So I heard a talk recently that I found to be amazing and wanted to share her information with you. This is not anything I came up with; this is her work, so I want to be totally clear about that.
While on her fostering journey, she realized, and you may have as well because I certainly had, there’s really not much information out there on trauma-informed sleep. Many of us are familiar with trust-based relational intervention, and being trauma-informed for daytime engagement. But once you get to the end of the day, or the middle of the night, and you’re all tired, It’s hard to keep your TBRI principles in mind.
For our son, when he first came to live with us, he slept without any issues. I could set him down wide awake and he would get to sleep on his own. He didn’t really have to self-soothe, he didn’t cry or fuss. He took his pacifier and went to sleep.
Now, I don’t know exactly what changed, or if it was because we connected during the day while he was awake. I’ll be honest: I held him a lot, I was attentive to crying, etc. (Gave him what he needed in order to connect). Or if it was that he developed self-awareness, as babies do, but at one point he could no longer get himself settled to sleep. Nap time was generally not a problem, but bedtime was a real struggle.
I found that I had to lay on the floor for upwards of two hours a night to get him to go to sleep. He stayed in a crib until he was four, which is really old to still be in a crib, but he seemed to really like it. He didn’t try to get out. And in the morning, he would just yell for us and wait for us to come and get him. But I also knew if he did not get himself to sleep on his own, he would be upset and raging in the crib and I was fearful he would get hurt. And we just didn’t think that moving to a regular bed was going to help things either.
Now as you may recall from a previous post, he came to us at three months old. So he, like many kiddos who come into care, may have had things happen to them at night while they’re sleeping. Or maybe he just had a fear of the dark, as many kids do. From the training I watched, Allison Ezell (I’ll include a link to her website below) talks about the fact that during sleep is a vulnerable separation for kids…as it is for any child, but especially for one in care. And if they had experienced trauma at night time, it would make sense that they would struggle to go to sleep, or stay asleep, even when they are in an environment that’s safe.
As we all know, telling a child they are safe and them feeling safe can be two very different things. So the first thing that Allison says to do is to fight fears of the night time with connection. Her advice includes adding some playtime to your bedtime routine. She suggests playing a card game or a board game or something quiet and calming, in the sleeping space, in the child’s room. Or it might be reading a book or having back scratches – things like that. And that sounds amazing and connecting.
I will give my own two cents here which is not intuitively calming but here it is: one of the things we do almost every night with our son, and he’s almost 11, is a little wrestling match before we lay down and have some reading and back scratches. Part of that just gets the wiggles out, but it also gives him some sensory input and connection through physical touch. Clearly that’s not going to be what every child needs; they might not want to be touched at all, so you being the expert on your child, will know what’s going to work best for them. And obviously if it is a new placement you might not know right away; it might take you a little bit to figure out what activity or activities are best suited for him. I’m just telling you what works for us is a little bit of high energy movement beforehand.
Then she says use some sort of separation ritual or security object to help with connection. Even having the child turn on the nightlight or the white noise machine or whatever it is that they’re needing, give them that power and control over their space.
The next thing she talks about is being nurturing at bedtime, but also giving structure. Stick to the routine because a child will often do much better if they know what to expect from the routine. I can testify that this is absolutely true. If we go off script in any way, it usually means bedtime is a lot more difficult. She goes so far as to suggest a visual schedule that shows them exactly what is coming next.
The third thing she talks about is understanding, as a parent, basic sleep foundations. She even encourages foster parents, who may have children of a variety of ages coming in and out of the home, to make yourself a cheat sheet to keep in the bedroom or the hallway to make sure you are totally in sync with how much sleep a child might need. This cheat sheet would include things like awake windows, a number of naps a child needs by age, overall amount of sleep a child needs, sleep cycles, eat/play/sleep pattern, practicing falling to sleep independently, and the understanding of putting to bed versus putting to sleep.
