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How to Have Happier Bedtimes and Better Sleep

Like most parents, my husband and I have struggled, bleary-eyed, through our share of sleep problems, from bedtime battles to bad dreams. But it wasn't until several months ago that we realized our two children's sleeping patterns had gone seriously awry. Not a night went by without my 6-year-old son slipping into our bed in the middle of the night or my 4-year-old daughter relocating to the sleeping bag that was permanently parked on our bedroom floor. Clearly, it was high time that they -- and we -- were sleeping through the night.

We have since followed the advice in this article and are all enjoying more peaceful nights. But there are plenty of other parents who are still suffering from the bedtime blues. A survey of studies revealed that 25 to 30 percent of all children experience some kind of sleep difficulty. And if you think your kids will eventually outgrow their sleep problems, think again. One survey found that 27 percent of elementary-school-age children resist bedtime, while another 11 percent have trouble falling asleep and difficulty waking in the morning. It should come as no surprise, then, that a recent survey by the National Sleep Foundation found that 60 percent of children ages 1 to 18 complain of being tired during the day. Chances are, their parents are as sleep-deprived as they are.

A good night's sleep is crucial for children's healthy growth and immune function. And sleep affects behavior -- exhausted kids are more likely to be cranky and impatient and to do poorly in school.

Though there are sometimes biological explanations for disrupted sleep, "the vast majority of sleep problems are caused by parents unintentionally not allowing children to get the sleep they need," asserts Marc Weissbluth, M.D., author of Healthy Sleep Habits, Happy Child (Ballantine, 1999) and an associate professor of pediatrics at Northwestern University Medical School. "There are too many activities -- both parents' and child's -- that interfere with an early bedtime." Other experts point out that many children, having been rocked or nursed to sleep (or allowed to fall asleep in their parents' beds) since birth, have simply never learned to fall asleep on their own. The good news is that you can help your child learn how to get a solid night's sleep. And most experts agree that the earlier you start, the easier it is to establish healthy sleep habits in your children.

Newborns slip between the waking and sleeping states with little regard for day or night, typically feeding every two to four hours. Not until about 6 to 8 weeks does a more regular cycle begin to emerge, in which the baby sleeps more at night and stays awake more during the day. Making sure that your infant is exposed to sunlight during the day and kept in a darkened room at night establishes this pattern.

By 3 or 4 months, babies' sleep cycles begin to vaguely resemble those of adults, passing through cycles of active sleep (REM, or rapid eye movement) and deep sleep. Both stages are critical to development. "We know that the human growth hormone is released during deep sleep, so children require this stage of sleep to grow," notes Paul Saskin, clinical director of the Regional Center for Sleep Disorders at Sunrise Hospital, in Las Vegas. "And it is thought that REM is needed for learning and memory. Like a computer backing up its hard drive, the brain is organizing its filing system."

Newborns sleep about 16 to 17 hours a day. By 4 months, total sleep decreases to about 15 hours, the longest sleep period (which, with luck, occurs at night) stretches from about four to nine hours, and midmorning and midafternoon naps develop. At this point, parents can start reinforcing their child's biological rhythms by anticipating their baby's natural sleepiness, soothing him and putting him down to sleep before he gets overtired, says Dr. Weissbluth. "Helping your child fall asleep is like surfing: You want to catch the wave of drowsiness as it's rising, before your baby crashes into an overtired state," he explains. A good rule of thumb is to put your baby down to sleep every two hours.

As their baby approaches 6 months of age, "parents often ask, 'Why is my child still waking up three and four times a night?' " says Mark D. Widome, M.D., a professor of pediatrics at Pennsylvania State University College of Medicine, in Hershey. "Instead, they should be asking, 'Why does my child need my help to get back to sleep when he wakes up?'"

Indeed, researchers at McGill University, in Montreal, videotaped a group of infants and found that all woke up an average of four times a night. Many, however, did not call out but managed to soothe themselves back to sleep (the so-called good sleepers). Those described as problem sleepers tended to cry out and make their awakenings known.

"By 5 or 6 months, if a healthy child is waking up at night for feedings, it's a learned behavior," says Dr. Widome. "Don't be so quick to take her out of bed and feed her. If you do, you're not giving her ample opportunity to try to get back to sleep herself." Keep in mind, too, that the more often you put your baby to bed when she's still awake, the more practice she'll get soothing herself to sleep.

Some parents are surprised to find that around 8 or 9 months, their baby, who had been sleeping through the night, suddenly begins to wake in the middle of the night and cry for them. "They're at that developmental stage when they are starting to understand object permanence," explains Claire Lerner, a child-development specialist at Zero To Three, a nonprofit organization devoted to promoting healthy development in the first three years of life. "They are beginning to understand that you exist out there even though they can't see you, so, naturally, they call for you."

Whether your child has regressed or has never quite mastered the skill of going to sleep solo, teaching him to fall asleep on his own takes a great deal of resolve. Some experts, echoing the advice of child-care expert Dr. Benjamin Spock, recommend putting your baby to bed and letting him cry it out. Within a couple of nights, the crying should dissipate, and healthy sleep habits should prevail.

