A reader writes:
Dear Dr. Rosen,
During my research into why one of my three-year-old twin daughters' is having sleeping issues, I came across an article of yours in Psychology Today and I am contacting you in the hope you might be able to offer us some much needed guidance.
Neither of my twin daughters has ever been fantastic sleepers since they were born. However twin #1 has started to sleep through the night for approximately the last five months.
Their evening routine consists of:
- Dinner at 5pm
- Relaxing bubble bath at 6pm
- Milk at 7pm
- Story in bed at 7.30pm
(No naps during the day)
(They both share a room/double bed, have their teddies in the bed)
However, twin #2 (Sally) is absolutely adamant she does not want sleep, no matter how tired she is. She cries and cries and screams that she is scared, so I have to sit on her bedroom floor (while she begs me to sleep with her in bed or hold her hand) until she eventually falls asleep. Then throughout the night (minimum of five times) she will wake up screaming for mummy. So I either sit on her bed until she falls asleep or shout at her to fall asleep. And then listen to her cry until she does. During this nighttime period I have tried different techniques: ignoring her, being nice to her, shouting at her, holding her hand, sitting in her room (chair or floor), sleeping with her, laying next to her until she falls back asleep, literally everything I can think of or have read up upon. The girls have a night light in their room, a teddy which projects stars onto the ceiling, and since a few months ago Sally has been adamant in leaving her room door open with the landing light on outside. I have tried explained to Sally that monsters, etc. are pretend and do not exist.
I have tired either emphasizing the importance of sleeping throughout the night to Sally and also on the other scale I have at times not to make a big deal out of it. I have tried to encourage her to sleep with rewards and treats but nothing has worked.
My twin girls are my entire world and mean absolutely everything to me. This entire situation is not fair on Sally nor myself. After nearly three and a half years of not being able to have a decent nights' sleep I am sincerely asking you for your help. I really do appreciate that you must be inundated with daily queries from parents regarding children and their sleep but I would really, really, appreciate your advice.
Sleepless in Seattle
I'm sorry to hear that you're having such a rough time. It sounds like Sally has a sleep-onset association disorder. While Sally may really enjoy holding your hand as she falls asleep in the evening, this can backfire when she repeatedly requires your physical presence to return to sleep when she awakens. All of us cycle through deep sleep, light sleep, and REM sleep many times throughout the night, often awakening briefly before falling back asleep. It seems as though Sally has ‘learned’ that your presence is necessary for her to be able to fall back asleep, and is now unable (and unwilling!) to do so on her own. Until that happens, she is likely to continue to demand direct physical contact with you to make that final transition into sleep, whether at the beginning or end of the night.
If you were OK with this, it wouldn’t be a problem. But it sounds like you’re not. So what you may need to do is to establish new sleep patterns, in which she goes to be awake and falls asleep on her own. You may need to use a gate at the bedroom door if she’s not interested in doing so; if she carries, on, returning to the doorway at 3-5 minute intervals to reassure her that she hasn’t been abandoned, but at the same time reinforcing the message that she needs to go to sleep (WITHOUT making physical contact with her) may be necessary until she internalizes the message.
One more thing: It's not clear to me how much time she is spending in bed. While she isn't napping, she probably still doesn't need more than 11-11.5 hours/24 hour day of sleep. If she is being put to bed for more than that, she is likely to put up a more sustained struggle to get what she wants (your hand in hers as she dozes off). This is something which needs to be looked at as well, and you may want to track her sleep (including car sleep and other sleep not counted as a formal nap) to get a better sense of what her true needs are. If you determine that she needs 11 hours a night, you might try and provide her with 10.5 (making sure that she doesn’t nap during the day) while making the changes to her falling-asleep patters, so that she’ll be sleepier and likely to put up less of a fight.
Dennis Rosen, M.D.
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