Posted by Dr Sophie Bostock - Sleep Expert on 18th Dec 2023
Kids’ Sleep: How to Ease Sleep Anxiety and Other Common Sleep Challenges for Children
Is your child reluctant to fall asleep alone?
Do they keep finding excuses to get out of bed?
Anxiety about sleep is probably the most common sleep challenge for young children, and is something most children will experience at some point. In this article I’ll explain why anxiety or stress can be a common thread linking many sleep disorders. I’ll also share guidance for parents to help ease anxiety and help their children fall asleep by themselves.
What is Sleep Anxiety?
Sleep anxiety, or night time anxiety, is fear or worry about going to sleep. Younger children may not be able to describe this feeling, but you may notice delaying tactics or resistance to bedtime instructions. Signs of anxiety about sleep may include:
- Anger, irritability or crying at bedtime
- Active defiance or resistance to getting ready for bed
- Withdrawal, and/or ignoring you and your instructions
- Expressing lots of fears or worries when in bed
- Fear of the dark, or of monsters
- Not letting you leave the room before they fall asleep
- Reappearing numerous times for water / snacks / a cuddle etc. after they have gone to bed
- Difficulty falling asleep, or waking up and being unable to fall back to sleep alone
Anxiety causes activation of our stress response, the biological ‘fight or flight’ reaction which evolved to protect us from danger. If we learn to see sleep as a source of danger, being told that it’s bedtime could trigger an increase in heart rate, make us hot and sweaty, and make us feel tense and ‘hyper’. Fears about sleep can therefore put us in the opposite state to readiness for sleep. If we don’t help to ease children’s sleep anxiety, they will find it harder to sleep, and will be more likely to wake up during the night.
What causes Sleep Anxiety?
Sleep anxiety can be part of a wider pattern of anxious thinking, though it may only be apparent at bedtime, when there are fewer distractions than during the day. Children with autism or ADHD for example, often experience worries, and may have more difficulty easing their mind at night than other children. Sleep anxiety might also develop in response to an illness or sleep problem, for example, after being sick or having had nightmares.
Children are more likely to become anxious when they are over-tired, which can lead to a negative cycle of anxiety, poor sleep, and even greater anxiety the following day.
Sleep anxiety can also occur in response to a new stressor or source of uncertainty during the day which has nothing to do with sleep: a new school or teacher, bereavement, or a change in friendship groups. Other common sources of worry include:
- Concern about parental separation or arguments at home
- Worry about exams or workload at school, especially for conscientious children
- Watching scary movies or video games
Children may not be able to label the source of anxiety or discomfort. They may not know what it is, or be able to explain it. They might simply say that they are scared of noises, the dark or monsters, or that they feel butterflies in their tummy. A change in sleep might be the first warning sign that your child has something on their mind.
How can other sleep disorders be linked to anxiety?
If you, or your child, falls asleep when they are still in a ‘fight or flight’ state, the brain can respond by resisting deep sleep, and staying in a lighter stage of sleep, where it’s easy to be woken up. This increases the risk of becoming sleep deprived.
When we’re in a state of stress or sleep deprivation we’re more likely to experience parasomnias; sleep disorders which involve faulty switching between sleep stages, or between sleep and wake. For example, anxiety can increase the risks of:
- Night terrors, which happen in the first part of the night, and can involve intense fear or screaming while asleep, or waking suddenly from sleep feeling afraid. The child will not be able to remember their dreams and may feel very confused.
- Nightmares, which typically happen in the second part of the night, and involve scary dreams or fears which your child remembers on waking, and may lead to a fear of going back to sleep.
- Sleep walking and sleep talking, which are periods of partial wakefulness from deep sleep. The rational, conscious part of the mind is still asleep, but your child will be able to repeat automatic actions like walking. Your child will typically not remember waking.
- Bruxism, or teeth grinding, which is often picked up by a dentist. Headaches or a sore jaw might also be signs of teeth grinding.
All of the above sleep disorders can also be a natural part of growth and development, and it’s absolutely possible that anxiety is not playing a role. However, if you do notice any of these things, it might be helpful to work through the ideas below.
How can you help to ease sleep anxiety?
The overarching principle for easing anxiety is to try and help your child to feel heard and understood, safe, and loved. This might feel very difficult if your child is defiantly resisting bedtime, or disrupting sleep for their siblings, but it’s a helpful goal to remember!
1. Protect enough time for your child to sleep
Anxiety increases when we are short of sleep. On average children aged 3 to 5 years need 10-13 hours of sleep, while 6 to 12 year olds are recommended to get 9-12 hours per night. (Read more about how much sleep children need here.) If you’re not sure whether your child is getting enough sleep, you could try starting the bedtime routine 15-30 minutes earlier for a week or two, to see if this makes any difference.
