If your child has struggled with sleep since babyhood, you may feel like you’ve tried everything. You’ve helped your child deal for so long with all the challenges that go along with poor sleep: irritability, trouble focusing, and behavior issues. But if you’ve been trying to improve your child’s sleep with piecemeal techniques, maybe it’s time for a full overhaul of your family’s approach to sleep. There’s a whole spectrum of issues that can be affecting sleep, and with a systematic and thorough approach, you can help your child sleep better.
In this ultimate guide, you’ll learn everything you can do to work on your family’s sleep - one step and one night at a time.
Schedule for Sleep
You know that a consistent bedtime is essential, but when exactly should your child go to bed? And how do you make that happen?
If your child is struggling with sleep, the best way to plan your schedule is to start with the morning and work backward. You know what time your child needs to get up for school, so start with that. Calculate how many hours of sleep he needs, based on his age, and subtract those hours to identify the ideal time when he should fall asleep.
However, sleep time isn’t the same thing as bedtime. Bedtime is the time when your child goes to bed, but sleep time is the time when he actually falls asleep - no more tossing and turning, and no more bathroom breaks. Your goal should be for your child to fall asleep within 15-20 minutes of bedtime, so subtract 15 minutes from his sleep time to figure out what time you want him to lie down with the lights out. Finally, subtract the time for his bedtime routine, which should be about 15-30 minutes, and you’ve arrived at the time when he should start getting ready for bed.
For example: say your child is 7 years old, which means he needs between 9-12 hours of sleep, but your child's ideal sleep window is 11 hours. His school starts at 8 am and it takes 45 minutes to get ready and 15 minutes to get to school, so he needs to wake up at 7 am. To get 11 hours of sleep, he needs to fall asleep at 8 pm. Subtract 15 minutes for falling asleep and 15 minutes for bedtime routine, and he needs to start getting ready to for bed at 7:30 pm.
That’s the time when your child will start thinking about bed - but you will be thinking about bed all day. Continue working backward: your child should be involved in quiet, relaxing activities starting an hour before bedtime (6:30 in this example), so that tells you what time to cut off running around outside and jumping on the furniture. It’s a good idea to finish dinner about an hour before bedtime too, so count back for how long it takes your child to eat, and you know what time you want to serve dinner (5:30 will give him an hour to eat).
Now you’re prepared for the evening, but your bedtime routine really starts in the morning - first thing when your child wakes up. By waking him at a regular time every morning and not letting him sleep in, you’re helping his body set his clock. First thing in the morning, go outside for a few minutes to expose him to direct sunlight, which is the best way to set circadian rhythms. Just a few minutes of sunlight first thing in the morning will actually help him be sleepier when bedtime rolls around.
Next, make sure he gets exercise outside during the day. The time of exercise doesn’t seem to matter much - one study found that moderate aerobic exercise had a positive effect on insomnia, no matter whether the participants exercised in the early morning or afternoon. Late evening exercise is a bad idea, though, since it will raise your child’s body temperature, which will delay the production of melatonin (the hormone that makes you feel sleepy).
And finally, be consistent - religiously so. Once your child’s sleep has stabilized and he isn’t sleep-deprived, it’s best to stick to the schedule exactly - every day.
Shape Your Environment
Schedule is just one piece of the puzzle; you can also adjust your home for better sleep. Start with lighting: lights are the biggest factor that set your child’s circadian rhythms, so bright lights at night will counteract all the hard work you’re doing of keeping him on a schedule. If you can, turn off or dim all the lights in your house about an hour before it’s time to start his bedtime routine, and use natural light. This will tell his brain it’s time to start producing melatonin in the most natural way possible - by the falling of darkness as the sun sets. If it’s too dark in your house to use only natural light in the evenings, then turn off half the lights, and get blue light filters for the others. (All light tells your brain it’s time to be awake, but blue light is the brightest, so it has the most pronounced effect.) And, of course, cut off screen time early in the day! - ideally in the early afternoon, before the sun starts to set.
Next, turn down the thermostat. The two main environmental triggers for sleep in the natural environment are darkness and cold, and just a couple of degrees can make a difference as your family is relaxing after dinner. Another way to mimic this effect is by having your child take a bath - the warm water will relax him, but when he gets out, his core body temperature will drop, telling his brain it’s evening and time to go to sleep. You can also just sit outside on the porch after dinner if you have space: enjoy a rocking chair or a hammock and all the natural triggers for sleep, right in your own backyard.
