Sleep Medicine

Patient and family education is important to us. Here you can learn more about sleep and healthy sleep habits, and view trusted insights from KidsHealth.org, the No. 1 most viewed health site for children, created by the experts at Nemours. We've also provided information from the most-respected non-profit organizations.

Healthy Sleep

All children need a good night’s sleep. It’s not only a time for rest, but sleep gives your child’s brain a chance to sort and store information from their day. When kids don’t get enough sleep or quality sleep, it can affect how they feel, act and do in school. Our pediatric sleep medicine specialists are here to get to the bottom of your child’s sleep problems and set your child on the path to a good night’s rest.

Natural Sleep Cycles: Five Stages of Sleep

Natural brain cycles are responsible for sleep, which is defined by 2 states:
  1. Non-REM (non-rapid eye movement) sleep, considered “quiet sleep” (5- to 20-minute intervals)
  2. REM (rapid eye movement) sleep, considered “active sleep” (60-70 minutes)

Normally, sleep occurs in stages that cycle several times throughout the night.

 
Stage 1: Non-REM Sleep

This is the transition from wakefulness to sleep. During this period the brain reduces activity and polysomnography (sleep study) shows high amplitude theta waves (slow brain waves).

 
Stage 2: Non-REM Sleep

At this time, the body’s temperature begins to decrease and the heart rate begins to slow to prepare for sleep. Bursts of rapid rhythmic brain waves (called sleep spindles) begin to appear.

 
Stages 3 & 4: Non-REM Sleep

These stages mark the transition between light and deep sleep where delta (very slow) brain waves begin to emerge in stage 3 and continue in intensity. Sleep walking and bedwetting often occur at the end of stage 4.

 
Stage 5: REM Sleep

After about 90 minutes of non-REM sleep, brain activity increases as the eyes begin moving rapidly and dreaming begins. REM is referred to as paradoxical sleep because muscles become more relaxed as the brain’s other systems become more active.


Good Sleep Habits

 
Independent Sleep

Consider the following recommendations to help your child develop good habits for getting to sleep on his or her own.

  • Keep your child’s room neat and clean — responsibility for this task will vary depending on your child’s age and abilities.
  • Put a nightlight or small light within your child’s reach.
  • A quiet fan or humidifier may allow for some “white noise” to filter out the noise coming from the rest of the house.
  • Place a few of your child’s favorite items around the bed so it becomes sort of a "mini-home."
  • Have a bedside table or shelf stocked with your child’s favorite books.
  • Give your child plenty of notice that bedtime is approaching. A predictable, consistent bedtime routine helps kids wind down toward sleep.
  • Set aside time to do something special with your child before bed. Avoid any activities that will excite your child. Let your child know your special time together will end at bedtime.
  • Once you finish playing or reading a story, tell your child goodnight and leave the room. If your child comes out, take your child back to bed and leave again.
 
Helping Your Preschool Child Develop Good Sleep Habits

Helping kids get enough sleep involves creating soothing and consistent bedtime routines.

The goal is for your child to learn to:
  • fall asleep on his or her own
  • not rely on your presence for this to happen
  • be able to go back to sleep during the night
  • go to bed at the same time every night — let your child know 30 minutes ahead of that time to get ready
Other ways to help your child develop better sleep habits:
  • make sure your child goes to the bathroom, washes up, and brushes his or her teeth
  • read a book with your child
  • make sure your child has a cup of water, a nightlight or anything else your child may need
  • remind your child to stay quiet and in bed
  • say goodnight
When your child goes to bed, make sure everything is done:
  • teeth brushed
  • said goodnight to everyone
  • had a drink of water
  • used the toilet

After your child is in bed, keep the TV and the rest of the home fairly quiet. Your child can awaken easily in the first hour of sleep.

If your child awakens, the goal is have the same conditions present that were there when your child fell asleep — that means you’re not present when your child falls asleep. Follow these recommendations for naptime too. You may be asked to track your child’s sleep in a sleep diary so you can measure progress made.

 
Sleep Tips for Teens
  • Try to stay on a schedule — go to bed and get up at roughly the same time each day, even on weekends. Don't sleep more than 2-3 hours later than usual.
  • Get into bright light as soon as possible in the morning, but avoid it in the evening.
  • Try not to nap during the day; or nap only for 20-30 minutes.
  • Avoid caffeine in the afternoon.
  • Don't exercise within 3 hours before going to bed.
  • Keep the temperature in your room comfortable.
  • Keep the room quiet and dark when sleeping.
  • Use the bedroom only for sleep, not for fun or watching TV. This will signal the body that when you are in your room, it's time to sleep.
  • Leave time to unwind before bed. Avoid stimulating activities like TV or lively music 30 minutes prior to bedtime.
  • Do not go to bed until you are drowsy. Trying to “make yourself fall asleep” will only make you wake up more.
  • Do not go to bed too hungry or too full — a light snack such as pretzels, crackers or popcorn just before bed may help make you drowsy.
  • Use a relaxation exercise, such as progressive muscle relaxation or guided imagery, just before bed.
  • If you are unable to fall asleep within 30 minutes, get out of bed and do something quietly in another room until sleepy.