Parents who consider this method too harsh often turn to "Ferberizing" -- the more gradual method described by Richard Ferber, M.D., director of the Center for Pediatric Sleep Disorders at Children's Hospital, in Boston, in his best-selling book Solve Your Child's Sleep Problems (Fireside, 1985). If a baby cries when put in his crib, parents are advised to give their child a reassuring pat and leave the room. If the crying continues, they wait five minutes and return to calm the child -- but they are not to pick him up. Parents wait for increasingly longer intervals between reassuring visits until the child finally falls asleep. Ideally, the whole process should take as little as three days.

"It's horrible to hear your child scream," concedes Lerner. "Parents have to know how much they can tolerate. Don't start any kind of sleep training until you are committed to following through -- if you let your baby cry one night and then go to him the next, it may worsen the problem."

Some parents balk at the idea of letting their child cry at all, worrying that by not responding to their baby's cries, they will lose her trust. "You have to balance the building of trust with teaching certain skills. Children do need to learn to fall asleep on their own," points out Jodi Mindell, Ph.D., author of Sleeping Through the Night: How Infants, Toddlers, and Their Parents Can Get a Good Night's Sleep (HarperCollins, 1997) and an associate professor of psychology at St. Joseph's University, in Philadelphia. "Trust is not going to be affected by two or three evenings of your child being upset while learning how to fall asleep. It will be balanced out by the other hours in the day in which you respond to your child and her cries."

By 18 months, most babies have given up their morning nap; at 3, some will be ready to give up their afternoon nap as well. At this stage, there is so much excitement in a toddler's life that she can't wind down at night, even when she's exhausted. If you find that your toddler has a cranky period toward the end of the day, it may be a sign that she needs to go to sleep earlier. "Well-rested children don't behave like that," notes Dr. Weissbluth.

Children often wind up in your bed at this age as a result of two major developmental milestones: Instead of just crying, they can now actually call out "Mommy" or "Daddy," which is a lot harder to ignore; and the move into a big-kid bed means they don't even need to call -- they can just show up at your bedside. Anat Schecter's older son, Jake, made it into a game. "We'd put him in, he'd run out, we'd put him in, he'd run out," says his mom. "This could go on for as long as an hour. So I ended up sitting outside the bedroom door. Whenever Jake left the room, I would walk him back to bed. This went on for several weeks until he realized that we weren't going to give in."

Nightmares and night terrors, which usually strike preschoolers, are common causes of night disturbance and resistance to bedtime at this age. "Nightmares are scary to kids, but night terrors are scarier to parents," says Dr. Widome. Children do not even remember having had night terrors, which are a partial arousal from deep sleep usually occurring within the first couple of hours after your child goes to sleep. She might sit up and scream, but she is not awake and not conscious that you're there. Night terrors tend to occur when your child is overtired, according to Dr. Widome. If she experiences them repeatedly, taking a very short nap in the late afternoon can reduce her fatigue.

Nightmares, on the other hand, tend to be concentrated in the second half of the night during REM sleep. Bad dreams are young children's way of playing out unresolved feelings or experiences, says Claire Lerner. Since they cannot yet distinguish between fantasy and reality, the scary feelings remain. In addition to providing comfort, help your child figure out ways to combat her fears. After having two bad dreams, my 4-year-old, Sara, was afraid to go back to sleep. Fortunately, her preschool class was making Native American "dream catchers" -- Sara's resembled a spiderweb with a feather dangling down. We hung it by her bed and talked about how the dream catcher would ensnare the bad dreams, while the good dreams would slide down the feather into her mind. The dream catcher worked-Sara hasn't had bad dreams since. Similarly, if your child is afraid of monsters, you might offer him a means of keeping them at bay (that is, in his control): One mother gave her son a bottle of "monster spray" (a water spritzer); another let her daughter choose a stuffed animal as her protector. Nightmares aside, if your preschooler is still waking up at night, you might want to consider using a system of rewards and consequences. Dr. Weissbluth recommends providing a set of sleep rules (close your eyes; stay quiet; stay in bed; try to sleep). For every night that he follows the sleep rules, the child earns a star. When he accumulates a certain number of stars, he receives a reward. When he doesn't follow the rules, he loses a privilege the next day. This method worked well with both our 4- and 6-year-olds. After just three nights, they were finally sleeping in their own beds until morning.

Insufficient sleep is the most insidious sleep problem among older children. They're going to sleep later yet waking up at the same time.

A growing body of research suggests that sleep deprivation has a significant impact on school behavior and performance. "Instead of becoming quiet and somnolent, as adults do, kids become hyperactive and out of control," says David Gozal, M.D., director of the Comprehensive Sleep Medicine Center at Tulane University Hospital Clinics, in New Orleans. "Their ability to pay attention decreases, as does their ability to concentrate, solve problems, and retain what they learn."

Experts agree that parents must set limits, not only on how late school-age kids can stay up but on what they can do before bedtime. Watching TV, playing computer and video games, and surfing the Net are stimulating activities that keep kids' minds working overtime. And a full plate of after-school commitments prevents them from finishing their homework at a reasonable hour. "Families need to make sleep a priority and put it into their schedules," says sleep expert Mary Carskadon, Ph.D., a professor of psychiatry and human behavior at Brown University. Sleep should not be a last resort after activities -- or energy -- run out.