Include all the senses in your environment for sleep. Music can help improve sleep quality and help your child relax before bed. Choose classical music or something with a slower beat, and start playing it in the early evening (it can be a nice background for dinner!). White noise can help your child fall asleep and stay in deep sleep longer, with fewer arousals, so add that to his sleep environment, too. You can also get a variety of noise “colors,” which are just background noise at different frequencies, some of which may be even better for sleep.
Smells can help with sleep too. One that’s easy to use is lavender, which can also help your child relax and as well as extend the time he spends in deep sleep. You can use lavender essential oil in a diffuser in your child’s room, add a few drops to his bath or even put a drop on his pillow.
Finally, evaluate your child’s room for allergens. Allergic reactions can disturb sleep by interfering with breathing and causing snoring, especially when your child is lying down. Start with washing all his bedding and using allergen-proof covers for his mattress, pillows, and bedding to reduce common triggers like dust mites. Keep pets out of the bedroom, and test regularly for mold.
You’ve set your child up for great sleep with a solid schedule and a soothing environment - but just like a horse you lead to water, your child is still the one who has to fall asleep. And while an exhausted child will sleep eventually, behavior can keep him up long past your well-planned bedtime. How do you handle when you’ve set your child up for success, but he’s still staying awake late into the night?
First and most importantly, stick with the schedule. This applies not only to your bedtime routine but - just as importantly - to your early morning. If he’s up late because of his behavior, and you still wake him up the next day, he’ll be tired and irritable. But over time, consistency will win out. If you let him sleep in, you’ll need to restart from scratch, so stick with the morning no matter what.
Second, try to identify and address the causes of your child’s behavior. This could take some detective work, especially if the causes are physical rather than behavioral. Even if he’s getting up and looking for you simply because he’s afraid, it might be hard for him to articulate what he’s feeling and why he’s acting the way he is. Instead of lecturing him, talk with him about the importance of sleep, and ask him what he needs to be able to lie down and relax. It might be that something as simple as a nightlight, a water bottle and a nightly “check for monsters” is all he needs to be able to settle down and relax. He might also be getting up because he wants more time with you, in which case spending some focused, intentional one-on-one time with him during the day could make a big difference when bedtime arrives.
Finally, consider that even though his refusal to sleep seems purely behavioral, it could have a physical cause. Talk with your pediatrician about whether a sleep evaluation is a good idea.
Evaluate for Sleep Disorders
If your child is always tired and none of the routine and environmental strategies are helping, it’s time to look at physical causes for sleep disruption. The most common of these are parasomnias, which include nightmares, night terrors, sleepwalking, sleep talking and confusional arousals. If your child wakes up at 11 and calls for you, but he doesn’t seem to see you when you come in his room, you’re not alone - around 50% of children experience some type of parasomnia during childhood. Most of these happen during sleep transitions, and your child will have no memory of them in the morning. The exception is nightmares, which happen during REM sleep, and which your child may remember for years.
Because parasomnias are so common, and because most children outgrow them in a few months or years, they usually don’t require treatment. Generally, the best thing to do is reassure your child during the episode, and safety-proof your home if sleepwalking is an issue (lock doors and windows at night, and put gates on stairs). However, if the episodes continue for months or years, or if they’re frequent enough to cause continual overtiredness that affects your child’s waking hours, talk with your pediatrician. A good bedtime routine can also reduce the frequency of parasomnia, so keeping a schedule is even more important if your child struggles with these.
Sleep apnea is another possible cause of your child’s exhaustion. This affects up to 5% of children, and it’s usually associated with snoring. However, snoring can also be caused by a stuffy nose, so if your child’s snoring is intermittent, you probably don’t need to worry. Even if your child snores every night, that doesn’t mean he has sleep apnea - nearly a third of children are habitual snorers. Evaluating sleep apnea can be difficult, especially in children, so the best way to diagnose is with a sleep study or a sleep report.
Restless leg syndrome is another physical reason why your child could be still awake late, affecting around 2% of children. If your child complains about his legs hurting or growing pains, RLS could be the cause - especially if someone else in your family has been diagnosed with it. RLS can be caused by an iron deficiency, so talk with your pediatrician about testing your child’s iron levels. Simple solutions that may help include stretching and exercise.
Finally, children’s sleep, just like adults’, can be affected by stress, anxiety and depression. Anxiety disorders are not uncommon, affecting around 17% of children, and your child’s sleep could be the first clue that something bigger is bothering him. Symptoms of anxiety disorders are similar to symptoms of poor sleep, and anxiety and stress are more likely to affect your child as he gets older, and his school and social life both get more challenging and complex. If, in addition to struggling to fall asleep, your child expresses a lot of worries during daylight hours, talk with your pediatrician about whether stress could be disturbing his sleep.