Limit-Setting Insomnia or Bedtime Resistance in Toddlers

Limit-setting insomnia is one of the two types of behavioral insomnia of childhood. It occurs when parents lose control of their child's behavior with resistance around bedtime and during awakenings from sleep. This condition often occurs in preschool-aged toddlers and school-aged children who stubbornly challenge their parents, especially at bedtime. Discover more about the symptoms of limit-setting insomnia and what can be done to ease bedtime resistance.

Overview

Insomnia is difficulty falling or staying asleep, and it may result from behavioral causes. As part of the basic guidelines for sleep hygiene, children need a regular bedtime routine and a relaxing sleep environment in order to sleep well. When there are a lack of parent-enforced boundaries regarding sleep, the bedroom may become a battlefield, setting up bedtime wars.

Younger children do not have the insight to recognize how much sleep they need or when they are not getting enough. If left unsupervised, they are unlikely to follow a regular sleep schedule but will fall asleep when they feel sleepy. If the child perceives that they will miss out on something fun—"Everyone else is staying up!"—they will want to stay up as well. Bedtimes may vary from one day to the next, leading to a disrupted circadian rhythm for sleep. Parents should step in to set appropriate bedtimes and enforce these daily, including the weekends. Ideally, sufficient time should be allowed for the child to meet their sleep needs.

This may require a firm application of parental authority. Children respond well to consistent expectations, and keeping a familiar bedtime routine can help. Imagine if your child did something wrong and you randomly responded with either a treat or with punishment. The child would be very confused and wouldn't know whether the action should be repeated—or not. If there is a lack of structure around bedtime, children may take advantage of this inconsistency. Without limitations, children will make unending demands, including for:

• Food
• Drinks
• Attention
• Playtime

These may occur at bedtime or even after awakenings during the night. Many children will push the envelope and this may result in tearful bedtimes that extend for hours.

Treatment

The solution is as one might expect: restoring your role as a parent and setting limitations on your child’s behavior. This will require consistency. It can be hard at first, especially if the child is crying out for your presence. There are some simple guidelines that may be helpful:

• Bedtimes must be enforced on a daily basis. Try to allow sufficient time in bed to meet the child's sleep needs. If you put the child to bed too early, they won't feel sleepy (and thus will struggle to get to sleep) and will wake early in the morning and disturb the household. Remember that these sleep needs gradually decrease as the child grows older.
• In the 20 to 30 minutes prior to bedtime, quiet activities should be undertaken, such as taking a bath, brushing teeth, and reading bedtime stories. Limit the time spent with each activity so it does not become a delaying tactic. Try to keep the routine consistent, so the child knows what is coming next and what is expected.
• Unreasonable demands during the period around and after bedtime should not be met. This means not bringing in wanted toys, fetching water or snacks, or indulging in requests for attention.

Following these guidelines will allow your children to have appropriate expectations, and their behavior will quickly fall into line. Additionally, in older children, the use of positive reinforcement for acceptable sleep-time behaviors may be helpful.

If you continue to struggle with bedtime, reach out for help from your pediatrician. In some cases, it can be helpful to discuss these concerns with a board-certified sleep specialist. Learn more about the types of behavioral insomnia of childhood.