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DEAR MAYO CLINIC: My 9-year-old son has been having trouble sleeping ever since we began social distancing more due to the COVID-19 pandemic. While he goes to bed at a reasonable time, he doesn't seem to fall asleep until after midnight and often comes into my room to tell me he cannot sleep. I am wondering if he has a sleep disorder. Do I need to take him to see a doctor or should I change our routine?
ANSWER: Many children your son's age have trouble falling asleep easily at night. The reason for this often can be traced back to habits a child has developed that interfere with good sleep. Certainly, now, as a result of the COVID-19 pandemic, anxiety levels have increased and home routines have become disrupted. However, it is unlikely your son has a sleep disorder.
Too little sleep can make it hard for a child to concentrate and pay attention at school. It also can lead to mood swings and irritability, and can increase a child's tendency to have bed-wetting accidents. Therefore, it's important to address your son's sleep problem.
Before making an appointment with your son's health care provider, make sure his routines are sleep-friendly. One of the best ways to ensure healthy sleep is setting a consistent wake-up time and sticking to it. The wake-up time doesn't have to be exactly the same time every day, but it should be within a one-hour window. It may seem helpful to let him sleep in on the weekends, but this disrupts his internal clock. That makes it much tougher to get back into a weekday sleep routine on Monday. Sleep deprivation then worsens during the week.
It's also important to consider your son's use of electronic devices before bedtime. Many tweens and teens have smartphones, tablets and TVs in their bedrooms. They keep their cellphones close by at all times. These devices can make it hard to disengage from stimulating activities.
Have your son turn off all electronic devices at least 30 minutes to one hour before bedtime. This gives the brain time to relax and wind down, making it easier to fall asleep. It is strongly recommend that all electronics be kept out of a child's bedroom.
Turning off electronics, and limiting exposure to the news and negative information, can help all family members, especially if your son is feeling anxious about COVID-19 and worried about getting sick. Redirecting evening TV watching to something family-friendly, like spending time doing a board game or craft, may ease his mind before bedtime.
Another step to take is to reduce the amount of time spent in bed at night lying awake. If your son is awake in bed for longer than 15–20 minutes during the night, encourage him to go to another room; stay in a sitting up position; and do boring things, such as listening to light music or practicing relaxation skills. He should try to go back to bed when he starts to feel sleepy, such as head bobbing or heavy eyes. This will increase the likelihood that his bed and bedroom become more associated with sleep.
Also, if he is involved in online schooling, set up a place outside the bedroom so he can continue to associate his bed and his bedroom with sleep versus schoolwork. If your son is sleepy during the day, discourage him from napping. Naps often do more harm than good when it comes to getting good sleep because they make falling asleep at night harder.
Daily exercise and other physical activity can aid sleep, as well. For some children, if they have not burned enough energy during the day, their body may not be fatigued and sleepy when it's time for bed. Encourage your son to be active and take part in some sort of exercise throughout the day, though I would recommend concluding physical activities at least two hours before bed.
Also, review what your family is consuming in the evening. Avoid foods and beverages that contain sugar at least two to three hours before bedtime, and reduce caffeine throughout the day. It would be ideal to limit soda and energy drinks, and avoid any caffeinated drinks past 3 p.m.
For some children, when they lie down at night, worries and concerns creep into their minds, making it hard to relax and fall asleep. Talk with your son about whether he is worried about the virus or if something else is causing him to lie awake at night. If he is fearful, talking about his concerns may help him recognize his anxiety, and allow him to relax and sleep.
Another technique to help clear his mind would be to have him take a few minutes before bedtime to write down anything that's on his mind or tasks he needs to do. Once they are on paper, sometimes children are better able to let their concerns go and get to sleep more easily.
Although uncommon, the source of your son's problem could be a sleep disorder related to the workings of his internal clock. The most common such problem for children your son's age is called "delayed sleep phase syndrome." Children who have this sleep disorder are "night owls." According to their internal clock, their day is longer than 24 hours. As a result, they tend to fall asleep at progressively later and later times each night, and then have difficulty waking up in the morning.
Have your son try to change any habits that may interfere with his sleep. While this may take some time and practice, it's not uncommon that sleep can improve within a couple of weeks of sticking to these healthier habits. If those changes don't help, make an appointment to have him seen by his health care provider. — Dr. Craig Sawchuk, Psychology, Mayo Clinic, Rochester, Minnesota
Information in this post was accurate at the time of its posting. Due to the fluid nature of the COVID-19 pandemic, scientific understanding, along with guidelines and recommendations, may have changed since the original publication date.