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Disruption of sleep due to fears and anxieties (and what to do about it)

Disruption of sleep due to fears and anxieties (and what to do about it)

As toddlers and preschool-aged children grow and develop emotionally, they begin to attach meaning to their experiences. Much of this development is positive, like feeling proud when finishing a peg puzzle or feeling happy to see a familiar friend at the playground. The development of fears is a natural part of this process and it can also be a good thing. For example, when a child learns that something can cause harm, a mild fear can lead to avoidance of danger. However, sometimes children develop fears that lead to bedtime anxiety and sleep disruption. From a parenting perspective, it can be very difficult to balance the desire to provide your child with support at night and maintenance of consolidated, independent sleep.

The Science

Most toddlers experience nighttime anxiety or fear at some point during their lives. There are many different ways that fears and anxiety can manifest themselves, including fears during the night, fears experienced during the day that cause anxiety at night, and fear of separation from parents.

Fears associated with the night

One recent study found that about a fifth of children develops a fear of the dark between age two and age three. Other night fears, such as fear of “monsters,” and unfamiliar noises also fall into this category. When children experience fears associated with going to sleep, they will often have trouble going to sleep at bedtime and may try to stall to keep a parent in the room or they may ask to have additional lights on at bedtime. Fear of the dark is obviously a big problem because nighttime is associated with darkness and the introduction of light into a child’s bedroom at night can itself cause biological sleep and circadian rhythm disruption. Learn more about whether a night light would be appropriate for your child.

Transfer of fears from day to night

Although it may not seem like a scary experience that occurred during the day could affect sleep, long-term memory consolidation happens during sleep so traumatic experiences that occurred during the day can be revisited and processed at night. For example, an experience (such as having a big dog unexpectedly bark at a child) can return in dream content during the night, often leading to a highly charged night waking following a stressful dream. These wakings are usually associated with a dramatic stress response, such as a child screaming and crying immediately upon waking. Few studies have quantified the effect of daytime fears on night anxiety, but one study found that children with fears experienced more night waking of longer duration than children without fears.

Anxiety from parental absence

It may seem strange, but most young children will go through a phase where they will be anxious that their parents are not around during the night. As a parent, this may seem like an irrational concern, because you know you would never leave during the night, but to your child, it is perfectly reasonable to call out just to make sure you are still there.

Separation-anxiety-related waking in babies and toddlers (see our 9-month and 18-month regression blogs) is typically associated with dramatic and stressful waking, but in older toddlers and pre-school-aged children, this type of waking can be quite different due to their cognitive abilities. For example, a three-year-old might call a parent into his room three times a night and ask to have his blanket rearranged. Although this may be frustrating to deal with as a parent, it’s important to understand that if your child is doing this that it may be a sign of a little bit of nighttime anxiety.

How do you manage night fears and anxiety?

The solution to guiding your child out of each of these types of nighttime anxieties depends on the cause of the problem. If your child is waking during the night and you suspect that fear or anxiety may be to blame, then it’s important to first determine the cause of that anxiety. Here are some basic do’s and don’ts for solving sleep problems associated with fears and anxiety:

Do provide comfort to your child as needed

If your child has a nightmare or wakes during the night following a scary experience during the day, provide your child with comfort and support. For example, if your child woke suddenly with high-stress screams following daytime exposure to a scary Halloween decoration, then go to her and provide her comfort and support to help her feel safe and secure again. Don’t worry about creating bad habits if you know your child is distressed. If your child continues to wake after a few nights and you think her fear has dissipated, then you may begin to change your response as described in the sections below.

Do give your child transition time

Transitions are hard in general for toddlers and preschoolers, but having you turn off the light and immediately walk out of the room can amplify the stress of the transition. If your child is expressing a fear of the dark or is having difficulty separating at bedtime, then it’s a good idea to end your routine with an activity that involves you sitting in the room with your child in the dark. This could be reading a book with a flashlight, telling a free-form story in the dark, or singing a song together in the dark while cuddling before you leave the room.

