When sleeplessness lasts for three or more months, it’s likely insomnia — and kids can have it too
According to Dr. Indra Narang, a sleep medicine physician at The Hospital for Sick Children, COVID-19 has impacted our sleep in myriad ways.
Not only are we having trouble falling and staying asleep, but many of us are also suffering from insomnia, whether due to prolonged stress, upended schedules or just general anxiety.
And kids are no exception. Narang says about 25 per cent of all children struggle with insomnia — a percentage that’s likely climbed in the past two years.
I spoke with Narang about some of the challenges kids are having with getting a good night’s sleep.
My four-year-old son cannot sleep unless I lie in the bed with him. If I resist, he’s awake for hours. How can I break this cycle?
“Sleep-onset association disorder” is when a child can’t initiate sleep without the presence of a parent. It’s typically borne out of behaviour that started from a very young age when the child needed a parent to lie next to him, or needed rocking to sleep, or needed a toy brought in, or milk. Now the child has an association to a need or habit in order to fall asleep.
Many children outgrow these associations, but if you don’t deal with them, these habits can be set for life. If a child resists falling asleep, he might get into the habit of going to bed really late, which could lead to shorter sleep durations, behavioural problems, excess fatigue and difficulty concentrating at school. These are the collateral consequences of not having a good sleep routine in childhood.
So, what can you do to help?
I can’t emphasize enough the importance of strict bedtimes and just as strict wake-up times. Even on weekends. And the whole family needs to practise good sleep hygiene, which means you need to role-model healthy sleep habits for your child, just as you likely do for physical activity or nutrition. We have recognized that family sleep patterns are foundational for children.
As part of your son’s sleep routine, you also want to reinforce the concept that bed or the bedroom is for sleeping, which means a dark and quiet environment. Try to encourage a relaxing activity before bedtime. This adherence to a relaxing routine helps take away the sleep-onset association, whatever that might be, for your child.
If your son is struggling to fall asleep without you there, think about leaving his room gradually over a few nights. You might start by saying, “I’m in the room. I’m not going to lie next to you, but I’m still here.” Then you start removing the sleep-onset association over several nights by removing yourself from his room.
My daughter’s sleep has suffered since a distressing incident a few weeks ago at school.
Anxiety over something that happened during the day can kick off a vicious cycle of poor sleep: Insomnia can set in when you become anxious that you’re going to be unable to fall asleep because you’re worried that you’re going to ruminate over what caused the stress in the first place.
I would start by helping your daughter explore some relaxation techniques before bed, whether that’s deep-breathing exercises, reading a book or listening to music. Mindfulness exercises that teach you to be in the moment and think about sleep differently have proven helpful in adults and kids alike. The goal is to help her feel free of fear or anxiety, and just feel safe, secure and relaxed.
Until my child turned 13, he was an excellent sleeper. Now he’s really struggling.
Kids this age are going through a circadian rhythm shift. Physiologically, things are changing. Melatonin — a natural hormone that promotes sleep — gets released later, which leads to more night-owl tendencies.
It’s also really important to understand the detrimental effect on kids of social media scrolling right before bed. When we talk about potential causes of insomnia among adolescents, we see stress and anxiety, certainly, but social media and prolonged blue-screen exposure before sleep are also big contributors.
In addition to encouraging relaxing activities and avoiding caffeine, I would start by setting limits on social media before bed, which could be a trigger for stress. Even if you have to resort to switching off the Wi-Fi in the house, it’s worth it.