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

Nightmares

It's not clear at what age kids begin to dream, but even toddlers may speak about having dreams — pleasant ones and scary ones. While almost every child has an occasional frightening or upsetting dream, nightmares seem to peak during the preschool years when fear of the dark is common. But older kids (and even adults) have occasional nightmares, too.

Nightmares aren't completely preventable, but parents can set the stage for a peaceful night's rest. That way, when nightmares do creep in, a little reassurance and comfort from you can quickly restore your child's peace of mind.

Helping kids conquer this common childhood fear also equips them to overcome other scary things that might arise down the road.

When Do Nightmares Happen?

Nightmares — like most dreams — occur during the stage of sleep when the brain is very active and sorting through experiences and new information for learning and memory. The vivid images the brain is processing can seem as real as the emotions they might trigger.

This part of sleep is known as the rapid eye movement or REM stage because the eyes are rapidly moving beneath closed eyelids. Nightmares tend to happen during the second half of a night's sleep, when REM intervals are longer.

When kids awaken from a nightmare, its images are still fresh and can seem real. So it's natural for them to feel afraid and upset and to call out to a parent for comfort.

By about preschool age, kids begin to understand that a nightmare is only a dream — and that what's happening isn't real and can't hurt them. But knowing that doesn't prevent them from feeling scared. Even older kids feel frightened when they awaken from a nightmare and may need your reassurance and comfort.

What Causes Nightmares?

No one knows exactly what causes nightmares. Dreams — and nightmares — seem to be one way kids process thoughts and feelings about situations they face, and to work through worries and concerns.

Most times nightmares occur for no apparent reason. Other times they happen when a child is experiencing stress or change. Events or situations that might feel unsettling — such as moving, attending a new school, the birth of a sibling, or family tensions — might also be reflected in unsettling dreams.

Sometimes nightmares occur as part of a child's reaction to trauma — such as a natural disaster, accident, or injury. For some kids, especially those with a good imagination, reading scary books or watching scary movies or TV shows just before bedtime can inspire nightmares.

Themes of a nightmare tend to reflect whatever the child is going through at that age, whether it's struggles with aggressive feelings, independence, or fears of separation. The cast of characters might include monsters, bad guys, animals, imaginary creatures, or familiar people, places, and events combined in unusual ways.

Young kids might have nightmares of being gobbled up, lost, chased, or punished. Sometimes a nightmare contains recognizable bits and pieces of the day's events and experiences, but with a scary twist. A child might not remember every detail, but can usually recall some of the images, characters, or situations, and the scary parts.

Encouraging Sweet Dreams

Parents can't prevent nightmares, but can help kids get a good night's sleep — and that encourages sweet dreams.

To help them relax when it's time to sleep and associate bedtime with safety and comfort, be sure that kids:

  • have a regular bedtime and wake-up time
  • have a sleep routine that helps them slow down, and feel safe and secure as they drift off to sleep. This might include a bath, a snuggle from you, reading, or some quiet talk about the pleasant events of the day.
  • have a bed that's a cozy, peaceful place to quiet down. A favorite toy, stuffed animal, night-light, or dream catcher can help.
  • avoid scary movies, TV shows, and stories before bed — especially if they've triggered nightmares before
  • know that nightmares aren't real, that they're just dreams and can't hurt them

After a Nightmare

Here's how to help your child cope after a nightmare:

Reassure your child that you’re there. Your calm presence helps your child feel safe and protected after waking up feeling afraid. Knowing you'll be there helps strengthen your child's sense of security.

Label what’s happened. Let your child know that it was a nightmare and now it's over. You might say something like, "You had a bad dream, but now you're awake and everything is OK." Reassure your child that the scary stuff in the nightmare didn't happen in the real world.

Offer comfort. Show that you understand that your child feels afraid and it's OK. Remind your child that everyone dreams and sometimes the dreams are scary, upsetting, and can seem very real, so it's natural to feel scared by them.

Do your magic. With preschoolers and young school-age kids who have vivid imaginations, the magical powers of your love and protection can work wonders. You might be able to make the pretend monsters disappear with a dose of pretend monster spray. Go ahead and check the closet and under the bed, reassuring your child that all's clear.

Mood lighting. A night-light or a hall light can help kids feel safe in a darkened room as they get ready to go back to sleep. A bedside flashlight can be a good nightmare-chaser.

Help your child go back to sleep. Offering something comforting might help change the mood. Try any of these to aid the transition back to sleep: a favorite stuffed animal to hold, a blanket, pillow, night-light, dream catcher, or soft music. Or discuss some pleasant dreams your child would like to have. And maybe seal it by giving your child a kiss to hold — in the palm of his or her hand — as you tiptoe out of the room.

Be a good listener. No need to talk more than briefly about the nightmare in the wee hours — just help your child feel calm, safe, and protected, and ready to go back to sleep. But in the morning, your child may want to tell you all about last night's scary dream. By talking about it — maybe even drawing the dream or writing about it — in the daylight, many scary images lose their power. Your child might enjoy thinking up a new (more satisfying) ending to the scary dream.

For most kids, nightmares happen only now and then, are not cause for concern, and simply require a parent's comfort and reassurance. Talk to your doctor if nightmares often prevent your child from getting enough sleep or if they occur along with other emotional or behavioral troubles.

Reviewed by: D'Arcy Lyness, PhD
Date reviewed: October 2010