Maintaining Healthy Sleep during Periods of Stress and Anxiety
Helping your little ones achieve stable, adequate sleep each night is hard even during the best of circumstances. When you add stress and anxiety into the mix it can make it even harder to build and maintain consistent sleep patterns with your child. This blog will help you decide whether you need to change your approach to your child’s sleep issues when you or your child are stressed or anxious.
The Science. Stress and anxiety can cause transient insomnia in adults. When stressful events happen, the release of stress hormones causes hyper-arousal which can make it harder to both fall asleep and stay asleep. Adults with a history of insomnia are more susceptible to re-developing insomnia and they also perceive that impact of stressful events as greater than people who are normally good sleepers, but even adults who normally sleep really well can have trouble during stressful times.
There are no studies that have shown a direct link between how transient stress or insomnia experienced by adults may affect children or vice versa, but current evidence suggests that these factors probably interact. Insomnia in one parent can induce insomnia in the other, and infant sleep problems can amplify insomnia in both parents. In addition, several studies have demonstrated that sleep problems in children are more common among parents who are stressed or anxious, particularly among moms who have post-partum anxiety or depression.
Babies and toddlers go through episodes of normal separation anxiety, typically around 9 months and around 18 months. During these phases of development sleep can become disrupted and many children will have difficulty falling asleep and staying asleep. There is not a lot of information on how external stressors and community trauma may influence sleep in young children, but most evidence suggests that babies and toddlers react to their parents’ emotional state. One qualitative study of 104 children conducted among families after the September 11th attacks found that children under age 5 had increased separation anxiety, more difficulty falling asleep alone, increased night waking, increased nightmares, and increased crying during sleep during the eight months following the attack.
The bottom line is that it’s normal to be stressed and anxious during times of crisis. It’s also normal for your stress to affect your sleep and your child’s sleep. There are several things you can do to help get yourself and your child on track. We’ve listed many of the things that you can do to help your baby or toddler sleep better and we’ve included resources for you to explore if you need more help for yourself.
What can you do to help your child maintain stable sleep?
First, you need to determine the likely cause of your child’s sleep difficulty. If your child was sleeping well, then suddenly started having sleep disruption it could relate to stress, but it might just be part of a normal developmental change. Here are some of the common sleep regressions (with hyperlinks to blogs describing them).
There is a normal change in sleep architecture around 4 months that causes a sleep regression.
There is a sleep regression between 8-10 months that is associated with separation anxiety.
Motor skill development (learning to sit up, walk, crawl) can cause a sleep regression.
There is a sleep regression associated with separation anxiety around 18 months.
Could your child be sick or teething? These both cause a temporary sleep disruption.
Lastly, if your child is not able to fall asleep independently then your child’s sleep trouble might be due to a sleep association.
If your child’s sleep trouble can’t be explained by any of the above “typical” causes, then your child may be reacting to the stress of being stuck at home all of the time or reacting to stress from caregivers. If you think this is the case, then try the following:
Keep a regular bed and wake time for your child.
We say this under normal circumstances, but these days it’s easy to get off schedule. Getting off schedule means that you lose the ability to predict when your child’s body (circadian rhythm) is ready for sleep. If you put your child down at a time that s/he can’t sleep it will amplify any underlying stress.
Maintain regular nap times.
Naps don’t have to be rigid, but they should be at roughly similar times each day for babies over 6 months old. Babies under 6 months won’t follow a perfect schedule, but awake windows between naps should be similar day-to-day.
Put your child down awake, but return for a cuddle if needed.
If your child normally falls asleep independently, but is suddenly crying after being put down, then it’s ok to leave the room, wait a few minutes and if your child is still crying, go back in for a cuddle. In this case it’s often helpful to do a little “reset” by replicating some of your bedtime routine. For example, go back into your child’s room, take your child out of the crib, rock and sing or shush to calm your child down, put your child down awake, then leave again repeating as necessary.
