Avoiding Bedtime Anxiety

bed-bedroom-blanket-1359554For parents, daytime is busy and filled with activity.  As the days wind down, our environments become quieter and our bodies are more still.  Naturally, our thoughts in turn become louder and many of us mentally rehash the day and what needs to be planned for tomorrow.   Those who are anxious tend to become more anxious during these bedtime hours as internal mental feedback is suddenly more audible than external noise and distractions.

For children, this process is no different.  Children are generally active throughout their days.  The world around them is often overstimulating, particularly with the rise of screen time.   Their worlds are full of sensory stimuli and their minds are continually taking in new information.  At bedtime, when everyone has gotten into bed, children tend to become anxious when faced with their own thoughts and feelings.  Most children find comfort in parental closeness, so when sleeping on their own without the physical presence of mom or dad, their own thoughts can leave them overwhelmed and fearful of sleeping alone.

Over the years, as a child psychiatrist, I’ve had hundreds of parents ask for advice on lessening bedtime anxiety for their children.  As a parent, I’ve also dealt with this problem myself when my children were small.

Here are my suggestions, based on years of experience with my patients, the literature on the topic, and parenting my own children:

1. Find the sleep solution that works best for YOUR CHILD.  Children who don’t sleep securely often are anxious and have behavioral issues the next day.  So, start with what works best for YOUR CHILD, and then work around that to find the balance you need to ensure your own sleep comfort.   

Many parents are familiar with the olden sleep debate between the “Ferberizers” and “Sears Followers”.  Dr. Ferber, a pediatrician, led the movement of allowing babies to “cry it out” and “learn to self soothe” after placing them in their crib separate from mom and dad.  Dr. Sears, a pediatrician and father of six, led the movement of attachment parenting and co-sleeping (while he advised using infant co-sleepers rather than sleeping with your infant in bed to avoid SIDS).  The truth of the matter is, both sides of the debate have their own arguments regarding infant sleep.  For us, co-sleeping with an infant co-sleeper became what was most comfortable.   It isn’t the case for everyone, and wasn’t for many of our friends and colleagues, but for us it was just what we chose and we slept better in the process.  We actually found being closer to our boys in physical proximity allowed us to connect better, and allowed me to respond to their need for comfort when they woke in the middle of the night.  We also learned later that many fellow parents did co-sleep but often parents were shy to talk about it, as though it were frowned upon.

This great old sleep debate also continues as children enter their primary years. Those advocating for co-sleeping argue that children are less prone to anxiety when sleeping with their parents and sleep more deeply, benefiting how they function the next day.  Co-sleepers argue that children will always find their way to their own rooms as they get older and naturally seek out independence.  In fact, they even say that children who co-sleep with their parents explore their daytime world more comfortably having known the security of sleeping by their parents at night.

Others argue that children need to learn independence and self soothing, and having them sleep on their own is a healthy long term habit that should begin early.  They believe children who sleep on their own are likely to be more independent and more able to soothe themselves in other situations.

The truth is, it doesn’t matter what side of this debate you fall on.  Children all differ.  Some naturally settle in their own beds well without a lot of facilitation.  Others require the comforting routine of a parent lying down with them and finding a graceful exit strategy once they’ve fallen asleep.  Other children settle best when sleeping in the same room as parents.

What does matter is that you prioritize where your child’s comfort fits in this picture, and then consider what is acceptable practice in your family and what fits your parenting style.  Try to work toward parenting based on your child’s cues, and be flexible and open enough in your thought process to provide your child with the comfort he needs to sleep peacefully.  If your child settles better when right next to you, then open yourself up to the idea of co-sleeping.  If your child sleeps better on his own and feels well with that, then encourage it.   It’s all about what your child needs to sleep well.

2. Find a very consistent bedtime routine that is comforting and provides your child with quiet time and your undivided attention, then stick to it. 

Having worked with families with various cultural traditions around sleep, I’ve found those who have a calming nighttime routine fare best with helping their children to sleep well.

Some have a routine like bath time, an evening snack of a small sandwich and warm beverage, and reading with mom or dad.  I’ve had several physician couples from abroad over the years tell me that they’ve given their children warm milk because of the small amount of tryptophan in the milk that aids with sleep.  There is something to warm baths and warm beverages that seems to cross cultures!  Still, I’ve had other parents tell me they watch a quiet television show with their children to help them wind down and then turn off the lights while their children fall asleep to the television on mute.  Others say that after baths, children read and then drift off to sleep.

