Sweet Dreams: Parent Strategies to Help Children and Teens Get the Sleep They Need

November 9, 2020 By Dr. Brittney Evans

Many parents know far too well the challenges that can accompany a child’s bedtime—the excuses, tantrums, tears, worries, and the dreaded complaint, “I can’t fall asleep.” Many more parents know frustration of a trying to help their child fall back to sleep following awakenings in the middle of the night. Helping children and teens achieve quality sleep is a challenge even during typical times, and during the current COVID-19 pandemic, many families are likely finding their children’s sleep and sleep routines even more disrupted. The effects of prolonged quarantine and remote learning mean that many of the external factors that typically help us to structure our days – for example, waking up on time to catch the bus, or participating in extracurricular activities such as camps and sports—have disappeared, and the boundaries that typically delineate our home, work and school lives have been blurred. These disruptions to our daily routines can increase sleep difficulties by getting in the way of enacting healthy sleep behaviors, also known as sleep hygiene. Sleep Hygiene includes a range of good sleep-promoting habits, such as staying out of bed during the day, sticking to a regular bedtime, and rising around the same time each day. Additionally, the current pandemic is an understandable source of uncertainty, fear, and anxiety for many children and families. Heightened levels of stress and anxiety can negatively impact sleep, and parents may be seeing their children show new or more frequent anxious behaviors at bedtime, such as delaying bedtime, reporting more bedtime fears, and having difficulty sleeping alone.

As many parents know, sleep is incredibly important for children’s health and functioning. Insufficient sleep in children can lead to greater levels of irritability and increased difficulty regulating emotions such as anxiety. Paradoxically, children who do not get enough sleep also often show higher levels of energy and hyperactivity, which can heighten the challenge of managing your child’s behavior, especially in the context of remote learning and our current environment with limited healthy outlets for children to release excess energy. Given the well-established benefits of healthy sleep on children’s growth, development, and emotional well-being (not to mention the respite for parents for whom a child’s bedtime provides a short window of well-deserved parent-only time), promoting healthy habits for your child’s sleep is always important, and perhaps even more pressing for many families at present. Below is a summary of simple, evidence-based strategies for parents of both younger children and adolescents to promote healthy sleep.

General Sleep Hygiene Recommendations

Children and adults of all ages can benefit from the following recommendations for healthy sleep habits:

• Ensure the bedroom is quiet, cool, and dark. People sleep best in these conditions. If your child prefers something like a white noise machine or a night-light, keep it on all night (as dim as your child will tolerate for the nightlight). Avoid television and other blue light screens in the bedroom.
• Remember that the bed is only for sleep, and sleep is only for the bed. Doing other things in bed, like reading, homework, or watching television, can confuse our brain. When we reserve the bed only for sleep, getting into bed helps cue our brains that it is bedtime and time for sleep, thus making falling asleep less of a struggle.
• Help your child or teen keep a regular bedtime and wake time. More regular schedules make it easier to fall asleep. Help your child maintain a regular schedule by setting a bedtime and ensuring they wake up around the same time each day. Ideally, your child’s weekend schedules should only vary by 1 hour of their normal weekday schedule.
• Get physical activity, but not too close to bedtime. Physical activity is important for people of all ages for promoting sleep, as well as other positive health effects. However, avoid intense physical activity within an hour of bedtime, as this can energize your body and make it more difficult to fall asleep.
• Avoid screens at least 30-60 minutes before bedtime. This a challenge in our current day and age, but research shows that the blue light emitted by electronics (phone, computer, television, tablet, etc.) suppresses melatonin, the hormone naturally produced in our brain that makes us feel sleepy. In other words, lights from electronics signal to our brains that it is daytime and we should be awake. Limiting screen time in the hour before bedtime allows our brains to produce melatonin and prepare for sleep.
• Avoid late afternoon naps. If your younger child naps during the day, avoid naps later than 3pm. If your teen must nap during the day, limit it to no longer than 30 min and not later than 4pm. Later or longer naps can reduce sleep drive and make it more difficult to fall asleep at night.
• Limit or eliminate caffeine. Young children should not consume food or beverages with caffeine, which they are more susceptible to than adults and which can make it more difficult to fall asleep. Caffeine can be hidden so check labels carefully (e.g., many people don’t realize that orange soda has caffeine!). Soda, iced tea, coffee drinks, green and black tea, and dark chocolate are common sources of caffeine. Aim to replace these items with non-caffeinated versions. If your teen consumes caffeine, encourage them to limit caffeine consumption to the morning hours, and cut off caffeine intake after 12pm to avoid negative effects on falling asleep.
• Rather than focusing on falling asleep, help children focus on relaxing their bodies. If children are in bed and relaxed, their bodies will naturally fall asleep when ready. It may be helpful to remind children of the following:
  “Do not stress about actually falling asleep, just focus on building good bedtime habits that help to give your brain and body clues that you are ready for sleep each night. Your job in bed is to rest, not to force sleep.”

