Why won’t she stay asleep?

DM posted on the suggestions thread: “I have a 21 month old that is still waking up several times a night. She cries in her sleep, and 75% of the time, she puts herself back to sleep with no intervention. She will do this anywhere from 1 – 8 times a night. Some of these episodes last just a minute or two, but some of them are getting to be much longer. If she is teething (currently 2 yr molars are breaking through early) or sick, I intervene as briefly as I can after about 20 minutes of crying. Currently, the episodes are lasting up to an hour or hour and a half. She has a consistent night time routine, and goes to bed at the same time each night. Is it normal for her to be crying in her sleep throughout the night? Am exacerbating the issue by ever intervening? Thank you for any insight you can provide. I am getting worried (and tired!).”

The post was made at 4:30 am!

By far the most common cause of night awakenings in toddlers is that they’re falling asleep with their parents. If you rock or hold your child she falls asleep, then put her quietly down and tiptoe away, she’ll almost certainly wake up later and wonder where you went. It may not be easy, but if this is what’s going on in your home, it’s time to teach her that she can fall asleep on her own. Until you do that, you’ll continue to be up at 4:30 am! If you need help in getting a child to learn this, post a comment below and we can talk about it.

If your child is falling asleep all on her own (in her own bed, in her own room), then something else is waking her up. Some of the issues that can cause this include:

  • Sleep-disordered breathing, sometimes called “sleep apnea,” is common and runs in families. Kids who have trouble breathing easily while they’re asleep will wake up. They’ve often got big tonsils or big adenoids, or other anatomic issues that create a small or floppy airway. These kids usually snore loudly, with gaps or interruptions in the breathing.

  • Eczema is a common itchy rash of childhood. The itchy feeling drives kids crazy and often wakes them up.

  • Overly cold or warm rooms are hard to sleep in, as are noisy rooms, or rooms with TVs in them. If your child falls asleep with a TV on, once the TV is off or changes noise patterns it will wake her up. Children’s rooms should not have televisions.

You mentioned that often she’ll put herself back to sleep on her own. Is it possible to move your room, or otherwise make it so you don’t wake up when she wakes up, at least if she’s fairly quiet?

Let me know if any of these ideas help!

© 2008 Roy Benaroch, MD from http://www.PediatricInsider.com

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2 Comments on “Why won’t she stay asleep?”

  1. DM Says:

    Thank you for the quick response.

    I have never rocked her to sleep – she has always gone to bed awake, even as a baby. She has always slept in her crib, and never in our bed.

    She has been checked for excema, and does not have it. I have also listened for sleep apnea, and she does not appear to have that either. Although I will say that she does have large tonsils, and had many throat infections this winter.

    Her room only has a humidifier in it (during the winter), or a mild noise maker in the summer. No TV’s or any other noise disturbances that I can decipher.

    She does have GERD, but is treated with 15 mg of Prevacid, and we feel like that is under control, although there is not way to tell for sure without extensive testing. She is thriving developmentally and physically (she is 35 inches, 31 lbs at 21 months). I have been told that they suspect she can feel pain much more deeply because she knew pain at such a young age from the GERD. Is that a theory you have heard?

    I will turn off the monitor as long as I feel comfortable that her sleep issues are not indicative of a larger issue!


  2. Dr. Roy Says:

    A distinction is developing in pediatrics to separate “sleep apnea”– which includes genuine periods of a complete cessation of breathing– from “sleep disordered breathing,” which children have a brief period of decreased breathing, usually from obstruction, but don’t stop completely. They just become a little bit more awake, exert a little more respiratory effort, and resume normal sleep and breathing. We do know that this sort of breathing pattern can contribute to complete awakenings, at least occasionally; it might also lead to behavioral problems like irritability and poor attention. Since your child has large tonsils, you may wish to talk with your pediatrician about evaluating the size of her adenoids (this requires an xray), and/or arranging for a formal sleep study to see if her sleeping patterns are normal.

    RE: GERD, Prevacid 15 mg at bedtime is usually quite effective, but some kids do require a higher dose. This can be something else to discuss with your daughter’s doctor. You’re right– testing for GERD is a hassle, though newer kinds of pH probes that use transmitters rather than dangling wires are a little less intrusive. If her awakenings correlate on a pH probe with episodes of GERD, you’ll want to maximize therapy to help her feel comfortable and help you get some sleep!

    Best of luck!


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