Sleep habits broken

Beverly posted: “Our four year old daughter is having trouble sleeping. Until a few weeks ago, she usually slept very well and only occasionally needed us after she went to sleep, unassisted, at 7:30pm until she woke at 6:30 the next morning. Now she is hysterical if we leave her before she falls asleep. She wakes ups frequently throughout the night and runs screaming from her room in search of us. We put her back to bed repeatedly, but eventually we let her fall asleep with us where she sleeps quite soundly for the rest of the night. Do we continue to put her back in her room despite her crying? Do we let her get through this phase and sleep with us until she’s ready to sleep alone again? Here’s a bit of additional info: She sleeps with two lamps on. She doesn’t nap during the day. She doesn’t receive much refined sugar. She doesn’t watch any TV – and gets a moderate amount of exercise. Her only outstanding medical condition is eczema.”

My first thought is: what happened a few weeks ago when her whole night routine changed? I would guess that a four-year-old would be pretty set in her ways, and some sort of medical or social change would be needed to upset her so much. It might not be something that would seem like a big deal to an adult, but think more from her point of view. Is she no longer spending time with her friends at school? Did Grandma move away? Are there workmen in the house? Did she see a scary movie (this includes just about any Disney production)? Or an episode of the local news—which is often much scarier than anything else on TV? If there was a specific factor that disrupted her routine, you’ll probably need to address that directly.

You mentioned she has eczema—if it’s been acting up, and she’s itchy, that will definitely disrupt sleep.

If there really doesn’t seem to be anything else going on, you’ll need to gradually withdraw your snuggly support at bedtime. For now, you can stay with her hugging in the room as she falls asleep. But in a few days, rather than hold her, just sit with her in her bed. A few days later, sit in a chair by her bed, but look at her. A few days later, sit in a chair, but read a book (this shows you aren’t really paying attention to her). Gradually, every few days, move that chair further away until you’re outside in the hallway.

At the same time, set up a “Chloe is happy in her bed!!” chart. Every morning, if she had a good night (that is, no crying at bedtime and no getting up), give her a big hug and a sticker for her chart first thing when she wakes up. When she gets 5 stickers, take her out for ice cream. If she had a bad night, do NOT start reminding her of this at first. But later in the day, around dinnertime, talk about earning a sticker for tomorrow. Be positive, and give a message like, “I know it’s hard, but I think you can do a good job!”. If it’s hard for her to earn a sticker at first, loosen the rules so she can get one even if she cries once or twice. But after a few weeks, expect her to make it all the way through.

If there’s something specific that threw her off, try to fix that. If not, handle this with gentle encouragement and a gradual withdrawal of the special support, while offering positive feedback for her success. Your family can get a good night’s sleep again!

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6 Comments on “Sleep habits broken”

  1. kmm Says:

    Dr. Roy,
    What about for a 21 month old? My daughter has always been an independent sleeper. The last two weeks, though, when we put her down, she screams for us to continue to rock her. After different attempts(some up to 1 1/2 hours), we finally get her down (sometimes having to rock her). Also, she is now waking in the night screaming for us to rock her (last night she was up for 4 hours). I’ve tried rocking her, just laying her back down, communication/no communication, letting her scream, lying on the floor next to the crib, letting daddy sit with her. As soon as I put her back down or step away she either clings tightly or just screams to be rocked. We never went through an ‘attachment’ phase, but this sure feels like one. I read in your book about Lauren’s case on the delayed training. Should I follow these same steps for separation anxiety issues? Any other suggestions? Thank you!

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  2. Dr. Roy Says:

    Kmm, you’re going to have to gradually withdraw the snuggly support at bedtime. Start with as little contact as you can get away with, and slowly give less and less every few nights. The exact steps don’t matter, but overall the idea is to make bedtime gradualy less intertwined and dependent on you. When she wakes, go back to what you were doing at bedtime. It’s slow, but it does work. Good luck!

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  3. kmm Says:

    Just to clarify-are you saying that when she wakes in the middle of the night to do our bedtime routine like reading books, prayers, and lullabies? What about when I do lay her back down and she starts screaming again? Do I pick her up or just scream it out? Thanks.

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  4. Dr. Roy Says:

    Right now, being held and rocking is her “sleep association”– SA for short. That is, she’s used to being held and rocked to sleep. As soon as she starts to stir in the middle of the night, she’ll need that same SA to get back to sleep. That’s fine if her SA is a comfy blanket, but not so fine if she insists that you are in the room rocking her!

    The best SAs are independent of mom or dad. A special blanket, a white noise machine, anything that a child can get used to being present at bedtime as a cue to go to sleep is good, as long as it’s not dependent on someone else being there.

    You want to replace the current SA with one that isn’t you. One way to do this is with baby steps like these:

    1. Rock her to sleep. (This is where you are now.)
    2. Hold her, but don’t rock.
    3. Sit with her in your lap, held up to you facing you.
    4. Sit with her in your lap, but facing away from you.
    5. Sit with her in your lap, but not snuggled against you at all.
    6. Sit next to her crib, holding her through the bars.
    7. Sit next to her crib, not holding her, but looking at her.
    8. Sit next to the crib looking away.
    9. Sit next to crib reading a book
    10. Sit a little further away, reading a book.

    …etc…every step gets a little less intimate and snuggly. You can come up with as many steps as you’d like. The final step is put her down awake and leave. When she’s used to one step, move on to the next. If she wakes at night when you’re at step 3, do step 3 again to get her back to sleep, since that’s her current sleep association.

    Both kmm and Beverly, the original poster, mentioned that their kids were independent sleepers until a short time ago. They both need to think carefully about what might have changed to disrupt their children’s good habits, to see if something else needs to be addressed.

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  5. Kinley Says:

    Dr. Roy,

    About three weeks ago we moved to a new state. My 28-month-old son slept in a crib up until the move; at our new house we have his mattress on the floor and are planning to purchase a toddler or twin bed in the next few days. Since the move, he has had trouble falling asleep, and he screams unless I lie down on the floor next to him until he falls asleep. (Before the move, he had done pretty well falling asleep on his own, although he did fight it from time to time.) During the night he wakes up once or twice and cries until I come back in and lie down (or even just sit down) next to him. Do the same steps you outlined for kmm and Beverly apply here, or given the big changes in his life (which also include a new daycare), would you suggest something different?

    Thanks for your help.

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  6. Dr. Roy Says:

    Kinley,

    Go with the steps above to gradually become less involved at bedtime, stretching that out until you son can fall asleep completely on his own. Once you’ve done that, he will no longer wake at night. He has a very good reason to have a disrupted sleep routine; but even though you understand why, you should still push just a bit to get him through this for everyone’s sake!

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