[ This is not even close to an exhaustive discourse on all sleep problems or all the causes of sleep problems or sleeplessness and it's not anywhere near an exhaustive discourse on all of the remedies available. ]
dealing with sleep problems  |
basic sleep facts
Sleep is cyclical. Most of us humans enter into sleep by first relaxing and then we slip into sort of half-asleep stage (where sometimes really good thinking happens -- some people keep a notebook by their bed just in case they think of something because they're not likely to remember their thoughts the next morning), and then we "go to sleep" -- entering into deepening levels of sleep and then REM sleep (where we do most of our dreaming). And then we almost -- or actually (especially if there's a little anxiousness) -- wake up before entering back into deepening sleep stages of sleep and then REM again. (A child or adult dealing with a bit of anxiety might find him- or herself waking up several times during the night.) Each cycle lasts somewhere around 90 minutes.
Our brains get used to things and keep us alert (and this keeps us awake) whenever things change. Our brains both get used to and tune out regular elements of our environments. If your child is used to sleeping with a light on, a dog on the bed, a favorite stuffed animal, noise in the house, quiet in the house, a parent in the room, a sibling in the room, etc., then a change in that element will result in some degree of sleeplessness. It takes time to get used to a new change in sleeping situation. A change can cause several minutes to a few hours of sleeplessness before sleep finally comes. This can happen for a few nights or even a week.
This is just the way our brains work. If your child is used to you being in the room or the light being on or the dog being there till s/he goes to sleep, she will have difficulty getting to sleep if one night you have other things to do, the light is off or the dog is out. S/he can get used to the change but it will take a week or so and if there are intense reactions (by parent or child) it may take a little reward program to settle things with the least trouble.
Sleep happens most easily when there's a consistent routine within which bedtime is routine -- this is true for adults and children. It is almost an art form to be able to get meaningful sleep without a routine. Few people can accomplish getting to sleep easily at differing times through the week. With regard to kids, if you're consistent in your interactions with your child and have your child on a regular (and therefor highly predictable) weekly schedule, he or she will sleep better (and eat better, behave better, feel better and do better in school).
Many people find that it's generally a better idea to get up and do something meaningful rather than lay in bed obsessing about the sleep you aren't getting. Sometimes there are things stressing, causing sleeplessness, that can be dealt with as long as the time is available.
If you label a problem a big deal, it will probably be one. Adult or child, if you label a sleeping problem a big deal, you may be adding to the problem. When problems are viewed as big, anxieties and self-doubts come into play and make things all the more complicated. Some people may have a sleepless night or two due to some physical or emotional problem or some hiccup in routine that resolves quickly. But if the problem is "blown out of proportion" there can be subsequent anxiety about getting enough sleep that can in and of itself cause sleeplessness long after any other cause of sleeplessness has resolved.
Many, if not most, people who believe they are having sleep problems underestimate how much they sleep. When there are sleep problems or problems with tiredness, the amount of time not sleeping may be over-reported. (Time flies when you're having fun, they say, and the opposite is true, too. Time spent laying awake wanting to sleep is not fun, and each minute can seem like ten or twenty.) There are sometimes reasons other than actual sleeplessness that may cause a person may feel he or she is not sleeping even if he or she actually is getting to. Anxiousness, agitation, and certain diseases and disorders can cause brief periods of sleeplessness and poor restfulness during sleep.
earth tetherhelp to sleep |
If you are anxious or depressed, your children are probably affected by it. If you're concerned about sleep problems in your child or children and you are experiencing depression or anxiety, one or more of your children may be affected. If you or someone else isn't working hard to convince them that everything is really all right or going to be all right, your children are probably going to be either anxious and depressed or anxious, depressed and angry -- even though he, she or they may hide their feelings from you -- and there may well be sleep problems as a result.
If there are problems occuring that cause worry during the day, thees may interfere with sleep even if they don't seem to be bothersome at sleep time.
Our minds can do a lot of multi-tasking and often things that are bothering us are "put aside" and out of consciousness but they are still being worked on or thought of even if they don't seem to be. This is even more complicated with children because their minds don't work the way adults' minds do and often they have things bothering them that adults around them wouldn't think (or wouldn't want to think) would be bothering them.
Generally speaking, we all need to feel secure and safe to easily get to sleep.
If there are threats to security, there are likely to be difficulties sleeping. If there are threats to security, deal with them. If nothing else can be done, work on faith. Threats to security may be very obvious and may also be subtle and difficult to recognize.
With regard to the issue of security and strategies to feel secure: If you and your child are living with your child's other parent and you have a much closer relationship with your child than you do your adult "significant other," the child may develop sleep problems (as well as eating, emotional and/or behavioral problems) -- especially if you have lots of secrets with your child that exclude your child's other parent and/or you rely on your child as an emotional support. A child may also feel very insecure if you give him or her the idea that his or her parents cannot successfully manage adult living challenges or if the child is given too many adult responsibilities or decisions.
Medications and some foods and drinks can cause sleeplessness.
Many medications and some foods and drinks can cause sleeplessness -- and, as one ages and ones' body changes, medications, foods and drinks that didn't cause sleep problems in the past may begin to cause sleep problems. Taking a medication at a different time, eating or going drinking later than usual may also result in sleep problems that didn't occur when the medication, food or drink was ingested earlier in the evening.
using hypnosis tapes/CDs for sleeplessness
Hypnosis tapes and CDs can be very helpful in dealing with sleeplessness in several ways. They can be used to keep one's mind occupied and focused on sleep in a much more practical fashion than is typical of the thinking that usually goes on when one lays awake trying to sleep. They may be able to suggest acceptable ideas about relaxing and setting problems aside for the night so that sleep can come. They may also be able to offer suggestions about letting one's self relax that amount to a new skill being learned that can be utilized on other occasions without the aid of the tape/CD. Hypnosis tapes/CDs provide a set of hypnotic interventions that can be accessed and utilized at any hour, day or night. They allow for a greater sense of control and an opportunity to "get to know" what messages are being delivered to the listener. Unlike a session with a therapist or hypnotist, tapes and CDs allow one to experience the session with whatever level of anxiousness about the experience that one feels a need for -- and then allows the listener to listen again, more relaxed because there are going to be no surprises.
