Sleep is as much a necessary part of normal life as eating and drinking. We cannot function without sleep. Besides resting the body, sleep helps the brain process memories and experiences. When childhood sleep problems arise, everybody suffers – the sleepless child and the sleepless parents and siblings. To understand sleep problems, we need to know the basic facts about sleep.
• Newborns – 4 months: 16-17 hours a day in about seven equal blocks
Stage I: Drowsy but still able to respond to voices, noises and other stimuli
Stage II: Dozing, falling asleep, but easily aroused. This is the sleep you see at a lecture when people close their eyes and let their heads fall and suddenly wake up as they fight to stay awake.
Stage III: Asleep. All muscles are relaxed and breathing begins to slow.
Stage IV: Deep sleep. In this stage, outside noises would not be noticed and the person is hard to wake up.
At the end of stage IV there is a brief awakening before going on to the next phase.
These stages of sleep occur in cycles throughout the night. The early part of the night, Stages I and II occur repeatedly until the first REM sleep occurs, about two hours after falling asleep. These early REM cycles are very short and last only a few minutes. They are followed by progressive periods of Stage II-IV sleep. As the night goes on, the REMS get longer and longer. REMS can be over 90 minutes in length. Dreams are the most long and intense in the early hours of the morning, just before arising.
Newborns almost always fall asleep while feeding. After about four months of age, it is best to try to feed the baby before bedtime and put him in the crib while still awake. He then will find some way of helping himself to fall asleep. A cloth diaper or thin blanket, or a small soft toy, can be introduced as a transitional object which will help him fall asleep. Many people find themselves rocking, shaking, rolling the carriage, or allowing the baby to pull on the mother’s wig, ear or finger, or lying in bed with the baby to get the baby to sleep. These are all transitional methods. I really prefer not using these adult dependent methods, since they do not allow the baby to learn to settle himself down.
There is a way of stopping these terrors if they happen repeatedly. In the beginning of the night, allow the child to fall asleep and sleep for about forty-five minutes. Wake him up fully, and then put him back to sleep. This method interrupts the disturbing cycle of brain wave activity which has developed.
This should not be right before bedtime since the exercise makes them alert and mentally active.
Sleep Routines – From an early age, it is advisable to develop a sleep routine to prepare the child for sleep. Brushing teeth, singing songs, reading stories, saying good night with a kiss, is a normal bedtime routine for a child even as early as one year of age. It takes a few minutes, but it is worth the time, since the parent and the child both benefit.
If your child is having difficulty falling asleep, make sure he is not getting any caffeine in his daily diet. Caffeine is a drug which can take up to 24 hours to wash out of the brain, so eating it ,even early in the morning is not acceptable. Watch out for the hidden caffeine in food:
If you are sure there is no chemical reason for the child’s difficulty falling asleep, there are other possibilities to be considered.
Naps – It is important that afternoon naps not be too late in the day. If the child falls asleep in the late afternoon, try to wake him up in about 20 to 30 minutes. He will be irritable for a few minutes, but he will soon come around, and then he can make it to bedtime without falling apart. A longer nap can disturb his night sleep.
Fears and Anxieties – Nighttime brings darkness, and an anxious child might feel frightened to be alone. Mild fears might be exaggerated by the child to gain more time with the parents. If the fears do not seem as strong as the child claims (most parents can tell), firm but gentle reassurance will usually suffice. If the child is truly terrified, there may be something troubling him. It is very helpful to try to get the child to express what exactly he feels is so frightening. This will sometimes reveal that he heard about someone who died recently, or that someone has threatened him. These disturbances do not always come out the first time you ask him, so keep the door of communication open by telling him repeatedly that he should always tell his Mother or Father about his troubling thoughts and feelings so you can help him. If the extreme fear of bedtime does not resolve after a few weeks, a professional child psychologist should be consulted.
Melatonin – If there are no fears, but the child simply cannot fall asleep, he may be lacking in a secretion of the pineal gland which is near the brain. This substance, called melatonin, is the signal to the brain that sleep is approaching. It sets the sleep clock in motion. This is why it is often used to treat the sleep disturbance that is associated with jet lag.
Many pediatricians, including me, recommend synthetic melatonin to be given as a supplement at bedtime for children who have difficulty falling asleep. A recently published paper also showed that melatonin is very useful in children with brain damage who cannot sleep. Melatonin can be purchased in a health food store or drug store, and is safe to be used any time it is needed. There have been no toxicities reported, even in long term use. The usual dose is 1, change this to little 1/2 milligrams at bed time, to be given with a calcium-rich food like milk or cheese or supplement like Tums. The dose can be as high as 6 milligrams, but most kids do well on doses between 1 ½ to 3 milligrams.
The important thing to note is that a child who does not sleep sufficiently can have problems during the day. Whether it is sleep apnea or other issues, a sleepless child is often irritable, intolerant, miserable, and restless. Rather than sleepy, he may be hyperactive and have difficulty concentrating. The whole personality is affected. Sleep is a critical factor in overall good health. Always take the matter seriously if a child cannot sleep. Consult your doctor if you feel that there is a real problem.