Schedules and Sleep Rhythm Disturbances
Schedule Disorders II: Other Common Schedule Problems
Not all sleep problems related to a child’s sleep schedule involve a shifted sleep phase. This chapter deals with three topics: schedule-related problems that occur despite a regular schedule, problems that can arise when the schedule is irregular or inconsistent, and ways to minimize problems when traveling across time zones.
Problems in Regular Schedules
Besides shifts in the sleep phase, which were discussed in the last chapter, there are a number of other ways even a basically regular schedule can give rise to problems. Since some of these problems can have more than one cause, and since a given cause can lead to more than one kind of problem, there will be some degree of overlap in the sections that follow.
The Too-Long-in-Bed Problem
Parents’ ideas of how long their children ought to sleep are often based less on biology than on misinformation or wishful thinking. Some families set a single “children’s bedtime” without taking into account that each of their children may have different sleep requirements (due to age differences or just normal variation among individuals) or that their children may not all get the same amounts of daytime sleep. Their expectations may be based on what their friends and neighbors tell them; everyone seems to have a friend or neighbor whose infant or toddler supposedly sleeps far more than their own child does. But these claims are often the result of faulty observations and assumptions. Sometimes parents think that their child sleeps more hours in a day than is, in fact, physiologically possible. The truth is that some children do stay in bed for long hours without calling or crying, but it does not follow that they are asleep the entire time: they may wake at night and look around, play quietly, or just think.
Most children past the early months of life sleep no more than eleven to thirteen hours total, including naps. They rarely sleep more than eleven hours at night; if they are napping a couple of hours during the day, they probably won’t sleep more than nine or ten hours at night. (The more they nap, the shorter their nighttime sleep is likely to be.) Most school-age children, having given up naps altogether, sleep between nine and eleven hours at night. So, when parents tell me they are having trouble getting their infant or toddler to sleep twelve hours at night (say, from 7:00 P.M. to 7:00 A.M.) along with two hours of napping, I have to tell them that fourteen hours of sleep in a day is not likely. We can adjust their child’s sleep so that he has an early bedtime or a late waking, I explain, but not both.
When you make your child stay in bed at night for more hours than he can sleep, any of several problems can appear. Like phase shifts, to which they have some similarities, these problems can exist alone or in combination with other problems.
Imagine that you have a child, of any age, who can sleep for no more than ten hours at night. If you expect (or hope) that he will get twelve hours of sleep at night, you may be in for trouble. Supposing you set his bedtime at 7:00 P.M. and expect him to sleep until 7:00 A.M., what will you see? Several scenarios can develop, depending on whether the beginning, middle, or end of the night is affected (see Figure 12). Your child might experience all three problems on the same night or at different times, sometimes having trouble going to sleep, sometimes waking too early, and sometimes lying awake in the middle of the night for long stretches. If your child is young he may even show a fourth scenario: actually sleeping all twelve hours at night but then being unable to nap during the day.
As you will see, all forms of the too-long-in-bed problem are solved by correcting the timing and distribution of sleep. Whether the nighttime problem appears as trouble falling asleep, waking too early, or an extended nighttime waking, the child generally is getting the amount of sleep he needs at night and no more. You can move that sleep around, but you cannot reasonably expect to get him to sleep longer at night, unless you can cut down on excessive daytime napping. (But only eliminate excessive napping; don’t make your child’s normal-length naps overly short in an attempt to maximize his nighttime sleep. Children are flexible about how their sleep is divided, but only up to a point.) Similarly, if your child’s only sleep problem is an inability to nap easily or well, then to get more daytime sleep you may have to shorten his night (see Chapter 12).
Trouble Falling Asleep at Bedtime
Suppose your child always takes two hours to fall asleep after his 7:00 P.M. bedtime, and after he finally falls asleep at 9:00 P.M., he sleeps through until 7:00 A.M. His sleep phase runs from 9:00 P.M. to 7:00 A.M., and that means his nighttime sleep requirement is ten hours. The period from 7:00 P.M. (when you want him to fall asleep) to 9:00 P.M. (when he actually does) falls in his forbidden zone, the one time he absolutely cannot sleep (see Chapter 9). This problem resembles a delayed sleep phase, except that the child still wakes at the desired time in the morning. What actually happens in those two hours varies from child to child (as with Adam, Mark, and Lindsey from the previous chapter, who were also being put to bed in their forbidden zone). Your child might cry quietly, demand your attention, or lie in the dark imagining things. You might only occasionally be aware that he’s awake, or you might spend those two hours rubbing his back to quiet him.
