How Do you Help Kids With Sleep Anxiety?

Sleep is one of those things everyone jokes about before you become a parent. “You'd better rest up now because you’ll never sleep again once the baby arrives.”

As someone who struggled with sleep even before having a baby, I was concerned. My worries came to fruition when we welcomed the most adorable baby girl into the world, who has struggled on and off with various sleep challenges ever since. That first year, my husband, father-in-law, and I took turns holding our little one, wrapped expertly in a blanket, every night for several months.

I’d written about my own challenges back in 2013, four years before her birth. So I know something about the importance of sleep hygiene (no screens, clean bedrooms, temperatures conducive to sleep), potential physical challenges that can cause issues, and the role of anxiety in getting a good night’s rest.

And yet, here we are, eight years later, with a solid bedtime routine, blackout curtains, all the best bedtime stories lined up on multiple shelves, and a little one who announced one night that she was afraid of sleeping. Moments later, she sat bolt upright in bed, exclaiming, “I told you! I can’t do it!”

The irony is, I knew exactly how she felt, and yet, I was still failing to help. But I knew Dr. Atul Khullar would have some answers; he’s the sleep doctor who helped me go from sleepwalking and night terrors as an adult to getting eight hours of solid shut-eye most nights.

What is sleep anxiety?

“Sleep anxiety is pretty common. It manifests in different ways in all sorts of ages,” says Khullar, who is a psychiatrist who specializes in the management of sleep, mood and anxiety disorders in Edmonton, AB. Some children struggle to go to sleep, wake up multiple times throughout the night—far beyond the baby stage—and wake up far too early and refuse to sleep anymore, despite being exhausted.

While it’s developmentally appropriate for young children to have some fear of the dark or have some separation anxiety, excessive struggles can make kids fear the act of sleeping itself, making a loop of worries that seems impossible to break. The struggles spill into the daytime when exhausted kids lash out with behavioural problems, while the whole family often also loses sleep and feels increasingly frustrated and helpless too.

Most caregivers with these issues have tried it all, myself included. We keep the room neat and welcoming, at just the right temperature, with the ideal amount of light (a small night light paired with blackout curtains), and we’ve created a rock-solid bedtime routine complete with hand-picked books for every day of the week. And there’s no TV for at least two hours before bed.

If you search for information on this topic, you’ll be inundated with information: everything from bedtime stories guaranteed to work as quickly as melatonin to magnesium sprays or melatonin itself, which should only be used under the care of a doctor. And yet often none of these resolve extra early wake-ups, nightmares or other sleep disturbances. (Ask me how I know.)

You can bring a child to their bed, but you can’t make them sleep

Nowadays, there are even sleep trackers that can track sleep duration, quality and the stages. They seem potentially helpful, but their use has now been linked to people, including older children, trying to achieve “perfect” sleep, ironically causing anxiety and insomnia called orthosomnia.

“As you’re well aware, the harder you actually try to sleep, the harder it is to sleep,” says Khullar. Parents really have to look in the mirror and examine their own ideas about sleep, he says.

It would be easy to feel frustrated, having spent years focusing so much time on sleep. But objectively, I had to admit there are things I was unintentionally doing to exacerbate the situation.

I’d been trying to convince her to sleep by telling her the importance of getting enough of it, and what would happen if we didn’t: late school days, not enough energy, less time for play. By focusing on these issues, particularly right before bed, I was creating a loop of anxiety, and the opposite of what she needed.

Alison Macklin, a Toronto-based child sleep expert, Hand in Hand Parenting certified instructor, and owner of I Heart U Parent Coaching, agrees. Her experience mirrors mine in many ways; she also had a baby in 2017, and she struggled severely with a baby and then a toddler who was anxious about sleep. But since then, she’s been focused on learning as much as possible and sharing what she learns with as many parents as possible.

Overcoming sleep anxiety is a process

People often come to her and hope for a neat little list of bedtime routines, or some quick way they can get their child to sleep well before a sibling arrives in a few days, says Macklin. And that’s just not realistic, she admitted. But what she can offer is a process that eventually leads to whole families connecting on deeper levels with more confident and secure children. That’s far more valuable than any sleep aid product on any pharmaceutical shelf. It’s all about “the long game”, and it’s a process that starts long before a child puts on their pyjamas.

“Children need connection to feel safe enough to release all the big, scary feelings that they’ve been holding onto. But in our society, we’ve had a long history of avoidance of emotions. And so, we easily snap into explaining something, teaching or disciplining. We have to be a parent and help this person grow and understand things,” says Macklin. “We need to help them with their emotions.”

In other words, having a child feel safe enough to sleep involves a lot of connection on the part of the parent. Kids often feel powerless, says Macklin. It’s hard to sleep when you’re holding onto all of those feelings.

The bedtime routines that help

Before bedtime, I try being playful. My daughter acts as a yoga instructor, and I pretend that I think downward dog is a downward frog. As she contorts into a perfect pose, I hop like a frog. “Like this, right?” I ask earnestly. Her belly laugh is deep, and it loosens the mood. We then read the classic Dr. Seuss book Green Eggs and Ham, as she ponders why anyone would even consider eating green meat or eggs, especially after it’s been on a goat. But now that the book’s done, the worries start to surface—concerns about upcoming tests, little things classmates say, and questions about whether we’ll actually get a dog one day.

Shannon Kelly, a Calgary-based registered psychologist with Creative Sky Psychology, says it’s common for some children to experience rumination loops towards nighttime, when things are quiet, and there are fewer distractions. You can help by calming the body—warm baths, quiet music, reading together, along with at least an hour or two of no screentime before bed.

Journaling helps with processing hard emotions, as does guided visualization. “Let’s say you’re imagining a container, and all your worried thoughts go in this container. We get to sit with them for a few moments, and then we put them away and tell our thoughts, 'We’ll get back to you the next day.'”

I put on some calming music while my daughter writes in her journal, and then it’s time for bed. The big moment melts into unconsciousness. Things are going smoothly for now.

When to get help

All the experts say if problems persist throughout the day—whether it’s anxiety, behavioural issues or physical symptoms—it’s time to see a professional. The reasons can vary greatly, and they include: allergies, asthma, sleep apnea, restless leg syndrome, iron deficiency, and digestive issues. Sleep issues can also signal anxiety disorders or untreated ADHD, which can cause delayed melatonin production and racing thoughts.

Even if there are underlying issues, it’s still important to make sure kids feel safe and secure at bedtime, says Macklin. And when they don’t, it’s important to validate those emotions, which is often much easier said than done.

How to manage your own stress

It’s difficult when caregivers struggle with their own sleep deficits, and stressors from a long work day, week or year. Macklin recommends a 10-minute vent session each day, if possible. You could chat with a spouse or a parent, or even leave a voice message, just getting out all the things you’re worried about before interacting with your child. And practicing some of the techniques you’d like your child to use, including mindfulness and gratitude, can go a long way. “Because, if we stay focused on the problems, on the stressors, whatever it is, it's not positive. You're going to be bringing all that negativity to your child, and it’ll be easier to get upset,” says Macklin.

Experts

• Dr. Atul Khullar is a psychiatrist who specializes in the management of sleep, mood and anxiety disorders in Edmonton, AB.
• Alison Macklin is a Toronto-based child sleep expert, Hand in Hand Parenting certified instructor, and owner of I Heart U Parent Coaching.
• Shannon Kelly is a Calgary-based registered psychologist with Creative Sky Psychology.