Go to Sleep!

By Sara Dimerman

If you were to take a poll of the number of Canadian parents who were awake late last night, you might be surprised. They weren't up past their bedtime because of an interesting movie on TV or because of a leisurely dinner with friends, but because of a child, or children, who would not settle. Alison Wilson, a Toronto mother to two young children, aged 4 and 2, battled until after 10pm to get her children to sleep. No sooner was her daughter tucked in and kissed goodnight, her son called out that he was frightened - of spiders, of the dark, of monsters under the bed, anything to keep Alison from going downstairs. Eventually, her husband crawled into bed with her daughter and her son into bed with her until they all fell asleep. At 2am, a drained daddy carried his son back into bed and slumped in beside his wife.

The Wilsons, like so many other families, have consulted books for answers on how to solve their children's sleeping (or lack thereof) problems. Their common complaint is that the solution is only temporary. Dr. Richard Ferber, one of the gurus of sleep related concerns and author of How to Solve your child's sleep problems, was a big hit in their home for a while. The family followed his advice religiously. This meant that once the children were in bed, but still awake and calling out, Alison made sure that they knew that she was still around to keep them safe and entered their room at prescribed intervals to reassure them. Gradually, after several nights and much patience, the children seemed to be falling into better sleep habits. Then her son got sick and Alison took pity on him. That night he was back in their bed and although she saw it as an exception to the rule, he thought that the rules had changed forever. Too tired to repeat the exercise, the Wilsons turned to another book for help. Dr. William Sears, an ardent advocate of the "family bed", encourages parents to sleep alongside their children. Many cultures encourage and follow this belief. With this as their new bible, the Wilsons were happily able to adopt this belief without any remorse.

Dr. Jack Muskat, a clinical psychologist in Thornhill, Ontario and consultant at the Sleep Disorders Centre of Metro Toronto, works with parents to better understand their child's sleep difficulties within a broader context of their overall psychological well-being and developmental needs.

Dr. Muskat not only helps parents deal with and overcome bedtime resistance, but also helps with concerns such as insomnia, sleepwalking, night terrors, oversleeping and excessive daytime sleepiness. During the assessment phase, Dr. Muskat thoroughly evaluates the nature, severity and duration of the sleep problem. This includes a detailed sleep history, relevant medical reports, school and social history. The treatment phase, based on the assessment findings, offers the parents a specific range of behavioural strategies and counselling on their use and application.

Dr. Muskat says that before any intervention on his part, all possible medical causes must be ruled out. In the majority of cases, where sleep disturbances are seen in otherwise healthy children, adjusting parenting skills, child management techniques or the environment can rectify sleep disturbances. Examples of environmental changes include adjusting the temperature in the child's room, considering whether his pyjamas may be too warm or cool, changing the intensity of light in the room and considering the noise level around the bedroom area.

Many parents consult Dr. Muskat when their children are between three and five years of age. They assume, correctly, that their children should have mastered falling asleep on their own and sleep for a reasonable amount of hours. This is also a time when many children experience night terrors and other fears. Dr. Muskat has consulted with parents of children as young as eight months who are often beside themselves after sleepless nights with a colicky, crying baby. A smaller group of parents of children between the age of 10 and 12 consult Dr. Muskat about their children's erratic sleep schedules and wanting to sleep in late on school mornings.

As part of the assessment, Dr. Muskat sees the child on his own. He wants to make sure the sleep difficulties are not related to temperament or developmental concerns. Some children who are having trouble sleeping are at risk for allergies or have chronic ear infections, he says. In fact, the problem is often caused by many factors. After a very thorough assessment to rule out any environmental problems, Dr. Muskat may refer the child for further evaluation by way of an overnight stay at the Sleep Disorders Centre of Metro Toronto to monitor specific sleep patterns and possible organic problems.

For those parents whose children are not experiencing sleep problems as a result of emotional or organic concerns, developmental delays or temperament, he offers this advise:

Try to be consistent about sticking to a scheduled bedtime. Don't allow a child into bed with you one night and not the next and so on. This can be very confusing. Be reasonable about dinnertime. Eating too late may mean that your child is too full to fall asleep. Too early and your child may be hungry Spend adequate time winding down before bedtime.

Dr. Muskat says that sometimes children express fears at night in order to keep parents close by. He suggests staying close, but not in the same room. When the problem is behavioural, he suggests not coming right away when your child calls, especially if he is out of bed. Instead he encourages parents to reward positive behaviour as in "when you're back in bed, I will come to you." Sometimes children will express sleep problems in response to a problem in the marriage. A parent may welcome a child into her bed to avoid being close to her spouse, for example.

In order to better manage a child, a parent has to get some rest. If your child is experiencing a sleep disturbance it may be wise to consult with a professional to determine the cause.

(c) Sara Dimerman B.A.A., Dip.C.S., all rights reserved