FIGURE 12. TOO LONG IN BED: POTENTIAL SLEEP PROBLEMS
If you see any such pattern in your child, treat the problem by giving him a later bedtime (at least initially). His bedtime should come at the start of his sleep phase so that he can fall asleep quickly. (In our example, bedtime would move to 9:00 P.M., and the child would still sleep until 7:00 A.M.) That should solve the schedule part of the bedtime problem, and any other associated problems can now be addressed.
You won’t need to do anything more if evenings are now pleasant, your child falls asleep quickly, and you know now that he is getting enough sleep. But if you want him to fall asleep earlier—so you can have some time to yourself in the evening, perhaps—use the same approach we discussed in the preceding chapter for fixing a delayed sleep phase: gradually move the morning waking earlier, then follow suit with the bedtime. (Remember, you must keep to the same schedule seven days a week, and don’t let longer naps during the day take up the lost morning sleep.)
Waking Too Early in the Morning
Suppose your child falls asleep easily at 7:00 P.M. as desired but wakes every morning at 5:00, ready to start the day. His sleep phase runs from 7:00 P.M. to 5:00 A.M., again indicating a ten-hour sleep requirement. It’s unfair and unrealistic to force him to stay in bed until 7:00 A.M. and hope he will go back to sleep. The problem is much like an early sleep phase, differing in that only one end of the sleep phase is earlier than desired, not both—since he usually falls asleep at a desirable hour—and the solution is the same: to eliminate the early waking, you must make bedtime later. You can do this by gradually adjusting the schedule later until your child is sleeping the particular ten hours you prefer (from 8:00 P.M. to 6:00 A.M., from 8:30 P.M. to 6:30 A.M., or from 9:00 P.M. to 7:00 A.M.).
Long Middle-of-the-Night Wakings
Seth was a two-year-old boy who woke up for two hours in the middle of the night, every night. He went to bed without difficulty at 7:00 P.M., he woke at 6:30 A.M., and he took a two-hour nap after lunch. He liked his crib and went to sleep at night and at nap time without problems. But at about one o’clock in the morning he would wake and start to cry. His parents thought that if they went to comfort him they would only reinforce bad habits and encourage the wakings, so they looked in on him only occasionally to make sure he wasn’t ill. Every night he cried off and on for one and a half to two hours before going back to sleep. Even though his parents were firm and consistent, this pattern continued for several months. Finally Seth’s parents tried bringing him into their bed when he woke up. Now he was happier, at least if he could keep one of them up to play with him. But he did not go back to sleep any faster—in fact, when he did finally get sleepy, he would ask to go back to his crib. At last, his parents started bringing him into the den when he awakened. His mother would put a video on, give him some toys, and try to doze on the sofa until he was ready to go back to sleep. He wasn’t crying now, at least, but his sleep was no better, and neither was his mother’s.
If a child takes one nap a day in addition to his nighttime sleep, his overall sleep is divided into two separate segments. On a two-nap schedule there are three segments, and so on. In young children, the number of sleep segments is fairly flexible: they can move without much difficulty from a two- to three-segment schedule or from a three- to four-segment schedule. Also, children get their deepest sleep at the start and end of the night (see Chapters 2 and 9); their sleep in the middle of the night can be quite light. (Remember, this is true of adults, too. If you wake in the middle of the night, you may notice that you feel more awake than you will when your alarm goes off a few hours later.)
We’ve already seen that when a child is put to bed for more hours than he can sleep he may have trouble falling asleep, or he may wake up too early in the morning. A third possibility is that he may find himself wide awake at some point in the middle of the night. In that case, a child is still getting his required nighttime sleep, but in two segments instead of one. This form of the too-long-in-bed problem is usually seen in children still taking naps; it is sometimes seen in older children, but it is uncommon once they reach school age. If your child follows this pattern, you should realize that he can’t be in pain, even if he is crying when he wakes at night, if whenever you pick him up he becomes happy and wants to play. If you take him into your bed, he won’t lie down and go to sleep; like Seth, he wants your attention. But he is fine if you get up and play with him, or (like Seth’s mother) put on a video for him, lie on the sofa, and let him play by himself. After a long period of wakeful activity—perhaps lasting thirty minutes to three hours—he goes back to sleep.
In my experience, when a child is consistently awake for a long time in the middle of the night and is happy if he is allowed to do what he wants during that time, the reason is almost always that he is in bed for more hours than he can sleep. It is easy to respond to this situation with the wrong approach. Strategies of setting strict limits, checking at intervals, and simply refusing to respond are all likely to fail, as they did with Seth. Those approaches all presume that the child is capable of sleep at that time. In fact, nothing you do in the middle of the night can solve this problem. The child is not able to sleep at that time of night; he is not even sleepy.
