Why Isn’t Your Child Sleeping?

Bedtime takes forever and then your child is up every morning at 2 a.m. unable to sleep. Many of our parents have kids with sleep issues. Fortunately, by understanding the relationship between sensory processing  and sleep, parents can work toward creating an environment that allows for a great night’s sleep.
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Sleep is integral for restoring our brain cells, nourishing our bodies, supporting brain health, and regulating sleep patterns. Poor sleep equals poor mental and physical development. According to Dr. Jamie Chaves, OTD, OTR/L, SWC of the Center for Connection (http://www.thecenterforconnection.org/jamie-chaves-bio/) the following list can indicate whether or not your child is getting enough sleep:

Does your child…

• Require longer than 30-45 minutes to settle before preparing for falling asleep?
• Take longer than 15-20 minutes to fall asleep?
• Require someone present in the room, next to the bed, or lying in bed in order to fall asleep?
• Have restlessness or frequent changing of positions?
• Get up or wake up at night on a regular basis?
• Have inconsistent sleep patterns (e.g. sleeps 6 hours one night and 10 hours the next night)?
• Get less than 8 hours of sleep for 3-5 year olds or less than 7 hours of sleep for 6-13 year olds (numbers according to the National Sleep Foundation)?

Chaves believes that poor sleep can be an indicator of sensory processing disorder (SPD).  Different subtypes of SPD impact sleep differently. Sometimes the bedtime routine leading up to bedtime is dysregulating, which consequently impacts the quality of sleep. Sometimes the child is so overstimulated from the day that settling to sleep can be challenging. Sometimes the overstimulation from the day is so exhausting to your child that they want to nap after school which disrupts his sleep at night. Sometimes the events of the day were understimulating and the body was essentially in sleep mode all day long. It’s important to note that children with unaddressed SPD have a difficult time self-regulating because they do not yet have the strategies to do so. Therefore co-regulation, adaptive strategies, and use of external sensory inputs will be necessary until they can internalize the strategies provided by an occupational therapist. Don’t be quick to brush off requests or complaints from a child as “behavioral” or a means to “escape bedtime”.
Here are some more tips from Chaves:
If your child…
​Doesn’t like the feeling of pajamas (or other specific clothes)

• He/She may be over-responsive to tactile input
• Try sleeping naked, wearing a compression shirt to bed, or wearing an oversized t-shirt to bed

Doesn’t like the feeling of sheets

• He/She may be over-responsive to tactile input
• Try lycra sheets (“Skweezrs”), using a weighted blanket (7-10% of child’s body weight)

Gets upset when bathing or showering

• He/She may be over-responsive to tactile input
• Try bathing or showering in the morning, bathing or showering before dinner, switching from a shower to a bath

Wants to sleep next to someone

• He/She may be seeking or under-responsive to proprioceptive input
• Try moving the bed to a corner, buying a body pillow

Wants stuffed animals or pillows piled on top

• He/She may be seeking or under-responsive to proprioceptive input
• Try sleeping under or on top of a bean bag, using a weighted blanket (7-10% of child’s body weight)

Changes positions throughout the night

• He/She may be seeking or under-responsive to vestibular or proprioceptive input OR over-responsive to tactile input (i.e. the movement is response to discomfort from pajamas/sheets)
• Try moving the bed to a corner, sleeping under or on top of a bean bag, using a weighted blanket (7-10% of child’s body weight), Lycra sheets (“Skweezers”)

Falls out of the bed

• He/She may be seeking or under-responsive to vestibular input
• Try moving the bed to a corner, sleeping under or on top of a bean bag, using a weighted blanket (7-10% of child’s body weight)

Must have complete silence when falling asleep

• He/She may be over-responsive to auditory input
• Try using a sound machine or white noise machine, wearing noise-cancelling headphones

Dislikes the taste of toothpaste

• He/She may be over-responsive to oral (taste/smell) input
• Try brushing without toothpaste at night, using an electric toothbrush, flavored toothpaste (not peppermint or cinnamon)

Snacks right before bedtime

• He/She may be seeking oral input
• Try only giving chewy or crunchy foods before bedtime and/or at dinner

Uses a bottle at bedtime

• He/She may be seeking oral input
• Try giving a piece of candy to suck on when reading in bed, keeping a cup of water next to the bed, using an electric toothbrush

Looks around room when falling asleep

• He/She may be seeking visual input
• Try putting in a nightlight, hanging blue or green tube lights, using a moving fishtank toy

Complains the room is too bright (even with the lights off)

• He/She may be over-responsive to visual input
• Try facing the bed away from the windows, getting heavy curtains for the windows, using a sleep mask

Here’s Chaves’s best bedtime routine:

1. Eat dinner early—about 2 ½ hours before bedtime.  This will allow for digestion.
2. Play hard for about 45 minutes before you start the quiet bedtime routine.
3. Transition to the calming routine by dimming the lights and playing classical instrumental music.
4. Brush teeth. This is usually not a favorite for most kids, so doing it first will allow for the other activities to re-regulate him/her.
5. Take a warm bath. Showers can be very stimulating because each stream can feel like a pin prick.
6.  Read 2-3 books together in bed.
7. Sing 1-2 songs.
8. Hug and kisses.
9. Lights out.

It’s important to make slow changes to the bedtime routine and to try each strategy for 1-2 weeks before giving up. Change is difficult for everyone in the family so it may be met with initial resistance. Try to get your child involved as much as possible in making decisions, such as picking the color of the sheets or deciding where the nightlight should be placed. No matter what, keep your sleep at the forefront of your conversations until you find a manageable solution!