Sleep strategies

Bedtime pass

Often, a child may resist going to sleep, and call out or leave their bedroom to seek their parents. One intervention that may be beneficial in dealing with these behaviours is use of a bedtime pass. You may want to provide your child with a pass that can be exchanged for leaving the bedroom for a brief amount of time. The bedtime pass may be a small index card with your child’s name written on the top. Departures from the bedroom should be short in duration and serve a specific purpose, such as, getting a drink, going to the bathroom, or giving a parent a hug. Once the pass has been used, the child must surrender it to the parent, until the next bedtime. Depending on the frequency of calling out or leaving the room (as identified during the baseline sleep log), your child may be provided with additional passes. Over time, decrease the number of passes provided for the child.

‘Stimulus fading’: a solution for co-sleeping

For children who are dependent on co-sleeping, the process of stimulus fading can help a great deal. The goal is to gradually eliminate the presence of a parent in the child’s bedroom by progressively over the course of nights increase the distance between the parent and child. For example, start by sleeping on a mattress next to the bed, when your child is comfortable move to a chair on the other side of the room, until you are faded out of your child’s room.

Faded bedtime and faded bedtime with response cost: getting your child adjusted to an earlier bedtime

i. If you are having difficulties getting your child to bed early, you may consider following the series of steps described below, known as ‘faded bedtime’.

First, determine a time at which your child is likely to fall asleep within 15 minutes of getting into bed. Once your child gets used to falling asleep at this time with little resistance, set the bedtime earlier and earlier each night until desired bedtime is achieved. In order for this method to be successful, your child must be awakened at the same time each morning and should not be allowed to sleep outside of prescribed sleeping times.

ii. Another similar method that involves progressively setting an earlier bedtime is called, ‘faded bedtime with response cost (FBRC)’.

In this scenario, set a predetermined time limit (e.g. thirty minutes) by which your child must fall asleep; if they have not managed to fall asleep in this time, gently rise your child and engage them in a calming activity (e.g. reading a book, listening to music) in a different room for another predetermined amount of time before putting them back into bed. This activity should have the effect of increasing your child’s motivation to fall asleep, maintaining the association between sleep and his bedroom. Repeat this procedure until your child is able to fall sleep; once your child successfully falls asleep before the predetermined time limit, set an earlier time as the new goal until the desired bedtime is reached.

‘Chronotherapy’: getting your child adjusted for a later bedtime

If your child needs to adjust to a later bedtime rather than an earlier one, a method called ‘chronotherapy’ may be helpful. Systematically delay bedtime and wake time in increments (10-30 minutes at a time) while maintaining a regular schedule during waking hours. Follow this procedure until your child goes to bed and falls asleep at a desirable time.

‘Extinction’ and ‘gradual extinction’: eliminating behaviors that disrupt sleep

If your child engages in behaviour that disrupts their sleep, such as crying out, these two methods of interacting with your child during episodes of sleep-disruption may help to gradually eliminate them.

The first method you may want to try involves putting your child to bed as normal, and having no interaction with them until their wake-up time regardless of the disruptions that may occur during sleep-time. It is important to keep in mind that this practice may temporarily increase negative behaviours in your child, but in the long-term may result in your child’s ability to sleep calmly throughout the night. However, bear in mind that this method should be used according to the actual situation. If the child engages in dangerous behaviours in his/her bedroom (e.g. self-harming), parents should intervene.

An alternative method of dealing with sleep disruptions involves not responding to your child’s disruptive-sleep-behaviour, such as crying out, for a predetermined period, and if by the end of this period your child is still not calm or asleep, then engage with your child and settle them into bed. It is important to keep interaction with your child at that moment to a minimum so that your child can eventually learn to settle him or herself to sleep independently.

Strategy for night terrors: scheduled awakenings

Your child may experience a kind of nightmare called night terrors; night terrors are frequent recurrent episodes of intense crying and fear during sleep, with difficulty arousing the child. Children are often unable to recall these episodes. If your child is experiencing sleep terrors, a strategy called scheduled awakening may help to diminish its occurrence.

It is suggested to wake your child for a 30-minute period of time prior to the usual time of the sleep terror episodes according to your child’s sleep diary. You can wake your child up at that time and then allow them to fall back into sleep. The arousal for the scheduled awakening should be minimal, which is just enough to open your child’s eyes. After a week without sleep terrors, you may try to gradually reduce the number of nights with scheduled awakenings (e.g. skip one night of scheduled awakening the next week, and additionally one night each week after). If sleep terrors persist, you may need to start a week of scheduled awakening once again. The tips above are advice only and should not be used as a replacement for comprehensive medical treatment. If you are concerned about your child’s sleep problem, please speak to a medical doctor.