Sleep Problems In Childhood And Its Remedies

A newborn baby doesn’t have a fixed pattern of sleep. The baby may sleep too much in the daytime while during the night it may awake. A regular sleep rhythm is established by 3-4 months of age. The common sleep problems in child are Bedtime struggles,Night waking, Parasomnias.

Bed time struggles

The child finding it difficult to fall asleep. It appears that children are in a state of continuous and everlasting love with life and thus are reluctant to withdraw from the events of the day. Hence in spite of their feeling sleepy,they are reluctant to sleep,not wanting to terminate their social activities and wanting to explore and learn more what life is all about. As the child grows older,a struggle for autonomy and independence with his parents regarding who actually is in control of his life may lead to bedtime struggles.

The most important cause for bed time struggles is an absence of clear cut and consistent limits set by the parents regarding acceptable bedtime behaviour. There may be lack of a fixed bedtime i.e. the child goes to bed sometimes at 8 p.m. and sometimes at 10 p.m. depending upon when the parents go to bed. If the child sometimes sleeps in the afternoon and sometimes not,his night routine will also be disturbed leading to bedtime struggles. So either the child should have an afternoon nap consistently or forgo it completely.

A regular routine allows a circadian(day and night) sleep rhythm to develop. The best remedy for bedtime struggles is that the parents firmly deal with it and set a definite time for “lights out”. If the child resists going to bed,just ignore it and put him to bed at the same time every day. However if you find that the child routinely is keeping awake even 1 hour after being put to bed,it means that the child is not sleepy at that time and so you have to postpone putting him to bed by say half an hour the next time.

Gradually,by trial and error,you will know the appropriate time for putting him to the bed. Having established a regular sleep routine,the parents should put him to bed at that particular bedtime hour every night. Suppose the child goes to bed at 9 p.m. Now if parents put him to sleep at 8 p.m. one day(because they are tired),bedtime struggle may ensue,as the child won’t sleep before the accustomed time.

After being put to bed,the child may try to engage parental attention in various ways like i want water,i want to go to toilet etc. All this is in spite the fact that the child recently had been to toilet or had drunk water. Parents should be firm in not responding to these demands of the child,who uses them to gain parental attention and postpone his sleep.Other measures to help in making the child sleep are to have a pleasing and relaxing bedtime routine. This may involve bathing the child before bedtime,changing his clothes to a comfortable night wear,telling him his favorite story etc.

Night walking

In this the child frequently arouses from sleep and does not go back to sleep easily,causing discomfort to the parents. It should be kept in mind that almost all children wake up in the night. Normally the child after arousing at night will go back to sleep,when the parents pat them. But if night waking is prolonged so that the parents also have to be awake and make all sorts of efforts to put him back to sleep,then it is a problem. There are various reasons why the child does so,and once the parents understand them,the remedy lies in eliminating them.

If he depends upon some active parental interventions( rocking him,carrying him etc) after waking up in the night, the parents should gradually cut down it to lull the child to sleep so that the child is conditioned to sleep without these interventions. If the child starts moving or whining in bed,the parents should not pick him immediately. Instead the parents should rely on verbal reassurance and getting patting him. Feeding at nights should be avoided since it wakes him up. Instead of that substitute it with water and then gradually cut it down completely.

Parasomnias

The parasomnias are specific events happening only during sleep. These are of four types. They are nightmare,night terrors,sleep walking and sleep talking.

Nightmare

It is a bad,frightening dream. An occasional nightmare occurs now and then in most individuals throughout life and is normal. But if the nightmares are recurrent,cause frequent nightmare awakenings and also distress during the daytime(by recollecting them),it is troublesome. A child awakening immediately after a nightmare will be alert and remember the contents of the dream. If he doesn’t wake up,then next day he can recall the dream,if not completely,at least partially. To reduce night mares,the child should not be allowed to watch or listen to horrifying,violent or frightening things,especially prior to bedtime. By and large nightmares do not have an adverse effect on the psyche of a child,unless they are frequent,in which case a psychological assessment may be needed.

Night terrors

The child becomes frightened and agitated in the middle of his sleep. He may scream,cry,thrash around;his eyes may be open and dilated and give the appearance of a ‘glassy stare’ ahead. But although seemingly awake,the child actually is in a state of deep sleep and difficult to arouse. Upon awakening,the child has no memory of the event(compare it with nightmares). Although frightening to the parents ,night terrors are benign and self-limited. The parents should not worry about it. The only thing required of them is to simply observe the child while he is having such an episode and not to intervene by trying to wake him up,because it only prolongs the event.

Sleep walking

(Somnambulism) It is phenomenon in which the child gets out of bed and then moves about in a confused and clumsy state. The parents should not make efforts to shake the child to wakefulness as it may lead to agitation. Rather,the environment should be made safe so that the child doesn’t self-injure himself;the child merely observed and gently led back to bed.

Sleep talking

In this benign condition,the child utters something while asleep. The parents are often alarmed by their child’s verbalization. It may persist throughout life,but the condition is benign. No treatment is warranted for it.