To eliminate a long nighttime waking, add up the hours of actual sleep your child gets at night and adjust his bedtime and wake-up time so they are separated by the same number of hours. For instance, if your child gets ten hours of sleep out of the twelve hours he spends in bed, that means setting his bedtime and wake-up time ten hours apart. That can be done by putting him to bed two hours later, waking him up two hours earlier, putting him to bed one hour later and waking him one hour earlier, or any other combination that may be convenient, as long the time between bedtime and wake-up time is ten hours. Initially it is better to underestimate the number of hours than to overestimate it, and if your total does turn out to be a little too low, then once he is sleeping through the night you should be able to extend nighttime sleep a little without recreating the problem. If he naps, don’t let the naps run any longer than usual: you want to move sleep from the ends of the night to the middle, not into the day. (On the other hand, if your child’s naps are too long, you would do well to shorten them to a normal length and move some of that sleep into the night as well; see Chapter 12.) Only after you have shortened his time in bed is it reasonable to eliminate the middle-of-the-night activities.
Seth, as we saw, was spending eleven and a half hours in bed at night and another two hours during the day, thirteen and a half hours in all. Since he was awake for one and a half to two hours each night, he was getting a total of eleven and a half or twelve hours of sleep—a normal amount for his age. He was waking at night because he simply couldn’t sleep thirteen and a half hours in a day. To fix the problem, we moved his bedtime two hours later, keeping his wake-up time and nap times fixed, and then (and only then) eliminated the nighttime videos. Seth’s nighttime wakings stopped completely within a few days.
Most children with this problem behave at night the way Seth did. However, some youngsters are quiet and apparently happy when they wake, so their parents—who hear them at night only occasionally—may assume that these children are asleep more than they really are. Other children wake but remain too sleepy to get up and play; they may lie in bed restlessly or even doze off and on for long stretches before fully returning to sleep. Some children even take to rocking or head banging to fill up the time (see Chapter 16). Even if your child is quiet during these long wakings, correcting the problem is still probably a good idea, assuming you even know it exists. Just because he is willing to entertain himself for long periods at night doesn’t mean he should have to, and, in any case, one day this willingness may cease and a big sleep problem may seem to develop suddenly, out of nowhere. All forms of this problem—once you are aware of its cause—can be handled in essentially the same way, by correcting the schedule.
If a young child sleeps well at night for more hours than most children his age, then unless he has an unusually long sleep requirement, he may not have enough sleep drive left to nap well in the daytime. This variation on the too-long-in-bed problem is discussed in the next chapter.
Short Sleep Requirements
Parents often tell me that their child “has never needed much sleep”: he sleeps only a few hours at night, during the day, or both, they say. This is usually a misperception. There is, of course, variation in sleep requirements, but the range is surprisingly small (see Figure 1). It’s very rare to find a normal nine-month-old who really needs only eight hours of sleep at night and one hour during the day, or a four-year-old who needs only seven or eight hours total. A child who truly has a short sleep requirement may be asked to spend more time in bed than he can sleep and, for that reason, the too-long-in-bed problems described in the previous sections could certainly develop; but, for most children, a short sleep requirement is almost never the actual explanation of these or any other sleep problems. So I usually start by assuming the child has a normal sleep requirement and normal sleep ability, and see if I can prove myself wrong.
Often, when I add up the parents’ reports of their child’s day and nighttime sleep hours, it becomes clear that the child actually gets a normal amount of sleep. Sometimes parents have an inflated idea of what “normal” sleep really is. In many other cases, the child is getting more sleep than his parents think he is. If they have to get up three times a night to get him back to sleep, they may end up very sleep-deprived and assume their child is, too. If they have to go to their child every hour, they may assume incorrectly that he never sleeps between their visits (they may not even realize that they themselves fall asleep between his calls). Finally, it’s often the case that the nights they remember most clearly are their child’s most difficult nights, when he really did not get very much sleep; nights when he slept well are easily forgotten.
When home life provides too little regular structure, with inadequate or inappropriate parental control and poor limit setting, inconsistent schedules, anxiety, or general chaos, total sleep time may truly be shortened. But it doesn’t follow that the child is truly a short sleeper and is getting all the sleep he needs. If we can help the family restore order and a sense of support and control, normal hours of sleep (and a much happier child) will usually reappear.