The most helpful elements of hypnosis tapes and CDs for sleeplessness would focus on imagery and suggestions that foster direct or indirect control over the things that seem to get in the way of falling asleep and staying there.
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a good hypnosis tape/CD for sleeplessness focuses on physical and emotional relaxation during listening, focuses on teaching or fostering already present relaxation skills that can be used when not listening to the tape/CD, fosters skills in being able to distract your attention away from -- temporarily forget about -- aches, pains and troubling thoughts about which there isn't anything to do for the night, fosters an ability -- and a trust in that ability -- to reliably recall important issues later that were let slip from focus of attention (so you can use the skills in distracting yourself or temporarily forgetting), fosters a general hopefulness and trust in your own resiliency, fosters emotional and physical healing, fosters an acceptance of problems with a positive attitude, fosters an ability to believably reassure one's self that whatever dangers there are, they can wait till morning and if they can't, you can survive whatever might happen, makes you glad you bought it, and, finally, gets you to sleep before you hear the tape/CD player click off. |
cautions Don't deal with symptoms before you deal with the problem(s) they flag. Hypnosis tapes/CDs can be very helpful during or following the process of treating sleep problems, BUT if sleep problems are symptomatic of some other disorder or disease that should be identified and treated - or symptomatic of stress and worry about something that should be directly dealt with - then reducing or eliminating the sleep problem symptom without dealing directly with the disease or stressor might result in masking an underlying problem that might get worse while being ignored.
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sleep problems in adults
In adults, sleep problems can occur because of disease processes, anxiety, depression, physical discomfort, and worry or stress. (Worry and stress are sometimes referred to as anxiety). As with most areas of life, one needs to be careful in assessing what the heck might be wrong that is keeping one awake nights. The common strategy for solving any problem is to decide what the cause(s) of the problem might be and then to decide what might be the most likely solution - and then try your best guess as to what will work and if it doesn't work, rethink.
Identify and deal as directly as possible with underlying difficulties first. If you decide that your best guess is that sleep problems are most likely due to a physical disease process (i.e., hyperthyroidism, breathing problems, etc.), see a physician. If you decide it's most likely a psychiatric problem like anxiety or depression (also a physiologically-based difficulty -- which we usually refer to this as a mental health problem), see a psychologist or a physician (your general practitioner or a psychiatrist). Add self-help strategies like hypnosis tapes/CDs only in consultation with the professionals you consult OR after you have exhausted their skills.
If you decide that your best guess is that sleep problems are most likely due to stress and worry about something (and you're pretty sure that your worry and/or stress doesn't qualify as depression or anxiety), add self-help strategies like hypnosis tapes/CDs AFTER you're certain you've done what you can to deal directly with whatever you are worried about or stressed by.
Using head-cleaners tapes & CDs for sleeplessness in adults. Anything that keeps you stressed during the day is very likely to interrupt sleep at night. Anything you can do to at least temporarily reduce stress feelings and resolve issues on your mind will in all likelihood help you get better sleep. All of the head-cleaners tapes and CDs can be used to reduce or resolve stress and get to sleep. The term "hypnosis" basically means sleep like condition. Most people feel they fell asleep for at least part of most hypnosis expriences. Using a hypnosis tape or CD to reduce stress you have about a particular issue AND to relax and get to sleep is a "two birds with one stone" high calibre idea. You simply begin listening to a hypnosis tape or CD at bedtime. The portion of the recording you do hear before slipping into sleep will actually have greater impact. The part you miss because you do slip into sleep won't have much of an effect but at least you got to sleep. If you don't get to sleep -- which will be unusual -- you used the time to deal with an issue.
Any of the head-cleaners recordings make good candidates for helping you get to sleep, though "are we asleep yet, too?" is focused directly on the elements of sleep problems listed above and will help you not only get to sleep but will plant suggestions that will help you get to sleep on other nights when not listening to the recording. This recording can be listened to at sleep time and when awakening during the night. If sleep problems have more to do with stress, any of the hypnosis CDs or hypnosis tapes I offer or that others offer might help even more.
sleep problems in children
Having a child with sleep problems can be quite a problem for parents. Not only does the parents have to worry about the child's problem, but the parents find themselves having to do extra duty themselves. A sleep problem for a child is a sleep problem for the parents.
As with adults, sleep problems in children can be caused by one or more factors. Illnesses can cause sleep problems by making the child uncomfortable or agitated. If breathing or coughing occurs or if bones and joints ache, if there's stomach problems, it's tough to sleep. Depression and anxiety can also cause sleep problems. And then there are also individual differences between people -- some children just don't seem to need as much sleep as others.
Some good questions to ask yourself if you believe your child has a sleep problem:
- 1. When your child does get to sleep, how much sleep does s/he seem to need to be in good spirits and function well the next day? Without interventions, does he or she get enough sleep to feel fine and function fine the next day? Do other members of the immediate or extended families seem to just do fine without much sleep?
2. Do others in your immediate or extended families have or have they had sleep problems or problems with anxiety or depression?