I’m going to jump in here for a second. I know she’s the expert, but as I just said above, you are the expert on your child, as I am the expert on mine. And so even though he is almost 11, there are some nights where I stay in his room with him until he falls asleep. Generally, that is when he’s really tired, and he falls asleep before I leave, but after our connecting time, and the lights are out, I say a prayer and a blessing, which I know would not be for everyone, but it’s part of our routine so I mention it here, then we might chat for maybe five minutes, if he’s interested in chatting, I usually let him have at it.
And then I will stay no more than about 10 minutes as he gets settled and comfortable. Many times, he is still awake when I leave the room and he gets himself to sleep. But for now, he feels like he needs me there for a little bit. Or his dad. Or his older brother. (But let’s be honest..it’s mostly me). So does he get himself to sleep independently? Most of the time. Are we still in a transition phase? Yes. Are we still practicing getting to sleep independently? Yes. Because we are hopeful, as is he, that someday he will launch, and it’s going to be a little awkward if we have to go over to his house every night to help him get to sleep lol.
For those of you who aren’t sure, that was a joke, because we know we’re not going to have an adult, living independently, that needs somebody to sit by him to get to sleep every night. But there are days where it does seem like maybe that will be the case. We don’t really believe it, but we didn’t believe we’d have a 10 1/2 year-old still needing us to be present for a little longer than usual at bedtime.
Now back to the professional: The next thing that she talks about are sleep disturbances. There are four main ones she discusses. First are night terrors, which seem like a child is acting out a nightmare of some sort, but they are fully asleep. They won’t remember the event the next morning, so when you as the parent hear it happening, you just ensure that the child is safe. Move things out of their way, don’t allow them to do something that’s unsafe, etc.
The second type of sleep disturbances are nightmares, and could be very violent and disturbing. The child will remember those, as they happen in REM sleep, which is active sleeping and dreaming. The night terrors, on the other hand, are in the early stages of sleep before the child is deep in sleep. The third sleep disturbance is sleepwalking – and again, they are deep asleep, so the goal for you is to maintain their safety, guide them back to their bed, and they will not remember it in the morning. And fourth one is sleep talking, which also will not be remembered, and is for the most part harmless. Although if a child is screaming, or saying things that are just overall concerning, those should be addressed with the doctor.
Then the last thing she mentioned to help a child’s brain prepare for sleep is consideration of the environment; including comforts or assistance items. These can include, but are not limited to: a weighted blanket, noise machine, special/scented lotions, night lights. One thing that we’d personally use in addition to all of those things is a couple fans. Our son generally sleeps very hot. And in general, he’s almost always hot so we have a couple fans in his room. He also has a compression sheet on his bed. Which you might be thinking makes him hot but ironically it doesn’t seem to make much of a difference. (A compression sheet, if you’re not familiar, is basically like a big like lycra tube that slips over the mattress and he gets underneath it; the pressure is similar to a weighted blanket, but different. He has a weighted blanket as well, and many times he will use both the weighted blanket and the compression sheet, but sometimes just one or the other. And sometimes none at all. But mostly he finds it very helpful.)
Additionally, we do give melatonin, which I don’t love, but has been a game changer for him. Specifically, we use a dual spectrum melatonin, which gives some immediately, and the remainder of the dosing is given throughout the night to keep him asleep. And he takes a magnesium gummy, which also helps support sleep and helps queue the body that it’s time to rest.
To wrap up, a few other suggestions that she gives are a nightly bath, blackout curtains in the bedroom, which we also have that as well, and keeping lights low after it gets dark. That’s easier said than done when it’s summertime and still light at 10 o’clock at night, but for a good part of the year, that would be good practice.
I know I’m not the expert here but I wanted to give a couple other suggestions for things we’ve found which have helped; to go from 2 hours (or more) to get to sleep, to just a few minutes (generally) is a big win in my opinion!
As I said, there’s not a ton of information online or in books that deal with trauma informed sleep care, so I personally found this very and lightning, and hope you do as well. As I mentioned, this is not my information, but belongs to the professional. Her website, if you’d like to look more into information she has to share, is dwellpediatricsleep.com.
Kwa dhati,
Kris