How much sleep is enough? Requirements vary from person to person, of course, but if a child is getting enough sleep, he functions well during the day, without signs of sleepiness. He wakes spontaneously, or at least easily, in the morning and from naps. He will not appear sleepy, except, of course, before naps and at bedtime, and he will not act overtired at other times (see Chapter 1), except perhaps at the afternoon “dip” (see Chapter 9). His behavior, attention span, and mood will not improve markedly when he happens to have slept longer than usual the previous night.
For us to say that a child’s total sleep requirement truly is short, he must sleep less than most children his age no matter what the circumstances. A child who gets a normal amount of sleep in his preferred circumstances does not have a short sleep requirement. If he falls asleep quickly when you rub his back, if he sleeps through the night when you stay with him, if he goes back to sleep when you take him into your bed after he wakes, or if he naps readily in the car, and if he gets a normal amount of sleep when you do these things, then the problem lies not in his sleep requirement but rather in his habits, associations, and fears, his ability to keep himself awake when circumstances are not to his liking, and the limits you are or are not setting for him. (For help with these problems, see Chapters 4 through 7.) Similarly, if he is obviously happier and better behaved on days when he has had more than his usual short sleep, then his sleep requirement is probably normal.
If your child really is one of the rare individuals who require unusually little sleep, and there is no underlying medical or psychological problem, do not medicate him to try to get him to sleep more than he needs to. Nor should you insist that he stay in bed longer than he can sleep. This situation can be difficult for you as parents, because your child may have to go to bed later, get up earlier, or nap less than would be convenient or restful for you. Still, if his time in bed is shortened to match his ability to sleep, most of his sleep problems (other than the short sleep) should resolve themselves, and those that persist will now be treatable.
Environmental Disturbances: Noise and People
Problems can occur when a child is wakened early by light or noise that he perceives as a sign that morning has arrived. You can block sunlight from entering the room, but street sounds are harder to control. Some children wake when they hear their parents getting up and simply will not go back to sleep. It’s not hard for these children to wake an hour or two early; by then they have completed most of their nighttime sleep, and that component of the drive to sleep (the homeostatic factor) is weaker than it was earlier in the night.
These environmental disturbances can affect a child’s sleep-wake rhythms. If your child is regularly awakened and exposed to early light, he may develop an early sleep phase. If the morning disruptions are frequent enough, he will begin to anticipate them and wake spontaneously just before dawn or just before the family gets up. This can be a challenging problem. Some parents resort to sneaking out in the morning and showering at night or when they get to work.
If you are struggling with this kind of situation, there are some steps you can take. You may be able to reduce the disturbances themselves. Use room-darkening shades and perhaps curtains to block out light; insulating curtains will also help to mute sounds from outside. You may have to shut the windows as well. Sometimes it is helpful to move the child to a quieter bedroom, perhaps switching rooms with a sibling who sleeps more soundly. Although I usually recommend against the use of gadgetry, machines that produce constant soft background noise, such as fans, humidifiers, or “white-noise” generators, can help mask occasional loud noises from outside, especially those occurring in the early morning. (Unless these machines seem to offer the only solution, though, I recommend avoiding them: children need to learn to sleep under natural conditions, and if they become dependent on the background sounds from these machines, they may have trouble sleeping in quieter surroundings.)
You can also try shifting your child to a later sleep phase, following the guidelines given in the preceding chapter. The rationale is that if you showered at an earlier point in his sleep, perhaps at three in the morning instead of at five or six, he would be too sleepy to get up. Fortunately, you can get the same effect by moving your child’s sleep schedule later instead of moving up your own morning schedule. Now the morning disturbances will fall earlier in his sleep phase, when he has had much less sleep, and he will be more likely to sleep through them.
Evening noise can be a more difficult problem than morning noise. It can be hard for a child to fall asleep when people are laughing and yelling in the next room. The house need not be silent—it’s okay to watch television at a low volume, for example—but do keep things relatively quiet long enough for your child to fall asleep. Once he is sound asleep he will soon be difficult to wake, at least for several hours. As long as his bedtime is properly set and he is ready for sleep, this need not be a major burden.
Sometimes a parent comes home just as a child is going to bed or before he has fallen asleep. The parent may want to spend some time with the child, and the child, wide awake again and excited at seeing the parent, may want to stay up later. If this parent always comes home around bedtime, the child may try to stay up every night and wait. The best solutions are for the parent to come home either early enough to spend some time with the child before his bedtime or (less ideally) late enough that the child is already sound asleep, or to shift the child’s sleep phase earlier or later to get the same result.
