Behavioral sleep problems in infants and children
Do all babies wake up at night? Does everyone have sleep problems? What is the connection between the anesthesia process and night awakenings? Psychologist Yulia Tamir answers all the questions and explains the principle of independent anesthesia
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Although it sometimes seems that the main sufferers of these problems are the parents, whose quality of sleep is impaired and so is their ability to function during the next day, we know today that the sufferers really are the ones whose voices are not heard - the children themselves
About thirty percent of children up to age 5 suffer from behavioral sleep problems. These problems are manifested by refusal to go to bed, need for prolonged presence of parents during bedtime and anesthesia, refusal to go to sleep in their own room and bed after getting used to sleeping with parents, multiple awakenings at night accompanied by crying, difficulty quitting eating and / or drinking at night, and wandering to parental bed during The night.
Although it sometimes seems that the main sufferers of these problems are the parents, whose sleep quality is impaired and so is their ability to function during the next day, we now know that the sufferers really are the ones whose voices are not heard - the children themselves. First and foremost, deep and continuous sleep at night is essential for the proper functioning of the immune system. Many studies show that fragmented sleep at night impairs the function of the immune system. In other words, the immune system of children who do not sleep well at night, responds in the best way to the causes of the disease. Other functions in the body are also impaired as a result of a fragmented night's sleep - including the digestive system and of course the hormonal system that is responsible for the normal secretion of many hormones during sleep, including of course the growth hormone.
In addition, fragmented sleep also has emotional consequences for the child - because fragmented sleep is actually an ongoing experience of panic, frustration and suffering. As is well known, waking up at night involves crying and distress. The crying is due to the fact that the child is summer, but instead of falling asleep immediately back, he wakes up and is unable to go back to sleep without assistance. The central emotional experience in many cases of a fragmented year is an abandonment experience. Children who have fallen asleep in the company of their parents wake up at night and find that they have actually been "abandoned" after falling asleep. A weighty emotional consequence is not least the development of "trauma" reluctance to stay in bed. The reluctance to stay in bed develops as a result of the child experiencing only negative emotions in her bed: he wakes up in his bed frightened, sucks in feelings of anxiety, reacts in tears and is immediately rescued from his bed by the parent.
Why do children have difficulty falling asleep on their own and are unable to sleep continuously until morning without waking up?
The reason is, those babies or children do not continue to sleep in the conditions in which they fell asleep. In other words, effective anesthesia and continuous sleep at night occur spontaneously, naturally and spontaneously, at any age, starting from infancy, if there are no changes in conditions after the anesthesia.
However, it is important to understand that there is really no such thing as “continuous sleep” neither in adults nor in children and infants. During normal and normal sleep there are a considerable number of short awakenings lasting a few seconds.
If the course of sleep seems to be diving in a pool - then the structure of sleep is as follows: During anesthesia, the diver enters the water and gradually dives deeper and deeper, the sleep becomes deeper and deeper, after reaching the bottom it gradually rises and at the end of each sleep cycle, the diver the water. This is the awakening. While removing the head from the water, the diver examines his surroundings. He makes sure the objects he left on the edge of the pool are in place. So does the old man, waking up and examining his surroundings, to make sure that all the stimuli that were around him when he fell asleep are in place. If everything is fine, and everything is in place, the diver returns and sinks again in the pool, for another dive / sleep cycle. This is how the diver continues to get his head out of the water again and again during the dive. Now, what happens if the diver finds out that his belongings are out of place or that this or that item is missing? In this case, the diver will have to get out of the water completely and look for his belongings. So is the old man - if he finds that something is wrong or missing in his environment he will have to wake up completely and try to restore the conditions of the anesthesia. If he is a baby, helpless, he will experience frustration and cry in anticipation that his parents will do it for him, over and over again during the night.
Therefore, the very phenomenon that babies wake up at night is, as mentioned, a normal phenomenon. But the problem begins when they discover that they are in different conditions from the conditions in which they fell asleep and that they need help from the parents who will provide them with the restoration of their anesthetic conditions, in order to fall asleep again: returning a pacifier, giving a bottle of milk or water, breastfeeding, bottle, swinging or just proximity Mom or Dad. These anesthetics were created over time out of the parent's attempts to calm and anesthetize the baby. Usually the first anesthetic that is offered, usually, whether the baby is breastfeeding or a bottle. Later, it develops into swaying on the hands, or in a stroller and in extreme but not rare cases, even for a car ride ...