Common Sleep Conditions

 
Bruxism (Teeth Grinding)

Bruxism can be a serious condition. Kids who grind their teeth are more likely to do it in the first half of the night, when they are less likely to be dreaming.

Teeth Grinding in Babies and Toddlers

Nearly half of all babies grind their teeth. It usually begins at about 10 months old, after the two top front teeth and two bottom front teeth come in. Generally, it’s nothing to worry about and usually goes away on its own without any damage to permanent teeth. After baby teeth are lost, if your child is still grinding, consult with your child’s dentist.


Teeth Grinding in Children and Teens

Children and teens also grind their teeth. Children with disabilities are more likely to grind their teeth, especially children with cerebral palsy and intellectual disabilities. Teeth grinding can cause tooth pain, jaw pain, and headaches. Also, it can wear down teeth.


Treating Bruxism

Nothing needs to be done if a child is grinding teeth once in a while and if it’s not too intense. It is usually nothing to worry about, as long as there is no damage to the teeth and no other symptoms.

 
Delayed Sleep Phase Syndrome

If your child or teen remains awake at least two hours past their usual bedtime because they are unable to fall asleep, it may signal Delayed Sleep Phase Syndrome (DSPS).

Often, it’s hard for someone with DSPS to wake up in the morning. If allowed to sleep until the late morning or early afternoon, your child feels rested and can function well. Many teens with DSPS describe themselves as being at their best in the evening and at night. They tend to “catch up” on their sleep during weekends.


Causes and Symptoms of Delayed Sleep Phase Syndrome

DSPS usually starts during the teen years and affects about 7% (1 out of 15) of teens. While the cause is unknown, sometime after puberty, most teens start staying up later at night and sleeping later in the morning.

Some symptoms may include:
  • Trouble falling asleep at a usual bedtime: Most teens with DSPS fall asleep late at night or in the early morning.
  • Difficulty with awakening in the morning: Since teens fall deeply asleep so late, most have difficulty getting up and ready on time in the morning.
  • Daytime sleepiness: Often teens who fall asleep late at night and awaken early for school suffer from feeling tired and sleepy during
    the day.
  • Other symptoms during the day: Sleepiness during the day and lack of energy may be mistakenly interpreted as depression. In addition, these teens may suffer from poor attention and motivation, sometimes diagnosed as attention deficit disorder.

Diagnosing and Treating DSPS

Keeping a sleep diary for a week gives enough information about when your child goes to sleep and wakes up to make a diagnosis.

Treatment includes resetting your child’s internal clock to establish the habit of being sleepy at a normal bedtime. If your teen isn’t motivated, it’s difficult to change the pattern.

To get back into a more regular schedule:
  • Don’t smoke and avoid caffeine or other stimulating drugs.
  • Limit daytime sleeping to one 15- to 20-minute nap, if any.
  • Go to bed earlier.
  • Gradually move back bedtime by 15 minutes intervals, that is, if your teen is going to bed at midnight, set bedtime at 15 minutes earlier at 11:45 p.m., for one or two nights, then 11:30 p.m. for one or two nights. Continue 15 minutes earlier every two nights, until bedtime is at 10 p.m.
  • Go to bed later: It’s easier for the body to get used to a later bedtime than an earlier one. Using a technique called “phase delay,” bedtime is delayed by 2 to 3 hours each night. For example, if a teenager usually falls asleep at 2 a.m. bedtime is delayed until 4 a.m. one night, 6 a.m. the next night.
  • Melatonin: There is limited evidence to support use of melatonin an hour prior to bedtime and this therapy should be used in consultation with your child’s doctor. Once the desired bedtime is reached, your teen must stick with their schedule every night for several months. Even one night of late night studying or socializing can return the internal clock to the delayed state.
 
Head Banging and Body Rocking

Babies often fall asleep when they are rocked back and forth by adults. Sometimes, babies and children rock themselves to sleep. When these rhythmic movements become intense, it results in head banging and body rocking, and known as “rhythmic movement disorders.” Your child may do this mostly when falling asleep (at naptime or bedtime) and then settle down once asleep.

