How to help your kids get to sleep and stay asleep: Take 'a hard look at the bedtime routine’
Topping the list of things messed up by the pandemic, particularly for families with kids? Sleep, of course. And while we're not quite at the fraught place we found ourselves in, say, this time last year, bedtime is still a pain point, whether you're parenting toddlers or teens.
"It's definitely pretty common, and especially [was] in the beginning, when the complaints were all over the place," Dr. Craig Canapari, a pediatric sleep expert at Yale-New Haven Children’s Hospital and director of the Yale Pediatric Sleep Center, tells Yahoo Life. "I saw a lot of people having struggles around bedtime, getting younger kids to settle, having a disruption to their routine, increased nighttime awakenings. Teens had different issues… A lot had gone totally nocturnal, and it was incredibly common to see them staying up until 3 or 4 in the morning, then sleeping till noon." For kids, it's exhausting and disruptive. For parents, he adds, "that's kind of a stressor.”
Luckily, he adds, for many, "Things are now sort of moving back towards normalcy."
Still, that doesn’t mean we're there yet. If you and your family are still struggling, Canapari, along with Lynelle Schneeberg, a Yale School of Medicine psychologist specializing in behavioral sleep medicine for children and adults, have an array of explanations and solutions. Because, as Canapari points out, "Most kids with sleep problems aren't really sleep deprived — but their parents are."
The problem: Hybrid school schedules creating a lack of consistency, combined with parents not enforcing bedtime routines
"Some kids are still doing online school… which seems to be associated with a lot more disrupted sleep because of spending so much time online, not getting as much exercise, meal times being less rigid and routines more poorly structured," Canapari says. He likens it to what's known as the "structured days hypothesis" in obesity research, which has found that kids who struggle tend to gain more weight in the summertime and on vacation, "when schedules are more relaxed… many get [less] physical exertion [than] at school," not to mention more screen time. He sees a similar problem when it comes to kids losing sleep during the pandemic.
"The first thing I've noticed is that flexing schedules have made it very hard for people — school does not always start at 8:25 anymore," Schneeberg adds. “So, when do we start the bedtime routine? Do we start it to fit with not logging on until 9:30?"
The solutions: Keep it consistent, both experts say.
Schneeberg suggests the following trifecta: Try to keep your child's wakeup time no more than two hours later than it was in pre-COVID times or will be on return-to-school days (to help keep that body clock set); work out a daily family routine that's not necessarily strict to the hour, but which has blocks of time set aside for eating, schoolwork, and other activities; stick to a consistent nightly routine.
"Start by taking a hard look at the bedtime routine," Canapari echoes. "Especially early in the pandemic, everyone's routines were more relaxed, and the result was that bedtime went a bit off the rails. The process took longer, and there was more conflict. Now parents should take a look at when their child is actually falling asleep." It's hard to generalize exactly when that should be, but it's important to factor in when they get up, he says, noting that certain ages need pretty fixed amounts of sleep: "Kids [younger than] 10 need at least 10 hours, while toddlers need 11 to 12 hours. In pre-puberty you don't see a lot of variability, so you're going to want to look at sleep requirements by age." If you have to wake up your young child kid in the morning, he points out, "they're probably not getting enough sleep."
A bedtime routine "should take no longer than 30 to 40 minutes… If you're spending 90 minutes trying to get your kid to bed, it’s probably pretty stressful." Part of what may add to the drawn-out drama, he explains, is that a child of any age — as well as an adult — will get a burst of energy at the end of the day. "A lot of parents are struggling because they’re trying to put them to bed in that burst of energy… If your child is getting really riled up, you probably need to try moving bedtime either 30 minutes either before or after that."
To help with the riling up, Canapari suggests thinking of the wind-down as a "bedtime funnel," with high-energy activities like running around outside at the top, or furthest from bedtime, and then ratcheting it down from there, to a quiet storytime before lights out.
The problem: "Sleep crutches"
"This comes back to a learned association where, if mom is nearby, I can fell asleep, and if not, I have a harder time," says Schneeberg. "In the time of COVID, it’s been so anxiety-provoking that many parents have been staying a little bit closer because kids will report some of their worries around bedtime and we want this information. But the bed in the bedroom is not the best place to download this stuff."