Wait a few minutes before responding during “extra” night wakings.
If your child is never up to eat before 2 AM, then a sudden waking at 10 PM may reflect some anxiety. Wait 2-5 minutes. If your child doesn’t seem to be settling, then go in and do a wellness check. If it appears nothing is wrong, then respond as described in the bullet above as needed.
Go outside.
We know that some of you may not be able to go outside due to local restrictions or the weather, but if you are able to sit in a backyard or on a deck for a short time during the day it can be helpful in breaking up the monotony of being in the house and the daytime light exposure can help maintain the alignment of the circadian rhythm. If you can’t go outside, then opening the windows and curtains while your child is awake is the next best option.
Maintain activity routines, but include variety.
Babies and toddlers do well with having similar routines each day, but lack of variety can be very frustrating. Here are some schedules we created to help inspire you to fill your child’s time with interesting activities (3-nap schedule, 2-nap schedule, 1-nap schedule).
Avoid screens, especially the news, in the 1-2 hours before you put your child to bed.
Exposure to stressful content can make it difficult to relax for sleep.
If you are just not in a place where it makes sense to do any of these things or if you just want to do what works in the moment to get by, then that's ok too (as long as it's safe, of course). Even if you create a sleep association now, you can always work on sleep in the future. We hope those suggestions help you get through this difficult time. As always, if you feel you just need to talk through your child’s sleep issues to develop a plan, then feel free to book a consultation with us.
If you need help with your own sleep issues, then first check out these recommendations for adults from our colleagues at the Sleep Research Society. If you need more help, then talk to your primary care doctor about getting a referral to a Sleep Clinician. The American Academy of Sleep Medicine is a great place to start when searching for adult sleep help.
References
Further reading on adult insomnia (peer-reviewed, scientific literature):
Morin, C.M., Rodrigue, S. and Ivers, H., 2003. Role of stress, arousal, and coping skills in primary insomnia. Psychosomatic medicine, 65(2), pp.259-267.
Basta, M., Chrousos, G.P., Vela-Bueno, A. and Vgontzas, A.N., 2007. Chronic insomnia and the stress system. Sleep medicine clinics, 2(2), pp.279-291.
Drake, C., Richardson, G., Roehrs, T., Scofield, H. and Roth, T., 2004. Vulnerability to stress-related sleep disturbance and hyperarousal. Sleep, 27(2), pp.285-291.
Yang, C.M., Lin, S.C. and Cheng, C.P., 2013. Transient insomnia versus chronic insomnia: A comparison study of sleep‐related psychological/behavioral characteristics. Journal of clinical psychology, 69(10), pp.1094-1107.
Further reading on interactions between adult anxiety/stress and sleep in early childhood:
Meijer, A.M. and van den Wittenboer, G.L., 2007. Contribution of infants' sleep and crying to marital relationship of first-time parent couples in the 1st year after childbirth. Journal of Family Psychology, 21(1), p.49.
Martini, J., Petzoldt, J., Knappe, S., Garthus-Niegel, S., Asselmann, E. and Wittchen, H.U., 2017. Infant, maternal, and familial predictors and correlates of regulatory problems in early infancy: The differential role of infant temperament and maternal anxiety and depression. Early human development, 115, pp.23-31.
Further reading on infant and toddler anxiety/stress:
DeLeon, C.W. and Karraker, K.H., 2007. Intrinsic and extrinsic factors associated with night waking in 9-month-old infants. Infant behavior and Development, 30(4), pp.596-605.
Kahn, M., Juda-Hanael, M., Livne-Karp, E., Tikotzky, L., Anders, T.F. and Sadeh, A., 2019. Behavioral interventions for pediatric insomnia: One treatment may not fit all. Sleep.
Klein, T.P., Devoe, E.R., Miranda‐Julian, C. and Linas, K., 2009. Young children's responses to September 11th: The New York City experience. Infant Mental Health Journal, 30(1), pp.1-22.