Do narrate what you are doing

It’s really helpful to narrate your actions even if your child is nonverbal. For example, if you are going to leave the room, say “Mommy/Daddy is going to sit with you while I sing your lullabies, then I’m going to go back to my bed to sleep.” This helps to avoid the panic that your child may experience if you get up and leave unexpectedly.

Do develop an exit strategy

If you are sitting or lying with your child at bedtime and/or during the night, then you’ll want to develop an exit strategy to help your child understand that you are available even if you are out of sight. One way to do this is by returning to your child’s room frequently saying the same phrase. For example, “You’re safe in your cozy bed. Mommy/Daddy is checking on you.” It's most useful to return to check on your child BEFORE he or she is upset or crying for you, and fade your checks over time as s/he tolerates longer periods alone.

Using this type of strategy will teach your child that you are available, but not necessary, for sleep. It’s important to know that this process may be time-consuming. If you need help putting together a more complex, step by step, intervention, then consider booking a sleep consultation for additional help tailored to specifically to your child and his or her particular fears and regressions.

Consider introducing a night light only if other options are unhelpful

Simply introducing a nightlight doesn’t usually solve these types of problems because night lights can cause night waking and circadian disruption if they are too bright. In addition, a bright nightlight can cast shadows that can lead to more stress and fear. That said, a dim nightlight has the potential to provide comfort. If you feel that a nightlight would be helpful, purchase one that is very dim and red or amber colored and place it as far from your child as you can. Blue light has the strongest influence on the circadian rhythm (so avoid blue and green lights), while red light has a minimal effect. If you are considering a night light, then check out this article.

Don’t use leading words and phrases

It’s important not to say things like “are you scared?” or “do you want me to turn on the light?” because these phrases imply that there might be a problem with the dark. Instead, come up with a phrase that is supportive and redirecting, like “You are safe. It’s time to sleep in your cozy bed.”

Don’t sneak away or lie

It can be tempting to tell your child you will stay in her room all night and you should feel free to do this if that is your plan, but if you sneak away and then she wakes up, she will not trust you and will probably have an even harder time going to sleep in the future.

Don't belittle or deny your child's fear

Avoid saying things like, "there's nothing to be afraid of," or "big boys aren't afraid of these things." Although the fear may be irrational, the FEELING is real. It's okay to acknowledge that your child is having a hard time and to reassure them that although things feel hard right you, you will help him/her get back on track, and things will get better soon.

Don’t rely on false “solutions

When children have issues like a fear of the dark or fear of monsters, some parents will do rituals to “clear” the room. For example, some parents will use “monster spray,” look under the bed, or turn on a closet light to keep away the monsters. These are not good solutions, because they imply that there are monsters around that need to be managed. What happens if your child wakes in the night afraid that the spray wore off? It’s best to use positive redirection through phrases like “you are safe, there are no monsters/bad guys/etc.” to help your child understand that there is no reason for concern.

These tips can help get you back on track if your child is a few nights into a regression related to fears or anxiety. If you’ve been sitting in your child’s room for many nights or trying methods you've read about online that seem to have exacerbated the fears, then you may need to develop a more complex approach by speaking with one of us.

Conversely, if you suspect that your child’s sleep problem has evolved from anxiety to testing behavior, then problem-solving can be more complicated. Please consider scheduling a consultation if you need additional help in putting together a plan tailored to your child’s situation.

References/Further Reading

Braig S, Urschitz MS, Rothenbacher D, Genuneit J. Changes in children's sleep domains between 2 and 3 years of age: the Ulm SPATZ Health Study. Sleep medicine. 2017 Aug 1;36:18-22.

Wagner U, Hallschmid M, Rasch B, Born J. Brief sleep after learning keeps emotional memories alive for years. Biological psychiatry. 2006 Oct 1;60(7):788-90.

Kushnir J, Sadeh A. Sleep of preschool children with night-time fears. Sleep medicine. 2011 Oct 1;12(9):870-4.

Mian ND, Godoy L, Briggs-Gowan MJ, Carter AS. Patterns of anxiety symptoms in toddlers and preschool-age children: Evidence of early differentiation. Journal of anxiety disorders. 2012 Jan 1;26(1):102-10.

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