Sleep in families with children
Sleep in families with children
Sleeping problems are quite common in Finnish families with small children. According to a Finnish study, up to 22–40 % of parents report sleep difficulties in children under two years of age. The most typical sleep problems burdening families are related to children waking up at night, resisting going to sleep and maintaining a regular circadian rhythm.
According to research, untreated sleep problems during childhood have a connection with sleep problems occurring in the child’s later life, as well as with problems regarding cognitive development, emotional life and behavior regulation. Disrupted sleep in the small child stage can also lead to a more permanent parental sleep disorder, which will emerge even later in stressful life stages.
What is a sleep disorder?
A sleep disorder is a symptom that differs from normal age-appropriate sleeping, which weakens the quality of sleep and reduces the functional ability. Children’s sleep disorders should always be assessed taking into consideration child’s age and developmental stage. The Finnish Institute for Health and Welfare (THL) has prepared a set of criteria to facilitate the assessment of children’s sleep quality. Check out the table here.
The major changes happen in a child’s sleep during the first two years of life. During the first year of life, short night awakenings are common, and they start to decrease during the second year of life. According to a Finnish study, a one-year-old child wakes up about 1-2 times a night, and two-year-olds wake up only 0-1 times a night. About 10 % of children wake up many times at night. Frequent waking is classified as four or more awakenings during the night at the age of 6–12 months, and 2–3 or more awakenings at the age of 1.5 years. Waking up means a signaled awakening, in which the child expresses his need for parent’s help.
At the small child stage, the amount of deep sleep increases and nighttime waking often calms down.
At the same time, the developing imagination can appear as nightmares or as difficulty staying asleep alone. The stage of mature sleep is reached around the age of five. Older children’s sleep problems start to resemble adults’ insomnia and often stem from worries and fears that burden the child’s mind. The concern can be related to close family members, interpersonal problems, performance pressure experienced in hobbies or at school, or sibling jealousy.
Treating sleep problems
Sleep is a complex entity that is affected by biological, environmental, psychological and social variables. Sleep hygiene, or sleep maintenance, means methods that improve the sleeping environment or habits related to sleeping.
Dealing with sleep problems starts with creating an overall picture and mapping possible causes. Sometimes good results are obtained by making the necessary changes to the sleeping environment, the routines or the rhythm of the day and meals. Insomnia in childhood, which includes sleep association disorder and sleep settling disorder, can be treated with the help of various behavioral interventions, or sleep schools.
There are many kinds of sleep schools, from slow and gentle to fast and firm. A suitable model is likely to be found for every family. A sleep school implemented at home and in a familiar environment usually produces the most permanent results. A sleep school implemented in a hospital environment can help in situations where the parental burnout is significant, and a quick intervention must be done to break the crisis. The effect of the hospital’s sleep school is often brief for parents, in case of not getting the additional guidance and support, that is needed to maintain new routines and operating models at home. Sleep school can be implemented from the age of 6 months onwards.
Unfortunately, there is a lot of false and negative information about sleep schools on social media, which can lead to parents holding off on making changes for too long. Parents may also feel blamed for implementing the sleep school, even if the sleep school was successful and increased the well-being of the whole family. According to research, individually, correctly and according to age chosen sleep training does not traumatize a child. A parent’s increasing lack of sleep, on the other hand, exposes them to general dissatisfaction and depression, which can weaken the interaction between the child and the parent and the quality of the maternal bond.
There isn’t one single way to sleep properly, and every family will surely find a way that works, in which individual traits and characteristics are taken into account. The ability to fall asleep independently, for the age level suitable regular rhythm and routines are a gift for a child that will bear fruit far into the future. Meritorious sleep research has been done in Finland. The multidisciplinary Child Sleep and Health study of The Finnish Institute for Health and Welfare (THL) and the resulting publications can be found here.
Sleep in a baby family
Families with babies are living through a period of intense changes, where a newborn baby develops at breakneck speed into a toddler curiously exploring the world around him. Many kinds of stages and recessions are typical for infant sleep problems. Babies need a lot of sleep, and based on research evidence, parents underestimate their need for sleep. A baby under three months can sleep 17-20 hours/day.
In the early stages, a baby can only manage to stay awake for short moments, which can barely last a feed and a diaper change. Most of the sleeping problems in the early stages are due to the fact that the baby is overtired. An overtired baby’s body has drifted into a state of stress and the baby is unable to fall asleep. Therefore, it takes even hours to put the baby to sleep, until the baby dozes off for a while. Only to wake up again moments later.
Gradually, the baby’s ability to stay awake increases and he becomes more active. The baby learns to move voluntarily, and he learns the basics of speech. All these stages of development are reflected in the baby’s sleep, and nights can become restless. It is important for the baby to practice his skills in peace both at night and during the day. That’s why you shouldn’t react automatically to baby’s every movement or noise at night or during naps, but to see if the situation could calm down on its own. By reacting too eagerly, we may even disturb the baby’s natural sleep process and wake up the baby who is in a light sleep.
Eating at night
Babies naturally feed at night. Some for a longer time and some for a shorter time. The general guideline is that a normally growing and developing baby, who is older than 6 months, does not need its nighttime meals in a nutritional sense. Paced feeding means responding to the baby’s hunger signals. When the baby is hungry, he is fed until he is full. This creates a natural eating rhythm based on hunger and fullness, which contributes to unbroken nights.
Sometimes, however, it can be difficult for parents to interpret whether a baby, who is whining and moving at night, is hungry or not. Therefore, feeding may become an automatic habit, when the parent wants to protect his own sleep and quickly put the baby back to sleep at night. The situation can lead to constant waking as the baby year progresses, because the baby is used to snacking on small portions of milk throughout the night. The situation can only be improved by pacing feedings and learning to distinguish the baby’s hunger signals from other noises and activities at night.
Sleep association disorder is the most typical reason for disturbing babies’ sleep. Sleep association refers to conditions in which the baby is used to falling asleep. In practice, it means the ways a parent uses to put a baby to sleep. Sleep associations, or sleep methods, can be divided into passive and to intensive ones. Passive sleep associations are, for example, a swaddle, a pacifier, a sleeping toy or, for example, falling asleep to a murmur background noise.
Intensive sleep associations include putting a baby to sleep with feeding, on lap or rocking on lap, bouncing on an exercise ball, or putting to sleep in a moving pram or car. All of them have in common that the parent has to wake up several times during the night, because the baby can’t fall asleep without a familiar sleeping method.
Waking up is a part of natural sleep
Natural sleep is not really completely uniform, but several micro-awakenings occur at night. In an adult, these always occur every 90 minutes, and in babies, depending on the stage of development, every 45–60 minutes. The awakening phase always follows at the end of the sleep cycle. A baby who is used to the parent’s help to put him to sleep notices, that the conditions have changed, and starts calling the parent to restore the familiar conditions.
The fact that the baby’s shorter sleep period wakes up the parent when the parent’s own sleep is at its deepest makes the baby-rhythmic waking especially difficult. When deep sleep is repeatedly interrupted, the restorative effect of sleep remains weak, and fatigue begins quickly affect the parent’s ability to function. Sometimes the parent is unable to fall asleep again but remains stressed waiting for the next wake-up call.
The ability to fall asleep independently helps the baby smoothly change from one sleep period to another without the parent having to wake up repeatedly to help the baby back to sleep. Based on research evidence, the passive sleep methods used by parents support the skill of falling asleep independently. The ability to fall asleep independently supports the child’s good sleep quality long into the future.