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Giving "independent anesthesia ability" - is in fact the creation of anesthesia habit in conditions that are stable and not transient throughout the night, that is, not to link the child's anesthesia to stimuli that may disappear after he falls asleep.
Giving such a habit can be done from the first days of the child's life by introducing a regular daily routine in which the bedtime is fixed, at a fixed time, in the evening. The return of a regular goodnight ceremony every evening strengthens in the developing baby the connection between environmental components that appear one after the other and going to bed. A recommended "good night ceremony" is for example: a last meal about half an hour before the bath (bottle or breastfeeding), bath, wearing pajamas, dimming lights, and lying in bed. Over time - the baby knows how to expect a "good night" ceremony and knows that at the end he is supposed to go to sleep. It can be said, therefore, that the existence of such a ritual makes it easier for the child to fall asleep in his bed as he prepares for sleep about an hour before he is actually placed in his bed.
It is important to note that in order for the baby to learn to fall asleep on its own, it must be placed in its bed awake, not sleepy and must be well aware of where it is.
During waking at night for eating in the first weeks of the baby's life - be sure to separate eating and sleeping - and try not to put the baby to sleep while eating but to lie in bed awake so that he can experience independent anesthesia at night as well. It is important to remember that feeding at night, as well as during the day, should not be a means of anesthesia but a means of nourishment!
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Independent anesthesia contributes to the emotional security of infants and children
A 2004 study in Sweden examined the effectiveness of a behavioral method of encouraging children to fall asleep on their own and the effect of this method on children's behavior and their emotional security during the day. The study included 95 children (48 girls and 47 boys) aged 4 months to 4 years whose parents complained of difficulty sleeping in the evening and multiple nocturnal awakenings. Most of the children were less than a year and a half old and a minority over the age of a year and a half to 4 years. As part of the study, parents were instructed on a behavioral method to impart independent anesthesia to their children. The parents were instructed to place the baby in bed after performing an orderly good-night ceremony. The guideline was to put the children in their beds tired but awake. If the child protested or cried, the parents were instructed to approach the child to show affection by stroking, patting the shoulder, etc. - but without getting out of bed and without talking to the child for about a minute and then withdraw for a few minutes. If the child continued to cry - you could approach him again for about a minute and retreat again for a few minutes, as long as necessary until the child falls asleep.
The parents were instructed to apply the process in two stages: in the first week, they had to apply the method only at bedtime in the evening and in the second week both at bedtime and at each night awakening. The results of the study showed that the number of nocturnal awakenings decreased from an average of four awakenings the night before the start of the process, at least one awakening on average after completing the application of the method for two weeks. These results were also seen three months later. In addition, the amount of sleep per night for children increased by a full hour from nine hours to ten hours on average per night.
Apart from sleep indices, this study also examined children's behavioral and psychological metrics during the day such as alertness versus fatigue, appetite versus lack of appetite, cheerful mood versus depressed, emotional confidence versus anxiety and social adjustment versus reluctance. The results showed that in all the indices there was an improvement in the children after two weeks of applying the independent anesthesia method - when the most significant improvement was in the mood (more cheerful) and in the level of emotional security. A more moderate improvement is also seen in the degree of social adaptation.
The American Academy of Sleep Medicine AASM published in 2006 a comprehensive review on the treatment of behavioral sleep disorders in children. The review concluded that indeed the most effective method of treating behavioral sleep problems in children is by giving the child independent anesthesia while demonstrating a supportive presence for one child for a limited time in case of protest and crying, similar to the Swedish study. However, the best and most effective way to treat behavioral sleep problems is to avoid them in the first place by guiding parents during pregnancy to instill the right sleeping habits in their children, while providing tools for dealing with existing behavioral problems. Couples who were instructed on how to give their children, when they were born, an orderly daily routine and allow their children to fall asleep on their own as part of a childbirth preparation workshop reported much less sleep disorders in their children a year later, compared to a control group.