Sleep Difficulties: Next Steps

The Rough Guide to Delayed Sleep

What is it?

Delayed sleep is the most common sleep difficulty that we see here at CAMHS in children and young people. But what is it?

There is a long time between the time the child or young person goes to bed and the time they fall asleep .
During this time the child or young person will genuinely not feel sleepy (but adults don't always believe them).
Usually (but not always) the child or young person will sleep late if not woken up. Often this is seen at weekends and holidays.
Sometimes, but not always, the child or young person will be in and out of bed.
Sometimes adolescents can have day-night reversal. That means they are sleeping from 4am or 5am and not waking up until 3pm or 4pm

Why does it happen?

The first thing to say is usually the reasons why the problem starts (or the trigger) is not the reason why the problem continues (the maintaining factors). So what are the most common maintaining factors?

The child or young persons body hasn't learned to associate (maybe because they spend a lot of time in or on their bed awake)
The child or young person's body clock has been reset do that they start to feel sleepy much later than bedtime. Usually the "wake-up" signal in their body clock happens late morning or early afternoon.
the child or young person is doing things which are not helpful, or are incompatible with sleep; playing, reading, watching tv, texting or browsing on a phone or tablet, playing computer games). This stops the eyes producing a chemical called melatonin. Melatonin is naturally produced by the body and makes you sleepy (and cooler).
Maybe there's too much going on in the house at night time. Arguments and / or general noise . This can wind everyone up and can make falling asleep really difficult.

Getting ready to start sleep management.

There are a few things to put in place first before you start:

Check that the room isnt too hot, too cold, too light, too dark or too noisy, also that they dont share the room with someone noisy. Try these things first and see if the sleep improves .
Check that the child or young person isn't drinking too much caffeine. This is found in tea, coffee, hot chocolate, energy drinks, some fizzy drinks
Make sure there aren't any medical reasons for the lack of sleep such as asthma or arthritis as these can make sleep difficult.
Check that there isn't a fear of sleeping on their own or being separated from parents/carers. Is the child or young person too scared to go to bed alone and sleep by themselves? If this is the case, gradually expose them to being alone.

Next Steps

If all of the check above didn't highlight any problems to solve first, you are ready to start:

Keep a sleep diary. There are two to download; one for parents/carers and another for older children and adolescents. Decide which you will use (only use one). Keep a diary for 2 or 3 weeks, but don't choose a time that runs over school holidays etc as sleep patterns tend to change during these times.
From the sleep diary, work out an approximate time when the child or young person falls asleep.
Make a plan: there's an example of a plan for you to download

Important things to remember!

For any sleep plan to work its really important that parents/carers, you really "buy in" to the plan. Even if you feel a bit sceptical about whether it will work or not, be prepared to give it a go, if you don't, it is unlikely to work.
For adolescents, its really important for buy in too. There are reasons adolescents might not buy in to change their sleep habits and these need to be explored. For example if friends are awake through the night too texting or on social media, or if they are not doing anything during the day and don't feel the need to sleep at night, change will be difficult.