Signs and Symptoms

Your child may be experiencing bedtime-related anxiety or insomnia. And they are not alone. About 27% of children are sleeping less than the recommended amount:

• Children ages 3 to 5 should be getting about 10 to 13 hours of sleep.
• Children ages 6 to 12 should be getting 9 to 12 hours  of sleep.
• Teenagers  should be getting about 8 to 10 hours of sleep.

If your child has difficulty waking up in the morning or is sleepy during the day, these may be signs that your child is not getting adequate sleep. Other signs include difficulty falling asleep or staying asleep, worrying about going to sleep, mood swings, irritability, decreased attention span, and memory problems.

Effects

Lack of sleep has consequences far beyond the unpleasant bedtime routine. Not getting enough sleep can have negative effects on cognitive development, self-regulation, attention, health outcomes, and overall quality of life. We’ve all seen what too little sleep can do to a child — and it’s never pleasant. From tantrums to falling asleep during the middle of the day, sleep deprivation can be detrimental to both the child and the family.

Lack of sleep can put children at risk for developing depression, general anxiety and other emotional problems, according to researchers.

Behavioral Insomnia

One out of four children experience behavioral insomnia, a highly common form of sleep disorder in children. It’s characterized by difficulty falling asleep or waking up frequently at night. Researchers believe it’s typically related to “negative sleep associations” in which the child has negative associations with going to sleep and tries to delay going to bed.

For example, the child may be unable to settle or soothe on their own and so they experience distress when they are faced with going to bed on their own. Perhaps they are used to having a parent rock or nurse them to sleep, watching TV before bed, or having a parent be with them in their room in order to fall asleep. Some children experience anxiety about going to sleep, fearing bad dreams or the monster hiding in their closet. Because of these negative associations, the child does anything in her power to avoid going to bed. The worry associated with falling asleep actually makes it more difficult to fall asleep, and the cycle perpetuates itself.

Other common causes of insomnia in kids include stress, caffeine or other stimulants, side effects from medication, medical or psychiatric disorders, and environmental factors.

Treatment Options for Insomnia and Bedtime Anxiety

There is no specific test to diagnose insomnia; your child’s physician can assess your child’s symptoms and help determine what form of treatment is best.  Treatment could include a combination of medication, behavioral modifications, and therapy.

Although medication is commonly prescribed for sleep insomnia, it should be used with caution. There aren’t any medications approved by the FDA for insomnia in children and there are potential safety issues and side effects. In addition, the medication usually has only a short-term effect.

A more effective form of treatment, according to researchers, is behavioral treatment. The goal is to remove the negative sleep associations and replace them with positive ones, using techniques like establishing a bedtime routine and learning relaxation techniques. This might include visualizing a happy or peaceful place with your child as they are about to fall asleep; this can be a powerful was to help them relax on their own without needing a parent nearby at all times.

The American Academy of Sleep Medicine recommends the following strategies to help address insomnia:

• Establish a consistent bedtime.
• Give your child anywhere from 10 to 30 minutes to fall asleep.
• Spend time with your child during their bedtime routine.
• Avoid screen time in the hour or so leading up to bedtime (digital devices have been shown to make it harder to fall asleep).
• Don’t let your child fall asleep while you are holding, rocking, or nursing them.
• Avoid giving your child anything with caffeine (chocolate, soda, etc.) before bedtime.

Using a reward system like a sticker chart to recognize positive bedtime behaviors can also be helpful. Children earn stickers for following their bedtime routine and, after earning a certain number, can redeem them for a small prize. This type of reward system can be effective, especially for young children.

Bedtime doesn’t have to be a disaster. Identifying why your child is anxious about going to bed can help you figure out how to address their anxiety and help them learn how to settle themselves down for a good night’s sleep.