Usually there is less noise and activity to disrupt sleep in the middle of the night than at the ends, but they may be present. For instance, suppose a child always has to be moved late at night, perhaps when he is brought home after falling asleep elsewhere. Usually that will not cause a big problem—children either sleep through the move or return to sleep promptly afterward. But if the child regularly wakes and cannot return to sleep easily, then it may help to bring him home earlier or later, or to shift his sleep phase so that the disruption occurs in a part of his sleep cycle when his sleep is less easily disturbed.
Also, if a child is on an exceptionally late or early schedule, a parent’s arrival late at night or departure early in the morning can coincide with the child’s normal period of relatively light sleep that comes in the middle of his night. If the noise usually awakens the child then, you can use the same techniques that you would try if this happened earlier in the evening or later in the morning: trying to be as quiet as possible; considering moving your child’s sleep schedule to make him less likely to wake at these times; or, if necessary, using a fan or other source of continuous background sound to help mask the parent’s activity.
The Television (or Computer or Phone) Problem
Young children are often willing to trade sleep for cartoons. If they are free to watch television immediately upon waking, they will probably choose to get up early for cartoons over returning to sleep for their last sleep cycle. (Although they may doze in front of the television, this sleep will be of poor quality.) As mentioned in the preceding chapter, even children who are difficult to wake for school are somehow able to get up for cartoons on the weekend. It is never a good idea to go right from bed to television. Besides being a habit that can directly cause insufficient sleep, it is also one that can leave a child (and his biological clock) confused about when morning really starts, and this, in turn, can lead to irregularity and unpredictability in his sleep schedule (see next section). For these reasons, it is best not to allow your child to watch any television for the first hour or two in the morning, at least until an hour late enough to allow him to completely finish sleeping. It’s a particularly bad idea, and an unnecessary temptation, to let your child have a television in his room—if he has one, now is the time to remove it. If cartoons are no longer available to him on weekend mornings, he will probably choose to stay asleep.
Older children often have a similar problem, but at the other end of the night: they stay up late to watch television, use the computer, or talk on the phone. The late-night shows they watch and the Web sites they surf are likely to be even less appropriate for them than some of the cartoons can be for younger children. Unlike as with a book, which becomes difficult to read when you are sleepy (and which you can put down today and pick up again tomorrow), you can watch television even when you are bleary-eyed with fatigue, and most programs are designed to keep you watching to the end, with teasers encouraging you to watch the next show. Talking on the phone doesn’t even require you to keep your eyes open. If you fight off the first wave of sleepiness to see the end of a show or to keep talking, you may have a half hour or so until the next wave hits, and by then another show or another subject may have caught your interest.
Just as television should not be a child’s first activity in the morning, it should not be his last activity at night. Set a time at which the television is turned off. Make similar rules for the computer and the phone. (While your child gets used to this change, others in the house may temporarily have to give up some television as well.) Reading or listening to stories is a far better activity with which to end the day. Again, letting your child have a television in his room is particularly unwise. Even an older child should not watch television alone in his room at night: late-night programs are geared for adults and may stimulate emotions in the child he does not yet fully understand and may find upsetting, confusing, or frightening. If you don’t supervise his viewing, you may be unaware of what he is being exposed to.
Don’t make late-night television a special weekend privilege, either. If there are shows you’d like to allow your child to see that are on too late, get in the habit of recording them, and watch them (ideally together) at a more reasonable time on another day.
Some children get up to watch television in the middle of the night. This is not terribly common, but it can happen if you allow it, especially if the television is in the child’s room. Even very young children know how to turn the television on. Children who exhibit this behavior usually fall asleep watching television; when they wake during the night, they want to resume their viewing. This development becomes more likely if the child is free to make up the lost sleep by sleeping late in the morning or by napping excessively or at the wrong hours in the daytime.
Needless to say, middle-of-the-night television should not be allowed for any reason. The child should not have access to a television during the night—it should be impossible for him to watch television at night without your knowing about it. If necessary, unplug your televisions at night or keep them in rooms where you can control access. Finally, as described earlier in this chapter, enforce a proper bedtime, morning wake-up time, and daytime naps so the “hole” in the middle of the night can close up.
Irregular and Inconsistent
Many of the children I see have difficulty sleeping because their sleep-wake patterns are irregular. They fall asleep early one night and late the next, they wake at odd hours, and they never nap at the same time two days in a row. Mealtimes are equally inconsistent.
If you are not sure whether this description fits your child, chart his schedule (using Figure 5) for a week or two. You may be surprised by what you find. If his schedule is irregular, then in all probability his circadian rhythms are also disrupted (see Chapter 9). His body temperature may be rising when he goes to bed and falling when he gets up, the opposite of what should be happening. He may be hungry between meals or when he should be sleeping, and not hungry at mealtimes. He may be active when he should be napping, and sluggish when he should be playing. He may have difficulty falling asleep at bedtime—if he has a bedtime—and he may wake during the night.
