your child. Do not force your child to accept the object, as some children will not accept one no matter how cute and cuddly the object.
How to maintain this routine Rewarding your child: It is important to encourage your child to maintain good bedtime behaviour through rewards and praise. The use of a reward chart or sticker chart is very useful and effective. If possible, try to include your child in designing a reward chart. Your child may like to choose some appealing stickers or decorate it. Clearly explain how the reward chart will work and discuss what an appealing reward may be. Using pictures of the desirable behaviour may help your child understand what is expected of them. Decide on one or two behaviours that you can reward (e.g. following the bedtime routine, staying in bed, not calling out to parents, engaging in alternative settling behaviours). When your child achieves a star make sure that you use specific praise. (e.g. well done, you were able to stay in your own bed all night ). Be a role model of good sleeping habits What kind of sleep behaviour are you modelling? Ensure that you are setting a good example for your child. Do you fall asleep in front of the TV? Do you race around right up until bedtime so that you are unable to fall asleep? How consistent is your bedtime routine? Try to remain calm and non-emotional when you are dealing with your child and their sleeping difficulties. Children become more upset and unsettled if they can see that their parent is upset and angry. When you first make these changes it may feel very strange. Give yourself a chance to get used to these changes and have confidence in your own ability to handle the problem in a different way.