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No More Sleepless Nights

If you were like many new moms, when your newborn started sleeping through the night you might have thought, "Hooray, we did it!" But then came teething and nap changes and nighttime sleep got thrown off again. Your kid is bigger now, but there may still be bumps in the night -- some of which could require treatment. Read on for the most typical problems, along with smart solutions.

Problem: Your child comes running into your room because she's been dreaming that monsters are chasing her.

Likely diagnosis: A nightmare. Kids usually start having bad dreams at around age 3, and they're a normal result of brain development. Cognitively, two things are happening to preschoolers at this time, says Parents advisor Judith Owens, M.D., director of the pediatric sleep disorders clinic at Hasbro Children's Hospital, in Providence. Their imaginations are expanding, and they're becoming more aware of the world around them. As a result, they develop more fears because they realize that some things can hurt them.

In-the-moment fixes: Reassure her, but don't go overboard. "If you let her sleep in bed with you, that sends the message that she's not safe in her room and something scary is actually in there," explains Parents advisor Jodi Mindell, Ph.D., associate director of the Sleep Center at The Children's Hospital of Philadelphia. Instead, tuck her back into her bed with a few soothing words and tell her you'll see her in the morning.

Long-term solutions: You can help your child feel more in control of her fears by building her coping skills. Ask her to tell you about the dream in the morning, and when she gets to the bad part, encourage her to use her imagination to come up with a new, positive ending (the scary giant hears his mom calling and runs away; or it becomes nice and stays for dinner). Have your child draw a picture of the dream and then together you can crumple it up and throw it away. In addition, try making a dream-catcher craft together to hang over her bed (go to dream-catchers.org for kid-friendly instructions). Tell her that according to American Indian folklore, hanging a dream catcher near your bed stops the nightmares and catches the good dreams for keeps. If your child continues to seem really disturbed by these bad dreams, discuss the issue with your pediatrician.

Problem: Your potty-trained 4-year-old, who never has accidents during the day anymore, wet his bed -- again.

Likely diagnosis: Normal bedwetting. "Many potty-trained kids can't physiologically hold their urine for ten to 12 hours at night -- it's out of their control," says Dr. Mindell. About 15 percent of kids still wet their bed at age 5, but most kids outgrow it by age 7. For some reason, boys take longer than girls to stay dry through the night. If your child hasn't had an accident for more than six months and suddenly starts wetting his bed, see your pediatrician. It may be a sign of an underlying medical issue, such as a urinary-tract infection, and treating the primary problem will resolve the bedwetting.

In-the-moment fixes: Make it routine for your child to use the toilet before lights-out. Just say, "You don't have to go, but you do have to try." Have your child wear a pull-up diaper to bed until he wakes up dry every morning for a few months. Then nonchalantly suggest going without. But if he starts bedwetting again, keep emotions out of it, says Dr. Mindell. "You don't want him to feel like a failure because that's going to make him feel stressed." Finally, don't let him drink more than a few ounces an hour or so before bed.

Long-term solutions: Once your child reaches age 7, he may become upset or embarrassed by his bedwetting, so ask your pediatrician about prescribing an alarm device to attach to his underwear before bed, suggests Dr. Owens. The alarm sounds as soon as it detects any urine. "The goal is for the alarm to train your child to associate the sensation of needing to urinate with waking up, so that eventually he doesn't need the alarm anymore," explains Dr. Owens. Your doctor can also prescribe medication to keep your child from wetting his bed, but usually this is reserved for occasional events such as a sleepover or a camping trip. "As soon as your child stops taking the medication, he's likely to start bedwetting again, so it doesn't permanently solve the problem," says Dr. Mindell.

Problem: When you and your spouse are up late watching a movie, your child walks down the steps, mumbles something about needing to make a sandwich, and starts rummaging around in her backpack.

Likely diagnosis: Sleepwalking and sleep talking. While night terrors affect just a small percentage of kids (the same deep-sleep trigger causes all three behaviors), half of kids will sleepwalk at some point during childhood, and almost all kids talk in their sleep.

In-the-moment fixes: If your child sleepwalks, you should gently guide her back into bed, trying not to wake her up so you don't unnecessarily disorient her. If she's talking in her sleep, ignore it.

Long-term solutions: Make sure your child gets enough sleep, perhaps by gradually introducing an earlier bedtime. When you're sleep-deprived, your body compensates by increasing the percentage of time spent in deep sleep, which is exclusively when night terrors occur, says Dr. Owens. The more sleep she gets, the less time she'll spend in deep sleep.

In the meantime, you'll also want to do some childproofing (or don't undo what you did when your child was a baby) such as installing stair and doorway gates so that any nighttime wandering that does occur is safer.

Problem: Your bedroom door is closed, but you can still hear your child's loud snoring. He also seems to be gasping for air sometimes.

Likely diagnosis: Obstructive sleep apnea, a condition that causes disordered breathing, often because of enlarged tonsils or adenoids. Sleep apnea -- characterized by Darth Vader-like mouth breathing, gasping, heavy snoring, and restless, sweaty sleep -- can momentarily arouse your child 20 to 30 times a night, even though he isn't aware of it. Getting poor sleep night after night can cause a child to be out of sorts, cranky, and hyperactive -- and even mis-di-agnosed with ADHD. Another sign of sleep apnea: Your child chews slowly and prefers soft food because swallowing tougher foods, like meat, can be painful if his tonsils are big, says Marcella Bothwell, M.D., a pediatric otolaryngologist at Rady Children's Hospital, in San Diego. Finally, being overweight, which reduces the amount of space in the airway, also increases a child's risk of sleep apnea.

In-the-moment fixes: There's not much that you can do to stop this condition, so if your child has any of the symptoms, talk to your pediatrician.

Long-term solutions: Many kids need to have their tonsils and adenoids removed. Research has found that within the first year after kids with sleep apnea had gotten their tonsils out, they were happier, sleeping better, and less hyperactive than before the surgery. If your child has large tonsils or most of the symptoms of obstructive sleep apnea, your pediatrician may recommend surgery right away.

Problem: A few hours after her bedtime, you find her screaming, shaking, and moaning. Although her eyes are open, she doesn't seem to see you.

Likely diagnosis: A night terror. This phenomenon occurs in deep sleep, which is why she doesn't notice you and probably won't recall it the next day. Night terrors affect up to 5 percent of kids, typically starting between the ages of 3 and 5, and they're more common in children who sleepwalk. Both sleepwalking and sleep terrors tend to run in families.

In-the-moment fixes: You'll want to comfort your child, but you'll only make things worse by awakening and frightening her. Instead, stand by quietly during the episode -- usually about five minutes -- to keep her safe.

Long-term solutions: Because night terrors, like sleepwalking, are caused by sleep deprivation, which causes children to spend too much time in the deep-sleep stage, the fix is the same: more sleep. Work with your child to gradually stick to an earlier bedtime.

Originally published in the September 2010 issue of Parents magazine.

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