It is important to realize that this problem differs (at least in part) from the bedtime difficulties and nighttime wakings described in Chapters 4 through 7. There may be stretches of time—hours, even—during which your child cannot fall asleep, or return to sleep, no matter what you do. Like a child either sent to bed in his forbidden zone or kept in bed more hours than he can sleep, he is unable to sleep because his sleep-wake rhythm is in the waking phase. However, when a child’s schedule is disorganized, these wakeful periods can appear at different times night to night. For the same reasons, periods of daytime sleepiness or crankiness can appear unpredictably from day to day.
Children’s daily rhythms can only be established and maintained in a consistent twenty-four-hour pattern if they are regulated by events that occur at the same times every day. Although regular exposure to light is the only stimulus known to directly control our biological clocks, other regularly occurring events can affect the amount and timing of exposure we get. If your child naps late in the day, he may be able to stay up later at night and be exposed to light later than usual; this extra light adjusts his clock later. If he misses a nap and falls asleep early, the opposite may occur: he gets less evening light and his clock moves earlier. If his meals are irregular, poorly timed hunger signals may leave him awake and exposed to light at an inappropriate hour.
If your child does not have reasonably consistent daily routines, his system has no way to know when he should be asleep and when he should be awake. The result is that his sleep-wake patterns deteriorate. If he sometimes goes to sleep at nine o’clock and sometimes at six, then when he goes to bed at six his body does not know whether to expect a late nap or an early bedtime, and therefore whether he should sleep one hour or ten. His sleep pattern becomes disorganized into irregular fragments, none of which even approximate the ten or more continuous hours of sleep a young child should have at night. Whereas normal nighttime sleep is interrupted only by brief arousals and the return to sleep is rapid, the child without a clear schedule may sometimes wake at night completely, for long periods, and his daytime naps may sometimes be unusually long.
James, for example, was a four-year-old boy whose sleep problems were difficult to characterize because they were so erratic. He had no formal bedtime and no regular bedtime routines. He went to sleep at any time between seven and eleven o’clock—whenever he got sleepy, which depended to some extent on if and when he had napped that day. He fell asleep sometimes in his own bed but more often wherever he happened to be, usually in the living room with the lights and television on.
When James fell asleep on the early side, he sometimes woke an hour or two later and would not go back to sleep for several hours. Other times, he would sleep for nine or ten hours and then find himself wide awake at four or five in the morning. On the days that followed these early wakings, he usually took a long nap and then stayed wide awake until eleven at night. He might still wake early the next morning, but he would be grumpy and might doze off and on during the day or even fall asleep so deeply that his parents could not wake him. When he did nap, it could be as early as 9:00 A.M., as late as 6:00P.M., or anywhere in between, and his naps could be as short as thirty minutes or as long as four hours.
James’s unstructured sleep habits mirrored a lack of structure in his home, which was not caused by family problems or any lack of caring on his parents’ part. It was a style commonplace in his family’s community: irregular mealtimes and bedtimes were quite usual and unremarkable in the family and among their friends. These irregularities did not bother James’s parents in the daytime, but they were concerned about his wakings at night. They did not see the connection.
When the family sought my help, I learned that, in addition to the absence of a consistent schedule, James had no customary routines to guide him in getting ready for bed and falling asleep. It was clear that his parents needed to establish a bedtime ritual that was pleasant and consistent. But better bedtime routines alone, even if they came at the same time each night, would not solve James’s sleep problems. He also needed more order in his haphazard daily schedule.
The fundamental problem was that, without any regular cues to guide it, James’s twenty-four-hour sleep-wake pattern had become badly disrupted. Although this problem sounds severe, the solution was actually simple and straightforward.
Correcting an Irregular Schedule
Setting up and sticking to a regular schedule is a necessary step toward solving this kind of sleep problem, whether the irregular schedule is the main problem, as it was with James, or just one factor complicating other problems. If the irregular schedule is the only problem, that may be all you need to do.
For the first few weeks, keep your child on a fairly strict timetable for going to sleep, getting up, and eating. Once things are going well, you can try being more flexible, within reason. But remember, if your child’s schedule has been unstructured in the past, it can revert easily if you are not careful.
