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Sleep and anxiety

Sleep issues are often linked to anxiety in young children. It is common for children to be very anxious or frightened to sleep alone.

Signs of sleep anxiety

Anxiety is a normal and common emotion. Children are not always aware of how and why they feel this way. Anxiety can then become an issue at bedtime and lead to frustration falling to sleep. This unease will then impact on their ability to feel safe falling to sleep in their own bed.

Anxiety can be triggered when your child hears, thinks or sees something scary. Their body then reacts and produces chemicals called adrenaline and cortisol (the ‘stress hormone’). Signs of this include:

  • heart beats faster
  • tummy feels uneasy and start to feel sick
  • feel a headache
  • legs tremble or shake
  • palms get sweaty

Common childhood anxieties

Anxieties can disrupt and get in the way of sleep. Some common anxieties your child may be experiencing include:

  • worrying about friendships
  • feeling ill
  • bullying at school
  • being in hospital or recovering from an accident
  • watching a scary movie
  • parents separating
  • the death of a loved one

Fear

All children feel scared from time to time. For some children it can be scary to go to bed alone. There are ways to feel brave and less scared when you are in a dark room alone.

The key to lowering the effect of anxiety is to be able to identify the worrying thought. This is so hard in a younger child as they are not always able to converse the thoughts and this can result in the fear being displayed in behaviours of restlessness, anger, irritability, frequent toilet stops and getting upset.

Fear triggers

It is important to face your child’s fears. A good routine will give your child reassurance, safety and security. The key is to be able to change a negative into a positive and help your child be calm and brave.

When a child has anxiety, sleep time magnifies the problems. The problem can feel more intense or overwhelming. This can lead to bedtime conversations of reassurance from parents and carers with bedtime stalls, for example “please can I have a hug?”, or “Just one more book”, or “Let me tell you this”. Then this over reassurance becomes a reward of parental presence and affirms that they cannot settle to sleep alone.

In an attempt to ease the anxiety, it actually reinforces and consolidates the sleep problem:

  1. Your child goes to bed alone
  2. Your child’s anxiety increases
  3. You stay with your child to comfort them
  4. Your child’s anxiety decreases (they feel a reward)
  5. Your child falls asleep (you both feel a reward)
  6. You get to relax (you feel a reward)
  7. Your child did not learn that sleeping alone is safe

By the end of the night your child got to sleep because you were there, and by the next night the cycle will start all over again.

Fear scale

Talking about their fears through the day and rationalising it through a scale can help your child feel brave enough to face their fears. Ask them on a scale of 1 to 10 with 1 being not very scared to 10 being very scared.

Teaching your child to face their fears helps them become more independent and do things on their own, even if they feel scary.

Facing fears

Breathing exercises

Relaxation before bed will help to empty the mind and set a restful state. Breathing exercises and positive reinforcement “I am brave” can all support a positive secure relaxed mind set. These are things that can be done to help your child become calm and brave. These include positive communication and breathing exercises:

  • Take in a big, slow breath through your nose.
  • Slowly counting to 5 while you breathe in.
  • Feel the breath fill up your belly like a balloon.
  • Slowly blow out your breath through your mouth like you are blowing out a candle.
  • Count slowly to 5 while you breathe out.

Repeat at least 10 times.

Balance their thoughts

It is important to balance your child’s thoughts and feelings. For a child to sleep, they need to feel safe. The key is to challenge and affirm that there is another explanation for their fears and worries which is more balanced and may lead to a different safer feeling.

For example, they may have her a loud noise outside at bedtime and it has made them feel scared and awake. Ask what your child thought it might be, and alien, a burglar, a monster? Help them work through the scenario:

  • What else could have made the noise? Someone taking out a wheelie bin?
  • Ask other people like siblings and grandparents and make a long list
  • Look for clues to decide what has made the noise
  • Look for another explanation for and against their original fear
  • Ask your child to rate their original fear on the fear scale. The goal is to reduce the fear

Practise

Like anything else, this is a skill they need to practise.

Set aside time each day for worry time. Together with your child, decide when this should be (this should not be before or during bedtime routine). Some children like to choose 15 minutes before tea.

Your child may choose to worry alone and use other ways to express their fears and worries.

During worry time, your child can think, write or tell you about any or all fears and worries. You can then both spend time problem solving and analysing these to create a safer rational alternative. If worries are raised at any other time especially near sleep time, give a reminder that this worry will need to wait for the next worry time.

The next time something happens, they will feel more calm and be able to rationalise it themselves. Another night, they may hear another loud noise outside at bedtime, but this time they decide it was a cat or a tree blowing in the wind. They will feel safe, and be able to get sleepy and tired again.

Rewards

It is useful to encourage your child overcome their anxieties using small rewards.

The rewards are more about doing things rather than having things such as watching a movie, painting nails with someone, going to the park, or going swimming. A final reward can be a toy or game that will motivate them.

Remember to always tie the rewards to practising steps, praise and encouragement from you.

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Disclaimer

Please note this is a generic information sheet relating to care at Sheffield Children’s. The details in this resource may not necessarily reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If you have specific questions about how this resource relates to your child, please ask your doctor.

Resource number: SLP36

Resource Type: Article

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