Sleep happens in cycles and will vary with age, current life occurrences and development. It is a normal process that is needed for growth and development. Ideally you need to go through all of the different stages to feel relaxed and refreshed.
Stage one – falling sleep, 0-10 minutes
Stage two – Disengaged from surroundings, 10-20 minutes
Stage three – Deeply asleep, 20-30 minutes
Stage four – Leaving deep sleep. If child is overtired, they may wake up at this point, 30-40 minutes
Stage five – Cycle ends. Child may either wake up or start another cycle, 40-50 minutes
What happens in stage five and why it is critical for sleep?
If a child comes into light sleep and they are not in the same place, or something is different from when they went to sleep, they will wake up fully. All children wake briefly at this point. The ones that wake parents are the ones that have needed an intervention to settle. Getting a child to go to sleep independently is key to nearly all sleep issues. With children with additional needs, all that changes is the journey to this goal and the time that it can take.
In order to work out whether your child has difficulties with sleep, first you need to calculate how much sleep they are getting over 24 hours.
Amount of sleep needed (over 24 hours)
| Toddler | 1-2 years old | 11-14 hours |
| Preschool | 3-5 years old | 10-13 hours |
Before you start any sleep improvement programme, keep a sleep diary for two weeks, showing when/where your child goes to sleep, what was needed to settle them and how long they slept for. An example of a sleep diary can be found on the Sleep Charity website.
Circadian rhythm
A person’s body clock which lasts just over 24 hours tells us when to wake and sleep. The feeling of needing to sleep is called sleep pressure.
Sleep environment
Keep the bedroom just for sleep wherever possible, with toys tided away for sleep times. The ideal temperature is 16-18 degrees Celsius.
Be aware of outside noises and use blackout curtains/blinds to support melatonin production.
Basic sleep hygiene
- Have consistent waking times each morning and bedtimes each evening to help set body clocks.
- Provide a predictable bedtime routine.
- Baths help some children with sleep, but not all.
- Ideally, don’t use screens in the build up to bedtime but if used as part of the settling routine, make sure it is passive watching (ie no games or fighting scenes). Remember that if they go to sleep with it on, they will wake up unless it is on when they come into their light sleep.
- Try to expose them as early as possible to 30 minutes of sunlight each morning.
Children that are struggling to sleep
- Focus on the environment – check for lights and noise that they may be extra sensitive to.
- Is the mattress the right height, softness/firmness? Are the bedsheets the right texture for them?
- Night lights can help some children but need to remain on all night – try using ones with an orange or red light bulb.
Proprioception
This can impact a child’s ability to know where they are in the bed. Try the following:
- Bolster cushions (within guidelines set by the Lullaby Trust).
- Put bed against a wall
- Use low level light (red or orange bulb)
- Tight sheet to tuck in or sleeping bag/pyjamas (one size too small)
- Canopy or den to help them feel contained
Vestibular
Low level mattress
If they need rocking, you can use a birthing ball to help meet sensory need prior to trying to settle.
Interoception
Ensure they have a filling late night snack.
Ensure they have been to the bathroom/toilet.
No drinks just before bed.
Teach them about body signals and awareness generally.
Be aware of how warm they are/how the temperature of room is for that child.
Sleep strategies
- Won’t sleep alone – use a ‘now and next board’, gradually withdraw – sitting slightly further away each night until you are out of the room.
- Early risers – you decide what time morning can start and anything before that is treated as night time waking – provide a basket of quiet activities the child can access if able to identify what time that they have woken up and is safe to do so.
- Middle of the night wakers – if this happens at a consistent time, go and gently half rouse them 30 minutes before and then let them settle back to sleep again.
- Wakes later in the evening who won’t go back to sleep – focus on day time sleeping and get that right to ensure that they are not overtired.
Sleepy foods
Milk, oats, turkey, almonds, cherries (the sourer the better), cheese.
Key message
Be consistent – everyone must be on board with changes in the home. Know that it can get worse before it gets better but stick with plan. Getting them to go to sleep independently on their own is key.
How/where they go to sleep needs to remain the same throughout the night.
Try a late snack to help with hunger issues.
By keeping a sleep diary, you know how much sleep your child is getting prior to starting. Review it in a couple of months even if it feels that there has been no improvement. You may find that they are getting a couple of hours more sleep than they were, so stick with the plan.
Be kind to all in the house when you are tired – persistence is key as there is no magic wand.
Further links and support
Pathological Demand Avoidance information
Sleep cards to help tackle common sleep problems
How to end screen time without a struggle