If you are not sure how long your child can sleep at night, start with the smallest amount you are sure he can achieve. It is much better to err on the lower end than the higher, because that will make it easier for him to sleep at the times you set, making it in turn easier for you to enforce the new schedule. If your child is at an age when he should still be napping, add suitable naps to the schedule as well (see Chapters 2 and 12). If you are not sure whether he needs a nap, try eliminating it; if you are not sure whether he needs one nap or two, try starting with just one. When his sleep settles into a regular pattern, it will become clear whether he needs more sleep; if so, you can gradually lengthen his time in bed at night, add new naps, or lengthen existing naps.
James’s parents agreed to set up a daily schedule for him that included a regular bedtime and wake-up time. There was to be no daytime sleep, as he was too old for regular naps. They instituted a bedtime routine that they felt would suit them. In addition, they agreed to provide his meals at the same times every day, whether he was hungry or not, and not to feed him at other times, except for appropriate snacks. Although these decisions were out of keeping with the relatively unstructured way of life they were accustomed to, they willingly accepted the changes once they understood that James would sleep better at night and probably feel better during the day.
Since James was usually asleep by 9:00 P.M. on days when he did not nap, we decided to start his bedtime there (we could certainly have started later if we weren’t sure about that time). He would go to bed every night at nine after a story or a quiet game; if he was still asleep at six in the morning, his parents would wake him for the day, dress him, and give him breakfast. He was not to sleep during the daytime at all—if he did fall asleep, his parents were to wake him as soon as possible, within ten or fifteen minutes at most. James probably needed a total of more than nine hours’ sleep, but I wanted to start with a sleep schedule I knew he could achieve. Once he was sleeping well on this schedule, then we could begin moving his bedtime earlier or his wake-up time later, in adjustments of fifteen minutes, as long as he was falling asleep quickly at night and had to be wakened in the morning.
His parents also began making sure that he always slept in his own room, not in the living room. When he wakened during the night they would go to him, but they wouldn’t allow him to get up and play, since that would only reinforce the habit of waking. They were to insist that he stay in bed at bedtime and after wakings during the night, even though at first he had trouble falling asleep at some of these times. They could sit with him, but quietly, without much conversation.
Once James’s sleep rhythm had normalized and he could consistently fall asleep quickly, which I told his parents to expect within a week or two, they were no longer to stay with him when he woke. (However, I asked that they delay this step until it became clear that, except for brief wakings, he was in fact able to sleep the full time his schedule called for.) We planned to enforce this rule with the methods discussed in the chapters on associations and limit setting (Chapters 4 and 5), but these measures proved unnecessary: James was never especially demanding even when he was awake, and he had never really associated his parents’ presence with falling asleep, anyway.
The family was able to follow through because they now understood the importance of a good daytime structure. Because they found it helpful to chart his sleep patterns, they continued to do so for two months, well beyond the few weeks I had asked for. Like most parents, they found it easier to stay consistent when they could see their child’s progress in black and white. James resisted the changes for the first week, but his parents held firm and were careful to be supportive. Soon both he and his parents began to look forward to the period before bed; it became an opportunity for a closeness they had not enjoyed before. By the end of the second week James was falling asleep easily at a regular bedtime and sleeping through the night. It soon became apparent that he could sleep longer than nine hours, so his parents gradually shifted him to a schedule that ran from 8:30 P.M. to 6:30 A.M.
Disrupted schedules usually happen because parents have not understood the importance of consistent daily routines. Occasionally, though, the disorganization and loss of structure stems from underlying family problems. When issues such as marital strife, physical or psychiatric illness, death, separation, and divorce are involved, parents may be unable or unwilling to enforce a normal schedule for their children. In these situations, I always urge the family to seek counseling.
Parents often wonder what to expect and what to do when traveling with children to different time zones. Understanding the effect such travel has on your child’s sleep pattern and learning to plan for it should help avoid worry and limit problems.
Neither children nor adults can adjust instantly from one time zone to another. However, children find the transition easier to make than adults do: the homeostatic drive to sleep (which makes you get sleepier the longer you stay awake) is very powerful in children, especially young children, and it can even overcome the stimulating effects of the circadian drive (which helps you wake in the morning, keeps you awake all day, and gives you a “second wind” in the early evening). If your child is not permitted to sleep when he expects to, he will be better able than you will be to make up the lost sleep at times when he would normally be awake.
Suppose you travel west by three time zones. Your child will want to go to sleep and wake three hours “earlier” than usual according to the new local time. If you keep him up until the local clock says it is his usual bedtime, then instead of waking three hours earlier than usual (local time) the next morning, he will sleep until closer to when the local clock says it is his usual wake-up time. Conversely, if you travel east, your child will go to sleep and want to wake “later” than usual, but if you wake him in the morning three hours earlier than he would like, when the local clock says he should be waking, then that night he will be able to fall asleep much earlier than the night before. In both cases, if the changes don’t happen the first day, they certainly will by the second or third. (As always, it’s important to limit daytime napping to the usual amount, so sleep lost at one end of the night will be moved to the other end.)
