Many parents tell us that their child with chronic pain has difficulties with sleep. Getting enough sleep and good quality sleep are important for all children but have a special importance for children coping with a chronic pain condition. Research has now shown that poor sleep makes it more difficult to cope with pain, makes children more irritable or anxious, and makes children feel more sensitive to pain. Medication is not usually a long-term solution for helping children get good quality sleep. But, the good news is that there are a number of strategies that involve making changes in sleep behaviors that can help. Here are five tips we often recommend to families:
1. Consistency in sleep schedules is key
Keeping a regular, consistent bedtime and wake time for your child helps establish times where your child’s brain and body are used to falling asleep and waking up. Having this regular pattern also reserves and protects enough time for sleep in your child’s daily routine. Typically, children may need as much as 10-11 hours of sleep, while adolescents may need 9 hours of sleep. This is often more than children think they need.
2. No weekend sleep-binging
It is tempting to let your child sleep in on the weekends, especially she is painful or when you know that she is not getting enough sleep during the week. However, when children sleep in on the weekends, this disrupts the body’s schedule that you are working to establish. It is just like flying to another time zone and getting off track. Some sleeping in on the weekend is reasonable, so we recommend a general rule of 2 hours difference. So if your daughter needs to be awake by 7:30 a.m. Monday-Friday, we recommend she sleep no later than 9:30 a.m. on weekends or non-school days. You may also help her think of things to do to wake up positively on these mornings. Some teens we’ve worked with like making a special breakfast or taking a walk during the morning.
3. Keep the bed a sleep-only zone
The bed should be a sleep-only zone and all other activities (homework, watching videos, etc.) should be done outside of the bed. This trains our brain to associate getting into bed with falling asleep. This is especially important for children with pain, who may spend extra time resting, often in bed. We recommend using a sofa or other area of the home to rest if this is to manage their pain—or better yet, using a more active pain coping strategy like relaxation or distraction.
4. Make an electronics curfew
Using electronics around bedtime may prevent children from settling to sleep for the night because the light from screens sends messages to our brains to stay alert and awake. Additionally, the activities that children do on phones are often too fun and engaging (e.g., responding to friends, watching videos) when they need to be preparing for sleep. We recommend setting a “curfew” for when all electronic activity is done for the evening, generally 30-60 minutes before bedtime. Keeping electronics outside of the bedroom overnight at a family charging station also prevents any overnight social media disruptions for your child. If your son or daughter uses a phone for a morning alarm, consider getting an alarm clock to use instead.
5. Create a wind-down plan
To help your child prepare for settling to sleep, reserve the 30 minutes before bed as a wind-down time. Encourage your child to adopt a nightly routine that includes one or two relaxing activities, like listening to soft music, reading, journaling, stretching or gentle yoga, or a deep breathing/muscle relaxation exercise. A wind-down plan can help your child transition from a busy evening of homework, chores, and electronics to a restful night of sleep.
The Take Away Message
Even though it can be distressing when your child with pain does not get enough sleep, changing a few habits is a goal that you can accomplish. Engage your child in choosing 1 or 2 habits to work on and help support him in making healthy sleep changes. However, if you feel like sleep problems are beyond what you can handle at home, you might consider talking with your child’s doctors about whether a referral to a sleep specialist may be needed.
Tell us about your child's sleep--what things have you tried to help improve your child’s sleep? What has worked well, and what hasn’t?
Guest authors of this blog post include Sarah Beals-Erickson, PhD and Maggie Bromberg, PhD, post-doctoral psychology fellows at Seattle Children's Research Institute.