3. Is the problem getting to sleep, awakening often and early or both? How about when the sleep problems first started?
4. How many nights a week does the sleep problem occur? How many nights each week do you believe it would occur if you didn't do something like give a med or read a story or stay in the room till the child falls asleep? How many nights each week does sleeplessness actually occur in spite of interventions (like reading, sleeping with, etc.)?
5. If it's not every night that sleeplessness seems to be a problem, is there a pattern associated with the day of the week, a particular activity or some other variable in the child's life? (That is, is it always on a night before school, a few nights after a visit to dad's, on the nights before tests, on the nights you eat a particular food, etc.)
6. Is there any history of traumatization? (That is, has your child been abused or has your child witnessed abuse or death or bloody accident, etc.?)
7. Have you experienced any significant loss or traumatization that might make you anxious about your child's welfare or your own?
8. Are sleeping conditions conducive to sleep? (That is, is there a little brother that coughs all night, is there a firehouse or police station next door, are there people talking and laughing in the next room?) How about when the sleep problems first started?
9. Have you ruled out any illnesses that might be causing sleep problems? How about when the sleep problems first started?
10. Is your child on a medication that might be causing sleep problems? How about when the sleep problems first started?
11. Is there television watching or story telling going on in your child's life that might be causing anxiousness? How about when the sleep problems first started?
12. Is there a history of nightmares? How often, how many?
13. Is there caffeine drinking or sugar eating going on in the hours just before bed? How about when the sleep problems first started?
14. Is there any reason for the child to worry about anything that may or may not happen after s/he goes to bed? How about when the sleep problems first started?
15. Is there napping going on during the day? How about when the sleep problems first started?
16. What does your child do when s/he can't get to sleep? What is the parental response to the sleeplessness of the child?
17. How much of a problem is this for your child, versus how much of a problem is this for you?
18. What possible benefits to the child are there to having the sleep problem? What possible benefits to the parents are there?
19. What do others see as contributing to the sleep problems your child is experiencing? Have you really thought about and ruled out these possibilities?
20. Is it possible that for one reason or another a bad habit got started?
| 1. When your child does get to sleep, how much sleep does s/he seem to need to be in good spirits and function well the next day? Without interventions, does he or she get enough sleep to feel fine and function fine the next day? Do other members of the immediate or extended families seem to just do fine without much sleep? |
Individual differences in sleep needs. If it seems like your child functions quite well with the sleep he or she gets, in spite of the fact that it seems to you to be too little sleep, maybe this is just an individual difference. If you know of others in your family that don't seem to need much sleep, this is probably some gene at work. Check with your pediatrician to be certain, but you're probably going to need to deal with this by finding things for your child to do in bed at night that are restful, quiet and absorbing -- absorbing enough that it keeps the attention while waiting for sleep but not so absorbing that it keeps your child awake beyond when he or she would have fallen to sleep. Nintendo-type stuff is too engaging. You'd likely often find your child still at the controls when you get up in the morning. Think books or music. One child I worked with could lay in bed and entertain himself quietly for hours with any household utensil. Imagination practice is good for kids and so is developing quiet, patient skills. Drugs can help knock a kid out for a night but that's not a good a learning experience as learning quiet patience.
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2. Do others in your immediate or extended families have or have they had sleep problems or problems with anxiety or depression? 3. Is the problem getting to sleep, awakening often and early or both? How about when the sleep problems first started? |
Anxiety, depression, disorders. There are a variety of psychological situations that are more habit than disorder which can lead to sleep problems, many of which will be addressed below. However, sleep problems can also be caused by anxiety, depression or other fairly serious psychiatric disorders. If there is a history of sleep disorders, anxiety and/or depression in the family gene pool, then there could be good cause to get a consultation from your pediatrician. There are many medications that can help with biological and psychiatric disorders (i.e., depression and anxiety). Most research shows that the best way to address these is with both medication and counseling.
Life would be much simpler if everything that happens was caused by one cause, but unfortunately there can be many causes in complex interaction causing what seems like one problem. Even if there is a biological or psychiatric component, if there have been efforts to soothe or compensate a young anxious mind, there can also be a habit or other psychological component that should probably be addressed at the same time (see the section on habits below).
Difficulty sleeping can occur because of something on a child's mind that he or she is not comfortable talking about. This can be because he or she has been exposed to or has experienced something scary or weird (horror movie, traumatic event, molestation). It is especially difficult to get kids to talk about things they think will be dismissed or will cause them to be told they're bad or stupid. It is also especially difficult to get a child to talk about things that they think will hurt or harm their parents.
Difficulty sleeping can also occur because of a medication or change in schedule or diet.
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4. How many nights a week does the sleep problem occur? How many nights each week do you believe it would occur if you didn't do something like give a med or read a story or stay in the room till the child falls asleep? How many nights each week does sleeplessness actually occur in spite of interventions (like reading, sleeping with, etc.)?
5. If it's not every night that sleeplessness seems to be a problem, is there a pattern associated with the day of the week, a particular activity or some other variable in the child's life? (That is, is it always on a night before school, a few nights after a visit to dad's, on the nights before tests, on the nights you eat a particular food, etc.) |
Regular elements, routine and sleep. If sleeplessness doesn't occur every night, it is sometimes very helpful to ask yourself what the difference might be due to. Sleep happens best when it is in a routine that is followed. Is the routine out of whack? Sleep is also tough when excited about something.
If the problem is the routine, either get more routine in your routine OR just get used to it -- your child will have a tough time sleeping when the routine needs to different. That means the next day may be tougher -- emotionally and behaviorally -- and it means you should probably try to be more patient with your child and have somewhat lower expectations. This is all the more important if your child's lack of sleep translates to lack of sleep for you, too. OR, you may be able to find something that helps get him or her asleep and make that a routine part of non-routine nights. A hypnosis or relaxation tape/CD focused on getting to sleep or focused on just relaxing might help a lot.