When traveling across time zones with children, most people make the necessary changes without even thinking about them because of expectations driven by activities, meals, and other obligations.
If you are traveling west (one to three time zones):
· Try to keep your child awake until the “correct” bedtime in the new time zone. If the change is too large to accomplish on the first night, do it gradually over two or three days.
· Be aware that you may have to get up early with your child for a day or two (if he usually wakes at 7:00 A.M. in New York, he may wake at 4:00 A.M. on the first day in California). It’s not fair to leave him crying for three hours in the morning just because he hasn’t fully adjusted to the new time zone. In any case, you will probably wake up early yourself for the same reason.
· Allow only the usual amount of napping. Initially your child will want to nap too “early” in the day. Try to delay his naps as much as you are delaying his bedtime.
· Consider moving bedtime and nap time somewhat later than usual beginning a few days before you travel. That will reduce the adjustment you have to make once you arrive, and it may prevent the very early wakings.
· If the trip is short, you could choose to let your child continue to operate according to his home time zone, especially if you’re only traveling one or two time zones or if your child usually goes to sleep and wakes up late. Thus, if he sleeps from 10:00 P.M. to 8:00 A.M. in New York, he would sleep from 8:00 P.M. to 6:00 A.M. while in Denver. Naps should be adjusted similarly. When you return to New York, he can go right back to the usual schedule without any readjustment.
If you are traveling east (one to three time zones):
· Your child may not be able to fall asleep until “later” than usual for the first day or two, and there is no point in making him try; you do not want him lying in bed wide awake and frustrated on his first night in a new place. If he usually goes to sleep at 8:00 P.M. in California, he may not be able to fall asleep until 11:00 P.M. in New York. (In fact, it would be counterproductive to let him fall asleep at eight o’clock on the first night in New York because, since that’s only five o’clock in California, he could treat that sleep as only a late nap and then be awake much of the night.)
· Wake your child at the “correct” wake-up time in the new time zone. If the change seems too large to accomplish the first morning, do it gradually over two or three days.
· Allow only the usual amount of napping. Naps, like bedtime, may initially tend to run late by the amount of the time change. Try to move the naps earlier, to match the earlier wake-up times.
· If the trip is short, you could choose to let your child continue to operate according to his home time zone. Thus, if he sleeps from 8:00 P.M. to 6:00 A.M. in California, he would sleep from 11:00 P.M. to 9:00 A.M. while in New York. Naps should be adjusted similarly. When you return to California, he can go right back to the usual schedule without any readjustment.
If you are traveling across more than three or four time zones (for instance, between the United States and Europe or Asia):
· Children handle these larger changes more easily than their parents do. Although the details can be confusing, most parents find that their children adapt quickly on their own. There is no need to make elaborate plans.
· You cannot force your child to sleep when he is not sleepy, but you can keep him awake when he should be awake in the new time zone. He will self-correct quickly, making up the lost sleep at proper times for the new time zone. If you wake him when he is sleeping at the “wrong” times, he will want to sleep at the “right” times. The rest will take care of itself. If that is all you remember, you will be successful.
· Simply be aware that if you travel east, your child may fall asleep much later than usual at first and have to be wakened in the morning; traveling west, he may want to fall asleep earlier than usual and you may have to keep him awake. In either case, the times he wants to sleep or stay awake may seem erratic for a day or two; he could be up much of the first night and want to sleep much of the first day. These problems should all resolve themselves within a few days.
· The changes are particularly easy to make for a young child who still naps: he already sleeps both in the daytime and at night, getting his sleep in several widely separated time segments. Instead of having to shift his sleeping schedule by six to twelve hours, he may only need to adjust by a few hours, if that. If you limit his sleep in the daytime, he will quickly increase the sleep he gets at night. If the original nap periods now fall at night, they can lengthen, and perhaps combine, to become the new nighttime sleep, and if the original nighttime sleep period now falls in the day, that sleep can shorten and perhaps split to become the new nap or naps.
· If your child is too old for regular naps, he (like you) will have to shift his schedule the full amount; still, as long as you do not let him sleep during the day (or at least limit it as much as possible), his inability to get enough sleep the first night (or two) will be enough to force his sleep into the next night and, when this happens, to put him on a correct local schedule.