2. A calming and consistent bedtime routine
Our brains are soothed by familiarity and predictability. Our internal sleep-wake rhythms are also strongest when we have a consistent bedtime, and wake time. When you repeat the same bedtime routine at the same time every night, your child will automatically start to feel more sleepy as the routine progresses. Of course, some variation is inevitable - don’t worry if travel or illness occasionally disrupt the routine - just aim to be consistent as often as possible.
The routine should include a calming activity in the bedroom with the lights dimmed. This should be something that your child enjoys, such as quiet play in their bedroom, reading a story in bed, or listening to calming music with a gentle massage. You could discuss the importance of a bedtime routine with your child and make a plan together. Avoid using screens/tablets as part of the routine, since these will activate your child’s brain.
To encourage your child to fall asleep feeling positive, try sharing ‘3 good things’ about each day before you switch out the light. This is a great way to encourage gratitude, to connect with each other, and to focus on the positive rather than worries.
The bedtime routine will ideally finish with a loving goodnight from you when your child is sleepy, followed by lights out and your child falling asleep on their own. (If this is tricky, see #5!) While a dark room is ideal for sleep, it’s more important to ease fears of the dark, and you may find you need to keep a dim night light on, or the door open and a light on outside the room.
3. Listen to fears, acknowledge their reality and provide reassurance
When your child wakes up during the night, and cries out, or comes into your room because they are afraid, encourage them to share what happened, and how they are feeling. For young children especially, nightmares can seem very real, and they will value your empathy, compassion and reassurance. You may need to remind them repeatedly that it was only a dream. Try to avoid making them feel silly or embarrassed since this could add to feelings of stress. It might be helpful to share times when you have been scared, and how you managed it.
Try to set expectations if they join you in your bed.. “Let’s have a cuddle here for a few minutes and then I’m going to take you back to your bed so that you can get some rest.” Both you and your child will usually sleep best in your own beds. You might need to reassure them that there is nothing scary in the room, and that they are perfectly safe. A ‘transitional object’ such as a favourite blanket, cuddly toy, or an item of your clothing can often provide comfort for them when you go back to your bed.
4. Address worries during the day with worry time
If you recognise sleep anxiety in your child, you’ll want to try and understand what is worrying them. Many children find it easiest to talk about their worries with a parent at bedtime, when there are fewer distractions. It’s important to encourage your child to talk about their feelings whenever they want to, but it could also be that focusing on stresses before bed could make them more top of mind. If this happens regularly, you could try introducing a daily ‘worry time’, such as before their evening meal.
Worry time is a set time every day where you and your child write down, share out loud or draw any worries you can think of. This might be fears about bed, or anything else. The goal is to get anxious thoughts out in the open where you can acknowledge them, discuss them, perhaps challenge them, or come up with rational alternatives. If worries come up at night, you can make a note to think about them the next day during worry time, so that you can let them go to allow sleep to come.
5. Gradually support your child to fall asleep on their own
If your child is reliant on you to be in their bedroom for them to be able to fall asleep, this can make it hard for them to fall back to sleep during the night, leading to sleep disruption for the whole family. It could also become a problem as they get older and want to have a sleepover with friends.
If you have been helping them to fall asleep for a long time, it’s a good idea to have a discussion about when this could change. Try to reach a joint decision that you will work towards helping them fall asleep by themselves. It’s important that they don’t feel rushed - you can do this in stages.
For example..
- First of all, after you have given them a last hug or kiss before lights out, sit in a chair by their bed while they fall asleep. They can see you, and feel your presence, but you are not actually touching them.
- After a few nights, move your chair a little further away. Again, you are still in the room, but they are alone in their bed. If they ask you to lie next to them, be positive and encouraging that they are doing really well on their own.. “Don’t worry - you can do this.”
- When they feel comfortable, start to take a few short breaks from their room as they fall asleep. For example, tell them you need to put the washing on, or make a quick phone call, and then you will be back. Always come back when you say that you will.
- If this is going well, try moving your chair outside the room. Tell them you will be just outside if they need you. Reassure them they can do this, and if they do insist on your coming back into the room, try to keep the interactions short and simple - you love them, but it’s time for sleep.. You will discuss whatever it is in the morning! If they come and find you, similarly, escort them back to bed, kindly but firmly.
You will eventually find that they stop asking you or expecting you to be outside the room. This might take a few weeks, or a bit longer, but they will eventually gain confidence that they can fall asleep by themselves.