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6. Is there any history of traumatization? (That is, has your child been abused or has your child witnessed abuse or death or bloody accident, etc.?) 7. Have you experienced any significant loss or traumatization that might make you anxious about your child's welfare or your own? |
If you are anxious about something significant, your child may well be anxious too. Most parents live in denial about how much their kids are soaking up from their parents' thoughts and worries. If a parent is a little worried and not making an effort to at least pretend not to be worried at all, his or her child or children may be anxious in the extreme. Children may be very anxious but also anxious about parents finding out about the anxiety because they don't want their parents to be concerned, angry or more anxious than they already are. Children pick up on parental anxiety and a little, "You don't have to worry," is usually totally inadequate in allaying fears.
If a child has been traumatized -- if he or she has been frightened in any way about his or her safety or ability to be safe -- there may be significant anxiety which can cause sleep difficulties.
In either of the above situations, it's a good idea to consult a psychotherapist that works with children if the sleeplessness is more than just once in awhile. Even if you feel that your child may have picked up on mild anxiousness on your part, if sleeplessness is happening a few nights a week or more often your child may be experiencing significant anxiety because of the way his or her child's mind magnified and/or imagined things. A good psychotherapist can help you identify what the anxiousness is about and can help you find ways to convey to your child that things are really okay or at least are going to be (even if you don't really believe that, it's important to children to believe it).
| 8. Are sleeping conditions conducive to sleep? (That is, is there a little brother that coughs all night, is there a firehouse or police station next door, are there people yacking and laughing in the next room?) How about when the sleep problems first started? |
If sleep conditions are not conducive to sleep, it's a no-brainer why there's no sleep. What many parents might miss is that first there may be problem sleep conditions which are understandable but then a bad habit develops that lasts long after the sleep conditions become more optimal. If a bad habit develops, it's just a matter of changing the habit (see the section on habits below).
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9. Have you ruled out any illnesses that might be causing sleep problems? How about when the sleep problems first started?
10. Is your child on a medication that might be causing sleep problems? How about when the sleep problems first started? |
If an illness may be causing a sleep problem, consult your pediatrician. If there was an illness that caused a sleep problem but the illness is passed but the sleeplessness has not, consider the possibility that you have a habit going on now (see the section on habits below).
| 11. Is there television watching or story telling going on in your child's life that might be causing anxiousness? How about when the sleep problems first started? |
Kids can be very anxious about elements of tv shows or stories -- elements that parents may have felt were funny or interesting. Kids think differently than adults do. They deal with information differently and they may have reactions or assumptions that an adult can barely imagine possible. And, to make it a little more complicated, kids don't really pay attention to their own thinking as well or as much as adults do, so things can bother them that they have trouble understanding. Kids may have very little insight into what makes them anxious, or may have difficulty verbalizing their fears even if they have an awareness of them. Kids can be fascinated but deeply frightened by stories with monsters, murders and mayhem and such. If sleeplessness occurs, ask yourself what was on tv and what stories they may have been reading or may have been told.
Adding to the complexity, a child may be anxious about something they watched, read or heard and be sleepless for a few nights before they resolve the issue (with or without help from parents), and then -- having developed a taste for late nights or the special interventions parents implemented -- they may have a habit to deal with after that (see the section on habits below).
| 12. Is there a history of nightmares? How often, how many? |
A nightmare or two every once in awhile is normal (though that doesn't mean they're not really scary). If nightmares persist, consult your pediatrician or a psychotherapist that works with kids. This could mean there is something bothering your child that can be causing or may cause emotional/psychological harm.
| 13. Is there caffeine drinking or sugar eating going on in the hours just before bed? How about when the sleep problems first started? |
Sometimes this can be happening without parents' awareness. Sometimes it can just be an oversight. Some kids are much more sensitive to caffeine or "energy foods." If there is food or drink intake happening along these lines in the hours before sleep, you might try experimenting with restricting these. Even if you stop caffeine drinking, etc., you still may have a habit to deal with. It can be fun to be up late. If you think you have a habit to deal with after restricting intake of food and drink, see the section on habits below.
| 14. Is there any reason for the child to worry about anything that may or may not happen after s/he goes to bed? How about when the sleep problems first started? |
Is there a concern that monsters will come with the lights out or that burglars may invade the house or that Dad will possibly beat up Mom when the lights go out? If these kinds of problems are causing sleeplessness, reassure your child, get a night light, get therapy and stop fighting. If there are anxieties about monsters or loss of parents, hypnosis tapes/CDs can help -- as can home-made tapes/CDs you make yourself for your child to listen to in bed at night.
Under these circumstances you might think you have a habit after awhile. However, sleep problems related to anxiousness don't turn into habits like opportunities to stay up late or nights with disturbances that keep kids up unless you've been routinely doing things to soothe and distract your child that may be sorely missed for awhile if they are withheld. Generally speaking, though, under conditions of anxiousness it's good to recognize that being fearful can itself become habitual in a complex way. In addressing anxiousness, it's important not to pressure the child unduly or miss what he or she is saying about his or her concerns. Reality is in the mind of the beholder.
| 15. Is there napping going on during the day? How about when the sleep problems first started? |
When napping is taking place, it's easier to do without sleep at night and it's harder to get to sleep and stay asleep. Sleep needs change. If your child naps during the day and then is unable to get to sleep and sleep through the night, the possibility that your child is no longer in need of a nap could be considered. Once you adjust this schedule, there still may be a habit left to deal with, depending on how fun it was to be unable to sleep nights (see the section on habits below).
