Sleep Challenges – Delayed Sleep Onset, Frequent Night Wakings, Insomnia…

There are a few basic human needs – food, water, air, clothing/shelter, and sleep.  Why sleep seems to elude so many…from the young to the old…is puzzling!  Difficulty falling asleep, difficulty staying asleep, and irregular sleep patterns are common in children with developmental disabilities.

Sleep patterns are affected by:

  • Nature (circadian rhythms, hormonal influences)
  • Environment (sleep associations and habits)

E struggled with falling asleep and staying asleep ever since she was born.  She took 2-3 hours to fall asleep.  And once asleep, she never slept more than 1-2 hours at a time; in the daytime her naps were 20 minutes long 1-3x a day (until she gave up napping at 2 yrs old).  She would waken and call me 6-10x a night until she was 2, then 4-8x a night until about age 3, and continues at 1-2x a night age 6+ (she has slept through the night only a handful of times).

I realize this is not an uncommon complaint with babies and toddlers, hence the plethora of sleep training methods and books.  My second child (no developmental delays) isn’t a much better sleeper.  And after years of being woken repeatedly throughout the night, I have difficulty falling – and staying – asleep.

So, here are my thoughts based on our experience:

  • Rule out any underlying medical condition.  Get a check-up, including bloodwork if necessary.  (see my post on bloodwork for little ones)
  • Follow a Sleep Hygiene schedule and stick to it religiously
    • Maintain a regular wake and sleep pattern seven days a week – get up and go to bed at the same time each day
    • Avoid daytime naps (adults), or make sure there is at least 4 hours between the end of a nap and bedtime for babies/toddlers/kids.  This might involve waking them up (unless they are sick).  Good luck with that…
    • Get exposure to light first thing in the morning – open the blinds, turn on the lights.  This helps your brain establish the wake part of your sleep-wake cycle.
    • Dim the lights for the hour before bed if possible.  This includes NO SCREEN (TV, tablet, phone) unless it is a specific reading screen.  This alerts your brain to release melatonin – the sleep hormone.
    • Avoid caffeine after lunch (adults); don’t give caffeine to kids (pop, dark chocolate)
    • Avoid nicotine and alcohol after supper (adults)(alcohol disrupts second stage sleep)
    • Exercise during the day anytime before supper; regular exercise can promote healthy sleep patterns
    • Don’t eat too much before bedtime
    • Establish a relaxing bedtime routine.  Bath (a warm bath followed by a drop in body temperature when you get out helps your body think it is time to sleep), stories, one last drink and potty trip.  Don’t rush this routine – relaxing takes time.  Allow your child to talk about his/her day.  We love Cloud B’s Tranquil Turtle to ease the transition between story time and sleep time.
    • Ensure the sleep environment is relaxing.  It should be very dark (blackout blinds); if you use a nightlight, it should be very very dim (try putting a sock or electrical tape over it).
    • Consider something for white noise (we use a cheap fan pointed at the wall on lowest setting). Cloud B makes a Sleep Sheep; there are other baby white noise machines available.
    • Essential oils might be a part of your routine to signal sleep – lavender and roman chamomile are safe to use with babies and toddlers.

The book I recommend for baby/toddler sleep issues is Elizabeth Pantley’s No Cry Sleep Solution.  She has one for older children as well.  Note that I don’t recommend letting babies or children of any age “cry-it-out” for a number of reasons that are supported by the scientific literature (see here, here, here).

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After trying all this, you still may struggle with sleep.  We gave E a low dose of melatonin (like the liquid one found here) for a year.  Give the lowest dose possible that is effective.  Note that melatonin will only help with initial falling asleep, and not staying asleep.  There are extended release formulas, but your child has to be able to swallow a pill whole to take them.  Talk to your child’s doctor before trying melatonin, as it is a hormone and may cause problems down the road (such as puberty issues, hormonal dependency, sleep cycle issues).

I had read at the time that melatonin will only work if there is a melatonin deficiency.  I know that it worked very well for E, and didn’t do anything for me.  Following sleep hygiene as above will stimulate your brain to produce more melatonin.

For very infrequent nights when we *had* to get sleep…note that Benadryl and Gravol are approved to give to children age 2+ and both have drowsiness as a side effect.

E’s sleep cycles did regulate at around age 4, even though she continues to have night wakings.

For myself, zopiclone does the trick as long as I don’t take it regularly (my body habituates to it VERY quickly).   There are several anti-depressants that can cause drowsiness, but they have side effects.

Sleep continues to be an issue at our house, but consistent, good sleep hygiene has helped a lot.

I strongly believe that in this life, nothing happens by accident or coincidence – things aren’t determined by fate or luck (good or bad).  I believe there is an overarching story – a beautiful picture of love, loss, and redemption – and that there is Someone who cares and is in control.  You are already a part of this story, whether you know or believe it or not.  While the end of the story has already been written, your own part lays open before you for you to choose your ultimate destiny.  Perhaps our coinciding struggles have been finely orchestrated to lead you to this one moment: The Bridge to God.

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“Praise be to the God and Father of our Lord Jesus Christ. The Father of compassion, the God of all comfort, who comforts us in all our troubles so that we can comfort those in any trouble with the comfort we ourselves have received from God. For just as the sufferings of Christ flow into our lives, so also should the comfort of Christ overflow.” (2 Corinthians 1:3-5)

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