When I see children or teenagers with sleep difficulties, the first questions in my mind are, “What is bedtime like? What time is it? How long does it take to fall asleep?” Often, one of the best treatments for insomnia is adjusting the timing of bedtime at night. It does not entail any prescriptions or side effects, just a recalibration in the schedule of the child and the family. The goal of adjusting bedtime is to use the natural need for sleep to address sleep problems.
Why Do You Fall Asleep?
In sleep medicine, we talk about two systems in the body which help people to fall asleep on time. Today we are talking about the homeostatic sleep drive. Although it has a complicated name, it is easy to understand. The longer you stay awake, the sleepier you are. Sleep drive essentially is your likelihood of falling asleep at a given time. Interestingly, this phenomenon is caused by the gradual accumulation of a neurotransmitter called adenosine during the day which is gradually reduce during sleep. The second system is called the circadian system or body clock and I will cover it in a later post.
When you look at sleep drive in a graph, you see that it it increases until you go to sleep, then it slowly decreases until you wake up in the morning.
Sleeping In and Napping Make You Less Tired At Bedtime
Prolonged sleeping in on the weekends is a major problem with teenagers. Although it feels good to catch up on sleep, it can make it nearly impossible to fall asleep on Sunday night, perpetuating the vicious cycle of adolescent sleep. The reason is that sleep drive is reduced at bedtime, as noted in the diagram below.
Younger children require a nap, usually up until age three or four years of age. After that age, a nap, especially a long one, can make it difficult to fall asleep at night. “Sneaky sleep” in a preschooler in the back of Dad’s car on the way home from daycare may sabotage bedtime by reducing sleep drive at night. Likewise, many teenagers are sleep deprived because of structural issues in their schedules and take prolonged afternoon naps.
Staying Up Later Means Falling Asleep Quicker
The reason adjusting bedtime later can help with insomnia is that it harnesses the body’s natural sleep drive to make falling asleep easier. When we move bedtime later in a child, we call that bedtime fading . When we do that in a teenager or adult, we call it sleep restriction, and it is a component of cognitive behavioral therapy for insomnia (CBT-I), the gold standard treatment for insomnia in individuals 18 and up. . Either way, the principle is the same. The key, either way, is ensuring that the wake time does not extend later as well, as the goal is maximizing sleepiness at bedtime.
In the next part of this serious I’m going to talk about the circadian system and how it interacts with sleep drive.
Parents– have you adjusted your children’s bedtime in the context of sleep training? Teenagers– have you found that sleeping in or napping affects your ability to fall asleep at night? Is Sunday a particularly difficult night for you?
Julian says
Dr Craig dropping science like Galileo dropped the orange …
I have trouble figuring out at what age early afternoon naps might start to be counter-productive. Some interesting tension with the “sleep begets sleep” concept, and this is a nice way to think about it.
Craig Canapari MD says
Good to see you here, Dr. Davies! Napping in little kids is an understudied topic and I do suspect that shorter naps in teens may not be counterproductive.
I do think that naps at kindergarten age are not normal, and that some (but not all kids) struggle at bedtime even with brief late afternoon naps. My kids both seemed to be able to nap until 5 pm and go to bed at 8 pm.
As for “sleep begets sleep”– when my three year old skips a nap, the dinner to bedtime stretch is no picnic, let me tell you. . .
sagerchatter says
My son turned four at the beginning of October. In the last month, we moved from a two hour naptime to a one hour “rest” time. He was rarely falling asleep during naps and on the days he did, bedtime entailed multiple curtain calls. He chooses a few toys to play with during his rest time, but so far he usually lays on his bed cozied up with his lovies for the first 30 mins – old habits die hard! Ever since this switch, he falls asleep within 10 mins at night which is glorious! Last Sunday, he fell asleep during his nap and sure enough, it took two hours for him to fall asleep – with several encores.
At the beginning of the year, if he missed his nap, he was a bear in the afternoon. Now, there’s minimal disruption of mood, save for the normal end-of-day antics; I knew this was a clue that he no longer needed a regular nap. We adjusted his bedtime (and subsequently, his waketime) a half hour earlier, and it seems to gel with his natural rhythm: in addition to falling asleep quickly at night, he wakes on his own about 15-20 mins before he knows he can get up – this has saved a lot of early morning headaches too, especially since we had a baby three months ago! Now he’s up 30 mins before she’s usually awake (she’s an incredible sleeper – only wakes once for a night time feed since the first week and recently has even slept through the night without a feeding at all. We’re talking 11-12 hours a night, all on her own! She’s ) which gives me time to make his breakfast and spend some time with him before it gets hectic.
That’s our experience with fading nap time. I hope is sister turns out to be the great sleeper he’s always been. I considered myself lucky he took regular naps up to this point!
Craig Canapari MD says
Thanks so much for sharing your experience. This is a really useful point. Careful attention to your child’s evolving sleep wake pattern helped you to make a seamless adjustment. Have a great Halloween!
Diana says
Dear Doctor, my 15 month child has a very early routine that starts at 5am and bedtime at 6pm. Do you have any advise on how can she do it later? She only does 1 nap at 11.30 (1 hour and a half), if I put her in bed late it’s chaotic!! Thank you in advance!
Craig Canapari says
Hi Diana. The key with moving bedtimes is doing it slowly– no more than 10 minutes later every few days.