| 16. What does your child do when s/he can't get to sleep? What is the parental response to the sleeplessness of the child? |
The answers to these questions are very telling. If there is anything fun or otherwise rewarding going on instead of sleeping, maybe the fun is the important issue. A child who finds that he or she is accepted in Mom's and Dad's bed or who finds that Mom will come in and sleep in his or her room -- or who gets a bowl of ice cream or a new CD -- "to help" him or her get to sleep is likely to find staying awake a way better idea than going to sleep. The fix is to withdraw these supports without making the child feel anxious that if he or she has a problem, Mom and Dad won't help. The problem rewards need to be gradually withdrawn and the habit needs to be dealt with (see the section on habits below).
| 17. How much of a problem is this for your child, versus how much of a problem is this for you? |
Here again, like the question above, is telling information. If the sleeplessness is not a problem for your child, it's not likely to be something your child will want to work on changing. If sleeplessness is not a problem for your child, working on sleep will be. If it is a problem for you, you'll need to make the situation a problem for your child before much will change. You can do this by reducing rewards for staying awake and offering rewards (be reasonable, now) for getting to sleep and staying asleep. Once you have a motivated child, you can work on the problem as a habit (see the section on habits below).
| 18. What possible benefits to the child are there to having the sleep problem? What possible benefits to the parents are there? |
By now, if you've gone through the questions above, this may seem redundant. It's good to go over again, though -- especially with regard to what might be the reward for the parent. Though Mom and Dad may say that they are very concerned about a child's sleeplessness, there may be underlying things going on for one or both that create and unconscious tendency to subtle sabotage their children's sleep efforts. If Mom and Dad are having struggles but they cooperate on the sleep problems of their child, everybody may consciously or unconsciously be motivated to keep the sleep problems happening. This underlying benefit from the sleep "problems," by the way, can be obvious or subtle. It would be obvious if Mom and Dad never really could talk without fighting except with regard to the kids' problems. It might not seem so obvious if Mom and Dad are actually uncomfortable sleeping together and (coincidentally) sleep problems in a child keeps them from going to bed together or even sleeping together.
It is a good idea to really think through the benefits from sleeplessness problems in children. Directly discuss and address benefits to your child that may get in the way. Directly deal with but unless you really think you have a very good reason to do so, do NOT discuss with your child the underlying parental motivations that may be in play.
Once you've uncluttered the situation vis-a-vis the rewards to the various players, you likely will have a habit to deal with (and again, see the section on habits below).
| 19. What do others see as contributing to the sleep problems your child is experiencing? Have you really thought about and ruled out these possibilities? |
This is just a good check on the various issues discussed above. Often we don't see things because we are too enmeshed in them (we can't see the forest for the trees). Though obviously one has to make the final decisions him- or herself, it's usually good to take into account what others are seeing and saying.
| 20. Is it possible that for one reason or another a bad habit got started? |
Habits can be broken with a little work. The longer a habit has been happening, the more work there is to do. The more rewarding the habit is, the more work there is to do. The more rewarding the habit is to anyone in the household, the more work there is to do.
When you work on a habit, the work is not done just because a few days go by without seeing it. Old habits die hard. Old habits recur -- usually during tough times when you can't really pay attention. It's not mischief or oppositionalism in a child nor is it in a relapsing adult. It's just a fact of life that old behaviors and attitudes keep coming back. You have to keep working on sustaining new habits and behaviors until the new ones are old ones.
To work on a habit, rely on a plan. Sometimes mindless reacting actually accomplishes everything that might have been hoped for from well thought-out logical strategizing. However, it is more likely that thinking through a problem and developing a well thought-out strategy that can be practically implemented will work better.
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1. Decide what your best guess is about what the problem might be. And don't forget to keep reviewing this assumption every once in awhile just in case your guess was wrong. 2. Decide what you might be able to do about the problems. There is usually something to do. The answer to this question, though, must be practical -- it needs to be something that you really can do. 3. Develop a plan for withdrawing rewards for problem habits, either abruptly or gradually and if gradually, then either slowly withdrawing rewards or swiftly withdrawing them, or something in between. 4. Develop a plan to reward good nights that gives rewards for little steps in the right direction at first and then slowly makes rewards a little more difficult to earn. Rewards should be given to both parents and child. (Always reward efforts at self- and child-improvement. Then they happen more often and more easily.) 5. Develop a plan to deal with any reasons for your child's anxiousness -- including anything your child actually does have good reason to be anxious about. If professional help is needed somewhere, get it. If unrealistic parental expectations are causing the problems, get over it. If your child is worried someone might be getting hurt when he goes to bed, make certain that's not the case before trying to get your child to believe assurances that smell like natural fertilizer. 6. Develop a plan to deal with any problem tendencies of your own. It may be seriously harmful to your child if you indulge or encourage your child's sleep difficulties because of your own immediate interests and without regard to your child's. An example of this would be the parent that wants to sleep in his or her child's room -- not to soothe the child's anxiousness but to avoid sleeping with the spouse. 7. Develop a plan for handling acting out and anxiousness. How will you deal with a child refusing to stay in his or her room -- what is most likely to work positively toward the goal of good sleep? (An angry reaction might be appropriate for the child rebelling because of anger, versus a child rebelling because of terror. A patient, nurturing, reassuring reaction would be more appropriate for anxiousness and much less effective with an angry child.) 8. Develop a plan to assist your child with whatever supports are practical and likely to be unhurtful over time. A night light, a book to read, recordings of soft music or stories to listen to -- and/or hypnosis and/or relaxation tapes/CDs -- might help and aren't likely to hurt (-- as opposed to allowing your children to watch tv, listen to loud chaotic modern music, play Nintendo or get on the computer till they get sleepy). 9. Develop a plan for training or fostering your child's get-to-sleep skills -- skills at being able to physically relax (become a limp noodle), set aside problems and worries for the night, have faith that he or she is safe and secure, and ignore any sensations that might be triggering arousal. Sometimes if you just put your child in the proper circumstances, they naturally exhibit these get-to-sleep skills. If so, then be sure to point it out to your child that he or she did exhibit one or more of these skills -- if you can't point it out at the time, then the next day -- point out instances when you see these skills and lavish praise on your child. 10. Develop a plan for identifying and measuring progress or lack thereof. You need to know if something hasn't been working, hasn't ever worked, never will work. You need to be alert to when it makes sense to rethink everything. Plan to need to identify loopholes and lack of progress. Loopholes require fine tuning the plans; no progress means back to the drawing board. 11. Implement plans. |
