When I think about sleep in preschoolers, there are several important topics that come to mind: increased independence, bedtime fears, parasomnias, and elimination of naps. The preschool years encompass ages 3-5, and this represents a time of increased cognitive complexity in children. They start to develop theories about how things happen in the world and begin to recognize that their perception of things can be uniquely their own. People have become much more permanent to them, and they can even demonstrate a morbid fascination with death.
After preschoolers have achieved the essential milestone of potty training, they continue to yearn for independence and increasing self-control. This independence is coupled with a healthy imagination and the ability to generate fears and worries. The way that this can have a direct effect on sleep is that they can start to generate real fears of the dark, and challenges with the idea of sleeping independently. For families who have co-slept, this tends to be the time when they start to entertain the idea of introducing independent sleep. The challenge with introducing independent sleep at this age us that children of this age group tend to be able to resist changes to bed environment and routine with much more endurance than a younger child. They have the increased cognitive ability to generate reasons for resistance, and they understand how to communicate their needs with greater articulation. In the childhood years, this increased articulation is an amazing bridge toward change, but the preschool years can be more challenging- it is not always apparent whether their expression of needs is actually in sync with their actual needs. For example, when my three year-old needs some special attention, she seems to rely on two primary statements, “I’m hungry” or “My ____ hurts.” At her preschool, she has been dubbed the “little old man” because she constantly reports aches and pains.
The truth is that she can be in pain or hungry, but often she just desires some extra focus and attention. We recently moved her older sister to her own room after they had always shared, and had to struggle throughout the first night as our three year-old woke up intermittently crying about the fact that she cannot sleep by herself. We prepared her for this change by discussing the great aspects of having her own room, but had not prepared her well for the fact that she was used to having big sister as one of her sleep onset associations. On the first night, we had 4 awakenings (typical for any child on any given night, these were a big deal because sister was not there and preschooler became distraught). The second night, we were reduced to two awakenings that required assistance getting back to sleep. The evening before night three, we discussed a possible reward for making it through night three without assistance- preschooler would get a special breakfast and would get to go out with daddy if she made it through three nights without needing help. She made it through that night without needing assistance, and has been fine ever since. When she is over-tired, she will say that she cannot sleep alone; this is her new “attention” mantra for bedtime, but she makes it through the night without issue.
It is not uncommon for some discomfort about sleeping independently to start to transition into fear of the dark. Many parents cope with fears of the dark by placing nightlights in the bedroom, which can be both a benefit and harm. For some children, the light emitted from a nightlight is too bright, and actually inhibits sleep. The fear of dark may be assuaged by the presence of light, but sleep quality can also be diminished, which then affects daytime functioning. For many children, the nightlight can be hard to let go, even when the fears have been outgrown. Parents also will often use hall lights or closet lights to help diminish fears, but this can mean that sleep is also further disrupted by household sounds through the open door. The best intervention is starting with allowing the child some safety devices (the Cloud B Sleep Turtle is my favorite) and discussing rewards for pushing through these fears. For some children, the positive praise associated with learning to be comfortable in the dark can be a huge reward, and this exercise helps to establish some great emotional regulation skills. For kids with a paralyzing fear of the dark, it can be important to practice brief exposures to the dark and increase tolerance slowly. It is important to remain supportive, and try to validate the fear while you work on a resolution.
It can be difficult to differentiate nighttime fears from parasomnias, because both of these have a tendency to start in the preschool age period. A parasomnia is a behavior that occurs during sleep and is inconsistent with stable sleep. The most common parasomnias are night terrors, sleepwalking, and sleep talking. For this age group, night terrors are the most common parasomnia, and they tend to appear around age 3, start to diminish significantly around age 5, and often disappear completely by puberty. A night terror often consists of an episode in which the child wakes up screaming and crying, and is inconsolable for a period of time (often between a few minutes and 45 minutes). Parents often report that they have difficulty arousing the child, and the child is inconsolable. Night terrors tend to occur in the first third of the night, and children have no dream content or recollection of their occurrence. The best way to work at preventing night terrors is to work on reducing stressors on the child, and maintaining a stable sleep schedule with adequate sleep time for age. These events tend to worsen when there are significant changes (e.g. travel or moving) and there has been some disruption to normal routine. If you do not have a stable routine for day and night, it can be really beneficial to start one at this time.
The end of the preschool period is usually established with the start of an important milestone: kindergarten! For children who still nap, a full day of kindergarten can be a significant challenge. The good news is that we usually know when kindergarten will start, and have a lot of time to prepare for this important milestone. Children tend to be more emotional and overreact when they have inadequate sleep, so it is in their best benefit to transition to the school sleep schedule before they actually start school. I usually recommend adopting the sleep schedule for school two weeks before the school year starts, simply to allow for circadian adjustment. For children who still nap, the recommendation is actually a month beforehand, simply because bedtime will likely take some time to settle as well. Remember that we usually have the same sleep need over a 24-hour period, so bedtime may need to be adjust significantly earlier while the nap is being eliminated, and may remain early for some time. For example, a child who takes a 2-hour nap each afternoon will likely need to go to bed almost two hours early. Their sleep onset and wake times will shift while they adjust, but that will allow for maximal sleep. Some kindergarteners really still need naps on weekends, simply because of the demands of the week, and this can be a fine practice, as long as it does not disrupt their ability to fall asleep on time on Sunday night.
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