The solutions: Set aside an earlier "worry time"
Instead, Schneeberg suggests turning to a technique called "worry time," setting aside 30 minutes or so earlier in the day, spending time going through any concerns when they won't interfere with bedtime. If new ones come up when they should be going to sleep, she says, put them in a "worry jar" to be dealt with the next day. "This gives you a place to put it… and you’re not associating the bed with worry."
She says there's been a lot more co-sleeping with kids of all ages in general during COVID. "Is that bad? Not if it doesn’t bother you," she says. "If it does bother you, and your child was an independent sleeper before COVID, then I’ve worked with a lot of parents to get that back on track." One way is for mom or dad to not be in the bed, but maybe "in the doorway, in a chair, doing their own thing…"
"We as parents have been reaching for comfort this whole time, and maybe you were cool with them coming to your bed because it gave you comfort," adds Canapari. "If they really need you to fall asleep and that's new [since the start of the pandemic], think of ways of gradually withdrawing your presence." He suggests you "leave for a minute, come back in and praise them for staying in bed, then keep increasing that interval by a minute and doing it again. Then they can build that muscle of being alone."
Schneeberg also suggests, for kids up to tweens, a "bedtime basket," filled with items they can amuse themselves with, from a book or word find to a drawing pad or electronic doodle tablet until they are sleepy. "Then, when they say they aren’t tired, say, 'Use your basket until you're sleepy,'" she says.
And in case you're wondering, no, there is no phone in the basket. Phones should be kept out of the bedroom at night and blue light should be blocked on every device (with a nighttime setting) as of post-dinnertime — then shut down completely about an hour, or at least half an hour, before bed.
The problem: Anxiety is prominent — and expressed at bedtime
"Anxiety tends to emerge in periods when there’s not a lot else going on," explains Canapari. "That’s why it's so common at bedtime." Adds Schneeberg, "[Kids are] not getting their social outlets, their physical outlets — all those things that kept your anxiety lower, many of them were either instantly gone or far fewer."
The solution: Minimize triggers during waking hours.
In addition to trying Schneeberg’s "worry jar," Canapari suggests parents be mindful of a child’s anxiety in general — and notes that when a kid suffers from it, it will usually be easy to see at times other than bedtime.
"I think that parents of anxious kids already have a feel for what generates anxiety — [and it could be parents] talking about finances, watching the news in front of them… Think, do you really need to watch CNN with your kid right there?"
The problem: Nighttime waking, in turn waking up parent
This means that your child is truly falling asleep without relying on a parent's presence and then waking up an hour or two or more later.
The solution: Look for underlying issues, strike deals ahead of time
Canapari suggests investigating whether or not there's a medical problem, such as sleep apnea or allergies. But most important is being consistent about having them fall asleep without you in the room — and not leading them back to their bed instead of occasionally letting them into yours.
"If you let them stay with you two or three nights a week, it's almost more of a reinforcing condition than letting them come in all the time," since they’ll always be holding out hope, he says. "Be really consistent about adhering to your wishes." If your child wanders in and wakes you, he says, proceed with "the silent return," leading them back to their bed without talking. Alternately, you could set up a system in which they are allowed to come into your room and get into a sleeping bag next to your bed, provided that "you don’t wake us."
But wait — what about just giving kids melatonin?
In the short-term, it's pretty safe, but it is a hormone. "A small dose of 1 to 3 mg is fine for rare bouts of insomnia, but if you’re using it more than once or twice, talk to a pediatrician… I don't recommend people medicate their way out of sleep issues," Canapari says.
A useful approach might be to use it sparingly in conjunction with a behavior plan, like "We are going to use for a week or two, but also get our bedtime routine very structured, with the idea that we will stop." Canapari adds that his worry is parents giving to their kids "in a vacuum, upping the dose… because higher doses will just have higher side effects,” — such as morning drowsiness, bedwetting, headache, dizziness or nausea — "with no benefits."
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