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Dealing with an 8 year old's habit of not going to sleep or waking early and getting up. First there needs to be an agreement with your child that the sleep problem is a problem for both of you and something that needs to be worked on. (It doesn't have to be whole-hearted.) Then decide on a reward program that gives a little reward (be reasonable) for the first night of successful, appropriate sleep, and a little reward then for two additional nights of successful, appropriate sleep, and then a little reward for every five. There should be a little reward for the child (i.e., a hotwheels car, a new Barbie outfit), and a little reward for the parent(s) involved in working on this (i.e., a new DVD or CD), though the frequency for parent's rewards could be at a less frequent schedule (i.e., for every seven nights or every fourteen). (Note: behavior programs in my experience work better if rewards are for numbers of accomplishments, not necessarily number of accomplishments lly avoiding .) Keep track of nights with a calendar or hand-drawn chart. Use happy faces, stickers or whatever seems fun to indicate good nights. Don't put anything for problem nights -- just blank. Convey an attitude to your child (and to other kids and other adults -- especially if your child is anywhere around) that this will be okay, that both you and your child can handle this. Convey a sense that you have every faith that its mostly a done deal, its just a matter of time and effort. Explain to your child and others in the household that this will take awhile and might be tough some nights and that dealing with this may involve both progress and setbacks at times. If you believe that sleep problems are more an interest in staying awake to avoid missing any fun, a stern attitude with rewards for good behavior might work best. If you believe that sleep problems are more an anxiousness about being alone, being in the dark, being away from parents, etc., a gentle, reassuring, patient attitude with rewards for little heroic accomplishments might work best. If reinforcing fun elements are abruptly removed, don't be surprised if there are some nights with crying and other upset. You might explain to your child some ideas for coping with loss of fun things, and commiserate that you know very well how frustrating it is to have to give up some fun. Consider gradual rather than abrupt withdrawal of reinforcing elements if anxiousness is involved. If your child has been sleeping with parents in their room, then it might work best to have a parent stay in the child's room at bedtime for a limited amount of time -- perhaps up to half an hour at first -- and then gradually withdraw the parent (each night the parent stays a little further from the bed until one night is just outside the room then the next night down the hall, and then the next night just somewhere else in the house. If there is considerable anxiousness or just to help, any audio tapes or CDs that you believe might be relaxing and soothingly entertaining to your child -- hypnosis tapes/CDs, relaxation tapes/CDs, stories for kids, soft and quiet music, etc. -- might help to distract from feelings of anger or anxiety. Recognize that when changing attitudes and fears or behaviors, old habits die hard. Like weeds, even when you think you eradicated them, they surprise you by growing back when your back's turned. It's just a matter of getting back to work if you find an old bad habit is back in town. Dealing with a 4 year old's habit of not going to sleep or waking early and getting up. First, if you can, get an agreement with your child that the sleep problem is a problem for both of you and something that needs to be worked on. (It doesn't have to be a whole-hearted agreement.) Then decide on a reward program that gives a little reward (be reasonable -- a sticker on a sticker chart or a happy face on a happy face chart may be plenty) for the first and every subsequent night of successful, appropriate sleep -- for the foreseeable future or at least for a few months. There should be a little reward for the parent(s) involved in working on this, too (i.e., a new DVD or CD), when the child has had a dozen or so good nights. If you use a sticker chart or a happy face chart to indicate good nights, don't put anything for problem nights -- just leave those boxes blank. Convey an attitude to your child (and to other kids and other adults -- especially if your child is anywhere around) that this will be okay, that both you and your child can handle this. Convey a sense that you have every faith that its mostly a done deal, its just a matter of time and effort. Explain to your child and others in the household that this will take awhile and might be tough some nights and that dealing with this may involve both progress and setbacks at times. If you believe that sleep problems are more an interest in staying awake to avoid missing any fun, a stern attitude with rewards for good behavior might work best. It is good to remember, though, that even angry young children can become frightened and possibly traumatized by experiences when they become scared about getting help and can't seem to get any. Like most of parenting, you have to "play it by ear." If you believe that sleep problems are more an anxiousness about being alone, being in the dark, being away from parents, etc., a gentle, reassuring, patient attitude with lots of excited praise for little heroic accomplishments might work best. If reinforcing fun elements are abruptly removed, don't be surprised if there are some nights with crying and other upset. Reassure your child that you do care about fears and upsets he or she may have, but that you are in charge and you know best. Consider gradual rather than abrupt withdrawal of reinforcing elements if anxiousness is involved. If your child has been sleeping with parents in their room, then it might work best to have a parent stay in the child's room at bedtime for a limited amount of time -- perhaps up to half an hour at first -- and then gradually withdraw the parent (each night the parent stays a little further from the bed until one night is just outside the room then the next night down the hall, and then the next night just somewhere else in the house. Any age-appropriate audio tapes/CDs that you believe might be relaxing and soothingly entertaining to your child -- hypnosis tapes/CDs, relaxation tapes/CDs, stories for kids, soft and quiet music, etc. -- might help to distract from feelings of anger or anxiety. If the problem is anxiousness that comes out as apparent worry about the whereabouts and safety of parents consider making an audio recording -- using your voice and if possible the voice of your spouse. You can use a cheap tape recorder and a cheap tape and if you speak clearly and carefully the quality will be fine -- it's your voice that is the important aspect of this tactic. Make a tape recording yourself to help your child get to sleep. Here are some ideas:
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If your child has an adolescent-level vocabulary and if sleep problems seem to be related to stress, "are we asleep yet, too?" is focused directly on the elements of sleep problems listed above. "healing tree 2" could also be very helpful. It focuses on the elements of get-to-sleep skills with a somewhat more intensive focus on resiliency and adjustment to changes and hardship. If sleep problems are related to thoughts that are difficult for your child to ignore at night (e.g., "I don't know, Mom, I just have too many thoughts at night..."), and again, if your child has a fairly mature vocabulary, "performance 2" could be very helpful. It focuses on relaxation and letting go of thoughts that are bothersome.
