ANXIETY, NIGHTTIME FEARS, AND SLEEP
Children with anxiety symptoms often complain about sleep disturbances. However, the relationship between sleep and anxiety is complicated. Sleep disturbances are a symptom of anxiety disorders, but sleep disruptions and inadequate sleep can lead to anxiety symptoms. It may be a challenge to determine which is the primary disorder. Therefore, the most effective strategy to address these disorders is an integrated approach that evaluates and treats both concerns at the same time.
Anxiety is healthy because it helps protect and enhance our performance in stressful or dangerous situations. However, experiencing too much anxiety or experiencing anxiety that is overwhelming at inappropriate times can lead to extreme distress and interfere with our ability to complete our daily activities. Given all of the developmental tasks that children need to accomplish, it is important that they learn skills to cope with anxious feelings.
Fears and anxiety are a part of normal development. Nighttime fears and nightmares are especially common in preschoolers, but can occur in older children. As children’s cognitive skills develop, they begin to gain a more complete understand that there are things that exist in the world that may hurt them (or a loved one). The following is a list of common fears:
INFANTS/TODDLERS (ages 0-2 years) loud noises, strangers, separation from parents, large objects
PRESCHOOLERS (ages 3-6 years) ghosts, monsters, supernatural beings, the dark, noises, sleeping alone, animals, blood, needles, thunder, floods
SCHOOL AGED CHILDREN (ages 7-12 years) realistic fears such as physical injury, illness, blood, needles, school performance, social situations, death, thunderstorms, supernatural phenomenon (ghosts, witches, aliens) and natural disasters
ADOLESCENTS (> 13 years) future events, the unknown, performance failure
It is important for parents to differentiate normal fears from more severe and persistent anxiety across the entire day. Also, some normal bedtime anxieties can become a larger problem if they are accidentally reinforced by parental reactions and attention. Anxiety disorders that may be associated with sleep disturbances include:
Stress reactions (e.g., natural disasters, trauma)
Adjustment disorders (e.g., reactions to major life changes such as moving, change of school, separation/divorce, death of a family member)
Separation anxiety (typically seen in younger children who are extremely unwilling to separate from their major attachment figures such as parents, grandparents or from home. The suggestion of having to separate typically results in crying, trembling, sweating, and physiological complaints)
Generalized anxiety disorder (excessive worry about a variety of events that is difficult to control and interferes with daily life)
Obsessive-compulsive disorder (recurrent obsessions, or intrusive thoughts, and compulsions/repeated behaviors that are time consuming and cause significant impairment in daily functioning)
Posttraumatic stress disorder (PTSD) (the experience or witness of a severely traumatic event that involved actual or threatened death or serious injury including physical, emotional, and sexual abuse)
If your child is exhibiting significant nighttime fears that are not developmentally appropriate, negatively impacting their ability to fall asleep and get an adequate amount of sleep, and/or affecting daytime functioning our sleep psychologist can help to address these issues.
What to expect when you arrive at the sleep clinic
When you arrive for your initial consultation with the sleep team, the team will spend time evaluating your child’s medical history, developmental history, family history (including medical history, psychological history, parenting skills, and limit-setting abilities), and your child’s behavioral history. A detailed history of your child’s sleep behaviors and fears will also be discussed. Your child will also likely have a brief physical examination. If any medical causes are suspected of contributing to your child’s sleep problems (e.g., gastroesophageal reflux, periodic limb movement, restless sleep, sleep apnea etc), further medical evaluation may be recommended.
The most effective treatment for sleep problems related to anxiety is to treat both the sleep issues and the anxiety at the same time. Our sleep psychologist will work with your family one-on-one to develop strategies to optimize your child’s sleep while helping him or her to develop appropriate coping skills to “boss back” their worries. Treatments for developmentally appropriate fears may include reassurance of the child’s safety, developmentally appropriate coping skills such as positive self-statements, fostering a sense of mastery and control, encouragement of a security object, use of a nightlight, avoidance of frightening or age inappropriate media, relaxation strategies, appropriate and consistent limit-setting, graduated checking, and rewards for appropriate bedtime behavior. Treatment for significant anxiety symptoms and pervasive worry may include cognitive behavioral therapy techniques that 1) increase awareness of physiological arousal and negative self-talk during anxiety events; 2) develop coping skills including relaxation skills, restructuring negative thoughts into positive, coping thoughts, and problem-solving strategies; and 3) utilize gradual desensitization, bedtime checks, and weaning of parents presence to increase independent sleeping skills. In cases of severe anxiety or where anxiety symptoms are affecting daytime functioning, a referral to a psychiatrist for a medical consultation may be needed. The frequency and duration of follow-up depends on each families needs, but you can expect to return in approximately 1 - 2 weeks following your initial visit.