“Get back into your bed and go to sleep!”

“But I just need a glass of water!”

Sleep – we all need it.  It’s a time when our body does important rest and restorative work and our brains take time to process information.  Sleep has a big role to play in our physical and mental health.  Troubled sleep can be linked to the well being of a child or others in the family and poor sleep can also indicate other mental health problems for the child.

As an infant grows, normally their sleep patterns will settle or become more consolidated. That is, instead of getting their sleep in a series of naps,  sleeping hours and waking hours become longer.  Sleep patterns change as a child grows – at first, most often during the first  6 months – bubs will have 6 to 8 sleeps in a 24 hour period and as they grow, they start to consolidate or join  up these sleeps – hopefully with more at night and less during the day.

There is variation in how much sleep we need, but for adults generally it’s 8 hours, primary school 9-11 hours and preschoolers around  11 to 14 hours.  Newborns usually sleep 14-17 hours, but not all in one go.

Two main things determine how sleepy we get.

• Thing 1 – sleep will depend on how long it has been since we last slept and
• Thing 2 – circadian rhythms – our internal body clocks mean we get sleepy at certain times of the day regardless of when we last slept

We can measure sleep in different ways.  We can have people report subjectively on their sleep by, for example, keeping a sleep diary, or we can use machines like polysomnographs. In fact, studies using high tech equipment indicate that the EEG activity in different parts of the brain, front versus back or left versus right, appear to reflect different ways that the brain organises itself as a child grows.

It is thought that sleep has strong links to the way brains process information and poor sleep or not enough sleep can affect thought patters, emotion and behaviour.

Sleep problems vary, too.  People can have troubles getting to sleep (called sleep onset problems) and these can start in preschool and last well into adolescence and adulthood.  People can experience insomnia (trouble getting to seep or staying asleep), sleep-related breathing issues (sleep apnoea, tonsillitis), hypersomnolence or too much sleep (narcolepsy), circadian rhythm issues, parasomnias (sleep terrors),  and sleep related movement disorders (restless leg syndrome).

Sleep problems can originate from a number of casual factors and that is why it is important to get a proper assessment if sleep is becoming a big problem for a young person.

Sleep problems can be caused by:

• being uncomfortable or environmental issues
• pain or illness
• neurodevelopmental disabilities like autism, certain syndromes like Rett or Tourette’s syndromes and intellectual disabilities
• medications and stimulants such as caffeine
• certain mental health issues – depression, anxiety, conduct disorders, ADHD or trauma
• parent mental health, parent stress and parenting skills

Sleep issues are linked to mental health disorders in a “chicken and egg” way.  Some sleep issues are a symptom of mental illness and other sleep issues may contribute to the development of a mental health concern.  When it comes to mental health, we definitely shouldn’t ignore someone’s sleep issues and it’s important that clinicians take the time to ask people about their sleep.

Before we get into what helps, it’s important to think about what does not help. The plethora of information and opinions available to parents is overwhelming and one of the areas that people love to share opinions about is children and sleep. Remember before about the age of six months, it is very likely that a bub will wake in the night and that this is what most babies do.  Over time, they should start to condense the times that they sleep having fewer sleeps during the day and more, longer sleeps at night.

Warning –  If you are having a sleepless night with your young one, don’t go surfing the net…especially when you, yourself, are sleep deprived.  You may drown in a sea of opposing advice about how to settle an infant.  Should you co-sleep?  Should you feed in the middle of the night?  Should your young one be in bed by a certain time?

There are plenty of people who will give you an opinion.  You need to choose something that is inline with your parenting values and you need to weigh up the pros and cons of your child, their needs, your health and family functioning and your ideal values before deciding how you might proceed.  I know a lot of families choose very attachment focused parenting options sometimes and these will usually include co-sleeping and are lovely if families have the time, determination, energy, health and support to manage the impact of co-sleeping.  However, if a lack of sleep or disturbed sleep is impacting on your child’s happiness and wellness, your day to day life, or your relationships with important other people, then it’s worth getting some help and prioritising what is important to you.

The things that can help with sleep problems will vary depending on the nature of the problem, but might include:

• routines and methods to settle young ones . Generally speaking, routines help our brains to predict what is coming next and this can help to calm us.  However, the things that calm each of us can differ – a lot!  One of the earliest tasks of parenting is to work out what will soothe your baby and what upsets them.  There are differences, even with babies from the exact same parents – How you swaddle them , when you bath them, when you use more vigorous play and rocking, how much they like to be held and touched and by whom.
• avoid caffeine and stimulants (including computer or light exposure –  the light from computer screens and tablets can be quite stimulating)
• try to have a regular bedtime and make night time boring – not too much active play on the way to bed!
• try to have children use their beds just for sleeping. Bed needs to be comfy, not fancy.
• consider light and dark exposure. Make it clear that there is a day time/night time difference in the amount of light in the room where you want the child to sleep
• behavioural treatments can help with bonuses for bedtime routines, staying in your own bed all night, for tantrums around bedtime and also gradual exposure for removing an adult from the room when the child is going to sleep
• assistance with nightmares and dreams – helping kids get back to sleep after a nightmare is on of my favourite things to do.  I like to help them with a little bit of education about the brain and dreams, some grounding exercises and lots of happy imaginings.
• medication or surgery. Where it is medically indicated, some people sleep better with medication and your GP or paediatrician will be best to guide you.  If a little one’s sleep is regularly disturbed by breathing or illness issues, surgery to remove tonsils and adenoids might also help.

So, generally, if a little one is having trouble getting to sleep, there are a range of factors that could be causing the issue – medical, behavioural, environmental or familial.  The best treatment will depend on tackling the likely causes and your family doctor, paediatrician, or maternal child health nurse will be able to help you unravel the possible reasons.  A Psychologist can help with some of the behavioural aspects of getting to sleep and also any mental health concerns that might be contributing.  Overall, sleep issues are well worth investigating and treating.  A good night’s sleep can help us manage many of life’s day to day hassles and enjoy life’s day to day delights.

For more, especially on adult sleep, the National Sleep Foundation (www.sleepfoundation.org) has some excellent information.