How To Deal With A Sleep Regression

“Help! Is my child having a sleep regression? She was sleeping great and now she’s waking up at night. WHAT DO I DO?”

One question I get asked all the time is what to do with a sleep regression. If you are not in the know, a sleep regression is when a child who was previously sleeping well starts either a) having difficulty falling asleep b) waking up at night or early in the AM or c) both. I’m going to be honest here– I don’t love the term “sleep regression” because I feel like the term is imprecise. Eagle eyed readers may note that I put the term “regression” in quotes. Am I throwing a bit of shade on the concept? Maybe. . . but tired parents still need help, even if the term is slippery. If you don’t care about the history of the term, but just need help– scroll down a bit. There’s a lot of talk about sleep regressions happening at certain ages (The “8 month sleep regression!” The “Two Year Old Sleep Regression!”). If you search on Google, you’ll find a ton of search results on this.

If you search the medical literature, however, you won’t find anything.

Why is this? Sleep medicine doesn’t really use the term, although there is some discussion about it in the psychological literature. Jodi Mindell, one of the best pediatric sleep researchers around, examined this issue:

“In 2018, she decided to do her own informal analysis using survey data she’d collected from a prior study she’d published in the journal Sleep in 2012. Dr. Mindell examined the sleep patterns of children aged 6 years and under, looking for spikes in night wakings at specific ages. Her analysis, which was based on data from thousands of mothers but which hasn’t been peer-reviewed or published, turned up nothing. Just 28 percent of the 300 or so parents of 3-month-olds she surveyed had complained about sleep problems (leap 3, according to “The Wonder Weeks”). Just 30 percent of the 300 or so parents of 5-month-olds reported more frequent night wakings (leap 4). Those percentages don’t suggest that all infants follow the same schedule of regression and growth, said Dr. Mindell: “The data clearly indicate that there’s no specific age at which all of a sudden you see a shift in sleep.” (From “Are Sleep Regressions Real?” in the New York Times.) 

Photo by Annie Spratt on Unsplash

Are sleep regressions real?

There is little scientific evidence for regressions occurring at predictable intervals with a few exceptions, specifically around learning to walk, and potty training. For more on the issues with the term, and how it came to be such a prevalent part of our parenting conversation, I highly recommend the above article about the history of sleep regression in the New York Times. 

Almost every parent has experienced the frustration of a child sleeping poorly after a period of good sleep.  These episodes seem to fit my definition of a phase: an annoying and inexplicable thing your child is doing that will probably get better soon, and that I as a pediatrician don’t have a great explanation for. So let’s call them regressions and be done with it.

Sleep regressions as a concept feel similar to “wake windows”— an idea that has a lot more traction among sleep consultants and on parent message boards than in the scientific literature.

What do I do if my child has a sleep regression?

Although I’m not that fond of the term, there is no doubt that many parents struggle with these unpredictable events. A few bad nights is unfortunately sometimes just the cost of doing business as a parent. Many parents who have been enjoying the hard-won fruits of a sleep training battle are justifiably freaked out when their sleeping angel becomes a little devil again.But if it persists for longer than that it runs the risk of being a bad habit. If it is disruptive, you may want to deal with it.

Here’s my check list for what YOU can do if your child has hit one of these speed bumps.

1. Rule out a medical cause. Is your child cutting a tooth? Does she have a cold or signs of an ear infection? Is she constipated? (Constipated kids don’t sleep well. I’m not sure why. As I tell my patients, I’m an “above the waist” doctor). Symptoms like snoring or complaining about leg pain at night can suggest medical causes of sleep problems. If in doubt, call or visit your friendly neighborhood pediatrician.
2. Take inventory of your sleep practices. Have you gotten a bit lazy in your bedtime routine– are you varying the time and sequence of events? Are you lying down with your child to fall asleep at bedtime when he used to fall asleep independently? Are you bringing him into your bed at night? If so, you need to go back to basics. Have a set bedtime routine every night at the same time and leave before your child falls asleep. If this is difficult, there is a whole host of techniques you can use.
3. Look at your child’s sleep duration at night. Maybe you read Weissbluth’s book and your child goes to bed at 6pm every night and you expect her to sleep until 6 AM and take two two hour naps. Maybe this worked in infancy, but your two year old won’t sleep for sixteen hours a day no matter how much you want her to. Track your child’s sleep for a few nights and consider adjusting her time in bed. Check your expectations versus the actual sleep requirements expected of a child that age. You may need to drop a nap (terrifying, I know) or move bedtime later.
4. Consider how you are responding in the middle of the night. If you are bringing your child into your bed you need to stop. You could consider the bedtime pass, where you give your child a pass to leave her room 1-2 times per night. After this you return her to her room without contact. Weissbluth also talks about the silent return– if your child shows up to your room, bring her back to her room without comment. You may need to do this 20-30 times for a night or two. It feels crazy but it will work quickly if you are consistent. Here’s a review of my favorite sleep training techniques.
5. Be patient. Generally these issues DO improve if you do nothing.
6. Consider bringing in a pro. A sleep consultant or sleep physician may be helpful if none of this work. I hate to toot my own horn, but check out my book as well— if you followed the steps in my book, I suspect your child will be falling asleep and staying asleep fairly quickly.