Sleep Strategies for Parents of Younger Children

Children need approximately 10-12 hours of sleep per 24-hour period, depending on their age. In addition to the sleep hygiene recommendations above, the following strategies can help make bedtime less of a battle and ensure your child gets enough sleep.

• Establish a bedtime routine that acts as a “wind down” period. Having a regular bedtime routine is a way to signal to your brain that it is time to get ready to sleep. Children especially benefit from routine and consistency, so having a regular bedtime routine can help bedtime go more smoothly. Your child’s bedtime routine should be no more than 20-30 minutes (or 45 minutes if it includes a bath). Many parents include calming relaxing activities with their child before bedtime such as reading or singing songs; however, other parents find that their child needs to move around before bedtime to release some final energy. Feel confident doing what works for you and your child. You may also consider “saying goodnight to electronics” as part of your bedtime routine to get your child on board with turning off the screens.
• Respond consistently to your child when they get out of bed. Many children have difficulty staying in bed after lights out and can come up with a multitude of reasons they can’t go to sleep just yet—they need a drink, or a snack, or to use the bathroom, or one more hug, etc. Sometimes children learn that these requests earn them more parent attention and can push back bedtime by hours! Try to address your child’s needs before bedtime (e.g., encourage them to use the bathroom before getting into bed, have a snack before bedtime, place a cup of water by their bed) so you can distinguish between a real need and a sleep stalling technique. If you do feel a need to meet your child’s request after lights out, respond calmly, quickly, and in a neutral tone before getting them back into bed. This will help reinforce the message that are not missing out on any fun after bedtime and will be more likely to stay in bed.
• If children complain of feeling hungry in the evenings, try a light snack before bed. Foods high in the amino acid tryptophan, such as bananas, may help children to sleep better. Avoid heavy, spicy or caffeinated foods and beverages before bed, however.
• Coping with bedtime fears and anxiety. Bedtime fears and anxiety are very common, and are reported by nearly 75% of children between ages 4-12 at some point in childhood. Some helpful strategies include:
• Make bedtime relaxing and calming. Avoid scary stories or television close to bedtime.
• Children who need to practice coping with anxiety can practice by “teaching” their favorite doll or stuffed animal how to be brave and relax at bedtime.
• Use a nightlight if your child is afraid of the dark, and try to keep it as dim as your child will tolerate.
• Communicate to your child the household plans for managing any events that they worry about on a recurrent basis that have a basis in reality. For example, if your child is afraid of a house fire, make a family emergency plan together and practice/review it once so your child knows what would happen in the unlikely event of that worry coming to pass. Having a plan can reduce anxiety. If your child continues to ask “what if” questions after you have answered the question or shown them the safety plan, calmly respond by saying something along these lines:
  “I know you feel worried about that, and sometimes those worries can set off the alarms in your body. I also know that you already know the answer to that question because we talked about it together recently. That tells me that this question is a worry thought, rather than a real question you need answered. I love you, and am not going to answer that question anymore because I think it’s really important for your brain to learn the difference between a worry thought and an emergency, so that worry thoughts don’t have to feel so scary.”
• Teach and model bravery for your child. Bravery means feeling afraid and doing something anyway! Tell them stories of worries you had as a child and how you learned to cope with them.
• Help children to leave their worries behind when they go to bed. If you find that your child’s worries all sneak up on them when they get into bed, pick a time earlier in the late afternoon as their designated “worry time” and allow them to worry on purpose about everything on their mind during this time, for a set amount of time.
• Provide motivation. If your child is brave and stays in bed, the sleep fairy can reward them. Alternatively, you could offer a special (preferred) breakfast or small treat in the morning (e.g., special snuggles, 5 minutes screen time) for meeting their behavioral sleep goal – e.g., staying in their own bed until a certain time.
• Still worried about your child’s sleep? Consider seeing a professional. Younger children may develop specific associations that they need in order to fall asleep, which may indicate that a child has what is referred to as behavioral insomnia. Most commonly, this looks like needing a parent in the room in order to fall asleep, and/or sleeping in the parent’s bed or room during the night. If you see this as a problem for your child or family, it may be helpful to seek help from a professional with specific training in pediatric sleep disorders. A professional can help you learn strategies to teach your child to sleep independently in a way that fits with your family’s preferences and goals. This can look very different from the “cry it out” technique that many parents find difficult or undesirable to enact, so don’t be deterred if you have tried in the past to make a change to your child’s sleep and were unsuccessful. Other children may struggle with anxiety that impacts sleep. Working with a professional can help you and your child learn specific skills and strategies to effectively cope with and reduce anxiety.