Other tapes & CDs & resources for helping kids
Check out http://www.stanford.edu/~dement/sleepaids.html for other recordings (relaxation, hypnosis, etc.) for kids having sleep problems.
Coping with Childhood Fears is a very brief, helpful article.
The Sleep Tight Video©; info on night terrors - A pediatrician-made video to help kids get to sleep and help parents; info on night terrors.
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e m a i l s
Dear Dr. J,
I have a 10 year old little boy who is having sleep problems. I do not want to medicate him if he can be helped another way.
His father and I seperated about 2 years ago. Bitter divorce. Lived in a rental home for about one year. Moved into my brothers house (house sitting) for the past year. My son used to wake up in the night at our rental home because he felt unsafe. He always heard noised outside. The only way he would get a good nights sleep is if he would get into bed with me. My son's grandmother (his fathers mom) used to tell him that it was an unsafe neighborhood and that to be very careful.
When we moved he seemed to sleep better. I don't know why, but the last month to a month and a half he started not sleeping again. Thinking someone is trying to get into the house. Always worried that I would fall asleep before he did. Wanting to get into bed with me. I will not let him sleep with me, because I get no sleep and get cranky. I also don't want him to get used to it. Who do I contact or what should I do to help my son sleep better?
Your input is greatly appreciated.
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reply:
Some of us get physical makeups that make it easy to sleep -- which is a drag if you need to get a lot done and need to squeeze extra hours out of some days -- and some of us get physical makeups that make it easy to stay awake -- which is a drag if you have a few things bothering you because just a little stress or anxiousness can make it hard to get to sleep.
If you haven't, explain to your son that one of the chores of childhood and adolescence is to become more and more able to work past fears when they start causing bad habits or diminish life in any needless way. You might sort of explain it as a sort of a "right of passage" -- something that when he gets past it he will be more of a mature young man. Dealing with a needless fear is something that happens again and again as we grow up and each time we conquer a needless fear it makes us stronger and more able to face life with maturity. It's an accurate, helpful way to think of it.
It also may help if you offer to help make getting himself comfortable sleeping in his own bed a special challenge with a sort of extra reward -- besides the reward of more maturity mentioned in the paragraph above. Offer something like a movie rental he can pick or a game or game rental or a special dinner when he manages to get himself sleeping back in his own room for a reasonable amount of time -- say 14 nights, for example. You can make it even more special with two goals and rewards -- one for the first 14 nights that he sleeps in his bed without even asking to sleep with you and one for 14 nights in a row. You can mold it in a number of ways -- a little reward for the first seven non-consecutive nights and then the next 14 non consecutive nights and a big reward for the first 21 nights.
Expect that once you get this dealt with he still might have a night every now and then when he asks if just tonight he can sleep with you or just in your room on the floor. You don't want to let it get started again. You might risk sitting in his room with him for awhile or reading a book to him to help him get to sleep in such a case.
I assume you probably already have thought of this but be certain he isn't having a Mountain Dew right before bed -- or two cups of coffee or a box of chocolate. Also, if he is on any kind of medication, you might check and see if there is caffeine in it (which a lot of over the counter meds, especially, have in them).
You can't keep people from telling him to be afraid or from seeing things on tv that will scare him but you can try. Knowing that grandma frightened him, you might talk with her if you have a reasonably good relationship. If not, you just have to live with it. You can try to make sure he doesn't watch frightening stuff on tv or movies about monsters, killers, burglars, terrorists or ghosts. There are some cool books -- Mrs. PiggleWiggle, for example, that make good read-to-kids books with great little lessons about dealing with fear, bath avoidance, forgetfulness, and other challenges -- pretty much exactly right for reading to ten year olds.
If you folks have some religion, it is nice to reassure kids that God watches over him and won't let anything happen to him that isn't supposed to in order to help him learn the lessons God wants him to learn.
It might also help to get him some soft music or some kids' books to listen to through headphones so the rest of the house isn't disturbed so when he is having trouble sleeping he can listen to a book till he falls asleep. There are a lot of kids books on CD or tape cassette.
Professional help-wise, you might ask around for a psychologist that works well with kids. Your pediatrician may have some ideas on one. The school principal or school counselor might have ideas. We shrink-types come in all sizes, shapes and abilities. The best way to find one is by recommendations from people who have found help with one. A psychologist can help him talk through fears that he may be uncomfortable talking to you about and can talk with you about strategies like the ones I just outlined above.
I hope that helps. Life's an adventure, huh? One thing after another. And like I said to tell him, remember that when you go through stuff it does make you tougher and wiser and able to appreciate other parts of life more. And if there is a God then there is probably a real good reason for all the hassles. And darned if life doesn't also seem to reach out and help now and then, too.
