In the age of cell phones, the internet, and 24/7 lifestyles, children are sleeping about an hour less than they did a century ago¹. According to Dr. Shelly Weiss², teenagers are suffering from chronic sleep deprivation. The average teenager sleeps only 7 hours per night (they need 8.5 to 9.5 hours) and doesn’t appear for breakfast until lunchtime on the weekends. However, your teenager probably isn’t the one waking you up in the middle of the night, it is your younger children. All of us, including children, wake up during the night and usually fall back to sleep without trouble. This is just part of our natural, nightly sleep cycle. However, some children wake up in the night and cannot get back to sleep. Why? Dr. Weiss’ talk at the Canadian Chapter of the AACP’s most recent symposium gave me some insight². (See Nov 27, 2011 blog post for more info on Dr. Weiss.)

For toddlers and preschoolers, a common reason for not being able to go back to sleep when they wake up in the night is due to behavioural insomnia. Children with behavioural insomnia often have difficulty settling at bed time and then wake up during the night and cannot get back to sleep until a parent intervenes. There are two main reasons for this: sleep association and positive reinforcement.

What is sleep association? As an example, if you rocked your child to sleep in your arms then put them to bed, you will need to rock them in your arms again when they wake in the night in order for them to fall back to sleep. Your child will likely not go back to sleep until you recreate the conditions that they associate with falling asleep the first time. So, what can you do? There are many successful strategies to deal with this including, putting your child to bed awake, making sure their room is dark, quiet and comfortable, and sticking to a regular schedule of waking, bedtime and nap time. Some behaviours to avoid at bedtime are rocking your child to sleep in your arms, allowing your child to fall asleep anywhere but their crib/bed, and putting them in a car or stroller to get them to sleep. Remember, anything that you do to get them to sleep at bed time you will have to do again when they wake up in the night, which might not be good for you or for your child.

And positive reinforcement? Simply by going to your child when they wake up in the night you are positively reinforcing this behaviour, giving them the attention they seek. What can you do? Some suggestions are to put your child to bed at a specific bedtime, ignore them until a set time in the morning, ignoring any crying or calling for you, and not let them come and sleep in your bed. If your child is used to you coming in during the night then you can gradually wean them of this habit using a schedule of progressive waiting before checking on them, with brief comforting (15-60 seconds) between wait times (graduated extinction). Of course, monitor your child for illness or injury.

In addition to behavioural insomnia, preschoolers may also suffer from nightmares, night terrors and sleep walking. To help with nightmares, avoid excessive stimulation such as violent television or computer games, keep a regular sleep/wake cycle, and reassure your child that they are safe. If nightmares become frequent, see your doctor.

There are, of course, other causes of children waking up in the night, including rhythmic movement disorder, obstructive sleep apnea, and seizures. For these problems, or any others that are not resolving over time or are causing daytime problems, see your doctor. 

Great information for all of us from Dr. Weiss' talk. For more information on obstructive sleep apnea, take a look at Dr. Goodfellow's sleep apnea link.

¹Matricciani L, et al. In search of lost sleep: secular trends in the sleep time of school-aged children and adolescents.Sleep Med Rev. 2011 May 23.

²Weiss, S. Pain or not pain? Evaluating the cause of childhood sleepiness.Canadian Chapter of the AACP , 2011 Symposium.

The 5th annual symposium of the Canadian Chapter of the American Academy of Craniofacial Pain (AACP) was a big success. For more information on the meeting, please check out the Canadian Chapter's website: http://aacpcanada.ca/

If you are a parent with a child who has trouble sleeping, Dr. Shelly Weiss’ talk was very interesting and relevant. Dr. Weiss is a paediatric neurologist at the Hospital for Sick Children in Toronto, the President of the Canadian Sleep Society and author of the book Better Sleep for Your Baby and Child: A Parent's Step-by-Step Guide to Healthy Sleep Habits. The Office Blog’s next post will be all about her talk. Stay tuned.

This past summer, Dr. Goodfellow successfully passed his exams to become a diplomate of the Academy of Clinical Sleep Disorders Disciplines. Dr. Goodfellow is truly on the cutting edge of treating sleep disorders such as sleep apnea and snoring. Congratulations!!

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