In response to my recent posting on teaching an older child how to fall asleep on her own, a reader wrote:
Recently, our 6 year old has started to have a very difficult time falling asleep. He actively tries not to, complaining that sleep is boring and that he doesn't know how to go to sleep. Advice?
If you, your son, and I were sitting down together, I would start by collecting more information so that I could get a better sense of what the problem was, and try to understand whether he resists going to bed because he feels he has better things to do than sleep (but once in bed he is able to fall asleep quickly), or because he is just not able to fall asleep, and finds himself lying awake in bed long after the lights have been turned out. I would then review his schedule to find out how much sleep time he is being given over the course of a 24 hour day (as a general rule, a 6 year old needs between 9 ½ -10 ½ hours sleep/day). If he regularly wakes up at 7 AM, and is put to bed at 7:30 PM, it would be very surprising if he was able to fall asleep promptly, because he simply shouldn't be sleepy enough. If it turned out that he was being given a 90 minute nap in his afterschool program, or catching a couple 20 minute catnaps in the car while being driven from place to place, this too would impact how sleepy he would be at the designated bedtime. And as we all know, lying in bed in a dark room just staring at the ceiling gets very boring very quickly.
I would also want to understand whether his schedule during the week was different from his schedule on weekends. If he is staying up later on Fridays and Saturdays and then allowed to sleep in until 9-10 AM on Saturday and Sunday mornings, the whole issue of circadian phase delay (which I have discussed in previous posts) becomes a factor, meaning that the child's internal body clock becomes disconnected from that of the environment, similar to what occurs when one travels across time zones. This causes problems in waking up at the desired time in the morning, and also makes it very difficult to fall asleep in the evening. With the internal clock 2-3 hours delayed, the child finds himself in that part of the internal body clock's cycle known as "the forbidden zone", during which it is almost impossible to fall asleep, unless one is significantly sleep deprived.
It would be important to understand what else the child was complaining about. Is it only boredom, or is there something else going on? Is he jealous of his older brother, who gets to stay up and watch American Idol? Are his parents spending less time with him, because of a new job or new sibling, and is this just his way of asking for more time with them? Is there a component of underlying anxiety driving his resistance to going to bed? Are there distractions in his bedroom that are making it difficult to unwind and fall asleep?
To try and make bedtime less of a struggle, the first interventions I usually recommend is to put the child on a regular schedule, and to make sure that he is not being expected to sleep longer than he actually needs or is capable of. I also recommend making the bedroom as conducive to sleep as possible, by removing any hindrances to sleep from it (such as bright light, TV, pets, video games). Once the schedule has been adjusted, and it seems as though there is more of a behavioral issue, that can be addressed in a way consistent with the family's culture and what the parents feel to be most appropriate. One approach might be to devote more focused time to the child in the evening, if that is what he is seeking. Another might be insisting that the child go to bed at the designated bedtime (after all, parents need quiet time alone, too!), though if not sleepy, to be allowed to read quietly to himself with a low wattage reading light until he is ready to fall asleep.
Dennis Rosen, M.D.
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