I don’t believe there is one routine that works better over the other.  Again, follow what comforts your child most.  The key is to focus on a routine that is consistent, involves time between you and your child that is relaxing, and provides comfort for all.  A lack of adherence to routine and rushing bedtime without focus on togetherness and relaxation is often what lends to a disrupted sleep schedule and heightened bedtime anxiety.

3.  Help your child process what has gone on during the day by spending 15 to 30 minutes talking about their day.  

Children and teens often tend to process much of their day right before bedtime.  Parents can lessen their child’s anxiety and overthinking at this time just by being present, asking open ended questions, and allowing their child time to vent and unload thoughts and feelings about the day.  Wrapping this time up with reassurance, prayer, and a warm hug can make all the difference for an anxious child to drift into a pleasant sleep.

4.  Turn high definition screens off including phones, video games, cartoons, and over stimulating television shows two hours before bed.   

Research shows us that children will sleep more soundly and enter deeper stages of rest when sleeping in the dark without any lights on.  In general, screens activate portions of the brain that interfere with quality sleep.  Cutting screen time off well before bedtime is an excellent habit.

While no screens at all is the preference for good sleep hygiene, many parents come to me and say they find their child is comforted by the light from a screen when the television is on and need it to fall asleep without being frightened or scared.  Again, routines should focus on what is best for each individual child, and don’t worry if what comforts your child differs from others.  Sleep is individualized for most of us and while what we deem as good habits are preferable, flexibility is sometimes needed to help children whose anxiety is heightened.  If your child feels more secure falling asleep to a muted television, simply make sure the television is on a boring channel and one that isn’t bound to harness your child’s attention.  After your child falls asleep, turn the television off so he or she is sleeping in a dark room.

5.  Read to your child before bed. 

Reading to your child allows his visual brain centers to relax.  You can read with a small nightlight, allowing your child to become more sleepy in the dark.  Reading to your child allows you to be present while simultaneously helping him to use his imagination to self soothe.  It distracts him in a healthy fashion from any worries, and allows close physical proximity for you both to bond.

6.  Provide a transitional object and use it therapeutically at bedtime.  

When a child is no longer of age where sleeping with stuffed animals is a danger for SIDS, it can be healthy and helpful to have a teddy bear or special pillow for comfort, especially for a child sleeping in his or her own room.  It can also help a child to engage in pretend.   As silly as it may sound to you, having conversations with your child’s stuffed animals can be a great way to help your child learn to self-soothe (i.e. mommy soothing the teddy bear to sleep).  Talking to your child’s stuffed animals and pretending to help them to fall asleep can help your child to do the same when you’ve left the room.  This fosters imagination, helps with self-soothing, and allows your child to help him or herself by helping “someone else” (teddy bear) do the same.   When my child was young, we would put his plush animals to sleep next to him by reading to them and singing to them.  I found that he was comforted by that routine, and I found that he’d sing to them to self-soothe at bedtime.

Children often project their own worries onto their stuffed toys.  As a parent, you can say things like, “I’m sure Teddy worries sometimes at night.  Let’s ask Teddy what he worries about.”  You will find that your child often tells you his or her own worries by telling you what “Teddy’s” are.   You can then say, “Let’s help Teddy to sleep better by letting him know that you are close by and mom and dad are, too”.   Engaging your child’s pretend world can be very healing.  It is parental play therapy for bedtime childhood worries!

7. Avoid caffeine eight hours before bed.

This advice speaks for itself.  However, many parents forget that iced tea and soft drinks also have caffeine.  Caffeine can not only cause wakefulness, but it can heighten anxiety!

8. If bedtime anxiety continues to be a problem, seek the advice of your pediatrician. 

Sometimes, there are medical causes of anxiety before sleep.  For instance, some children feel discomfort in their chest or throat, and have heightened congestion due to struggling with reflux.  Many infants have “silent GERD”, a condition where the discomfort from heartburn causes them to dislike being flat on their backs.  These babies constantly wake to nurse or drink from their bottles to soothe their throats.  Other children who snore can have sleep apnea, frequently waking throughout the night, having daytime headaches, or feeling tired in the morning.  Your pediatrician can help you figure out if an underlying medical problem may be an issue.  For some children, certain supplements or medications may be beneficial for sleep if behavioral health reasons are behind bedtime anxiety, but should be used as a last resort and only with the supervision of a physician.