Sleep Strategies for Parents of Adolescents

Adolescents need between 8-10 hours of sleep per night, although many teens get far less than that amount. Parents’ influence over your child’s sleep declines as your child gets older, but if your teen is having difficulty sleeping, you can encourage your teen to try the following strategies:

• Encourage a bedtime routine. Adolescents still benefit from having a consistent bedtime routine, even though it will look different than the routine of a younger child. A bedtime routine could be as short as 10 minutes and consist of 2-4 brief activities, such as brushing teeth, washing up, and saying goodnight. Even a simple routine helps to cue the brain that it is now time to sleep.
• Consider keeping electronics out of the room at night. As discussed above, the light from electronics interferes with sleep. Teens may have a particularly hard time ignoring the lure of friends, games, and social media on electronics after bedtime. Help your teen establish limits for electronics if needed (e.g., charging their phone away from their bed) or discuss removing electronics from the bedroom at night if necessary to getting a good night’s sleep.
• Avoid watching the clock. For many people who have difficulty falling asleep, or wake up in the night, it is tempting to check the clock to see what time it is or how long you have been lying in bed. However, this practice can produce more anxiety and pressure to fall asleep, which does the opposite of promoting sleep. If this is a challenge for your teen, you and your teen may discuss removing the clock from their room or keeping electronics outside of the bedroom at night to break the habit of clock-watching.
• Teach your teen the “half hour – half hour” rule. If it consistently takes your teen a long time to fall asleep at night (a “long time” is considered to be 30+ minutes), it is unhelpful to continue lying in bed tossing and turning. Instead, if your teen has been lying awake for 30+ minutes, they should get out of bed and do a relaxing or boring activity (not exciting, interesting or stressful) for about 20-30 minutes or until they feel sleepy. Then, they can return to their bed. They can repeat this as needed until they fall asleep. Getting out of bed shifts attention from “trying” to sleep, which is usually counterproductive, and it prevents the brain from creating an association between the bed and wakefulness.
• Pay attention to drug and alcohol use. Be mindful of your teen’s drug, alcohol, and tobacco use. All of these can negatively impact sleep. If your teen uses substances and is struggling with sleep, they may need support around reducing or eliminating substance use.
• Watch the weekends. Teens are more prone to sleeping in late on weekends, especially if school starts early during the week. However, sleeping very late on weekends can throw off teen’s sleep schedules and make it harder to fall asleep at night, similar to the how you might feel when experiencing jet lag. If your teen has trouble sleeping at night, try to encourage your teen wake up within an hour of their regular wake time, even on weekends.
• Consider seeing a professional if your teen continues to struggle with sleep. The most common sleep problem in adolescents is insomnia, which involves chronic difficulty falling asleep or staying asleep and results in negative consequences during the day. Cognitive Behavioral Therapy for Insomnia (or CBT-I) is the most effective treatment for insomnia. In fact, research of CBT-I has shown that it is more effective than medical treatment for insomnia, including the front-line prescription sleeping pills. A professional trained in CBT-I can help your teen learn new behaviors and thoughts to reduce or eliminate insomnia and obtain healthy sleep.

At Chicago Psychotherapy, LLC, we offer evidence-based treatment for sleep concerns, parenting support, and gold-standard treatment for Anxiety, Adjustment Disorders, Mood Disorders, and Obsessive Compulsive Disorder across the lifespan. To connect with a member of our team about support for you or your family member, please contact us.

References

• Jacobs, G. D., Pace-Schott, E. F., Stickgold, R., & Otto, M. W. (2004). Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Archives of internal medicine, 164(17), 1888-1896.
• Jacobs, G. D. (2020). CBT Training Manual for Insomnia. CBTforINSOMNIA.com
• Mindell, J. A. & Owens J. A. (2010). A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems, 2nd ed. Philadelphia: Lippincott Williams & Wilkins.
• Muris, P., Merckelbach, H., Ollendick, T. H., King, N. J., & Bogie, N. (2001). Children’s nighttime fears: Parent–child ratings of frequency, content, origins, coping behaviors and severity. Behaviour research and therapy, 39(1), 13-28.
• National Sleep Foundation. (July 28, 2020). What Happens When My Child or Teen Doesn’t Get Enough Sleep? SleepFoundation.Org