Nightwakings can occur for many different reasons, but are most often related to negative sleep onset associations. Positive sleep associations are what you want your child to have in order for her to fall asleep quickly and easily on her own. They are the conditions that are present at the time your child falls asleep. They are usually required again following normal nocturnal arousals. Positive sleep associations may include a favorite stuffed animal, sleeping in a certain position, sucking a pacifier, having a night light etc. The sleep onset associations should be consistent at bedtime and throughout the night. Parents often fall into the habit of placing their infants to bed after they have fallen asleep such as following nursing or drinking from the bottle, rocking, singing, or cuddling. Negative sleep onset associations require a parent’s presence or are things that are no longer present when your child wakes in the middle of the night. Negative associations interfere with your child’s ability to learn the important skill of self-soothing and inhibit her ability to fall asleep on her own. It is important to note that we all wake through the night. This is normal. The problem occurs when your child cannot soothe herself back to sleep following a nightwaking. Studies suggest that 25% – 50% of 6- to 12- month-olds and 30% of 1- year-olds have problems with nightwakings. Approximately 15% – 20% of toddlers ages 1- to 3-years old continue to experience nightwakings.

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 nightwakings 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 nightwakings (e.g., gastroesophageal reflux, periodic limb movement, restless sleep, sleep apnea etc), further medical evaluation may be recommended.


Treatment for nightwakings related to negative sleep onset associations may include establishing good sleep habits including a consistent sleep/wake schedule, a consistent bedtime routine, the maintenance of a daytime nap (at least through age 3), the encouragement of a transitional object, graduated extinction, fading of adult intervention, weaning/discontinuation of nighttime feedings (when developmentally appropriate), reinforcement strategies, and scheduled awakenings. Our sleep psychologist will work with your family one-on-one to develop a personally tailored sleep behavior medicine program to fit your family’s needs. Following the initial consultation and treatment session, your family will be asked to complete a 2-week sleep log so that our providers will have detailed information about how the changes you are making are working. The frequency and duration of follow-up depends on each families needs, but you can expect to return in approximately 2 weeks following your initial visit.