Should You Worry About Your Child’s Head Banging or Body Rocking?

For most children, this behavior is not a cause for concern and most stop by age 4; however, you may have to watch your child a little closer. Children with other issues such as developmental delay, autism, or blindness may rock or bang their heads more forcefully and hurt themselves; consult your doctor.

Follow these tips:
  • It’s unlikely your child will hurt himself. There is no need to put extra bumpers in the crib or place pillows around it.
  • Be careful not to reinforce the head banging — try not to go to your child every time — you may be accidentally encouraging this behavior.
  • Move the crib or bed — move the crib or bed away from the wall if the noise is disturbing the rest of the family. If your child is in a bed, put guardrails on all sides.
  • Head banging and rocking can loosen the screws and bolts in your child’s crib or bed — tighten these fasteners on a regular basis.
 
Periodic Limb Movement Disorder (Twitching and Jerking at Night)

Periodic Limb Movement Disorder (PLMD) is a repetitive, sometimes intense movement of the limbs — usually the legs — during sleep that typically lasts a few seconds.

Most children and teens are unaware of the movements that feel like a tingling, crawling, creeping pain and look like brief muscle twitches or jerking movements. They tend to occur in groups, and last from a few minutes to a few hours, and can cause your child to awake during the night, which may lead to daytime sleepiness.

Children and teens with PLMD may also experience Restless Leg Syndrome, a related disorder that can happen at night or during times of rest, or on long car rides.


Causes of Periodic Limb Movement Disorder

PLMD may be related to low iron levels in the blood (anemia) or due to chronic illnesses, such as diabetes and kidney disease. However, for most children with PLMD, the cause is not known.

Symptoms may include:
  • leg movements
  • restless sleep
  • sleep disruption
  • daytime sleepiness
  • behavior and academic problems

Diagnosing and Treating Periodic Limb Movement Disorder

Your child’s doctor may order an overnight sleep study or polysomnography, in which you and your child will spend the night in a sleep lab at a hospital or clinic. While your child is sleeping, a sleep technologist will look for movements or wakings.

Treatments may include:
  • avoiding caffeine
  • treatment of iron deficiency
  • medications
Other recommendations may include:
  • keeping your child's room neat, clean and clutter-free
  • using a nightlight or small light within his or her reach which may help your child feel more secure during the night
  • using a quiet fan or humidifier
  • placing favorite items around your child’s bed
  • having a bedside table or shelf stocked with his or her books
  • giving your child notice that bedtime is approaching
  • avoiding activities that may excite your child at bedtime
  • leaving your child’s room after saying goodnight

Bed-Sharing

The practice of bed-sharing — parents sharing a bed with their infant — is a hot topic. Supporters of bed-sharing believe that a parent's bed is just where a baby belongs. But others worry that bed-sharing is unsafe.

Co-Sleeping, Room-Sharing, and Bed-Sharing

Many people use the terms "bed-sharing" and "co-sleeping" to describe the same thing, but there are differences:

  • Co-sleeping: This is when a parent and child sleep within a "sensory" distance of each other, meaning that each can tell that the other is near by their touch, sight, or even smell. (Co-sleeping is sometimes also called sleep-sharing.)

    Room-sharing and bed-sharing are types of co-sleeping:
    • Room-sharing: This is when parents have a crib in the room with them, a bassinet or portable crib near the bed, a separate crib attached to the bed, or a similar arrangement.
    • Bed-sharing: This is when parents share their bed with their children (sometimes called the "family bed"). This is what has raised concerns with pediatricians and others.

Why Some People Bed-Share

Bed-sharing supporters believe — and some studies support their beliefs — that bed-sharing:

  • encourages breastfeeding by making nighttime breastfeeding more convenient
  • makes it easier for a nursing mother to get her sleep cycle in sync with her baby's
  • helps babies fall asleep more easily, especially during their first few months and when they wake up in the middle of the night
  • helps babies get more nighttime sleep (because they awaken more often with shorter feeding time, which can add up to a greater amount of sleep throughout the night)
  • helps parents regain closeness with their infant after being separated from their babies during the workday

But do the risks of bed-sharing outweigh the benefits?

Is Bed-Sharing Safe?

In some non-Western cultures, bed-sharing is common and the number of infant deaths related to it is lower than in the West. Differences in mattresses, bedding, and other cultural practices may account for the lower risk in these countries.

Despite the possible pros, various U.S. medical groups warn parents not to place their infants to sleep in adult beds due to serious safety risks. Bed-sharing puts babies at risk of suffocation, strangulation, and sudden infant death syndrome (SIDS). Studies have found that bed-sharing is the most common cause of deaths in babies, especially those 3 months and younger.

