My daughter Madi, who is now 2 years old, sleeps 11 hours solid through the night. However, as an infant, she could not sleep more than 3 hours in a row. I often asked myself, "Why won't my baby sleep!” Madi's interrupted night time sleeping made me review the medical literature to find some of the common causes that can impair a child's ability to sleep.
I found that many physicians separate these types of sleep problems into 3 main categories:
1. Behavioral insomnia of childhood
2. Psychological (conditioned) insomnia
3. Transient sleep disturbances.
Before focusing just on these issues, there can be a number of other sleep-related problems that are not based in developed behaviors. For example, if your child snores or has pauses in breathing with sleep, this should be discussed with your doctor, because it may be a sign of a different condition known as sleep disordered breathing. We are planning to talk more about this topic at a later date, but would like to focus on behavioral sleep problems in this article.
It also might help first to determine what your child’s sleep needs are, and see if there are any changes you can make to your night time routine to help your child fall asleep more easily.
Behavioral Insomnia of the Child
Behavioral insomnia can happen in young children age 0 to 5 years and can also continue until the child is older. If your child has a behavioral type of insomnia, you may be asking yourself: “Why won't my child sleep?” Your child might be refusing to go to sleep, take a long time to fall asleep, or start waking up during the night. Behavioral insomnia is thought to be caused by unhealthy habits during the evenings that are coinciding with when sleep should start. Parents may also have difficulties setting limits or effectively disciplining their child when it comes to sleep, which may contribute to behavioral insomnia.
I struggled with forming healthy bedtime habits, as well as limit setting, in the evenings with Madi. From the time Madi was born until 11 months old, I breastfed her to fall asleep. Madi would wake up in the middle of the night and I would breastfeed and cuddle her until she fell asleep again. She often resisted trying to fall asleep again, so I would pick her up to play with her. Altogether, these are examples of how my unhealthy night time habits and difficulty with setting limits may have reinforced Madi waking up throughout the night and not getting a full night’s rest. When this type of behavior becomes ingrained and effects your or your child’s quality of life during the day time, it can be called a type of insomnia. This type of insomnia most commonly develops from a caregiver’s having difficulty setting consistent bedtime rules and enforcing a regular bedtime.
During the night, children experience a brief arousal (waking up from sleep) that occurs at the end of each 60- to 90-minute sleep cycle. This is normal. They may also awaken throughout the night for other reasons and not able to get back to sleep (often due to difficulty “self-soothing”) unless they get what they received in the past to help fall asleep. In Madi’s case, this was breastfeeding. We hit a wall where she would not fall back asleep in the night unless I got up and breastfed her.
Self-soothing is a behavior your child learns to help them fall asleep on their own without the need for their parent or caregiver to rock, cuddle, breastfeed, or sing them back to sleep. Children learn through reinforcement that when they cry in the middle of the night, that Mommy or Daddy will come and cuddle them back to sleep. It is not their fault, or your fault, and it happens often in many families! But over time, these routines can become challenging for parents, because your children will wake you up in the middle of the night and prevent you from getting a good night's rest.
The good news is your baby can learn to self-soothe at night!
Psychological (Conditioned) Insomnia
Psychological insomnia may also be the cause of your child not sleeping. It most often happens in older children and teenagers, where there is anxiety about falling asleep or staying asleep. Psychological insomnia may be related to genetics, medical problems, acute stress, or mental health problems.
My own personal example of psychological insomnia would be when I am on call at the hospital. On busy call nights, my pager would go off every 15 to 30 minutes with medical consults or patient issues on the wards. But even when it was quiet, I couldn’t seem to fall asleep! I was too worried about my pager going off that I could not relax. This was a good example of conditioned insomnia.
Transient Sleep Disturbances
Transient sleep disturbances occur when a child, who used to sleep normally, starts waking up through the night. This condition can be caused by stress or disruption of their normal sleep schedule, such as traveling.
If your child persistently has trouble falling asleep and maintaining sleep, they should see their primary care provider to ensure that there are no medical issues causing the child to have difficulty sleeping.
Madi often experiences transient sleep disturbances after traveling from Atlanta to Edmonton where there is a time change. See how to handle time change when traveling with a toddler.