Dr. Johnson
"I was just reading some of the questions on head cleaners for children but amazingly I didn't find one to answer my question. My 17 month old daughter will not sleep through the night she use to but for the past 4-5months she is up at least three times. I thought it was something medical but discovered it was not. Then I thought it was teasing but it was not . When my mother stayed at the house over night my 17 month old child slept 12 hours for her but the next night when I was back home she reverted back to her old ways Please help. If our sleepless nights don't end we'll go crazy."
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Though there is probably always a cause to any effect, finding the cause can
sometimes be difficult or even impossible. Your best bet is to ask around
to find a pediatrician or child psychologist that has a strong reputation
for dealing with toddler problems, and then go over everything with a fine
tooth comb. There is likely a growth-spurt/developmental physical or
psychological thing, a disease (dis-ease) -type thing, or an environmental
sound or motion thing (-- or who knows what else -type thing), but finding
it might be tough. The fact that one time when you weren't there, the child
slept doesn't necessarily mean anything -- that could be just a fluke. You
might inquire in detail whether there was something your mom did that might
have tired your child out. You might inquire what food and drink she had
that night and compare it to habits you have with respect to drinks and
snacks. You might take a look at the differences in how you and your mother
differ in levels of anxiety or self-assuredness (the issue being whether you
are generally anxious and might be making your daughter anxious). I'd try
to figure out if something happened 4-5 months ago that might have made your
child anxious or that may have changed her schedule in some way. Did you
change dinner time, did you start having a snack or drink before bed or did
you decide to stop having snacks before bed or did you start having them
earlier or later? When she awakens, does she need to change her diaper or
does she need to go to the toilet? Is toilet training being undertaken in
the past 5 months? Is mom in any new relationships or does she have a
different schedule -- or does anyone else in the household -- compared to 5
months ago. If there is a pattern to the awakening -- if it happens at
pretty much the same time each night, perhaps you could take a weekend night
to either stay up or set your alarm to be up for the half hour before your
child usually wakes and see if something is happening that might wake her
(i.e., heavy trucks that drive by, chronic party people coming home next
door, a sibling that goes to the bathroom in the middle of the night, a
house pet that wakes up and roams around at night, an alarm clock that you
haven't noticed that is set in another room and goes off for sixty seconds
every night).
Children are changing a great deal in almost every way in their first years of life and they are picking up on all sorts of subtle and not-so-subtle stuff in their environment and are trying to make sense out of what happens around them without much language to use to think about it, much less understand or talk about it. Many adults don't realize that little pictures have great big ears and they become anxious about things their parents don't think they're aware of (tv shows, overheard telephone conversations, tearful upsets). On the other hand, kids also start picking up on things and can begin manipulating the adults around them without even thinking about it or realizing their doing it.
Bottom line is that you probably need to bite the bullet and go see somebody who understands little kids and their parents and their interactions -- somebody who can watch you as you explain and read the cues that don't show up in email or over the phone that might suggest ways to go to find a solution. If you decide it is just a behavior that needs to be rubbed out, you might end up traumatizing your child and things could be worse. If you decide it is something else that needs to be coddled and cuddled out, you might end up reinforcing late night wakenings and things could be worse. Sounds like things don't need to be worse.
Ask all the parents, teachers and doctors you know about any professional they know of that might have some magic with these kinds of problems. If you get no ideas, start calling around to pediatricians and speak either with them or their nurses to see if someone knows of someone.
At the very least, invite your mom to come sleep over at your house a few nights so you can get some rest and so you can think this all through. (As you become more and more sleep deprived, your judgment will get increasingly suspect.) It may be that you will need such help off and on for the next few years until she grows into another episode of physical development. Or, it may be that you have a child that doesn't need much sleep and that some day she will be able to work three jobs, raise two kids and keep her house spotless while she gets her MD and law degrees. If that's the case (she just needs little or no sleep and that never changes as she grows up), you just need to keep a lid on safety and rest issues for the household while your daughter grows to an age where you can just give her some coloring books or imagination games to keep her in her bed all night even if she isn't sleepy or sleeping.
Good luck. Sorry I don't have a handy dandy solution at the ready for you.********************************************************
an excerpt from an email response -- 12 year old boy having trouble getting to sleep
A lot of kids have trouble getting to sleep -- it's a funny state of being that is hard to describe and hard to make one's self get into. For most kids (and most adults), telling them to get to sleep is like telling them to start producing theta waves with their brains -- it's talking about something that everybody does but few recognize how the heck they do it.
If your son is a poor sleeper because he's gone through some tough life experiences or because he's finding his brain just too alive because of adolescence's arrival, my tapes may be helpful in getting him into sleep and teaching him to relax. (If this has suddenly begun to be a problem, it could be either or both. It's tough to get a kid at 12 to tell you if something weird has happened to them or if they're being bothered by weird thoughts, but it may be helpful to have him checked at by both a pediatrician and a child psychologist.)
If your son is and has always been a generally poor sleeper -- probably because of the physiology you inadvertently arranged for him yourself -- then my tapes, if helpful to his getting to sleep, will probably lose efficacy after a few listenings. In this case, you should probably settle into a plan for the next year or so of finding him things to read or listen to in bed along with a strong expectation that he be out of bed first thing in the morning whether he got sleep or not. (Letting kids sleep in after they have been up late is okay for a special weekend party or sleep over, but as a habit you just enforce an alternative internal clock setting.) Also, if this is the case, you probably should also settle your mind on checking his bed late at night pretty much every night for the next six years to make sure he's not using his sleeplessness to go hang out with friends while you sleep.