An adult bed has many safety risks for a baby, including:

  • suffocation from lying face-down on a waterbed, a regular mattress, or soft bedding such as pillows, blankets, or a quilt, or due to an infant's head being covered by such items
  • suffocation, when an infant gets trapped or wedged between a mattress and headboard, wall, or other object
  • strangulation in a bed frame that allows part of an infant's body to pass through an area while trapping the baby's head

Among older infants (4 to12 months old) who died due to bed-sharing, having an additional item (like a pillow or a blanket) on the bed increased the risk of death. Babies should always be placed to sleep on their backs on a firm mattress without any pillows, blankets, toys, stuffed animals, or other items.

Because of the risks involved, both the American Academy of Pediatrics (AAP) and the U.S. Product Safety Commission (CPSC) advise against bed-sharing. The AAP does recommend the practice of room-sharing without bed-sharing. Room-sharing is thought to help lower the risk of SIDS.

safe sleep infant illustration

Besides the potential safety risks, sharing a bed with a baby sometimes prevent parents from getting a good night's sleep. And infants who co-sleep might learn to associate sleep with being close to a parent in the parent's bed, which can become a problem at naptime or when the baby needs to go to sleep before the parent is ready.

Bed-Sharing & SIDS

Some studies suggest that bed-sharing increases the risk of SIDS, especially in infants younger than 12 weeks old.

Factors that can increase this risk include:

  • a baby sleeping on a couch alone or with a parent
  • a baby sleeping between two parents
  • a mother who smokes
  • parents who are extremely tired
  • a parent who has recently used alcohol or drugs
  • bed-sharing with pillows or bedcovers

It's safer to use room-sharing without bed-sharing. Experts note that parents and babies sleeping in the same room can reduce the risk of SIDS because they tend to wake up more often throughout the night.

How to Room-Share Safely

To avoid the risks of bed sharing while enjoying the benefits of room-sharing, parents have lots of options. To keep your little one close by, but not in your bed, you could:

  • Put a bassinet, play yard, or crib next to your bed. This lets you keep that desired closeness, which can be especially important if you're breastfeeding. The AAP says that having an infant sleep in a separate crib, bassinet, or play yard in the same room as the mother reduces the risk of SIDS.
  • Buy a device that looks like a bassinet or play yard with one side that is lower, which attaches to your bed to allow you and baby to be next to each other while eliminating the possibility of rolling over onto your infant.

How to Bed-Share as Safely as Possible

Despite the risks of bed-sharing, some parents decide this sleeping arrangement is best for their family. If you do choose to share your bed with your baby, follow these precautions:

  • Don't share a bed with an infant under 4 months of age — a bassinet or crib next to the bed is a better choice.
  • Always place your baby on his or her back to sleep to reduce the risk of SIDS.
  • Dress your baby in minimal clothing to avoid overheating.
  • Don't place a baby to sleep alone in an adult bed.
  • Don't place a baby on a soft surface to sleep, such as a soft mattress, sofa, or waterbed.
  • Make sure your bed's headboard and footboard don't have openings or cutouts that could trap your baby's head.
  • Make sure your mattress fits snugly in the bed frame so that your baby won't become trapped between the frame and the mattress.
  • Don't cover your child's head while sleeping.
  • Don't use pillows, comforters, quilts, and other soft or plush items on the bed. You can dress your baby in a sleeper instead of using blankets.
  • Don't drink alcohol or use medicines or drugs that could keep you from waking or might cause you to roll over onto, and therefore suffocate, your baby.
  • Don't place your bed near draperies or blinds where your child could be get caught in and strangled by cords.
  • Don't fall asleep with a baby on your chest.
  • Don't sleep on couches, recliners, or rockers with a baby.

Who Shouldn't Share a Bed With a Baby?

If an infant and a parent are bed-sharing, keep the following people out of the sleep environment:

  • other children — particularly toddlers — because they might not be aware of the baby's presence
  • parents who are under the influence of alcohol or any drug because that could lower their awareness of the baby

And nobody should smoke in the room, as this increases the risk of SIDS.

Moving Out of the Parent's Bed

Eventually, the bed-sharing routine will be end at some point, either because the child wants to or by the parents' choice.

If you've been bed-sharing with your little one and would like to stop, talk to your doctor about making a plan for when your baby will sleep in a crib. Moving to a crib by 6 months of age is usually easier — for both parents and baby — before the bed-sharing habit is ingrained and other developmental issues (such as separation anxiety) come into play.

Reviewed by: Rupal Christine Gupta, MD
Date reviewed: September 2014