Sleep Associations

All childhood sleep experts address the importance of sleep associations. Note the cardinal rule:

All children should fall asleep under the same circumstances that they will experience when they awaken during the night.

Notice that I said when they awaken, not if they awaken. We all experience about five brief awakenings during the night. We change body position, check our environment, straighten our blanket, or reposition our pillow. If all is well we return to sleep quickly, usually without remembering we were awake. But if you awaken to find things not as they were when you fell asleep (a missing pillow, a light on), and you’ll suddenly find yourself wide awake assessing the situation.

In order to fall back to sleep after nighttime awakenings, children quickly develop the habit of needing the same circumstances around them as when they first fell asleep. If you allow a child to fall asleep on the couch in the den with the TV on, for example, and then you carry him to bed, he will awaken to a changed environment and may be unable to fall back to sleep on his own. Instead he may begin to cry or come to your bedroom complaining that he can’t sleep and want you to do something about it. And, of course, this isn’t a time when you particularly want to be up with him because you also need your sleep.

A disrupted sleep association often, for example, becomes a problem for very young children who are regularly rocked to sleep and then laid to bed after they are asleep. They awaken to a new circumstance and react to the parent’s absence and the absence of rocking. Although a young child will enjoy the relaxing comfort of rocking, or of a little back rub, take care you don’t establish a habit of his falling asleep while you are doing it. Be sure to stop and leave the room before he actually falls asleep. And don’t lie down in bed with your child until he goes to sleep, because you will not be there when he awakens.

Remember, then, in order for your child to sleep well at night, he must learn to fall asleep alone under the same conditions he will experience upon waking during the night.

Disruption of sleep association, however, does not appear to apply to the use of audio programs as relaxation aids. If you leave the child’s bedroom light on while he falls asleep and then turn the light off after he falls asleep, he awakens to a disrupted association that demands assessment and consequently alertness because somebody has clearly altered—been in control of—the environment while he was asleep; the assessment may thus short circuit to anxiety over loss of control and further disruption of sleep.

But audio recordings in the natural world have a beginning and end: a child learns quickly the audio program will end (unless you’ve set the machine to repeat, an inadvisable action). Relaxation and receptivity to sleep are the goals of the program, not prevention of the natural occurrences of brief awakenings. The relaxed child, secure in his environment, returns to sleep even when not listening to a program because things are as they should be. Thus, even restless children tend to experience deeper sleep after using the programs, with a reduction in the number of anxious nighttime awakenings that lead to disruption of sleep.

Further, if your child has developed the habit of needing you present in order to fall asleep, you may find the sleep programs particularly helpful. The program becomes a transitional experience that keeps him company, entertains him, and then naturally puts him to sleep. Then, with time, he learns to fall asleep on his own, without endless episodes of crying or begging for “one more story.”

If your child continues to insist that you be present when he falls asleep, you may wish to institute a behavioral program designed to eliminate this habit. As mentioned above, you must establish conditions for falling asleep that will be present when he awakens during the night. You will need to make a concerted effort to establish reproducible sleep associations, and it must be done consistently or it is likely to fail.

Begin by asking yourself how long you can listen to your child cry before feeling that you have to do something. It is best to start slowly and can be as short as a minute, but you will achieve your goal more quickly if you begin with five minutes. Each night at bedtime and after nighttime awakenings, your child must fall asleep alone, without your being in the room. Gradually, you will need to let your child cry for longer periods of time, before returning for a few minutes to check on him. When you return you can pat him on the back, reassure him that everything is all right, that you care about him, but always leave the room while your child is still awake.

You will need to continue this until he finally falls asleep while you are out of the room. If the child has not gotten back to sleep, but the crying has stopped or has eased to mild whimpering, don’t go back in. On the first night you might want to make fifteen minutes the longest time that you wait before returning, if your child is still crying. On subsequent nights, progressively increase the time that you wait before returning. If your child awakens crying during the night, begin the same procedure again, waiting for five minutes and working up to fifteen. The same procedure can also be used during naptime.

Use a gradual approach such as this. Your child needs to learn that you are nearby and taking care of him; he can only learn this through experience. He will eventually conclude that it isn’t worth fifteen or twenty minutes of crying just to have you return briefly, and in the process he will learn to fall asleep alone and in bed.

By the end of the first week, your child should sleep better, and by the end of the second week, he will likely have fallen into normal sleep patterns. For older children who have been sleeping poorly for many years the changes may take a little longer, but this procedure should nevertheless work. If the child is old enough, you can explain that you will do your pleasant bedtime routine together and then you will leave the room with the door open.

If your child gets out of bed during the night, take him back into the bedroom, put him into bed, and tell him that he must stay in bed or you will close the door for a while. If again he gets out of bed, put him back to bed and close the door for about a minute. Don’t lock the door, but if he tries to open it, hold it closed. (Locking the door can be very scary and counterproductive in this new learning process.) You want him to learn that the door being open is under his control, but that you cannot be manipulated. Keep in mind that you are trying to help him learn to calm down and fall asleep on his own. If you lose your temper, threaten him, or spank him, the situation will only deteriorate. You want an atmosphere of support and caring, not of fear and punishment.

If your child continues to get out of bed, increase the door closure time to three and then five minutes, which should be the maximum time on the first night. If he stays in bed, open the door after the time is up and give him a word of encouragement. And if your child gets out of bed later, after a nighttime awakening, follow the same pattern you used at bedtime, beginning with one minute.

Don’t be surprised if the first few nights aren’t easy, but be assured things should get much better after one to two weeks. Practice consistency, since your child needs to learn exactly what to expect. Don’t make the mistake of thinking that it won’t hurt if you ease up for just one night. Such a lapse could easily delay your success for an additional week or longer. Research has shown that “intermittent rewards” that occur only one out of ten times can sustain undesirable behavior. So you won’t be doing yourself or your child any favors by making such an exception. In fact, quite the opposite; you will simply extend a surely frustrating process for both of you.

Throughout this process both parents should alternate, although you don’t need to adhere strictly to an every-other-night schedule; this alternation simply shows the child his parents are of one mind in this bedtime issue. Your child should expect both of you to respond the same way to any of his actions. During this process avoid if possible the use of a sitter, but if you must use a sitter, let your sitter put your child to bed in the easiest way possible. Thus, the exception falls on the sitter and consistency remains the bastion of the parents—the normal nightly family routine.

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