A Note about Nap Strikes

When you child starts refusing naps, it can be quite painful, whether you are a stay at home parent, or work outside of the home. What can compound the frustration is when your child continues to nap in school or for their babysitter but cannot be bothered to go down when you are at home.  Children are more likely to skip naps for their parents than for child care providers. Why is this? Think of attention as the currency that your child is always seeking. Attention from parents is infinitely more valuable than attention from teachers or babysitters. (This also explains the often observed fact that kids don’t want to get out of bed on school days but get up early on weekends. For my kids, this is less for attention for me than for time on the almighty iPad, a privilege which they only get on the weekend).

Naps are also problematic for a few other reasons. First, it is light during the day, which is not conducive to good sleep. Second, your child’s natural sleep drive is less during the day than at night.

There are are some times when you expect your child to reduce the number of naps:

• Between six and fifteen months, babies who are taking a third nap will give it up, and bedtime will get earlier.
• Around 18-24 months, children will typically move from a morning and afternoon nap.
• Between ages 2-4 years, most children will give up their nap entirely.

In the first two scenarios, you can lean into the less frequent, shorter naps.

With children between ages two and four may be in the natural process of giving up their naps, and you have a perfect storm of nap refusal and parental despair. This is often a painful process as your child doesn’t just naturally wake up one day and not need the nap anymore. Typically, they are whiny and difficult during the prior nap period, and this can persist for a month or two.

If you think that your child is now habitually skipping a nap that you are confident that you no longer need, I have a few suggestions:

1. Make sure the room is pitch black, if at all possible.
2. Try a later or earlier nap time– by 15 minute intervals. See if a new time works better.
3. Make sure your nap time routine is a mini version of bedtime, but keep it short– 10-15 minutes.
4. If all else fails, expect that your child will stay in their room for 30 minutes, even if he cries. It is totally reasonable to expect some down time for yourself, even if your child is unable to sleep.

For more on napping, here’s a guide to dealing with nap difficulties.

A few more questions and answers about sleep regressions:

What is the first thing parents should do if their child is now having sleep issues?

Check and see if your sleep habits have slipped a bit. Is bedtime later or more variable? Are you being lax with your bedtime routine?

How long can we expect sleep regression to last?

Usually they are pretty brief— say, less than a week.

If your child’s sleep regression is so disruptive and doing nothing is just not working, what can we do to make it come to an end?

It’s time to go back to basics and make sure that you have a high quality bedtime routine and that you do the minimum you need to to soothe your child. I would also check in with your child’s pediatrician.

Can they be prevented? For example, when you’re about to potty train your child, can you prepare for a possible sleep regression and stop it from happening?

I would double down on your high quality bedtime routine and also make sure that you going to be extra careful about respect your child’s bedtime and sleep schedule.

What can we avoid doing so we don’t make sleep regression worse or last longer than it needs to?

Make sure that you are not inadvertently causing the regression by giving too much attention. For example, if your baby starts crying at night and you then start giving him a bottle every night, you will likely cause the problem behavior to continue.

Are kids going to go through a sleep regression? Are some more likely than others?

There’s very little research on sleep regressions— as noted above, the term is poorly defined. As a parent, I can tell you that children frequently regress in many domains, just when you think you have things figured out.

What are medical causes we should be on the lookout for?

Often the common cold may present with a sleep problem first. I’ve asked myself on many occasions, “why is my kid doing this weird thing?” and then a day or two later he will get a cold.

Snoring and complaints about legs can represent medical causes of sleep disruption and should be discussed with your pediatrician.

How do you tell the difference between “regression” and an issue like teething or a fever that might cause interruption in sleep patterns?

Often, it’s not obvious until a day or two later, as noted above.

What are good sleep practices for kids that we should make sure to faithfully implement so we all get a good night’s sleep?

Bedtime, bedtime, bedtime. I almost called my book The Bedtime Habit as your child’s bedtime is the foundation of their high quality sleep, and thus, your own.

Further reading

Here is a nice article in Romper about sleep regressions. 

Have you experienced a sleep regression? Tell us about it– what happened and how did you fix it? Write it out in the comments below.